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Qanaq D, O'Keeffe M, Cremona S, Bernardo WM, McIntyre RD, Papada E, Benkalkar S, Rubino F. The Role of Dietary Intake in the Weight Loss Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Systematic Review and Meta-analysis. Obes Surg 2024; 34:3021-3037. [PMID: 38907132 PMCID: PMC11289176 DOI: 10.1007/s11695-024-07183-8] [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: 05/13/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 06/23/2024]
Abstract
The relationship between postoperative dietary intake and weight loss after bariatric surgery remains unclear. We performed a systematic review and meta-analysis of studies published between January 2000 and May 2023, reporting weight loss outcomes, and dietary intake before and after Roux-en-Y gastric bypass and sleeve gastrectomy. A total of 42 studies were included. There was no detectable difference in dietary intake between the two procedures. Roux-en-Y gastric bypass induced an average decrease in energy intake of 886 kcal/day at 12-month post-surgery; however, there was no correlation between daily energy intake and weight loss. These findings show a substantial reduction of energy intake in the first year after bariatric surgery but do not support a link between lower energy intake and greater weight loss.
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Affiliation(s)
- Dalal Qanaq
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, 11481, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Centre, 11481, Riyadh, Kingdom of Saudi Arabia
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Majella O'Keeffe
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
- School of Food and Nutritional Sciences, University College Cork, College Road, Cork, Ireland
| | - Simone Cremona
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- General and Digestive Surgery Department of Hospital Del Mar de, 08003, Barcelona, Spain
| | | | - Robert D McIntyre
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- School of Sport, Exercise and Applied Science, St Mary's University, Twickenham, London, TW1 4SX, UK
| | - Efstathia Papada
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- Division of Medicine, University College London, London, WC1E 6JF, UK
| | - Saumit Benkalkar
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
| | - Francesco Rubino
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK.
- Bariatric and Metabolic Surgery, King's College Hospital, London, SE5 9RS, UK.
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Al-Kadi A. Gastroscope-assisted laparoscopic sleeve gastrectomy: A case report with an unexpected old deflated intragastric balloon. Int J Surg Case Rep 2022; 95:107250. [PMID: 35636218 PMCID: PMC9149178 DOI: 10.1016/j.ijscr.2022.107250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/21/2022] [Accepted: 05/22/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction and importance Obesity has become a global health crisis and is now considered a pandemic. Intragastric balloons (IGB) can aid obese patients achieve a better effect of weight loss than medications while being noninvasive compared to surgical therapy. Case presentation We report a case of a 42-yr-old female with difficulty in losing weight even after three attempts of IGB and several diet programs. At the time of presentation, the patients BMI was 46.2 kg/m2. The patient experienced no gastrointestinal symptoms or stomach complaints and was found to have morbid obesity with hypertension and glucose intolerance. Clinical discussion Laparoscopic sleeve gastrectomy (LSG) was suggested for the patient. While performing LSG in association with a gastroscope, an unexpected old and deflated gastric balloon was found residing inside the stomach cavity. The rest of the surgery had no difficulty after the old gastric balloon was removed. The patients BMI post-LSG after 18 months was noticed to be 26.6 kg/m2. Conclusion We recommend performing gastroscopy prior to LSG for every patient with a previous gastric balloon insertion, especially if they had it more than once, to avoid potential complications during surgery. Intragastric balloons (IGB) can aid obese patients achieve a better effect of weight loss than medications. A patient (Female, 42-yr-old) failed to reduce weight after three attempts of IGB. Hence, advised for laparoscopic sleeve gastrectomy. Gastroscopy was done to remove the old deflated IGB that was found inside the stomach cavity. We recommend gastroscopy prior to LSG for patients with a previous gastric balloon insertion to avoid potential complications during surgery
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de Lucena AVS, Cordeiro GG, Leão LHA, Kreimer F, de Siqueira LT, da Conti Oliveira Sousa G, de Lucena LHS, Ferraz ÁAB. Cholecystectomy Concomitant with Bariatric Surgery: Safety and Metabolic Effects. Obes Surg 2022; 32:1093-1102. [PMID: 35064462 DOI: 10.1007/s11695-022-05889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity and fast weight loss in the postoperative period of bariatric surgery increase significantly the risk of cholelithiasis. Moreover, emerging evidence has pointed out the role of bile acids as possible metabolism and weight loss enhancers. This study aims to analyze the influence of cholecystectomy (CL) concomitant with bariatric surgery on weight loss, metabolic repercussions, and postoperative morbidity. STUDY DESIGN Retrospective cohort study. A total of 363 medical records were analyzed between 2002 and 2017, with 255 patients divided into four groups: with concomitant CL: sleeve gastrectomy (SG + CL group) and Roux-en-Y gastric bypass (GB + CL group); without concomitant CL: sleeve gastrectomy (SG group) and RYGB (GB group). RESULTS CL concomitant with bariatric surgery is not related to worse long-term metabolic outcomes when compared to isolated bariatric surgery. In the postoperative follow-up of the isolated bariatric surgeries, 18 (16.5%) patients underwent cholecystectomy. There was no statistical difference between the groups regarding post-surgical complications. CONCLUSION CL did not lead to worse metabolic outcomes and was also not related to a higher incidence of postoperative complications. Cholelithiasis and cholecystitis are important concerns in the postoperative period of bariatric surgery and a careful evaluation of the concomitant procedure should be performed.
