Impact of Roux-en-Y Gastric Bypass and Vertical Gastrectomy on weight loss: a retrospective and longitudinal study in the State of Paraná, Brazil

AIM

to compare the impact of Roux's Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) techniques on body weight reduction over 1 and 5 years after bariatric surgery in obese patients in the state of Paraná.

METHODS

longitudinal and retrospective study, conducted between January 2010 and December 2013, with 737 patients of both sexes submitted to RYGB or SG and evaluated in the preoperative, 1 and 5 years after bariatric surgery (BS). Age, height, body weight, Body Mass Index (BMI), biochemical and pressure parameters were recorded.

RESULTS

of the total of patients, men represented lower frequency, were slightly older, with higher body weight, BMI and worse metabolic and pressure conditions than women in pre-BS (p<0.05). Regardless of sex, RYGB and SG were effective in promoting body weight reduction and BMI in 1 and 5 years after BS; the RYGB technique had greater impact on these variables in both sexes (p<0.05). The highest percentage of lost weight was observed in women who underwent the RYGB technique in the first year after BS. Five years after BS, the RYGB technique promoted a higher rate of body weight reduction in men and women compared to the SG technique (p<0.05).

CONCLUSION

regardless of sex, the RYGB technique promotes a higher degree of body weight reduction and BMI over time compared to the SG; having its biggest impacts in the 1 year after BS, especially in women.

O impacto do Bypass Gástrico em Y de Roux e da Gastrectomia Vertical na perda de peso: um estudo retrospectivo e longitudinal no Estado do Paraná, Brasil

RESUMO Objetivo: comparar o impacto das técnicas Bypass Gástrico em Y de Roux (BGYR) e Gastrectomia Vertical (GV) na redução do peso corporal ao longo de 1 e 5 anos após a cirurgia bariátrica em pacientes obesos no Estado do Paraná. Métodos: estudo longitudinal e retrospectivo, realizado entre janeiro de 2010 a dezembro de 2013, com 737 pacientes de ambos os sexos submetidos a BGYR ou GV e avaliados no pré-cirúrgico, 1 e 5 anos após Cirurgia Bariátrica (CB). Foram registrados idade, estatura, peso corporal, Índice de Massa Corpórea (IMC), parâmetros bioquímicos e pressóricos. Resultados: do total de pacientes, homens representavam menor frequência, eram ligeiramente mais velhos, com maior peso corporal, IMC e pior condição metabólica e pressórica que mulheres no pré-CB (p<0,05). Independente do sexo, BGYR e GV foram efetivas em promover redução do peso corporal e IMC em 1 e 5 anos pós-CB; tendo a técnica de BGYR maior impacto nestas variáveis em ambos os sexos (p<0,05). A maior porcentagem de peso perdido foi observada em mulheres submetidas a técnica da BGYR no primeiro ano após a CB. Cinco anos após a CB, a técnica de BGYR promoveu maior taxa de redução de peso corporal em homens e mulheres comparado a técnica da GV (p<0,05). Conclusão: independente do sexo a técnica de BGYR promove maior grau de redução do peso corporal e IMC ao longo do tempo em comparação com a GV; tendo seus maiores impactos no 1 ano pós-CB sobretudo em mulheres.

Analysis of blood lipid changes and influencing factors in physical examination population of a city in central China

Purpose

The prevalence of cardiovascular diseases (CVDs) associated with lipid levels is increasing worldwide. Our purpose is to analyze the distribution level and influencing factors of lipid in the whole population and to put forward suggestions for preventing abnormal lipid levels.

Methods

The study was based on a sample of 91,480 Chinese who participated in a nationwide physical examination program in Wuhan, a midland city in China, in 2018. The distribution of blood lipid in the population was observed using average, and the relationship between the influencing factors and blood lipid level was observed by quantile regression (QR).

