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Costa M, Correia-Costa L, Santos AC, Azevedo I. Obstructive sleep related breathing disorders and cardiometabolic risk factors - A Portuguese birth cohort. Respir Med 2024; 222:107531. [PMID: 38246393 DOI: 10.1016/j.rmed.2024.107531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Pediatric obstructive sleep related breathing disorders (SRBD) are an important under-diagnosed health problem with associated cardiometabolic comorbidities, demonstrated with polysomnographic studies in selected samples. Our main goal was to assess the prevalence of SRBD in a population-based cohort and to analyze its association with cardiometabolic risk factors, in general and by sex. METHODS Pediatric Sleep Questionnaire (PSQ) was applied to parents of 7-years-old children evaluated in the birth cohort, Generation XXI. Sex, anthropometrics, blood pressure (BP), lipid profile, glucose, insulin, HOMA-IR, and high-sensitivity C-reactive protein were compared among children with/without SRBD, using Chi-square, Mann-Whitney tests and logistic regression models. RESULTS A total of 1931 children (51.2 % boys) were included; 17.5 % were overweight and 15.7 % obese. The prevalence of SRBD was 13.4 %, more frequent among boys (15.7 % vs.10.9 %, p = 0.002) and in overweight/obese children (22.0 % vs.13.6 % vs.11.3 % in obese, overweight and normal weight group, respectively, p < 0.001). Children with SRBD had higher systolic BP (107 ± 8 vs.105±9 mmHg; p = 0.001) and lower HDL-cholesterol levels (54 ± 11 vs.56 ± 11 mg/dL; p = 0.04) than children without SRBD. After adjustment for sex, age, birthweight-for-gestational age and maternal age, children with SRBD had higher BMI-z-score, systolic BP, insulin and HOMA-IR levels, and lower HDL-cholesterol, when compared to those without SRBD, but these associations were lost when adjusting to BMI z-score. Analyzing obese children with the same regression model, those with SRBD presented lower HDL-cholesterol than those without SRBD. CONCLUSIONS Our results identified a male predominance of SRBD in pre-pubertal children and highlighted the potential contribution of SRBD to cardiovascular risk in obese children.
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Affiliation(s)
- Mariana Costa
- Faculty of Medicine, Universidade do Porto, Porto, Portugal; Department of Pediatrics, Centro Hospitalar de Leiria, Portugal
| | - Liane Correia-Costa
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Pediatric Nephrology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.
| | - Ana Cristina Santos
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Inês Azevedo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Clinical Epidemiology, Predictive Medicine and Public Health Department, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Department of Obstetrics-Gynecology and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal; Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
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Behrooznia Z, Jangjoo A, Qoorchi Moheb Seraj F, Khadem-Rezaiyan M, Zandbaf T, Hassani S. Diabetic Markers, Five Years after Bariatric Surgery. Middle East J Dig Dis 2023; 15:270-276. [PMID: 38523888 PMCID: PMC10955987 DOI: 10.34172/mejdd.2023.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/18/2023] [Indexed: 03/26/2024] Open
Abstract
Background: Bariatric surgery delivers substantial weight loss for obese patients with comorbidities like diabetes mellitus. We aimed to investigate the impacts of bariatric surgery on diabetic markers after 5 years of follow-up. Methods: This is a retrospective study on patients with diabetes and a history of bariatric surgery between 2016-2017. The diabetic markers before and 5 years following surgery, including a lipid profile, glucose level, and the required antidiabetic medications, were evaluated. Results: 34 consecutive patients were included, 30 (88.2%) women, with a mean age of 52.71±8.53 years. The majority (65%) of surgeries were Roux-en-Y gastric bypass (RYGB), and the remaining were one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG). The serum levels of diabetic markers reduced during follow-up (P=0.001), except for high-density lipoprotein levels and serum total cholesterol, which increased (P=0.011, P=0.838). Low-density lipoprotein levels reduced, but it was insignificant (P=0.194). Surgery types had affected the changes of diabetic markers (P>0.05). Demand for oral medication was reduced significantly, but insulin injection reduction was not significant (P=0.006 and P=0.099, respectively). Conclusion: Our study showed favorable bariatric surgery results on patients with diabetes in long-term follow-up. However, dyslipidemia is still a concern.
