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Griffin SB, Palmer MA, Strodl E, Lai R, Chuah TL, Burstow MJ, Ross LJ. Preoperative dietitian-led Very Low Calorie Diet (VLCD) Clinic for adults living with obesity undergoing gynaecology, laparoscopic cholecystectomy and hernia repair procedures: a pilot parallel randomised controlled trial. Br J Nutr 2024; 131:1436-1446. [PMID: 38220220 PMCID: PMC10950445 DOI: 10.1017/s0007114524000114] [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: 09/15/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
Obesity can increase the risk of postoperative complications. Despite increased demand for patients living with obesity to lose weight prior to common surgical procedures, the impact of intentional weight loss on surgical outcomes is largely unknown. We aimed to conduct a pilot study to assess the feasibility of a full-scale randomised controlled trial (RCT) to examine the effect of preoperative dietitian-led Very Low Calorie Diet (VLCD) Clinic on surgical outcomes in gynaecology and general surgeries. Between August 2021 and January 2023, a convenience sample of adults living with obesity (BMI ≥ 30 kg/m2) awaiting gynaecology, laparoscopic cholecystectomy and ventral hernia repair procedures were randomised to dietitian-led VLCD (800-1000 kcal using meal replacements and allowed foods), or control (no dietary intervention), 2-12 weeks preoperatively. Primary outcome was feasibility (recruitment, adherence, safety, attendance, acceptability and quality of life (QoL)). Secondary outcomes were anthropometry and 30-d postoperative outcomes. Outcomes were analysed as intention-to-treat. Fifty-one participants were recruited (n 23 VLCD, n 28 control), mean 48 (sd 13) years, 86 % female, and mean BMI 35·8 (sd 4·6) kg/m2. Recruitment was disrupted by COVID-19, but other thresholds for feasibility were met for VLCD group: high adherence without unfavourable body composition change, high acceptability, improved pre/post QoL (22·1 ± 15 points, < 0·001), with greater reductions in weight (-5·5 kg VLCD v. -0·9 kg control, P < 0·05) waist circumference (-6·6 cm VLCD v. +0·6 control, P < 0·05) and fewer 30-d complications (n 4/21) than controls (n 8/22) (P > 0·05). The RCT study design was deemed feasible in a public hospital setting. The dietitian-led VLCD resulted in significant weight loss and waist circumference reduction compared with a control group, without unfavourable body composition change and improved QoL.
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Affiliation(s)
- Sally B. Griffin
- Department of Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Michelle A. Palmer
- Department of Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD, Australia
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rainbow Lai
- Department of Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD, Australia
| | - Teong L. Chuah
- Surgical and Critical Care Services, Logan Hospital, Meadowbrook, QLD, Australia
- Department of Surgery, Mater Hospital, South Brisbane, QLD, Australia
- Mayne Academy of Surgery, Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Matthew J. Burstow
- Surgical and Critical Care Services, Logan Hospital, Meadowbrook, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Lynda J. Ross
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Saito Y, Morine Y, Ikemoto T, Yamada S, Teraoku H, Yasui-Yamada S, Nishi M, Sakaue H, Kamada M, Matsuura T, Shimada M. Preoperative Weight Loss Program for Hepatocellular Carcinoma Patients with High Body Mass Index in Hepatectomy. World J Surg 2023; 47:3348-3355. [PMID: 37840060 DOI: 10.1007/s00268-023-07220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND This study aimed to investigate the usefulness of a weight-loss program (WLP) in patients with a high body mass index (BMI) prior to liver resection (Hx) for hepatocellular carcinoma (HCC). METHODS Among 445 patients with HCC who underwent initial Hx between 2000 and 2020, 19 with a high BMI (≥25.0) were enrolled in our WLP since 2014. For calorie restriction, the amount of energy consumed was calculated as the standard body weight (SBW) kg × 20-25 kcal/day. Protein mass was calculated as SBW kg × 1.0-1.2 g/day to maintain skeletal muscle mass. Patients also performed both aerobic and resistance exercises. The before-and-after changes were compared, and the effect of WLP on the short- and long-term results was investigated. RESULTS The average length of WLP was 21 days, and weight loss was successfully achieved in all patients. Body fat mass was reduced during the program, while skeletal muscle mass was maintained. WLP led to improvements in liver function and fibrotic markers, without tumor progression. There were no postoperative complications (≥Clavien-Dindo [CD] III). A retrospective comparison between with and without WLP using propensity score-matching analysis revealed that WLP group showed better NLR value, however, there were no significant differences in both short and long-term outcomes after Hx based on participation in the WLP. CONCLUSIONS WLP with multidisciplinary intervention improved immune-nutrition status and liver function of obese patients. WLP had not affected both short and long-term outcomes after Hx.
