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Poitou C, Puder L, Dubern B, Krabusch P, Genser L, Wiegand S, Verkindt H, Köhn A, von Schwartzenberg RJ, Flück C, Pattou F, Laville M, Kühnen P, Clément K. Long-term outcomes of bariatric surgery in patients with bi-allelic mutations in the POMC, LEPR, and MC4R genes. Surg Obes Relat Dis 2021; 17:1449-1456. [PMID: 34083135 DOI: 10.1016/j.soard.2021.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gene mutations in the leptin-melanocortin signaling cascade lead to hyperphagia and severe early onset obesity. In most cases, multimodal conservative treatment (increased physical activity, reduced caloric intake) is not successful to stabilize body weight and control hyperphagia. OBJECTIVES To examine bariatric surgery as a therapeutic option for patients with genetic obesity. SETTING Three major academic, specialized medical centers. METHODS In 3 clinical centers, we retrospectively analyzed the outcomes of bariatric surgery performed in 8 patients with monogenic forms of obesity with bi-allelic variants in the genes LEPR (n = 5), POMC (n = 2), and MC4R (n = 1). RESULTS In this group of patients with monogenic obesity, initial bariatric surgery was performed at a median age of 19 years (interquartile range [IQR], 16-23.8 yr). All patients initially experienced weight loss after each bariatric surgery, which was followed by substantial weight regain. In total, bariatric surgery led to a median maximum reduction of body weight of -21.5 kg (IQR, -36.3 to -2.9 kg), median percent excess weight loss (%EWL) of -47.5 %EWL (IQR, -57.6 to -28.9 %EWL). This body weight reduction was followed by median weight regain of 24.1 kg (IQR: 10.0 to 42.0 kg), leading to a final weight change of -24.2 % EWL (IQR: -37.6 to -5.4 %EWL) after a maximum duration of 19 years post surgery. In one patient, bariatric surgery was accompanied by significant complications, including vitamin deficiencies and hernia development. CONCLUSION The indication for bariatric surgery in patients with monogenic obesity based on bi-allelic gene mutations and its benefit/risk balance has to be evaluated very cautiously by specialized centers. Furthermore, to avoid an unsuccessful operation, preoperative genetic testing of patients with a history of early onset obesity might be essential, even more since novel pharmacological treatment options are expected.
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Affiliation(s)
- Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, CRNH Ile de France, F-CRIN/FORCE Network Paris, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France
| | - Lia Puder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin, Germany; Department for Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Beatrice Dubern
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France; Pediatric Nutrition and Gastroenterology Department, Assistance Publique-Hôpitaux de Paris, Trousseau Hospital, Paris, France
| | - Philipp Krabusch
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin, Germany; Department for Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Laurent Genser
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France; Department of Hepato-Biliary and Pancreatic Surgery, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Susanna Wiegand
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Berlin, Germany
| | - Hélène Verkindt
- CHU Lille, Endocrine and Metabolic Surgery, Integrated Center for Obesity, Lille, France
| | - Arvid Köhn
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Berlin, Germany
| | - Reiner Jumpertz von Schwartzenberg
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Berlin, Germany
| | - Christa Flück
- Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics and Department of BioMedical Research, Bern University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - François Pattou
- CHU Lille, Endocrine and Metabolic Surgery, Integrated Center for Obesity, Lille, France; University of Lille, Lille Pasteur Institute, Inserm U1190, European Genomic Institute for Diabetes, Lille, France; F-CRIN/FORCE Network, Pierre Bénite, Lyon, France
| | - Martine Laville
- F-CRIN/FORCE Network, Pierre Bénite, Lyon, France; Département Endocrinologie, Diabète et Nutrition, Hospices Civils de Lyon, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Univ-Lyon, CarMeN Laboratory, Université Claude Bernard Lyon1, F-CRIN/FORCE Network, Pierre Bénite, Lyon, France
| | - Peter Kühnen
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin, Germany.