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Affiliation(s)
| | - Gabriel Guerra Cordeiro
- Medical School, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, PE, 50670-901, Brazil.
| | | | - Flávio Kreimer
- Department of Surgery, Federal University of Pernambuco, Recife, PE, Brazil
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Barocrinology: The Endocrinology of Obesity from Bench to Bedside. Med Sci (Basel) 2020; 8:medsci8040051. [PMID: 33371340 PMCID: PMC7768467 DOI: 10.3390/medsci8040051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Obesity has reached pandemic proportions. Hormonal and metabolic imbalances are the key factors that lead to obesity. South Asian populations have a unique phenotype, peculiar dietary practices, and a high prevalence of consanguinity. Moreover, many lower middle-income countries lack appropriate resources, super-specialists, and affordability to manage this complex disorder. Of late, there has been a substantial increase in both obesity and diabesity in India. Thus, many more patients are being managed by different types of bariatric procedures today than ever before. These patients have many types of endocrine and metabolic disturbances before and after bariatric surgery. Therefore, these patients should be managed by experts who have knowledge of both bariatric surgery and endocrinology. The authors propose “Barocrinology”, a novel terminology in medical literature, to comprehensively describe the field of obesity medicine highlighting the role of knowing endocrine physiology for understating its evolution, insights into its complications and appreciating the changes in the hormonal milieu following weight loss therapies including bariatric surgery. Barocrinology, coined as a portmanteau of “baro” (weight) and endocrinology, focuses upon the endocrine and metabolic domains of weight physiology and pathology. This review summarizes the key pointers of bariatric management from an endocrine perspective.
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Five-Year Weight Loss Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech 2020; 30:542-553. [PMID: 32658120 DOI: 10.1097/sle.0000000000000834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Laparoscopic vertical sleeve gastrectomy (LVSG) has overtaken the laparoscopic Roux-en-Y gastric bypass (LRYGB) as the most frequently performed bariatric surgical procedure. To date little has been reported on the long-term outcomes of the LVSG procedure comparative to the traditionally favoured LRYGB. We undertook a systematic review and meta-analysis to review the 5-year outcomes of comparing LVSG and LRYGB. We undertook a systematic review and meta-analysis to compare 5-year weight loss outcomes of randomized controlled trials comparing LVSG to LRYGB. MATERIALS AND METHODS Searches of electronic databases (PubMed, Embase, CINAHL, Cochrane) were undertaken for randomized controlled trials describing weight loss outcomes in adults at 5 years postoperatively. Where sufficient data was available to undertake meta-analysis, the Hartung-Knapp-Sidik-Jonkman estimation method for random effects model was utilized. The review was registered with PROSPERO and reported following in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS Five studies met the inclusion criteria totaling 1028 patients (LVSG=520, LRYGB=508). Moderate but comparable levels of bias were observed within studies. Statistically significant body mass index loss ranged from -11.37 kg/m (range: -6.3 to -15.7 kg/m) in the LVSG group and -12.6 kg/m (range: -9.5 to -15.4 kg/m) for LRYGB at 5 years (P<0.001). Systematic review suggested that LRYGB produced a greater weight loss expressed as percent excess weight and percent excess body mass index loss than LVSG: this was not corroborated in the meta-analysis. CONCLUSIONS Five year weight loss outcomes suggest both LRYGB and LVSG are effective in achieving significant weight loss at 5 years postoperatively, however, differences in reporting parameters limit the ability to reliably compare the outcomes using statistical methods. Furthermore, results may be impacted by large dropout rates and per protocol analysis of the 2 largest included studies. Further long-term studies are required to contradict or validate the results of this meta-analysis.