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Affiliation(s)
- Yu Saito
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan.
| | - Yuji Morine
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Tetsuya Ikemoto
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Shinichiro Yamada
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Hiroki Teraoku
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Sonoko Yasui-Yamada
- Department of Nutrition, Tokushima University Hospital, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Maki Nishi
- Department of Nutrition, Tokushima University Hospital, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Hiroshi Sakaue
- Department of Nutrition, Tokushima University Hospital, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Motomu Kamada
- Department of Rehabilitation, Tokushima University Hospital, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Tetsuya Matsuura
- Department of Rehabilitation, Tokushima University Hospital, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, 770-8503, Japan
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Formisano E, Schiavetti I, Gradaschi R, Gardella P, Romeo C, Pisciotta L, Sukkar SG. The Real-Life Use of a Protein-Sparing Modified Fast Diet by Nasogastric Tube (ProMoFasT) in Adults with Obesity: An Open-Label Randomized Controlled Trial. Nutrients 2023; 15:4822. [PMID: 38004217 PMCID: PMC10674249 DOI: 10.3390/nu15224822] [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: 10/25/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Protein-sparing modified fast (PSMF) diet is a very-low-carbohydrate ketogenic diet administered to patients with obesity, which preserves lean mass and suppresses appetite as well as continuous enteral feeding. Thus, we aim to evaluate the effect of the PSMF diet administered continuously by nasogastric tube (NGT) or orally. METHODS Patients with a body mass index (BMI) > 34.9 kg/m2 were randomly assigned to receive a whey protein PSMF formula through NGT (ProMoFasT) or orally. Data were collected at baseline and after 150 days. The endpoints were assessed in the intention-to-treat population. RESULTS We enrolled 20 patients in the ProMoFasT group and 24 in the oral group. No differences in body weight, BMI or waist circumference between the two groups were found after 150 days. At follow-up, FFM (%) and MM (%) results were higher in the ProMoFasT group than the oral group (63.1% vs. 52.9%, p = 0.012 and 45.0% vs. 36.1%, p = 0.009, respectively) and FM (kg) and FM (%) were significantly lower in the ProMoFasT group (36.9 kg vs. 44.0 kg, p = 0.033 and 37.4% vs. 44.9%, p = 0.012, respectively). Insulin levels were lower in the ProMoFasT group than the oral group at follow-up (11.8 mU/L vs. 28.0 mU/L, p = 0.001, respectively). CONCLUSION The ProMoFasT is more effective in improving body composition and glucometabolic markers than the same diet administered orally.
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Affiliation(s)
- Elena Formisano
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy (P.G.)
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, 16132 Genova, Italy
| | - Raffaella Gradaschi
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Paolo Gardella
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy (P.G.)
| | - Carlotta Romeo
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy (P.G.)
| | - Livia Pisciotta
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy (P.G.)