| | - Karine Clément
- Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, CRNH Ile de France, F-CRIN/FORCE Network Paris, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, F-CRIN/FORCE Network Paris, Paris, France
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Pratt JS, Roque SS, Valera R, Czepiel KS, Tsao DD, Stanford FC. Preoperative considerations for the pediatric patient undergoing metabolic and bariatric surgery. Semin Pediatr Surg 2020; 29:150890. [PMID: 32238283 PMCID: PMC7238975 DOI: 10.1016/j.sempedsurg.2020.150890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
To ensure successful outcomes in pediatric patients with severe obesity who undergo metabolic and bariatric surgery (MBS), a number of pre-operative patient management options should be considered. This manuscript will review the indications and contraindications of MBS and special considerations for youth who might benefit from MBS. The treatment team conducts a thorough pre-operative evaluation, assessing risks and benefits of surgical intervention, and prepares patients and families to be successful with MBS by providing education about the surgical intervention and lifestyle changes that will be necessary. This article reviews the pre-operative considerations for adolescents with severe obesity who are being considered for MBS, based upon recent clinical practice guidelines.
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Affiliation(s)
- Janey S.A. Pratt
- Stanford University School of Medicine, Palo Alto, CA, USA,Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA,Corresponding author at: Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Always Building, M116, Stanford, CA 94305, USA, (J.S.A. Pratt)
| | | | - Ruben Valera
- Tufts University School of Medicine, Boston, MA, USA
| | - Kathryn S. Czepiel
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA,Internal Medicine- Neuroendocrine Division and Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
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de Toro-Martín J, Guénard F, Tchernof A, Pérusse L, Marceau S, Vohl MC. Polygenic risk score for predicting weight loss after bariatric surgery. JCI Insight 2018; 3:122011. [PMID: 30185664 DOI: 10.1172/jci.insight.122011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/31/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The extent of weight loss among patients undergoing bariatric surgery is highly variable. Herein, we tested the contribution of genetic background to such interindividual variability after biliopancreatic diversion with duodenal switch. METHODS Percentage of excess body weight loss (%EBWL) was monitored in 865 patients over a period of 48 months after bariatric surgery, and two polygenic risk scores were constructed with 186 and 11 (PRS186 and PRS11) single nucleotide polymorphisms previously associated with body mass index (BMI). RESULTS The accuracy of the %EBWL logistic prediction model - including initial BMI, age, sex, and surgery modality, and assessed as the area under the receiver operating characteristics (ROC) curve adjusted for optimism (AUCadj = 0.867) - significantly increased after the inclusion of PRS186 (ΔAUCadj = 0.021; 95% CI of the difference [95% CIdiff] = 0.005-0.038) but not PRS11 (ΔAUCadj= 0.008; 95% CIdiff= -0.003-0.019). The overall fit of the longitudinal linear mixed model for %EBWL showed a significant increase after addition of PRS186 (-2 log-likelihood = 12.3; P = 0.002) and PRS11 (-2 log-likelihood = 9.9; P = 0.007). A significant interaction with postsurgery time was found for PRS186 (β = -0.003; P = 0.008) and PRS11 (β = -0.008; P = 0.03). The inclusion of PRS186 and PRS11 in the model improved the cost-effectiveness of bariatric surgery by reducing the percentage of false negatives from 20.4% to 10.9% and 10.2%, respectively. CONCLUSION These results revealed that genetic background has a significant impact on weight loss after biliopancreatic diversion with duodenal switch. Likewise, the improvement in weight loss prediction after addition of polygenic risk scores is cost-effective, suggesting that genetic testing could potentially be used in the presurgical assessment of patients with severe obesity. FUNDING Heart and Stroke Foundation of Canada (G-17-0016627) and Canada Research Chair in Genomics Applied to Nutrition and Metabolic Health (no. 950-231-580).