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Mocanu V, Tavakoli I, MacDonald A, Dang JT, Switzer N, Birch DW, Karmali S. The Impact of ADHD on Outcomes Following Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2020; 29:1403-1409. [PMID: 30706311 DOI: 10.1007/s11695-019-03735-5] [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: 01/06/2023]
Abstract
The objective our study was to carry out a systematic review and meta-analysis to examine the impact of attention-deficit and hyperactivity disorder (ADHD) on bariatric surgery outcomes. Despite the effectiveness of bariatric surgery, about 10 to 20% of patients continue to regain weight after the procedure. New evidence supports that ADHD may be directly associated with obesity and may affect outcomes following bariatric surgery. However, certain psychiatric illnesses, such as ADHD, are rarely screened for, leading to a continued lack of data on the interaction between ADHD and bariatric surgery. A comprehensive literature search for both published and unpublished studies of ADHD and bariatric surgery from 1946 to August 2018 was performed. The search was conducted using the Medline, EMBASE, Scopus, the Cochrane Library, and Web of Science databases as well as conference abstracts. Our search strategy terms included "(ADHD OR attention deficit hyperactivity disorder) AND (bariatrics OR obesity surgery OR gastric bypass OR gastric sleeve OR Roux-en-Y OR RYGB OR sleeve gastrectomy)" and was limited to human studies in the English language. Preliminary database search of the literature yielded 104 articles after 70 duplicates were removed. A total of five studies with 492 patients were included. The overall ADHD rate was 20.9% with reported rates ranging from 7 to 38%. The weighted mean age was 44.0 ± 10.2 years, the weighted sex was 83.6% female, and the weighted mean follow-up was 22.2 months. Preoperative weighted mean BMI was 43.7 versus a postoperative weighted mean BMI of 34.7. No statistical significance was observed for mean BMI difference between non-ADHD vs. ADHD patients undergoing bariatric surgery (three studies; MD - 2.66; CI - 7.54 to 2.13; p = 0.28). Statistical significance was, however, observed for postoperative follow-up between patients with ADHD vs. non-ADHD subjects (three studies; MD - 7.28; - 13.83 to -0.73; p = 0.03). Patients with ADHD do not have a statistically significant mean BMI difference following bariatric surgery but have a statistically significant reduction in postoperative follow-up versus non-ADHD patients. Targeted strategies aimed at improving clinic attendance for this at-risk ADHD population may improve bariatric outcomes and minimize recidivism rates.
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Affiliation(s)
- Valentin Mocanu
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
| | - Iran Tavakoli
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Andrew MacDonald
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Jerry T Dang
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Noah Switzer
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Daniel W Birch
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Shahzeer Karmali
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Jackson HT, Anekwe C, Chang J, Haskins IN, Stanford FC. The Role of Bariatric Surgery on Diabetes and Diabetic Care Compliance. Curr Diab Rep 2019; 19:125. [PMID: 31728654 PMCID: PMC7205514 DOI: 10.1007/s11892-019-1236-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Bariatric surgery is a durable and long-term solution to treat both obesity and its associated comorbidities, specifically type 2 diabetes mellitus (T2DM). Many studies have demonstrated the benefits of bariatric surgery on T2DM, but weight recidivism along with recurrence of comorbidities can be seen following these procedures. Patient compliance post-bariatric surgery is linked to weight loss outcomes and comorbidity improvement/resolution. The role of compliance with respect to T2DM medication in bariatric patients specifically has not recently been examined. This article seeks to review the role of bariatric surgery on short- and long-term resolution of T2DM, recurrence, and compliance with T2DM medication following bariatric surgery. RECENT FINDINGS Seven randomized control trials have examined metabolic surgery versus medical therapy in glycemic control in patients meeting criteria for severe obesity. Six out of seven studies demonstrate a significant advantage in the surgical arms with regards to glycemic control, as well as secondary endpoints such as weight loss, serum lipid levels, blood pressure, renal function, and other parameters. While patient compliance with lifestyle modifications post-bariatric surgery is linked to weight loss outcomes, there are no studies to date that directly evaluate the role of lifestyle modifications and T2DM medication adherence in the management of T2DM post-bariatric surgery. Bariatric surgery is an effective treatment option to achieve long-term weight loss and resolution of obesity-related medical comorbidities, specifically T2DM. Patient compliance to lifestyle modifications post-bariatric surgery is linked to weight loss outcomes and comorbidity resolution. The role of diabetic care compliance in bariatric patient outcomes, however, is poorly understood. Further studies are needed to elucidate the predictors and associated risk factors for non-compliance in this patient population.