Results

A total of 91,480 people were evaluated in this study, among which 59,165 (64.68%) were female with a mean age of 51.71 ± 10.82 years. QR results showed that different physical examination indexes had different effects on lipid levels. Fasting plasma glucose (FBG) has the largest QR coefficient and BMI had positive effects on total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C). In males, age has a positive influence on TC, LDL-C, and high-density lipoprotein cholesterol (HDL-C), while in females, age has a positive influence on all four indexes.

Conclusion

We found that the TC and LDL-C levels of females were more susceptible to age than males, and the lipid levels of older females were higher than males. BMI has a greater effect on lipid levels in males than in females. Regardless of gender should pay attention to dyslipidemia caused by diabetes and abnormal liver function.

Association Between Telomere Length and Cardiovascular Risk: Pharmacological Treatments Affecting Telomeres and Telomerase Activity

Telomeres represent the ends of chromosomes, and they are composed of an extensive number of - TTAGGG nucleotide sequence repeats in humans. Telomeres prevent chromosome degradation, participate in stabilization, and regulate the DNA repair system. Inflammation and oxidative stress have been identified as important processes causing cardiovascular disease and accelerating telomere shortening rate. This review investigates the link between telomere length and pathological vascular conditions from experimental and human studies. Also, we discuss pharmacological treatments affecting telomeres and telomerase activity.

Targeted Metabolomics Revealed a Sex-Dependent Signature for Metabolic Syndrome in the Mexican Population

Metabolic syndrome (MetS) is a group of several metabolic conditions predisposing to chronic diseases. Individuals diagnosed with MetS are physiologically heterogeneous, with significant sex-specific differences. Therefore, we aimed to investigate the potential sex-specific serum modifications of amino acids and acylcarnitines (ACs) and their relationship with MetS in the Mexican population. This study included 602 participants from the Health Workers Cohort Study. Forty serum metabolites were analyzed using a targeted metabolomics approach. Multivariate regression models were used to test associations of clinical and biochemical parameters with metabolomic profiles. Our findings showed a serum amino acid signature (citrulline and glycine) and medium-chain ACs (AC14:1, AC10, and AC18:10H) associated with MetS. Glycine and AC10 were specific metabolites representative of discrimination according to sex-dependent MetS. In addition, we found that glycine and short-chain ACs (AC2, AC3, and AC8:1) are associated with age-dependent MetS. We also reported a significant correlation between body fat and metabolites associated with sex-age-dependent MetS. In conclusion, the metabolic profile varies by MetS status, and these differences are sex-age-dependent in the Mexican population.

Evaluation of Lipid Profile and Inflammatory Marker in Patients with Gastric Helicobacter pylori Infection, Ethiopia

INTRODUCTION

H. pylori are gram-negative, microaerophilic helical-shaped bacteria with multiple flagella and commonly exist in the stomach. This infection may cause significant mucosal inflammation and damage, leading to ulcers in the stomach. It can also affect organ systems external to the gastrointestinal tract. To assess cardiovascular risk factors and to predict cardiovascular disorders, we are evaluating and comparing lipid profile and inflammatory marker between H. pylori-positive and negative patients.

OBJECTIVE

To evaluate and compare lipid profile (TC; TG; LDL; HDL) and inflammatory marker (hs-CRP) in dyspeptic patients with and without H. pylori infection.

METHODS

Comparative cross-sectional study was conducted from September 2020 to January 2021 at Debre Markos Referral Hospital, Debre Markos Health Center, and Hidassie Health Center, Ethiopia. Each of 50 H. pylori-positive and negative dyspeptic patients were studied. The data were checked for completeness and analyzed by SPSS version 25.0 Software. A p-value < 0.05 was considered statistically significant.

RESULTS

Serum mean high-density lipoprotein (HDL) values were 37.54 ± 7.98 mg/dL and 43.12 ± 7.86 mg/dL (p < 0.05) for H. pylori-positive and negative dyspeptic patients, respectively, and median serum high sensitive C reactive protein (hs-CRP) levels were 6.29 mg/L (1.66-41.34) and 3.35 mg/L (0.39-10.01) (p < 0.05) for H. pylori-positive and negative dyspeptic patients, respectively.