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Affiliation(s)
- Juan de Toro-Martín
- Institute of Nutrition and Functional Foods (INAF) and.,School of Nutrition, Université Laval, Quebec City, Quebec, Canada
| | - Frédéric Guénard
- Institute of Nutrition and Functional Foods (INAF) and.,School of Nutrition, Université Laval, Quebec City, Quebec, Canada
| | - André Tchernof
- School of Nutrition, Université Laval, Quebec City, Quebec, Canada.,Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Louis Pérusse
- Institute of Nutrition and Functional Foods (INAF) and.,Department of Kinesiology and
| | - Simon Marceau
- Department of Surgery, Université Laval, Quebec City, Quebec, Canada
| | - Marie-Claude Vohl
- Institute of Nutrition and Functional Foods (INAF) and.,School of Nutrition, Université Laval, Quebec City, Quebec, Canada
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Koliaki C, Kokkinos A. Comment on: Adiponectin gene variant RS rs266729: Relation to lipid profile changes and circulating adiponectin after bariatric surgery. Surg Obes Relat Dis 2018; 14:1408-1410. [PMID: 30061069 DOI: 10.1016/j.soard.2018.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Bandstein M, Voisin S, Nilsson EK, Schultes B, Ernst B, Thurnheer M, Benedict C, Mwinyi J, Schiöth HB. A Genetic Risk Score Is Associated with Weight Loss Following Roux-en Y Gastric Bypass Surgery. Obes Surg 2017; 26:2183-2189. [PMID: 26832135 PMCID: PMC4985537 DOI: 10.1007/s11695-016-2072-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Currently, Roux-en Y gastric bypass (RYGB) is the most efficient therapy for severe obesity. Weight loss after surgery is, however, highly variable and genetically influenced. Genome-wide association studies have identified several single nucleotide polymorphisms (SNP) associated with body mass index (BMI) and waist-hip ratio (WHR). We aimed to identify two genetic risk scores (GRS) composed of weighted BMI and WHR-associated SNPs to estimate their impact on excess BMI loss (EBMIL) after RYGB surgery. Methods Two hundred and thirty-eight obese patients (BMI 45.1 ± 6.2 kg/m2, 74 % women), who underwent RYGB, were genotyped for 35 BMI and WHR-associated SNPs and were followed up after 2 years. SNPs with high impact on post-surgical weight loss were filtered out using a random forest model. The filtered SNPs were combined into a GRS and analyzed in a linear regression model. Results An up to 11 % lower EBMIL with higher risk score was estimated for two GRS models (P = 0.026 resp. P = 0.021) composed of seven BMI-associated SNPs (closest genes: MC4R, TMEM160, PTBP2, NUDT3, TFAP2B, ZNF608, MAP2K5, GNPDA2, and MTCH2) and of three WHR-associated SNPs (closest genes: HOXC13, LYPLAL1, and DNM3-PIGC). Patients within the lowest GRS quartile had higher EBMIL compared to patients within the other three quartiles in both models. Conclusions We identified two GRSs composed of BMI and WHR-associated SNPs with significant impact on weight loss after RYGB surgery using random forest analysis as a SNP selection tool. The GRS may be useful to pre-surgically evaluate the risks for patients undergoing RYGB surgery. Electronic supplementary material The online version of this article (doi:10.1007/s11695-016-2072-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcus Bandstein
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden.
| | - Sarah Voisin
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Emil K Nilsson
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Bernd Schultes
- Interdisciplinary Obesity Center, eSwiss Medical & Surgical Center, St. Gallen, Switzerland
| | - Barbara Ernst
- Interdisciplinary Obesity Center, eSwiss Medical & Surgical Center, St. Gallen, Switzerland
| | - Martin Thurnheer
- Interdisciplinary Obesity Center, eSwiss Medical & Surgical Center, St. Gallen, Switzerland
| | - Christian Benedict
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Jessica Mwinyi
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
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Gasparotto AS, Borges DO, Zandoná MR, Ramos MJ, Meihnardt NG, Mattevi VS. Adiponectin promoter polymorphisms are predictors of lipid profile improvement after bariatric surgery. Genet Mol Biol 2017; 40:736-742. [PMID: 29064512 PMCID: PMC5738613 DOI: 10.1590/1678-4685-gmb-2016-0241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/03/2017] [Indexed: 01/26/2023] Open
Abstract
Our aim was to investigate if single nucleotide polymorphisms (SNPs) located in
the 5′ regions of leptin (LEP, -2548 G > A, rs7799039),
resistin (RETN, -420 C > G, rs1862513) and adiponectin
(ADIPOQ, -11391 G > A, rs17300539 and -11377 C > G,
rs266729) genes were related to changes in body mass index (BMI) and metabolic
variables after bariatric surgery in 60 extremely obese individuals. At
baseline, ADIPOQ -11391 A-allele carriers showed higher plasma
adiponectin and lower total cholesterol levels when compared to G/G homozygotes.