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Samir Giuseppe Sukkar
- Dietetics and Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Koutoukidis DA, Jebb SA, Foster C, Wheatstone P, Horne A, Hill TM, Taylor A, Realpe A, Achana F, Buczacki SJA. CARE: Protocol of a randomised trial evaluating the feasibility of preoperative intentional weight loss to support postoperative recovery in patients with excess weight and colorectal cancer. Colorectal Dis 2023; 25:1910-1920. [PMID: 37525408 DOI: 10.1111/codi.16687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/02/2023]
Abstract
AIM Excess weight increases the risk of morbidity following colorectal cancer surgery. Weight loss may improve morbidity, but it is uncertain whether patients can follow an intensive weight loss intervention while waiting for surgery and there are concerns about muscle mass loss. The aim of this trial is to assess the feasibility of intentional weight loss in this setting and determine progression to a definitive trial. METHODS CARE is a prospectively registered, multicentre, feasibility, parallel, randomised controlled trial with embedded evaluation and optimisation of the recruitment process. Participants with excess weight awaiting curative colorectal resection for cancer are randomised 1:1 to care as usual or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian. Progression criteria will be based on the recruitment, engagement, adherence, and retention rates. Data will be collected on the 30-day postoperative morbidity, the typical primary outcome of prehabilitation trials. Secondary outcomes will include, among others, length of hospital stay, health-related quality of life, and body composition. Qualitative interviews will be used to understand patients' experiences of and attitudes towards trial participation and intervention engagement and adherence. CONCLUSION CARE will evaluate the feasibility of intensive intentional weight loss as prehabilitation before colorectal cancer surgery. The results will determine the planning of a definitive trial.
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Affiliation(s)
- Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC+ in Health Sciences, University of Southampton, Southampton, UK
| | | | - Alison Horne
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - T Martyn Hill
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Amy Taylor
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Felix Achana
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon J A Buczacki
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Poniewierska-Baran A, Warias P, Zgutka K. Sirtuins (SIRTs) As a Novel Target in Gastric Cancer. Int J Mol Sci 2022; 23:ijms232315119. [PMID: 36499440 PMCID: PMC9737976 DOI: 10.3390/ijms232315119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
Gastric cancer is a major health burden worldwide. Among all neoplasms, gastric cancer is the fifth most common and the third most deadly type of cancer. It is known that sirtuins (SIRTs), are NAD+-dependent histone deacetylases regulating important metabolic pathways. High expression of SIRTs in the human body can regulate metabolic processes; they prevent inflammation but also resist cell death and aging processes. The seven members of this family enzymes can also play a fundamental role in process of carcinogenesis by influencing cell viability, apoptosis and metastasis. This review collects and discusses the role of all seven sirtuins (SIRT1-SIRT7) in the pathogenesis of gastric cancer (GC).
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Affiliation(s)
- Agata Poniewierska-Baran
- Institute of Biology, University of Szczecin, Felczaka 3c, 71-412 Szczecin, Poland
- Correspondence:
| | - Paulina Warias
- Department of Physiology, Pomeranian Medical University in Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Katarzyna Zgutka
- Department of Physiology in Health Sciences, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Żołnierska 54, 70-210 Szczecin, Poland
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McKechnie T, Povolo CA, Lee J, Lee Y, Park L, Doumouras AG, Hong D, Bhandari M, Eskicioglu C. Very low energy diets before nonbariatric surgery: A systematic review and meta-analysis. Surgery 2022; 172:1733-1743. [PMID: 36273973 DOI: 10.1016/j.surg.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Very low energy diets serve as an intensive approach to weight loss in a short period of time. Although the preoperative use of very low energy diets to optimize patients with obesity before bariatric surgery is well established, the evidence for very low energy diets before other types of surgery remains unclear. The aim of this review was to determine the impact of preoperative very low energy diets on perioperative outcomes in nonbariatric surgery. METHODS Medline, EMBASE, CENTRAL, and PubMed were systematically searched from inception through to July 2021. Articles were included if they evaluated very low energy diets use before any type of nonbariatric surgery. The primary outcome was postoperative morbidity. Secondary outcomes included compliance, safety, and preoperative weight loss. A pairwise meta-analyses using inverse variance random effects was performed. RESULTS From 792 citations, 13 studies with 395 patients (mean age: 56.5 years, 55.8% female) receiving very low energy diets preoperatively in preparation for nonbariatric surgery were included. Mean duration of preoperative very low energy diets was 6.6 weeks (range, 0.42-17 weeks). Target daily caloric intake ranged from 450 kcal to 1,400 kcal. Compliance with very low energy diets ranged from 94% to 100%. The mean preoperative weight loss ranged from 3.2 kg to 19.2 kg. There were no significant differences in postoperative morbidity (odds ratio, 1.10; 95% confidence interval, 0.64-1.91; P = .72), operative time (standard mean difference -0.35; 95% confidence interval, 1.13-0.43, P = .38), or postoperative length of stay (standard mean difference 0.40, 95% confidence interval -0.11-0.91, P = .12) with very low energy diets. CONCLUSION Although the currently available evidence is heterogenous, preoperative very low energy diets are safe, well tolerated, and effectively induce preoperative weight loss in patients undergoing nonbariatric surgery for both benign and malignant disease. Further prospective studies are warranted.