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Affiliation(s)
- Hope T Jackson
- Department of Surgery, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
| | - Chika Anekwe
- Harvard Medical School, Boston, MA, USA
- Internal Medicine-Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital (MGH) Weight Center, Boston, MA, USA
| | - Julietta Chang
- Weight Loss Surgical Institute of Central Coast, Marian Regional Medical Center, Santa Monica, CA, USA
| | - Ivy N Haskins
- Department of Surgery, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital (MGH) Weight Center, Boston, MA, USA
- Internal Medicine-Neuroendocrine Unit and Pediatrics Endocrinology, Massachusetts General Hospital, Boston, MA, USA
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Sista F, Abruzzese V, Carandina S, Salvatorelli A, Furia MD, Cipolloni G, Vicentini V, Guadagni S, Clementi M. Which is the correlation between carcinoid tumor and Laparoscopic Sleeve Gastrectomy? A case series and literature review. Ann Med Surg (Lond) 2018; 36:252-255. [PMID: 30568792 PMCID: PMC6287372 DOI: 10.1016/j.amsu.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction Gastric Carcinoid Tumors (GCT) are very rare in general population, but some studies evidenced a higher incidence among bariatric surgery patients. Laparoscopic Sleeve Gastrectomy (LSG) is a widely accepted procedure for the surgical treatment of morbid obesity. LSG acts both in reducing food intake and interfering with hormonal balance in the gut-brain axis. In these patients, incidental GCT diagnosis can occur both during pre-bariatric surgery investigation and during post-operative follow-up. Methods We retrospectively analyzed the database of obesity patients submitted to LSG in two different centers to find out incidence of GCT in patients treated by surgery from May 2013 to March 2018. Results From the 560 obese consecutive patients underwent LSG, we recorded two cases of patients with GCT (0.36%): the case 1 was a patient who had a pre-operative diagnosis of GTC receiving a curative LSG which totally included the carcinoid in the resected portion; the case 2 was a patient that received a curative endoscopic resection 42 months after LSG. Discussion the predisposing factors that can correlate GCT with obesity and LSG and in particular the hormonal changes have been discussed. We illustrated our experience about the management of these tumors in obese patients. Conclusion there are neither certain data which evidence a correlation between obesity and GCT, nor data to support the hypothesis of a higher incidence of GCT after bariatric surgery. Based on our experience in obese patients the finding of GCT in the pre-operatory phase is not an absolute contraindication for bariatric surgery. Recent observations showed a high incidence of Gastric Carcinoid Tumor (GCT) in candidate patients for bariatric surgery. From a multicenter experience with Laparoscopic Sleeve Gastrectomy. We retrospectively recorded two GCT cases in obese patients (the first found out during pre-operative investigations and the second one detected 52 months after surgery). The possible correlations between obesity, LSG and GTC have been discussed.
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Affiliation(s)
- Federico Sista
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Valentina Abruzzese
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Sergio Carandina
- ELSAN, Surgical Obesity Center(CCO), Clinique Saint Michel, Toulon, France
| | - Andrea Salvatorelli
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Marino Di Furia
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Gianluca Cipolloni
- Pathology Unit, Biomedical Department, San Salvatore Hospital, Via L Natali 1, 67100, Coppito (AQ), Italy
| | - Vincenzo Vicentini
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Stefano Guadagni
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Marco Clementi
- Department of Medicine, Health and Life, University of L'Aquila, Piazza S, Tommasi, 67100, Coppito (AQ), Italy
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Chihaoui M, Sebai I, Oueslati I, Grira W, Yazidi M, Rissouli C, Ftouhi B, Ksantini R, Chaker F, Slimane H. Évolution des paramètres anthropométriques et métaboliques après chirurgie bariatrique : expérience tunisienne monocentrique. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10
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Zoon HFA, de Bruijn SEM, Smeets PAM, de Graaf C, Janssen IMC, Schijns W, Aarts EO, Jager G, Boesveldt S. Altered neural responsivity to food cues in relation to food preferences, but not appetite-related hormone concentrations after RYGB-surgery. Behav Brain Res 2018; 353:194-202. [PMID: 30041007 DOI: 10.1016/j.bbr.2018.07.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND After Roux-en-Y gastric bypass (RYGB) surgery, patients report a shift in food preferences away from high-energy foods. OBJECTIVE We aimed to elucidate the potential mechanisms underlying this shift in food preferences by assessing changes in neural responses to food pictures and odors before and after RYGB. Additionally, we investigated whether altered neural responsivity was associated with changes in plasma endocannabinoid and ghrelin concentrations. DESIGN 19 RYGB patients (4 men; age 41 ± 10 years; BMI 41 ± 1 kg/m2 before; BMI 36 ± 1 kg/m2 after) participated in this study. Before and two months after RYGB surgery, they rated their food preferences using the Macronutrient and Taste Preference Ranking Task and BOLD fMRI responses towards pictures and odors of high-, and low-energy foods and non-food items were measured. Blood samples were taken to determine plasma endocannabinoid and ghrelin concentrations pre- and post-surgery. RESULTS Patients demonstrated a shift in food preferences away from high-fat/sweet and towards low-energy/savory food products, which correlated with decreased superior parietal lobule responsivity to high-energy food odor and a reduced difference in precuneus responsivity to high-energy versus low-energy food pictures. In the anteroventral prefrontal cortex (superior frontal gyrus) the difference in deactivation towards high-energy versus non-food odors reduced. The precuneus was less deactivated in response to all cues. Plasma concentrations of anandamide were higher after surgery, while plasma concentrations of other endocannabinoids and ghrelin did not change. Alterations in appetite-related hormone concentrations did not correlate with changes in neural responsivity. CONCLUSIONS RYGB leads to changed responsivity of the frontoparietal control network that orchestrates top-down control to high-energy food compared to low-energy food and non-food cues, rather than in reward related brain regions, in a satiated state. Together with correlations with the shift in food preference from high- to low-energy foods this indicates a possible role in new food preference formation.