Approximately 32 months post-surgery, a mean reduction of 35% in BMI and an
important improvement in metabolic profiles were observed. In addition, for the
ADIPOQ -11377 polymorphism, a higher decrease in lipid
profile was associated to the C/C genotype. Moreover, individuals bearing the
A-C haplotype for the two ADIPOQ SNPs were more prone to show a
reduction in low-density lipoprotein levels after bariatric surgery (-43.0% A-C
carriers vs. -18.1% G-G carriers, p = 0.019). We did not find any association of
leptin and resistin SNPs with the clinical parameters analyzed. In summary, our
results indicate that the A-C haplotype is a predictor of better lipid profile
post-surgery and the studied SNPs in ADIPOQ gene are associated
to changes in metabolic variables in obese individuals.
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Affiliation(s)
- Aline Simas Gasparotto
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Diego Olschowsky Borges
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Marília Remuzzi Zandoná
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mauricio Jacques Ramos
- Centro de Atenção ao Obeso Classe III, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Nelson Guardiola Meihnardt
- Centro de Atenção ao Obeso Classe III, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Vanessa S Mattevi
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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Resende CMM, Durso DF, Borges KBG, Pereira RM, Rodrigues GKD, Rodrigues KF, Silva JLP, Rodrigues EC, Franco GR, Alvarez-Leite JI. The polymorphism rs17782313 near MC4R gene is related with anthropometric changes in women submitted to bariatric surgery over 60 months. Clin Nutr 2017; 37:1286-1292. [PMID: 28579220 DOI: 10.1016/j.clnu.2017.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/20/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evaluate whether the polymorphism rs17782313 near MC4R gene influences long-term outcomes after bariatric surgery. METHODS The rs16782313 polymorphism was genotyped in 217 individuals undergoing bariatric surgery and analyzed in detail in 141 women. Data for comorbidities, BMI, excess weight loss (EWL), and body composition were obtained before and during 60 months after surgery. RESULTS The risk allele was found in 65 (47%) of the 141 women. Pre-surgical body weight and BMI were higher in carriers of the rs17782313 polymorphism (CC + CT group) than in non-carriers (TT group) (p = 0.039 and 0.047, respectively). The number of women who acquired surgical success (EWL > 50%), was lower in CC + CT group compared to TT group (p = 0.015). The minimum BMI seen during the 60 months of follow-up was higher in CC + CT group compared to TT group (p = 0.028). The number of women who presented BMI < 30 kg/m2 (no longer classified as obesity) after 24 months of surgery was inferior in CC + CT group (6 out 35 patients - 17%) than in TT group (19 out 49 patients - 37%, p = 0.043). Moreover, the number of patients maintaining BMI > 35 kg/m2 were higher carriers (18 out 35 patients - 51%) compare to non-carriers (16 out 49 patients - 32%, p = 0.045). CONCLUSION Women with extreme obesity carrying rs17782313 MC4R polymorphism present a higher pre-surgical BMI, are more unlikely to reach non-obesity BMI (<30 kg/m2) and tend to maintain a BMI > 35 kg/m2 that characterize treatment failure.
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Affiliation(s)
| | - Danielle Fernandes Durso
- Departamento de Bioquimica e Imunologia - ICB, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
| | - Karina Braga Gomes Borges
- Departamento de Análises Clínicas de Toxicológicas - FAFAR, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rafaela Messias Pereira
- Departamento de Bioquimica e Imunologia - ICB, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
| | | | - Kathryna Fontana Rodrigues
- Departamento de Análises Clínicas de Toxicológicas - FAFAR, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - José Luiz Padilha Silva
- Departamento de Estatística, ICEX, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Gloria Regina Franco
- Departamento de Bioquimica e Imunologia - ICB, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
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Hindle A, de la Piedad Garcia X, Brennan L. Early post-operative psychosocial and weight predictors of later outcome in bariatric surgery: a systematic literature review. Obes Rev 2017; 18:317-334. [PMID: 28170168 DOI: 10.1111/obr.12496] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/10/2016] [Accepted: 11/23/2016] [Indexed: 01/18/2023]
Abstract
This is the first systematic review to synthesize the evidence concerning early post-operative variables predictive of later weight and psychosocial outcomes in bariatric surgery. Eight electronic databases for empirical studies were searched (1954 to 2016). Most of the 39 included studies reported solely on weight outcomes; eating and psychosocial outcomes were less common. A better early weight loss trajectory was the most consistent predictor of more successful medium-term weight outcome (≤24 months); however, its relationship to longer term weight loss maintenance is less certain. Early eating adaptation may be associated with later weight loss, but further research is needed. Evidence is lacking for associations between early adherence or early psychosocial variables and later outcome. In particular, the relationship between early post-operative depression and later weight remains unclear. Little research has considered early prediction of later eating or psychosocial outcomes. Consideration of mediating or moderating relationships is lacking. The body of evidence is limited, and synthesis is hampered by heterogeneity in the type and time at which predictors and outcomes are measured and quality of statistical reporting. Further research on prospective prediction of bariatric surgery outcome is needed to guide early post-operative intervention for those at greatest risk of poor outcomes.