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Affiliation(s)
- Tyler McKechnie
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada. https://twitter.com/tylermckechnie
| | - Christopher A Povolo
- McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Jay Lee
- McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Yung Lee
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada. https://twitter.com/YungLeeMD
| | - Lily Park
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada. https://twitter.com/lilyistweetingg
| | - Aristithes G Doumouras
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare-Hamilton, Ontario, Canada
| | - Dennis Hong
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare-Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare-Hamilton, Ontario, Canada.
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Griffin SB, Palmer MA, Strodl E, Lai R, Burstow MJ, Ross LJ. Elective Surgery in Adult Patients with Excess Weight: Can Preoperative Dietary Interventions Improve Surgical Outcomes? A Systematic Review. Nutrients 2021; 13:3775. [PMID: 34836028 PMCID: PMC8623302 DOI: 10.3390/nu13113775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/12/2022] Open
Abstract
This systematic review summarises the literature regarding the impact of preoperative dietary interventions on non-bariatric surgery outcomes for patients with excess weight/obesity, a known risk factor for poor surgical outcomes. Four electronic databases were searched for non-bariatric surgery studies that evaluated the surgical outcomes of a preoperative diet that focused on weight/fat loss or improvement of liver steatosis. Meta-analysis was unfeasible due to the extreme heterogeneity of variables. Fourteen studies, including five randomised controlled trials, were selected. Laparoscopic cholecystectomy, hernia repair, and liver resection were most studied. Diet-induced weight loss ranged from 1.4 kg to 25 kg. Preoperative very low calorie diet (≤800 kcal) or low calorie diet (≤900 kcal) for one to three weeks resulted in: reduction in blood loss for two liver resection and one gastrectomy study (-27 to -411 mL, p < 0.05), and for laparoscopic cholecystectomy, reduction of six minutes in operating time (p < 0.05) and reduced difficulty of aspects of procedure (p < 0.05). There was no difference in length of stay (n = 7 studies). Preoperative ≤ 900 kcal diets for one to three weeks could improve surgical outcomes for laparoscopic cholecystectomy, liver resection, and gastrectomy. Multiple randomised controlled trials with common surgical outcomes are required to establish impact on other surgeries.
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Affiliation(s)
- Sally B. Griffin
- Department of Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD 4131, Australia; (M.A.P.); (R.L.)
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia;
| | - Michelle A. Palmer
- Department of Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD 4131, Australia; (M.A.P.); (R.L.)