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Affiliation(s)
- Zahra Behrooznia
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Jangjoo
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farid Qoorchi Moheb Seraj
- Neurosurgical Department, NeuroVascular Section, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of General surgery, School of medicine, Mashhad Azad university of medical sciences, Mashhad, Iran
| | - Solmaz Hassani
- Endocrine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Zhou X, Ke Z, Sun F, Li F, You Z, Zhang J, Gao Y, Zhu Z, Tong W. Effect of Bariatric Surgery on Metabolic Syndrome in Chinese Patients with Low Body Mass Index: a Propensity Score Matching Study. Obes Surg 2023; 33:3051-3061. [PMID: 37561268 DOI: 10.1007/s11695-023-06765-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Bariatric surgery (BS) is known to improve the components of metabolic syndrome (MS) in patients with obesity. However, few studies have evaluated the effect of BS on patients with MS at low BMI levels. The study aims to assess the effect of BS on MS in patients with low BMI by comparing BS with medical therapy (MT). METHODS A total of 271 patients with MS who underwent BS and MT at a single institution were reviewed in this retrospective cohort study. A 1:1 propensity score matching was performed for the BS and MT groups with BMI<35 kg/m2. We analyzed the 5 years effect of BS versus MT on the remission of MS, its components, atherosclerotic cardiovascular disease (ASCVD) risk, and medication used. RESULTS Patients in the MT group showed a decrease in the prevalence of MS to 62% at the 1st year and 10% at the 5th year. In the BS group, MS prevalence in patients with BMI<35 kg/m2 decreased to 30% and 9% at the 1st and 5th year, whereas in patients with BMI≥35 kg/m2 was 26% and 7%, respectively. The 10-year ASCVD risk and the lifetime ASCVD were significantly decreased 5 years after BS in patients with BMI<35 kg/m2. The number and daily drug dose of hypoglycemic drugs, antihypertensive medications, and lipid-lowering drugs were reduced from baseline in both BS and MT groups. CONCLUSION Bariatric surgery significantly improves MS remission rates and long-term cardiovascular risk in Chinese patients with metabolic syndrome and a BMI <35 kg/m2.
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Affiliation(s)
- Xunmei Zhou
- Department of Endocrinology, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing, 400042, China
| | - Zhigang Ke
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Fang Sun
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing, 400042, China
| | - Fan Li
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Zaichun You
- Department of General Medicine, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Jian Zhang
- Department of General Medicine, Xinmiao Central Hospital, Fuling District, Chongqing, 408114, China
| | - Yu Gao
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing, 400042, China.
| | - Weidong Tong
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Abernathy OL, Okut H, Paull-Forney BG, Schwasinger-Schmidt TE. Bariatric Surgery Improves Renal Function in Patients With Obesity. Cureus 2021; 13:e17458. [PMID: 34603860 PMCID: PMC8475746 DOI: 10.7759/cureus.17458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Background Obesity affects 93.3 million adults in the United States and is a predisposing factor for the development and progression of chronic kidney disease (CKD). The objective of this study is to examine the association between weight loss and renal function in participants undergoing bariatric surgery following a 12-week multidisciplinary, community-based weight loss program. Methodology This is a retrospective chart review of participants who voluntarily enrolled in a 12-week multidisciplinary weight loss program prior to bariatric surgery from 2009 to 2018. The primary outcome was to assess the association between weight loss and renal function in participants undergoing bariatric surgery. Secondary outcomes included changes in hemoglobin A1c, lipids, fasting glucose, and blood pressure. Results Among the 55 participants, baseline glomerular filtration rate (GFR) was 49 mL/min/m2, 80% were female, and the average baseline weight was 131 kg. At one-year post-intervention, 69% of patients improved in the CKD stage, with 45% of the participants improving from stage 3A to stage 2. GFR improved to 15 mL/min/1.73m2 (p = 0.025), and there was a negative correlation (rs = -0.3556) between weight and GFR (p = 0.013). Participants with hyperlipidemia had a 12 mL/min/1.73m2 rise in GFR, while participants without the diagnosis at one year had a 24 mL/min/1.73m2 rise in GFR (p = 0.007). Conclusions This study demonstrated improved renal function and reduced progression of CKD following a combined lifestyle and surgical intervention, indicating the importance of a comprehensive approach for the management of the chronic disease.