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Affiliation(s)
- A Hindle
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - X de la Piedad Garcia
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - L Brennan
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
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9
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Ahuja NK, Nimgaonkar A. Precision Bariatrics: Toward a New Paradigm of Personalized Devices in Obesity Therapeutics. Obes Surg 2016; 26:1642-5. [PMID: 27067911 DOI: 10.1007/s11695-016-2180-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The prevalence and complexity of obesity and its associated metabolic complications highlight the importance of building a rigorous investigative framework for the development of novel weight loss therapies. Device-based interventions in particular constitute a market poised for rapid expansion in the coming years. Optimizing outcomes for this new class of therapies requires attention to an evolving taxonomy of subdivisions within the broader obesity phenotype and a means for stratifying patients toward maximally effective interventions. Extant bariatric devices implicitly prioritize anatomic variables as surrogates for physiology, a somewhat arbitrary assumption that merits empiric validation. Utilizing the governing principles of systems biology and recent innovations in clinical trial design, a robust and precise research infrastructure can and should be developed to more effectively mitigate this contemporary epidemic.
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Affiliation(s)
- Nitin K Ahuja
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock Suite 412, Baltimore, MD, 21287, USA.
| | - Ashish Nimgaonkar
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 424, Baltimore, MD, 21205, USA.,Center for Bioengineering Innovation & Design, Johns Hopkins University, 3400 N. Charles Street, Clark Hall, Suite 200, Baltimore, MD, 21218, USA
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10
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Albuquerque D, Stice E, Rodríguez-López R, Manco L, Nóbrega C. Current review of genetics of human obesity: from molecular mechanisms to an evolutionary perspective. Mol Genet Genomics 2015; 290:1191-221. [DOI: 10.1007/s00438-015-1015-9] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/11/2015] [Indexed: 12/18/2022]
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Lucke-Wold BP, Logsdon AF, Turner RC, Rosen CL, Huber JD. Aging, the metabolic syndrome, and ischemic stroke: redefining the approach for studying the blood-brain barrier in a complex neurological disease. ADVANCES IN PHARMACOLOGY 2014; 71:411-49. [PMID: 25307225 DOI: 10.1016/bs.apha.2014.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The blood-brain barrier (BBB) has many important functions in maintaining the brain's immune-privileged status. Endothelial cells, astrocytes, and pericytes have important roles in preserving vasculature integrity. As we age, cell senescence can contribute to BBB compromise. The compromised BBB allows an influx of inflammatory cytokines to enter the brain. These cytokines lead to neuronal and glial damage. Ultimately, the functional changes within the brain can cause age-related disease. One of the most prominent age-related diseases is ischemic stroke. Stroke is the largest cause of disability and is third largest cause of mortality in the United States. The biggest risk factors for stroke, besides age, are results of the metabolic syndrome. The metabolic syndrome, if unchecked, quickly advances to outcomes that include diabetes, hypertension, cardiovascular disease, and obesity. The contribution from these comorbidities to BBB compromise is great. Some of the common molecular pathways activated include: endoplasmic reticulum stress, reactive oxygen species formation, and glutamate excitotoxicity. In this chapter, we examine how age-related changes to cells within the central nervous system interact with comorbidities. We then look at how comorbidities lead to increased risk for stroke through BBB disruption. Finally, we discuss key molecular pathways of interest with a focus on therapeutic targets that warrant further investigation.
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Affiliation(s)
- Brandon P Lucke-Wold
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA
| | - Aric F Logsdon
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia, USA
| | - Ryan C Turner
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA
| | - Charles L Rosen
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA
| | - Jason D Huber
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia, USA; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia, USA.
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