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4215, Australia
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD 4059, Australia;
| | - Rainbow Lai
- Department of Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD 4131, Australia; (M.A.P.); (R.L.)
| | - Matthew J. Burstow
- Division of Surgery, Logan Hospital, Meadowbrook, QLD 4131, Australia;
- School of Medicine, Griffith University, Gold Coast, QLD 4215, Australia
| | - Lynda J. Ross
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia;
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Kashihara H, Shimada M, Yoshikawa K, Higashijima J, Tokunaga T, Nishi M, Takasu C, Yoshimoto T. The influence and countermeasure of obesity in laparoscopic colorectal resection. Ann Gastroenterol Surg 2021; 5:677-682. [PMID: 34585052 PMCID: PMC8452473 DOI: 10.1002/ags3.12455] [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: 09/11/2020] [Accepted: 03/01/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the influence of obesity and the usefulness of a preoperative weight loss program (PWLP) for obese patients undergoing laparoscopic colorectal resection (LCR). METHODS Study 1: 392 patients who underwent LCR for colorectal cancer were divided into two groups: those with a body mass index (BMI) ≥25 kg/m2 (n = 113) and those with a BMI <25 kg/m2 (n = 279). The influence of BMI on LCR was investigated. Study 2: Patients with a BMI ≥28 kg/m2 who were scheduled to undergo LCR (n = 7, mean body weight 87.0 kg, mean BMI 33.9 kg/m2) undertook a PWLP including caloric restriction and exercise for 29.6 (15-70) days. The effects of this program were evaluated. RESULTS Study 1: The BMI ≥25 kg/m2 group had a prolongation of operation time and hospital stay than the BMI <25 kg/m2 group. Study 2: The patients achieved a mean weight loss of 6.9% (-6.0 kg). The mean visceral fat area was significantly decreased by 18.0%, whereas the skeletal muscle mass was unaffected. The PWLP group had a significantly lower prevalence of postoperative complications compared with the BMI ≥25 kg/m2 group. CONCLUSION Obesity affected the surgical outcomes in LCR. A PWLP may be useful for obese patients undergoing LCR.
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Affiliation(s)
| | | | | | | | | | - Masaaki Nishi
- Department of SurgeryTokushima UniversityTokushimaJapan
| | - Chie Takasu
- Department of SurgeryTokushima UniversityTokushimaJapan
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Aubrey C, Skeldon M, Chapelsky S, Giannakopoulos N, Ghosh S, Steed H, Pin S. Preoperative weight loss in women with obesity in gynaecologic oncology: A retrospective study. Clin Obes 2021; 11:e12445. [PMID: 33710796 DOI: 10.1111/cob.12445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 01/24/2023]
Abstract
To retrospectively review the efficacy of short term supervised medical weight loss for women with obesity, body mass index (BMI ≥40 kg/m2 ) in gynaecologic oncology, and the associated perioperative and pathologic outcomes. A retrospective study of a dedicated preoperative weight loss clinic for gynaecologic oncology patients from March to December 2019. Statistical analysis was performed with McNemar's test for correlated proportions, Pearson's correlation tests for continuous variables, and paired t-tests to compare means. Generalized estimating equations (GEE) were used to determine the factors associated with weight loss over time. A P-value of <.05 was used for statistical significance. Review of cases up-graded after surgery was performed by a gynaecologic pathologist. There were a total of 49 women included in the study. The most common referral reason was endometrioid carcinoma or hyperplasia of the endometrium (77.6%). Mean initial weight was 130.2 kg, and corresponding mean BMI 48.1 kg/m2 . Patients attended on average nine preoperative weight loss visits. A significant difference between initial weight and weight at surgery was demonstrated, from 129.6 to 118.0 kg (8.4% weight loss) (P < .0001). This difference persisted to their post-surgical visit, with an additional mean loss of 1.89 kg (9.4% weight loss) (P = .044). The majority (92.1%) of patients with endometrial pathology had surgical management, and of these 85.7% were minimally invasive. Preoperative weight loss is a feasible option in gynaecologic oncology patients. Greater understanding of clinical significance, follow-up, and ideal target population for this intervention is needed.