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Affiliation(s)
- Oaklee L Abernathy
- Internal Medicine, Kansas University School of Medicine-Wichita, Wichita, USA
| | - Hayrettin Okut
- Preventive Medicine, Kansas University School of Medicine-Wichita, Wichita, USA
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Stenberg E, Olbers T, Cao Y, Sundbom M, Jans A, Ottosson J, Naslund E, Näslund I. Factors determining chance of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a nationwide cohort study in 8057 Swedish patients. BMJ Open Diabetes Res Care 2021; 9:9/1/e002033. [PMID: 33990366 PMCID: PMC8127970 DOI: 10.1136/bmjdrc-2020-002033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/19/2021] [Accepted: 05/02/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Bariatric and metabolic surgery is an effective treatment option for type 2 diabetes (T2D). Increased knowledge regarding factors associated with diabetes remission is essential in individual decision making and could guide postoperative care. Therefore, we aimed to explore factors known to affect the chance of achieving diabetes remission after bariatric and metabolic surgery and to further investigate the impact of socioeconomic factors. RESEARCH DESIGN AND METHODS In this nationwide study, we assessed all patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) surgery between 2007 and 2015 in the Scandinavian Obesity Surgery Registry. Remission was defined as absence of antidiabetic medication for T2D 2 years after surgery. Multivariable logistic regression was used to evaluate factors associated with diabetes remission, with missing data handled by multiple imputations. RESULTS A total of 8057 patients were included. Mean age±SD was 47.4±10.1 years, mean body mass index 42.2±5.7 kg/m2, mean hemoglobin A1c 59.0±17.33, and 61.7% (n=4970) were women. Two years after surgery, 6211 (77.1%) patients achieved T2D remission. Preoperative insulin treatment (OR 0.26, 95% CI 0.22 to 0.30), first-generation immigrant (OR 0.66, 95% CI 0.57 to 0.77), duration of T2D (OR 0.89, 95% CI 0.88 to 0.90), dyslipidemia (OR 0.71, 95% CI 0.62 to 0.81), age (OR 0.97, 95% CI 0.96 to 0.97), and high glycosylated hemoglobin A1c (HbA1c) (OR 0.99, 95% CI 0.98 to 0.99) were all associated with lower T2D remission rate. In contrast, residence in a medium-sized (OR 1.39, 95% CI 1.20 to 1.61) or small (OR 1.46, 95% CI 1.25 to 1.71) town and percentage of total weight loss (OR 1.04, 95% CI 1.03 to 1.04) were associated with higher remission rates. CONCLUSION Among patients with T2D undergoing RYGB surgery, increasing age, HbA1c, and diabetes duration decreased the chance of reaching diabetes remission without cut-offs, while postoperative weight loss demonstrated a positive linear association. In addition, being a first-generation immigrant and living in a large city were socioeconomic factors having a negative association.