CONCLUSION

H. pylori infection significantly alters serum high-density lipoprotein (HDL) and high sensitive C reactive protein (hs-CRP) levels in dyspeptic patients, as a result, increase the potential risk of cardiovascular diseases.

Metabolomic Profiles of Plasma Retinol-Associated Dyslipidemia in Men and Women

Background and Aims: Studies of both animals and humans show that a high intake of vitamin A is associated with a lower risk of dyslipidemia. However, an association of plasma retinol levels with dyslipidemia is unclear. Therefore, the aim of this study is to investigate an association between plasma retinol and dyslipidemia and to identify related metabolites and pathways in the general population. Methods: We included 250 participants aged 20-80 years from the Wellness Living Laboratory (WELL) China cohort. Associations between plasma retinol levels and dyslipidemia were analyzed using adjusted logistic models. Related metabolites were identified using ANCOVA, adjusted for the false discovery rate (FDR) and used for pathway analyses. Because there are sex differences in plasma retinol levels, all analyses were conducted separately by sex. Results: Plasma retinol was significantly higher in men than in women. A positive association between plasma retinol and dyslipidemia was found in both sexes. In men, the 2nd and 3rd tertiles showed significantly higher proportions of dyslipidemia than the 1st tertile (1st tertile vs. 2nd tertile: p = 0.026; 1st tertile vs. 3rd tertile: p = 0.003). In women, the 3rd tertile showed a significantly higher proportion of dyslipidemia than the 1st and 2nd tertile (3rd tertile vs. 1st tertile: p = 0.002, 3rd tertile vs. 2nd tertile: p = 0.002). Overall, 75 and 30 metabolites were significantly associated with retinol levels in men and women, respectively. According to these metabolites, lipid metabolic pathways, including glycerophospholipid, arachidonic acid, linoleic acid, alpha-linolenic acid, and glycosylphosphatidylinositol (GPI), as well as steroid hormone biosynthesis pathways were found to overlap across the sexes. These pathways showed that elevated retinol levels might be associated with hormone metabolism and inflammation status. Conclusions: We found a positive association between plasma retinol levels and dyslipidemia. Related metabolomic profiles and interrupted pathways showed that such an increase might be associated with steroid hormone synthesis and inflammation. In addition, large, population-based longitudinal studies and intervention studies are needed to confirm the role of retinol in lipid metabolism and the prevention of cardiovascular disease (CVD).

Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths

The recognition of cardiovascular disease (CVD) as a "male" privilege has been a commonly held concept. However, emerging data describe another reality. Heterogeneities have been convincingly demonstrated regarding CVD manifestations, risk factor burden, and prognosis between males and females. The aim of the present narrative review was to highlight sex- and gender-related discrepancies in primary and secondary CVD prevention, underscoring plausible underlying mechanisms. Manifestation of CVD in women is characterized by atypical symptoms/signs and inadequately studied pathophysiology features challenging accurate diagnosis and effective treatment. Regarding CVD risk assessment, the burden and effect size of conventional, novel, and female-specific risk factors needs better clarification. Hitherto outcomes are nonconsistent, while most importantly, the interpretation of the attendant metabolic paths remains a challenge; the interactions among genetic, metabolic, and environmental factors are of high complexity regulated by genomic and nongenomic sex hormones effects. To deal with these key points, the National Institutes of Health currently calls upon investigators to provide a sex- and gender-specific reporting in all health research hypotheses. The implementation of high-quality studies addressing these issues is an imperative need to maximize cost-effectiveness in prevention and management strategies.

Dyslipidaemia in the elderly: to treat or not to treat?