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Affiliation(s)
- Harriët F A Zoon
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Suzanne E M de Bruijn
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Paul A M Smeets
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands; Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cees de Graaf
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | | | - Wendy Schijns
- Vitalys Obesity Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Edo O Aarts
- Vitalys Obesity Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Gerry Jager
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
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Leptin and Leptin Resistance in the Pathogenesis of Obstructive Sleep Apnea: A Possible Link to Oxidative Stress and Cardiovascular Complications. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:5137947. [PMID: 29675134 PMCID: PMC5841044 DOI: 10.1155/2018/5137947] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/05/2018] [Accepted: 01/23/2018] [Indexed: 12/17/2022]
Abstract
Obesity-related sleep breathing disorders such as obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) cause intermittent hypoxia (IH) during sleep, a powerful trigger of oxidative stress. Obesity also leads to dramatic increases in circulating levels of leptin, a hormone produced in adipose tissue. Leptin acts in the hypothalamus to suppress food intake and increase metabolic rate. However, obese individuals are resistant to metabolic effects of leptin. Leptin also activates the sympathetic nervous system without any evidence of resistance, possibly because these effects occur peripherally without a need to penetrate the blood-brain barrier. IH is a potent stimulator of leptin expression and release from adipose tissue. Hyperleptinemia and leptin resistance may upregulate generation of reactive oxygen species, increasing oxidative stress and promoting inflammation. The current review summarizes recent data on a possible link between leptin and oxidative stress in the pathogenesis of sleep breathing disorders.
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Franco RR, Ybarra M, Cominato L, Mattar L, Steinmetz L, Damiani D, Velhote MCP. Laparoscopic sleeve gastrectomy in severely obese adolescents: effects on metabolic profile. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:608-613. [PMID: 29412386 PMCID: PMC10522071 DOI: 10.1590/2359-3997000000310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 05/17/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to conduct clinical and metabolic evaluations of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG) (up to 24 months). SUBJECTS AND METHODS This was designed as a retrospective, descriptive series of cases study, conducted in Instituto da Criança, São Paulo, Brazil. Analysis of clinical and laboratory data from 22 obese adolescents between 14 and 19 years old submitted to LSG between 2007 and 2014. Patients had BMI > 40 kg/m2 or BMI > 35 kg/m2 with comorbidities. Anthropometric, clinical and laboratory assessments were performed: before surgery, 6, 12, 18, and 24 months after surgery. We assessed weight loss and metabolic changes up to 24 months after LSG. RESULTS The mean preoperative weight and BMI were 128.5 kg (SD = 23.1) and 46.5 kg/m2 (SD = 74), respectively. There was an average weight loss of 34.5 kg in the first 12 months' post LSG, corresponding to a 60% excess weight loss (EWL), as well as an average reduction in BMI of 12.3 kg/m2. However, after 24 months, the average EWL was 45%, corresponding to an average weight regain (WR) of 13.3 kg (15%) within two years. LSG improved dyslipidemia in 67.8% of patients, a significant remission of hepatic steatosis 47% and 37.7% systemic arterial hypertension; type 2 diabetes remission was complete. CONCLUSIONS LSG proved to be a safe and effective procedure and seems to be the new hope for the obesity epidemic.
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Affiliation(s)
- Ruth Rocha Franco
- Universidade de São PauloFaculdade de MedicinaDepartamento de Endocrinologia PediátricaSão PauloSPBrasilDepartamento de Endocrinologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP), São Paulo, SP Brasil
| | - Marina Ybarra
- Universidade de São PauloFaculdade de MedicinaDepartamento de Endocrinologia PediátricaSão PauloSPBrasilDepartamento de Endocrinologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP), São Paulo, SP Brasil
| | - Louise Cominato
- Universidade de São PauloFaculdade de MedicinaDepartamento de Endocrinologia PediátricaSão PauloSPBrasilDepartamento de Endocrinologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP), São Paulo, SP Brasil
| | - Larissa Mattar
- Universidade de São PauloFaculdade de MedicinaDepartamento de Nutrição PediátricaSão PauloSPBrasilDepartamento de Nutrição Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP), São Paulo, SP, Brasil
| | - Leandra Steinmetz
- Universidade de São PauloFaculdade de MedicinaDepartamento de Endocrinologia PediátricaSão PauloSPBrasilDepartamento de Endocrinologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP), São Paulo, SP Brasil
| | - Durval Damiani
- Universidade de São PauloFaculdade de MedicinaDepartamento de Endocrinologia PediátricaSão PauloSPBrasilDepartamento de Endocrinologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP), São Paulo, SP Brasil
| | - Manoel Carlos Prieto Velhote
- Universidade de São PauloFaculdade de MedicinaDepartamento de Cirurgia PediátricaSão PauloSPBrasilDepartamento de Cirurgia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr-HCFMUSP), São Paulo, SP, Brasil
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13
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Rogers AM. Comment on: Is a "retained fundus" seen on postoperative upper gastrointestinal series after laparoscopic sleeve gastrectomy predictive of inferior weight loss? Surg Obes Relat Dis 2017; 13:1151. [PMID: 28755889 DOI: 10.1016/j.soard.2017.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Ann M Rogers