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Affiliation(s)
- Erik Stenberg
- Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences and Wallenberg Center for Molecular Medicine, Linköping University, Linkoping, Sweden
- Department of Gastrosurgical Research, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Orebro, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Jans
- Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Johan Ottosson
- Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Erik Naslund
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Näslund
- Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
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Tashiro Y, Han Q, Tan Y, Sugisawa N, Yamamoto J, Nishino H, Inubushi S, Sun YU, Zhu G, Lim H, Aoki T, Murakami M, Bouvet M, Hoffman RM. Oral Recombinant Methioninase Inhibits Diabetes Onset in Mice on a High-fat Diet. In Vivo 2021; 34:973-978. [PMID: 32354882 DOI: 10.21873/invivo.11865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIM We have recently shown that oral recombinant methionase (o-rMETase) prevents obesity in mice on a high-fat (HF) diet. The present study aimed to determine if o-rMETase can inhibit the onset of diabetes in mice on a HF diet. MATERIALS AND METHODS The mice on a HF diet were divided into two groups: 1) HF+phosphate buffered saline (PBS) group; 2) HF+o-rMETase group. RESULTS The blood glucose level in the HF+PBS group increased to average of 201 mg/dl during the experimental period of 8 weeks. In contrast, the blood glucose level in the HF+o-rMETase group maintained an average of 126 mg/dl (p<0.01, HF+PBS vs. HF+o-rMETase). The glucose tolerance test showed a significant increase in tolerance in the HF+o-rMETase group at 120 min after glucose injection compared to the HF+PBS group (p=0.04). Visceral adipose tissue was significantly less in the HF+o-rMETase group than the HF+PBS group (p=0.05). There was no difference in insulin levels, cholesterol or triglycerides between the HF+PBS and HF+o-rMETase groups. CONCLUSION o-rMETase inhibited the onset of diabetes as well as prevented obesity on a high-fat diet, offering a possibility of a new and easy-to-use alternative to severe dieting or insulin injections.
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Affiliation(s)
- Yoshihiko Tashiro
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | | | | | - Norihiko Sugisawa
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Jun Yamamoto
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Hiroto Nishino
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Sachiko Inubushi
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Y U Sun
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Guangwei Zhu
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Hyein Lim
- Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Takeshi Aoki
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Masahiko Murakami
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Michael Bouvet
- Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Robert M Hoffman
- AntiCancer Inc, San Diego, CA, U.S.A. .,Department of Surgery, University of California, San Diego, CA, U.S.A
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Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, M. Cabral P, Guerreiro V, Lourenço R, Meira P, Salazar D, Ferreira MJ, Pedro J, Barkoudah E, Sande A, Lau E, B. Souto S, Preto J, Freitas P, Carvalho D. Beta Cell Function as a Baseline Predictor of Weight Loss After Bariatric Surgery. Front Endocrinol (Lausanne) 2021; 12:714173. [PMID: 34456871 PMCID: PMC8387593 DOI: 10.3389/fendo.2021.714173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/22/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Obesity is a multifactorial disease, which is strongly associated to other metabolic disorders. Bariatric surgery is the most effective treatment of morbid obesity. The role of beta cell function in weight loss after bariatric surgery is uncertain. AIM To evaluate the association between beta cell function and percentage of total body weight loss (TBWL%) 1, 2, 3, and 4 years after bariatric surgery in patients with morbid obesity. METHODS Retrospective longitudinal study in patients with morbid obesity followed in our center between January 2010 and July 2018. Patients were excluded if they had diabetes at baseline or missing data on the needed parameters. We evaluated baseline Homeostatic Model Assessment of IR, Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index, and Matsuda and DeFronzo index, and TBWL% at years 1 to 4. Linear regression models were used to evaluate the association of indexes of insulin resistance with TBWL% (unadjusted and adjusted for age, sex, BMI, and type of surgery). RESULTS There were 1,561 patients included in this analysis. HOMA-beta was negatively associated with TBWL% at second, third, and fourth years post-surgery (β = -1.04 [-1.82 to -0.26], p<0.01; β = -1.16 [-2.13 to -0.19], p=0.02; β = -1.29 [-2.64 to 0.06], p=0.061, respectively). This was not observed in the first year post-surgery nor for the other indexes. Glycemia at baseline was positively associated to EWL% at second and third years post-surgery. CONCLUSION β-cell function at baseline seems to be associated to long-term weight loss, explicitly after the first year post bariatric surgery. This might be a helpful predictor of weight loss in clinical practice.