INTRODUCTION

The elderly population (i.e. aged ≥ 65 years) is increasing worldwide. Ageing is associated with a higher incidence and prevalence of cardiovascular disease (CVD). Areas covered: The prevalence of CVD risk factors including type 2 diabetes mellitus, hypertension and dyslipidaemia also increases with advancing age, contributing to the higher absolute CVD risk observed in the elderly. The present narrative review comments on the associations of dyslipidaemia with CVD as well as the effects of lifestyle measures and lipid-lowering drugs on lipids and CVD risk with a special focus on the elderly population. Individual treatment goals and therapeutic options according to current guidelines are also reviewed. Finally, we discuss special characteristics of the elderly that may influence the efficacy and safety of drug therapy and should be considered before selection of hypolipidaemic pharmacotherapy. Expert commentary: There may be a greater CVD benefit in older patients following drug therapy compared with younger ones. Treatment goals and therapeutic options should be individualized according to current guidelines. Specific characteristics that may influence the efficacy and safety of drug therapy in the elderly should be considered in relation to dyslipidaemia treatment.

Aging and dyslipidemia: a review of potential mechanisms

Elderly adults constitute a rapidly growing part of the global population, thus resulting in an increase in morbidity and mortality related to cardiovascular disease (CVD), which remains the major cause of death in elderly population, including men and women. Dyslipidemia is a well-established risk factor for CVD and is estimated to account for more than half of the worldwide cases of coronary artery disease (CAD). Many studies have shown a strong correlation between serum cholesterol levels and risk of developing CAD. In this paper, we review the changes of plasma lipids that occur in men and women during aging and the potential mechanisms of age-related disorders of lipoprotein metabolism covering humans and/or animals, in which changes of the liver sinusoidal endothelium, postprandial lipemia, insulin resistance induced by free fatty acid (FFA), growth hormone (GH), androgen (only for men) and expression and activity of peroxisome proliferator-activated receptor α (PPARα) are mainly focused.

Validity and reliability of male andropause symptoms self-assessment questionnaire among elderly males in Khuzestan province of Iran

Background:

Andropause is a condition of decreasing testosterone in men that usually begins to occur at about 40 years of age. Many men find it difficult to acknowledge there may be a problem by refusing to even talk about the symptoms.

Aims:

The study was conducted to the standards of MASSQ (2012) within male older adults to introduce a relevant criterion.

Materials and Methods:

About 382 men with age range of 50-80 and with the mean age of 65.3 ± 2.32 were sampled with the cluster-ratio sampling method from the eight cities of Khuzestan province in southwestern Iran. The aged samples replied to the 25 items of MASSQ.

Results:

Coefficients of Cronbach's alpha (α = 0.89), split-half (0.91), convergent validity (0.72), divergent validity (−0.32), and criterion validity (0.67) were estimated, which were significant at P < 0.01. The exploratory factor analysis demonstrated that the 25-items of MASSQ for aged samples are organized into four factors (sexual, somatic, psychic, and behavioral) which clarify 79% of the scale's variance. Second-order confirmatory factor analysis pointed out that the factors are well-matched up onto a principal factor. Consequently, the four-factor model was well appropriate for the data by the fit index techniques for adjusting the scale [adjusted goodness of fit index = 0.92, goodness-of-fit statistic = 0.91, root mean square error of approximation = 0.006, incremental fit index = 0.94, normed fit index = 0.91, comparative fit index = 0.97].

Conclusions:

The results pointed to the well-adjusted reliability and validity of MASSQ and its usefulness for the relevant studies as well.

Skeletal muscle adiposity is associated with serum lipid and lipoprotein levels in Afro-Caribbean men

OBJECTIVE

When compared with other ethnic groups, African ancestry individuals have lower triglycerides and higher High-density lipoprotein cholesterol (HDL-C) levels, although the mechanisms for these differences remain unclear. A comprehensive array of factors potentially related to fasting serum lipid and lipoprotein levels in African ancestry men was evaluated.

DESIGN AND METHODS

Men (1,821) underwent dual-energy X-ray absorptiometry measures of total body fat and quantitative computed tomography assessments of calf skeletal muscle adiposity [subcutaneous and intermuscular adipose tissue (AT), and muscle density as a measure of intra-muscular AT].