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Affiliation(s)
- Christa Aubrey
- Gynecologic Oncology Fellow, Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Skeldon
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Chapelsky
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nadia Giannakopoulos
- Department of Anatomic Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Research Scientist, Alberta Health Services-Cancer Control Alberta, Department of Medical Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Helen Steed
- Cross Cancer Institute, Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sophia Pin
- Cross Cancer Institute, Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Maruyama K, Shimada K, Makino A, Hisamune R, Shirota T, Gomi K. Effective and safe reduction in visceral fat using a formula diet in a short period before highly invasive endoscopic surgery - Case series. Int J Surg Case Rep 2021; 83:106026. [PMID: 34058461 PMCID: PMC8175398 DOI: 10.1016/j.ijscr.2021.106026] [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: 05/10/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction We retrospectively assessed the efficacy and safety of use of short-term formula diet therapy to achieve preoperative reduction in visceral fat immediately prior to highly invasive endoscopic surgery. Presentation of case We reviewed 5 cancer patients who underwent thoracoscopic and/or laparoscopic-assisted esophagectomy or gastrectomy. The cases were those with a BMI ≥30 kg/m2 or waist circumference ≥100 cm. Patients replaced one meal out of the three main meals with one or two sachets of formula diet (170–340 kcal). The other two meals were set to 600 kcal. The dietary therapy was implemented approximately 1 month before the operation. Weight loss achieved after dietary therapy ranged from 6.4% to 14.1% (p < 0.01). With the exception of one case, the decrease in visceral fat area ranged from 17.0%–40.7% (p = 0.03). Postoperative complications were anastomotic insufficiency in two cases. Discussion Although the decreases of the visceral fat were effectively implemented, the adverse effects on postoperative complications must be examined in the farther study. Conclusion It was suggested that use of formula diet to achieve preoperative visceral fat reduction in a short period of time immediately prior to highly invasive endoscopic cancer surgery would be an effective and safe strategy. We assessed efficacy of formula diet therapy to highly invasive endoscopic surgery. The decrease in visceral fat area ranged from 17.0% to 40.7% (p = 0.03). It should be emphasized that there were no more serious life-threatening cardiopulmonary complications. Preoperative formula diet therapy may be an effective means to reduce visceral fat.
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Affiliation(s)
- Kiyotomi Maruyama
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan.
| | - Kou Shimada
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan.
| | - Arano Makino
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan
| | - Ryo Hisamune
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan
| | - Tomoki Shirota
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan
| | - Kuniyuki Gomi
- Department of Surgery, Suwa Red Cross Hospital, 5-11-50 Kogandoori, Suwa, Nagano 392-0027, Japan.
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11
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Imai K, Chikazawa K, Ito T, Kimura A, Ko H, Miho Y, Kuwata T, Konno R. Assessing the Effectiveness of a Weight Reduction Program in Hospitalized Obese Patients Undergoing Laparoscopic Surgery. Gynecol Minim Invasive Ther 2021; 10:44-46. [PMID: 33747773 PMCID: PMC7968598 DOI: 10.4103/gmit.gmit_73_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Investigate the efficacy of a hospitalized weight reduction program before laparoscopic surgery among high body mass index (BMI) patients with endometrial cancer. The patients were housed in a shared room, received exercise guidance, and restricted to a total caloric intake of 1200 kcal. A physiotherapist and a dietitian provided pedometer and nutritional guidance, respectively. The primary outcome was weight reduction. Among the 16 patients included, 12 (75%) had Stage I endometrial cancer and 10 (62.5%) underwent laparoscopic surgery. Weight and BMI at first consultation were 88.4±10.4 kg and 34.8±3.9 kg/m2, respectively. The rate of weight reduction was 6.5%±2.5%; on average, BMI decreased by 2.1±1.0 kg/m2. The duration from initial consultation to surgery was 39.1±11.4 days. Hospitalization duration until weight reduction was 20.8±8.0 days; there were no surgical complications. Our hospitalized weight reduction program may be effective for obese endometrial cancer patients.