- Department of Surgery, College of Medicine The Pennsylvania State University, Hershey, Pennsylvania
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14
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Liu JY, Mu S, Zhang SP, Guo W, Li QF, Xiao XQ, Zhang J, Wang ZH. Roux-en-Y gastric bypass surgery suppresses hypothalamic PTP1B protein level and alleviates leptin resistance in obese rats. Exp Ther Med 2017; 14:2536-2542. [PMID: 28947917 PMCID: PMC5609316 DOI: 10.3892/etm.2017.4801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 02/13/2017] [Indexed: 12/20/2022] Open
Abstract
The present study aimed to explore the effect of Roux-en-Y gastric bypass (RYGB) surgery on protein tyrosine phosphatase 1B (PTP1B) expression levels and leptin activity in hypothalami of obese rats. Obese rats induced by a high-fat diet (HFD) that underwent RYGB (n=11) or sham operation (SO, n=9), as well as an obese control cohort (Obese, n=10) and an additional normal-diet group (ND, n=10) were used. Food efficiency was measured at 8 weeks post-operation. Plasma leptin levels were evaluated and hypothalamic protein tyrosine phosphatase 1B (PTP1B) levels and leptin signaling activity were examined at the genetic and protein levels. The results indicated that food efficiency was typically lower in RYGB rats compared with that in the Obese and SO rats. In the RYGB group, leptin receptor expression and proopiomelanocortin was significantly higher, while Neuropeptide Y levels were lower than those in the Obese and SO groups. Furthermore, the gene and protein expression levels of PTP1B in the RYGB group were lower, while levels of phosphorylated signal transducer and activator of transcription 3 protein were much higher compared with those in the Obese and SO groups. In conclusion, RYGB surgery significantly suppressed hypothalamic PTP1B protein expression. PTP1B regulation may partially alleviate leptin resistance.
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Affiliation(s)
- Jia-Yu Liu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Song Mu
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Shu-Ping Zhang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Wei Guo
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Qi-Fu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiao-Qiu Xiao
- Laboratory of Lipid and Glucose Metabolism, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Jun Zhang
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Zhi-Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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15
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Kheniser K, Kashyap SR. Canagliflozin versus placebo for post-bariatric surgery patients with persistent type II diabetes: A randomized controlled trial (CARAT). Diabetes Obes Metab 2017; 19:609-610. [PMID: 27995724 DOI: 10.1111/dom.12860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Karim Kheniser
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - Sangeeta R Kashyap
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio
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16
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Johnson ML, Saffrey MJ, Taylor VJ. Glucagon-like peptide-1 (GLP-1) increases in plasma and colon tissue prior to estrus and circulating levels change with increasing age in reproductively competent Wistar rats. Peptides 2017; 90:55-62. [PMID: 28237410 DOI: 10.1016/j.peptides.2017.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/30/2017] [Accepted: 02/21/2017] [Indexed: 02/04/2023]
Abstract
There is a well-documented association between cyclic changes to food intake and the changing ovarian hormone levels of the reproductive cycle in female mammals. Limited research on appetite-controlling gastrointestinal peptides has taken place in females, simply because regular reproductive changes in steroid hormones present additional experimental factors to account for. This study focussed directly on the roles that gastrointestinal-secreted peptides may have in these reported, naturally occurring, changes to food intake during the rodent estrous cycle and aimed to determine whether peripheral changes occurred in the anorexigenic (appetite-reducing) hormones peptide-YY (PYY) and glucagon-like peptide-1 (GLP-1) in female Wistar rats (32-44 weeks of age). Total forms of each peptide were measured in matched fed and fasted plasma and descending colon tissue samples for each animal during the dark (feeding) phase. PYY concentrations did not significantly change between defined cycle stages, in either plasma or tissue samples. GLP-1 concentrations in fed plasma and descending colon tissue were significantly increased during proestrus, just prior to a significant reduction in fasted stomach contents at estrus, suggesting increased satiety and reduced food intake at this stage of the cycle. Increased proestrus GLP-1 concentrations could contribute to the reported reduction in food intake during estrus and may also have biological importance in providing the optimal nutritional and metabolic environment for gametes at the potential point of conception. Additional analysis of the findings demonstrated significant interactions of ovarian cycle stage and fed/fasted status with age on GLP-1, but not PYY plasma concentrations. Slightly older females had reduced fed plasma GLP-1 suggesting that a relaxation of regulatory control of this incretin hormone may also take place with increasing age in reproductively competent females.
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Affiliation(s)
- Michelle L Johnson
- School of Life, Health and Chemical Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK.
| | - M Jill Saffrey
- School of Life, Health and Chemical Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK.
| | - Victoria J Taylor
- School of Life, Health and Chemical Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK.