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Affiliation(s)
- Marta Borges-Canha
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- *Correspondence: Marta Borges-Canha, ; orcid.org/0000-0003-2929-3751
| | - João Sérgio Neves
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Fernando Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria Manuel Silva
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cláudia Costa
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto, Francisco Gentil, EPE, Porto, Portugal
| | - Pedro M. Cabral
- Serviço de Patologia Clínica do Centro Hospitalar Universitário Cova da Beira, EPE, Covilhã, Portugal
| | - Vanessa Guerreiro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Patrícia Meira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria João Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Pedro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ebrahim Barkoudah
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Ana Sande
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eva Lau
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma B. Souto
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - John Preto
- Serviço de Cirurgia Geral do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Tashiro Y, Han Q, Tan Y, Sugisawa N, Yamamoto J, Nishino H, Inubushi S, Higuchi T, Aoki T, Murakami M, Hoffman RM. Oral Recombinant Methioninase Prevents Obesity in Mice on a High-fat Diet. In Vivo 2020; 34:489-494. [PMID: 32111745 DOI: 10.21873/invivo.11799] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND/AIM obesity is a world-wide recalcitrant problem leading to many diseases. Dietary methionine restriction (MR) has been shown to prevent obesity, but it is an onerous regimen. The present study aimed to determine the effects of oral recombinant methionase (o-rMETase), on preventing obesity in mice on a high-fat diet. MATERIALS AND METHODS Male C57BL/6J mice in the control group were fed a control diet (CD) (+6.5% fat) for 25 days, and others were fed a high-fat (HF) diet (+34.3% fat) for 25 days. Then, the mice were divided into three dietary groups: 1) HF + phosphate buffered saline (PBS) group; 2) HF + o-rMETase group; and 3) untreated non-HF group. RESULTS The mice on the CD increased in body weight by 14% during experimental period of 25 days; in contrast the mice in the HF+PBS group increased by 33%; however, the mice on the HF+o-rMETase group increased only by 14% (p=0.02, HF+PBS vs HF+o-rMETase). CONCLUSION The HF+ o-rMETase group had the same weight increase as untreated mice on a normal fat diet, demonstrating the potential for o-rMETase to eliminate the need for dieting to maintain normal body weight.
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Affiliation(s)
- Yoshihiko Tashiro
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | | | | | - Norihiko Sugisawa
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Jun Yamamoto
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Hiroto Nishino
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Sachiko Inubushi
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Takashi Higuchi
- AntiCancer Inc, San Diego, CA, U.S.A.,Department of Surgery, University of California, San Diego, CA, U.S.A
| | - Takeshi Aoki
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Masahiko Murakami
- Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Robert M Hoffman
- AntiCancer Inc, San Diego, CA, U.S.A. .,Department of Surgery, University of California, San Diego, CA, U.S.A
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Ekberg NR, Falhammar H, Näslund E, Brismar K. Predictors of normalized HbA1c after gastric bypass surgery in subjects with abnormal glucose levels, a 2-year follow-up study. Sci Rep 2020; 10:15127. [PMID: 32934313 PMCID: PMC7492212 DOI: 10.1038/s41598-020-72141-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022] Open
Abstract
Clinical biomarkers can predict normalization of HbA1c after Roux-en-Y gastric bypass (RYGB) surgery, but it is unclear which are the most predictive.The aim of this study was to compare biomarkers for insulin sensitivity and other clinical parameters in the prediction of normalization of HbA1c after RYGB surgery. This study included 99 (23 men) obese subjects (BMI > 35 kg/m2) undergoing a laparoscopic RYGB. Clinical and biochemical examinations were performed pre-operatively and up to 2 years after surgery. Pre-operatively, normal fasting glucose levels were found in 25 individuals (NG), prediabetes in 46 and type 2 diabetes (T2DM) in 28. At baseline IGF-I (SD), IGFBP-1 and adiponectin levels were low while leptin was high. Weight loss was observed in all three groups, most in the prediabetes group. After 2 years HbA1c was decreased in prediabetes and T2DM. In all three groups insulin, HOMA-IR, lipids and blood pressure improved, IGFBP-1 and adiponectin increased and leptin decreased. IGF-I (SD) increased only in T2DM. In those with prediabetes or T2DM (n = 74), HbA1c at 2 years correlated to baseline BMI (r = -0.27, p = 0.028), age (r = 0.43, p < 0.001), HbA1c (r = 0.37, p = 0.001) and IGFBP-1 (r = 0.25, p = 0.038), and was normalized in 45/74 (61%) at 1 year and in 36 subjects (49%) at 2 years. These responders were younger, had higher BMI, larger waist circumference, lower HbA1c and lower IGFBP-1 levels at baseline. In a multiple regression model age (negative, p = 0.021) and waist circumference (positive, p = 0.047) were the only predictors for normalized HbA1c. RYGB normalized HbA1c in 49% at two years follow-up, which was predicted by low baseline IGFBP-1 level, a marker of hepatic insulin sensitivty and insulin secretion. However,. younger age and larger waist circumference were the only predictors of normalized HbA1c in multivariate analysis.