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Affiliation(s)
- Ken Imai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenro Chikazawa
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takaki Ito
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Azusa Kimura
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroyoshi Ko
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yokota Miho
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryo Konno
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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12
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A deep pancreas is a novel predictor of pancreatic fistula after pancreaticoduodenectomy in patients with a nondilated main pancreatic duct. Surgery 2020; 169:1471-1479. [PMID: 33390302 DOI: 10.1016/j.surg.2020.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND We investigated the risk factors for clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy in patients with a nondilated main pancreatic duct. METHODS We investigated a total of 354 patients who underwent pancreaticoduodenectomy. The diameter of the main pancreatic duct, the shortest distance from the body surface to the pancreas (the pancreatic depth), and the computed tomography attenuation index (the difference between the pancreatic and splenic computed tomography attenuation) were measured in preoperative computed tomography. RESULTS One hundred eighty-one (51.1%) patients had a nondilated main pancreatic duct, and 50 (27.6%) of the 181 patients with a nondilated main pancreatic duct developed a clinically relevant postoperative pancreatic fistula. Univariate analyses revealed that the calculated body mass index (≥21.8 kg/m2) (P = .004), deep pancreas (pancreatic depth ≥51.2 mm) (P = .001), and low computed tomography attenuation index (≤-3.8 Hounsfield units) (P = .02) were significant risk factors for clinically relevant postoperative pancreatic fistula. The multivariate logistic regression analysis revealed that deep pancreas (odds ratio 2.370; 95% confidence interval 1.0019-5.590; P = .049) was an independent risk factor for clinically relevant postoperative pancreatic fistula. Among patients with a nondilated main pancreatic duct, deep pancreas (in comparison to patients without deep pancreas) was associated with male sex (72.7% vs 54.9%; P = .016), higher body mass index (22.5 kg/m2 vs 19.6 kg/m2; P < .001), a history of diabetes mellitus (24.5% vs 8.5%; P = .006), a lower computed tomography attenuation index (-9.6 Hounsfield units vs -4.6 Hounsfield units; P = .007), a longer operative time (454 minutes vs 420 minutes; P = .007), and a higher volume of intraoperative blood loss (723 mL vs 500 mL; P < .001), respectively. CONCLUSION Deep pancreas may be an important parameter associated with significant risk factors for clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy in patients with a nondilated main pancreatic duct.
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13
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Zhang X, Cui L, Chen B, Xiong Q, Zhan Y, Ye J, Yin Q. Effect of chromium supplementation on hs-CRP, TNF-α and IL-6 as risk factor for cardiovascular diseases: A meta-analysis of randomized-controlled trials. Complement Ther Clin Pract 2020; 42:101291. [PMID: 33321447 DOI: 10.1016/j.ctcp.2020.101291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of this systematic review is to assess the relationship between chromium supplementation and inflammatory biomarkers levels (hs-CRP, TNF-α, IL-6) as risk factor for cardiovascular diseases. Recent studies raise questions regarding the potential of chromium supplementation to decrease the blood-levels of inflammatory markers, lowering cellular oxidative stress as markers of myocardial infarction; however, the results of the researches are inconclusive. METHODS The following databases including PubMed, Scopus, Cochran Library and Embase databases were systematically searched until April 2020. Analysis was performed using random-effect model. RESULTS The pooled findings for biomarkers of inflammation showed that chromium supplementation significantly reduced serum high-sensitivity C-reactive protein (hs-CRP) (WMD: -0.87 mg/dL, 95% CI: -1.49, -0.26), and tumor necrosis factor-alpha (TNF-α) (WMD: -0.97 pg/ml; 95% CI: -1.92, -0.01) and chromium insignificantly reduced interleukin -6 (IL-6) (WMD: -0.45 pg/ml, 95% CI: -1.18, 0.29). CONCLUSION Overall, the results of this systematic review and meta-analysis imply that chromium supplementation may help to improve biomarkers of inflammation as markers of myocardial infarction.