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17
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Bariatric Surgery Significantly Reduces Serum Concentration of Vascular Endothelial Growth Factor A and Increases Apelin-12 in Patients with Morbid Obesity. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2016.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Osland E, Yunus RM, Khan S, Memon B, Memon MA. Weight Loss Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech 2017; 27:8-18. [PMID: 28145963 DOI: 10.1097/sle.0000000000000374] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage morbid obesity. The aim of this meta-analysis was to compare the postoperative weight loss outcomes reported in randomized control trials (RCTs) for LVSG versus LRYGB procedures. MATERIAL AND METHODS RCTs comparing the weight loss outcomes following LVSG and LRYGB in adult population between January 2000 and November 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The review was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Nine unique RCTs described over 10 publications involving a total of 865 patients (LVSG, n=437; LRYGB, n=428) were analyzed. Postoperative follow-up ranged from 3 months to 5 years. Twelve-month excess weight loss (EWL) for LVSG ranged from 69.7% to 83%, and for LRYGB, ranged from 60.5% to 86.4%. A number of studies reported slow weight gain between the second and third years of postoperative follow-up ranging from 1.4% to 4.2%EWL. This trend was seen to continue to 5 years postoperatively (8% to 10%EWL) for both procedures. CONCLUSIONS In conclusion, LRYGB and LVSG are comparable with regards to the weight loss outcomes in the short term, with LRYGB achieving slightly greater weight loss. Slow weight recidivism is observed after the first postoperative year following both procedures. Long-term reporting of outcomes obtained from well-designed studies using intention-to-treat analyses are identified as a major gap in the literature at present.
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Affiliation(s)
- Emma Osland
- *Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston †Department of Human Movements and Nutrition ¶Mayne Medical School, School of Medicine, University of Queensland, Brisbane §School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences and Centre for Health Sciences Research, University of Southern Queensland, Toowoomba ∥Sunnybank Obesity Centre, South & East Queensland Surgery (SEQS), Sunnybank #Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia ‡Institute of Mathematical Sciences, University of Malaya, Kuala Lumpur, Malaysia **Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK
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19
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Santo MA, Riccioppo D, Pajecki D, Kawamoto F, de Cleva R, Antonangelo L, Marçal L, Cecconello I. Weight Regain After Gastric Bypass: Influence of Gut Hormones. Obes Surg 2016; 26:919-25. [PMID: 26450709 DOI: 10.1007/s11695-015-1908-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Roux-en-Y gastric bypass (RYGB) is the gold standard bariatric operation. However, a major concern in late follow-up is the substantial weight regain. Understanding the role of gastrointestinal hormone secretion in this situation is relevant. METHODS The aim of the present study was to evaluate the influence of gastrointestinal hormones comparing postprandial secretion of ghrelin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and leptin between patients with weight regain and those with favorable weight control. Twenty-four patients with follow-up from 27 to 59 months were divided into two groups according to sustained weight loss: group A (14 patients) had sustained weight losses, and group B (10 patients) had significant weight regain. Basal serum levels of ghrelin, GIP, GLP-1, and leptin after fasting and 30, 60, 90, and 120 min after a standard meal were measured. RESULTS There was no difference in the ghrelin secretion. There was a difference in the GIP secretion, with a higher percentage increase in 30 min in group A (330% × 192.2%; p = 0.01). There were also differences in the GLP-1 secretion, with higher increases in absolute (p = 0.03) and percentage values after 30 min in group A (124% × 46.5%; p = 0.01). There was also a difference between baseline leptin values, with higher levels in group B (p = 0.02). CONCLUSIONS The secretion of gut hormones in patients with weight regain after RYGB is different from that in patients with satisfactory weight outcome. After meal stimulation, reduced levels of GIP and GLP-1 may indicate the influence of gut hormones in the process of weight regain.
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Affiliation(s)
- Marco Aurelio Santo
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil.