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Affiliation(s)
- Neda Rajamand Ekberg
- Centrum of Diabetes, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, D02:04, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, D02:04, Karolinska Institutet, 171 76, Stockholm, Sweden. .,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
| | - Erik Näslund
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, D02:04, Karolinska Institutet, 171 76, Stockholm, Sweden
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Brunet E, Caixàs A, Puig V. Review of the management of diarrhea syndrome after a bariatric surgery. ACTA ACUST UNITED AC 2019; 67:401-407. [PMID: 31843494 DOI: 10.1016/j.endinu.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 02/07/2023]
Abstract
Obesity is a prevalent health problem in our population. Bariatric surgery is the indicated treatment for severe cases. It is very effective (together with an adequate lifestyle modification) but it is also associated with frequent adverse events. One of the most frequent and disturbing adverse event is diarrhea. Diarrhea after bariatric surgery may be secondary to multiple causes and the physiopathogenic mechanisms may depend on the type of surgery performed. The most frequent diarrhea mechanisms are dumping syndrome, vagotomy, short bowel syndrome, carbohydrate malabsorption, protein malabsorption, alterations of the microbiota, Clostridium difficile infection, bacterial overgrowth, bile salt malabsorption, pancreatic insufficiency, endocrinological disorders, addictive disorders, and other digestive disorders not necessarily related to surgery.
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Affiliation(s)
- Eduard Brunet
- Unidad de Gastroenterología, Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Assumpta Caixàs
- Servicio de Endocrinología y Nutrición, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
| | - Valentí Puig
- Unidad de Gastroenterología, Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
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Impact of Bariatric Surgery on Long-term Cardiovascular Risk: Comparative Effectiveness of Different Surgical Procedures. Obes Surg 2019; 30:673-680. [DOI: 10.1007/s11695-019-04237-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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12
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Jermendy G. [De-escalation of antihyperglycemic treatment in patients with type 2 diabetes - when less is more]. Orv Hetil 2019; 160:1207-1215. [PMID: 31352807 DOI: 10.1556/650.2019.31488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Type 2 diabetes - due to its natural course - should be considered as a progressive chronic disease. Owing to this fact, antihyperglycemic treatment should be continuously increased stepwise in order to achieve proper glycemic control. Lifestyle modification should be initiated immediately after manifestation, shortly followed by metformin monotherapy, and later, dual or triple combinations and, finally, injectable derivatives - only insulin in the past - should be used for appropriate glycemic control. Guidelines about treatment approach of patients with type 2 diabetes unequivocally emphasize and describe in detail the need of treatment intensification, in other words, stepwise escalation in clinical practice. In the last couple of years, evidences provided that step down therapy, simplification of complex treatment regimens should also be considered in certain cases. This approach was generally called de-escalation in antihyperglycemic treatment which should be considered in patients with type 2 diabetes 1) after bariatric (metabolic) surgery; 2) with significant weight reduction irrespective of its origin; 3) with complex insulin regimens where re-evaluation of this treatment was missed; 4) with continuously decreasing renal function; 5) among elderly patients with comorbidities; 6) in social deprivation. In this article, data about therapeutic de-escalation of antihyperglycemic treatment in patients with type 2 diabetes and first experiences with this treatment approach are summarized. Orv Hetil. 2019; 160(31): 1207-1215.
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