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Affiliation(s)
- Xuehong Zhang
- Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital, Nanchang University Affiliated People's Hospital, 92 Aiguo Road, Nanchang, 330006, China
| | - Liang Cui
- Ultrasound, Jiangxi Provincial People's Hospital, Nanchang University Affiliated People's Hospital, 92 Aiguo Road, Nanchang, 330006, China
| | - Bin Chen
- Internal Medicine, Wannian County People's Hospital, 6 Zhengda West Street, Shangrao, Jiangxi Province, 335500, China
| | - Qinzhi Xiong
- Internal Medicine, Yifeng County People's Hospital, 30 Nanmen Road, Yichun City, Jiangxi Province, 336300, China
| | - Yanqin Zhan
- Internal Medicine, The First People's Hospital of Linchuan District, 109 Longjin Road, Fuzhou, Jiangxi, 344100, China
| | - Jinhua Ye
- Internal Medicine, Zhangshu City People's Hospital, 13 Yaodu Road, Yichun City, Jiangxi, 331200, China
| | - Qiulin Yin
- Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital, Nanchang University Affiliated People's Hospital, 92 Aiguo Road, Nanchang, 330006, China.
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14
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Griffin SB, Ross LJ, Burstow MJ, Desbrow B, Palmer MA. Efficacy of a dietitian‐led very low calorie diet (VLCD) based model of care to facilitate weight loss for obese patients prior to elective, non‐bariatric surgery. J Hum Nutr Diet 2020; 34:188-198. [DOI: 10.1111/jhn.12819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/13/2022]
Affiliation(s)
- S. B. Griffin
- Department of Nutrition & Dietetics Logan Hospital Loganholme QLD Australia
- School of Allied Health Sciences Griffith University Gold Coast QLD Australia
| | - L. J. Ross
- School of Exercise and Nutrition Sciences Queensland University of Technology Brisbane QLD Australia
- School of Allied Health Sciences Griffith University Gold Coast QLD Australia
| | - M. J. Burstow
- Division of Surgery Logan Hospital Loganholme QLD Australia
- School of Medicine Griffith University Gold Coast QLD Australia
| | - B. Desbrow
- School of Allied Health Sciences Griffith University Gold Coast QLD Australia
| | - M. A. Palmer
- Department of Nutrition & Dietetics Logan Hospital Loganholme QLD Australia
- School of Allied Health Sciences Griffith University Gold Coast QLD Australia
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15
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The Incidence of Postoperative Complications after Gastrectomy Increases in Proportion to the Amount of Preoperative Visceral Fat. JOURNAL OF ONCOLOGY 2019; 2019:8404383. [PMID: 31929799 PMCID: PMC6942899 DOI: 10.1155/2019/8404383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022]
Abstract
Background Visceral obesity is a risk factor for complications after gastrectomy in patients with gastric cancer. However, it is unclear whether postoperative complications decrease with preoperative reduction of visceral fat without the achievement of a nonobese state. This is because previous studies have performed categorical comparisons of obesity and nonobesity. The current study was performed to estimate the impact of the preoperative visceral fat area (VFA) as a continuous variable on postoperative complications after gastrectomy. Methods Consecutive patients with gastric cancer who underwent curative gastrectomy between June 2006 and August 2017 at the Kyoto University Hospital were included in this retrospective study. The VFA at the level of the umbilicus was measured using preoperative computed tomography. The relationship between postoperative complications and VFA was investigated with univariate and multivariate analyses. Results total of 566 patients were included in the study. Their mean VFA was 110 ± 58 cm2, and postoperative complications occurred in 121 patients (21.4%). The larger the VFA (<50, 50–99, 100–149, and ≥150 cm2), the higher the incidence of postoperative complications (11%, 14%, 21%, and 38%, respectively, P < 0.001). Multivariate logistic regression analyses showed that the VFA was associated with postoperative complications (odds ratio: 1.009, 95% confidence interval (CI): 1.004–1.013, P < 0.001), with an incidence of postoperative complications that was 9% (95% CI: 4%–12%) higher for every 10 cm2 increase in the VFA. Conclusion The incidence of postoperative complications after gastrectomy increases in proportion to an increase in the preoperative VFA.
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