| | - Daniel Riccioppo
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
| | - Denis Pajecki
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
| | - Flavio Kawamoto
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
| | - Roberto de Cleva
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
| | - Leila Antonangelo
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil.,Central Laboratory of Hospital das Clínicas, São Paulo, Brazil
| | - Lia Marçal
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil.,Central Laboratory of Hospital das Clínicas, São Paulo, Brazil
| | - Ivan Cecconello
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
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20
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Timing of food intake is associated with weight loss evolution in severe obese patients after bariatric surgery. Clin Nutr 2016; 35:1308-1314. [DOI: 10.1016/j.clnu.2016.02.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/02/2016] [Accepted: 02/09/2016] [Indexed: 01/26/2023]
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21
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Stanford FC, Alfaris N, Gomez G, Ricks ET, Shukla AP, Corey KE, Pratt JS, Pomp A, Rubino F, Aronne LJ. The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study. Surg Obes Relat Dis 2016; 13:491-500. [PMID: 27986587 DOI: 10.1016/j.soard.2016.10.018] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/13/2016] [Accepted: 10/23/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients who undergo bariatric surgery often have inadequate weight loss or weight regain. OBJECTIVES We sought to discern the utility of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with inadequate weight loss or weight regain. SETTING Two academic medical centers. METHODS We completed a retrospective study to identify patients who had undergone bariatric surgery in the form of a Roux-en-Y gastric bypass (RYGB) or a sleeve gastrectomy from 2000-2014. From this cohort, we identified patients who were placed on weight loss pharmacotherapy postoperatively for inadequate weight loss or weight regain. We extracted key demographic data, medical history, and examined weight loss in response to surgery and after the initiation of weight loss pharmacotherapy. RESULTS A total of 319 patients (RYGB = 258; sleeve gastrectomy = 61) met inclusion criteria for analysis. More than half (54%; n = 172) of all study patients lost≥5% (7.2 to 195.2 lbs) of their total weight with medications after surgery. There were several high responders with 30.3% of patients (n = 96) and 15% (n = 49) losing≥10% (16.7 to 195.2 lbs) and≥15% (25 to 195.2 lbs) of their total weight, respectively, Topiramate was the only medication that demonstrated a statistically significant response for weight loss with patients being twice as likely to lose at least 10% of their weight when placed on this medication (odds ratio = 1.9; P = .018). Regardless of the postoperative body mass index, patients who underwent RYGB were significantly more likely to lose≥5% of their total weight with the aid of weight loss medications. CONCLUSIONS Weight loss pharmacotherapy serves as a useful adjunct to bariatric surgery in patients with inadequate weight loss or weight regain.
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Affiliation(s)
- Fatima Cody Stanford
- MGH Weight Center, Gastrointestinal Unit-Department of Medicine, Massachusetts General Hospital, Boston, MA; Endocrine Unit, Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Nasreen Alfaris
- MGH Weight Center, Gastrointestinal Unit-Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, MA
| | - Gricelda Gomez
- Harvard Medical School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
| | - Elizabeth T Ricks
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, NY; Institute of Human Nutrition, Columbia University, New York, NY; Texas Tech University- Paul L. Foster School of Medicine, El Paso, TX
| | - Alpana P Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Kathleen E Corey
- Harvard Medical School, Boston, MA; Gastrointestinal Unit-Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Janey S Pratt
- Harvard Medical School, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Alfons Pomp
- Department of GI Metabolic and Bariatric Surgery, Weill Cornell Medical College, New York, NY
| | - Francesco Rubino
- Department of Metabolic and Bariatric Surgery, Kings College London and Kings College Hospital, London, UK
| | - Louis J Aronne
- Institute of Human Nutrition, Columbia University, New York, NY
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22
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Amin T, Mercer JG. Full4Health: Understanding food-gut-brain mechanisms across the lifespan in the regulation of hunger and satiety for health. NUTR BULL 2016. [DOI: 10.1111/nbu.12193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T. Amin
- Rowett Institute of Nutrition and Health; University of Aberdeen; Aberdeen UK
| | - J. G. Mercer
- Rowett Institute of Nutrition and Health; University of Aberdeen; Aberdeen UK
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de Hollanda A, Ruiz T, Jiménez A, Flores L, Lacy A, Vidal J. Patterns of Weight Loss Response Following Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2016; 25:1177-83. [PMID: 25421881 DOI: 10.1007/s11695-014-1512-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite the health benefits of bariatric surgery (BS) extend beyond WL, better understanding of the WL response may help improve the outcomes of BS. In this context, we aimed to assess patterns within the variability of weight loss (WL) after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS WL data from 658 subjects that underwent RYGB (n = 464) or SG (n = 194) as first BS were analyzed. Based on excess WL (EWL), subjects were categorized as good WL responders (EWL ≥ 50 % at nadir weight and throughout follow-up), primarily poor WL responders (1-PWL:EWL < 50 % at nadir weight and thereafter), and secondarily poor WL responders (2-PWL:EWL ≥ 50 % at nadir weight, but <50 % at last follow-up visit). Predictors associated with different WL outcomes were ascertained using regression analysis. RESULTS Median follow-up was 55.7 months. Nadir EWL ranged 12.4-143.6 %; last follow-up visit EWL ranged -22.1-143.6 % and weight regain (WR) ranged 0-64.1 kg. Good WL was found in 75.7 of the cohort. 1-PWL response (4.7 %) was characterized by lesser WL but similar WR as compared to good WL and was associated with larger BMI and diabetes prior to surgery. 2-PWL response (19.6 %) was characterized by larger WR as compared to the other groups and was more common following SG. Lesser percentage of medical appointments kept was associated with 1-PWL and 2-PWL. CONCLUSION Our data show the high inter-individual variability of the WL response at mid-term after RYGB and SG and that poor WL after BS could be illustrated by two different patterns, characterized either by sustained limited WL (1-PWL), or pronounced weight regain (2-PWL).
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Affiliation(s)
- Ana de Hollanda
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Clinic Universitari, Villarroel 170, 08036, Barcelona, Spain
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24
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Erim T, Colak Y, Szomstein S. Gastric carcinoid tumor after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2015; 11:e51-2. [DOI: 10.1016/j.soard.2015.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 02/06/2023]
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