RESULTS

Multivariable linear regression analysis identified age (-), total body fat (+), subcutaneous AT (-), fasting glucose (+), fasting insulin (+), diastolic blood pressure (+), and non-African ancestry (+) as independent correlates of triglycerides (all P < 0.05). Total body fat (+), intra-muscular AT (-), and diastolic blood pressure (+) were independent correlates of Low-density lipoprotein cholesterol (LDL-C) (all P < 0.001). Age (+), waist circumference (-), fasting insulin (-), physical activity (+), and alcohol intake (+) were independent correlates of HDL-C (all P < 0.05).

CONCLUSIONS

A novel relationship between skeletal muscle adiposity and serum lipid and lipoprotein levels in African ancestry men, independent of total and central adiposity was illuminated. In African ancestry populations, genetic factors are likely a significant determinant of triglycerides levels.

Fat-free mass and fasting glucose values in patients with and without statin therapy assigned to age groups between <60 and >75 years

OBJECTIVE

The aging-associated changes in body composition result in an increased cardiometabolic risk. A tremendous reduction of cardiovascular morbidity and mortality can be obtained by statin therapy. Statins are well tolerated, with myopathy as the most serious negative side effect. Some recently published studies indicate that the incidence of type 2 diabetes might be increased during intensified statin therapy. The aim of our study was to investigate whether statin therapy has an influence on the aging-associated changes in fat-free mass (FFM).

METHODS

A total of 3,280 persons attending a medical outdoor center between January 2005 and July 2011 were assigned to 3 age groups from <60 to >75 years. Clinical data, body mass index (BMI), and body composition were evaluated in the different age groups in patients with and without statin therapy. To analyze the impact of statin use on FFM, we regressed a patient's FFM on an interaction term between statin use and age and other control variables.

RESULTS

Aging was associated with a decrease in BMI and FFM, while fat mass continuously increased up to the age of >75 years. This was paralleled by a continuous increase in fasting glucose levels in patients with and without statin therapy. The loss of FFM between the age group <60 years and >75 years was more pronounced in statin-treated patients (10.88%) than in non-statin users (8.47%). Creatine phosphokinase values revealed a decrease of 7.77 U/l between the age groups <60 and >75 years in non-statin users and of 14.75 U/l in statin users. Statistical analysis indicated that the effect of statin therapy on FFM is more pronounced in younger than in older patients.

CONCLUSIONS

Patients under statin therapy seem to be more vulnerable to the aging-associated lowering of FFM. Diagnostic procedures and interventions to prevent a loss of muscle mass might be of particular advantage in elderly patients under statin therapy.

Advancing age is associated with gene expression changes resembling mTOR inhibition: evidence from two human populations

Interventions which inhibit TOR activity (including rapamycin and caloric restriction) lead to downstream gene expression changes and increased lifespan in laboratory models. However, the role of mTOR signaling in human aging is unclear. We tested the expression of mTOR-related transcripts in two independent study cohorts; the InCHIANTI population study of aging and the San Antonio Family Heart Study (SAFHS). Expression of 27/56 (InCHIANTI) and 19/44 (SAFHS) genes were associated with age after correction for multiple testing. 8 genes were robustly associated with age in both cohorts. Genes involved in insulin signaling (PTEN, PI3K, PDK1), ribosomal biogenesis (S6K), lipid metabolism (SREBF1), cellular apoptosis (SGK1), angiogenesis (VEGFB), insulin production and sensitivity (FOXO), cellular stress response (HIF1A) and cytoskeletal remodeling (PKC) were inversely correlated with age, whereas genes relating to inhibition of ribosomal components (4EBP1) and inflammatory mediators (STAT3) were positively associated with age in one or both datasets. We conclude that the expression of mTOR-related transcripts is associated with advancing age in humans. Changes seen are broadly similar to mTOR inhibition interventions associated with increased lifespan in animals. Work is needed to establish whether these changes are predictive of human longevity and whether further mTOR inhibition would be beneficial in older people.

Role of Endogenous Estrogen on the Incidence of Coronary Heart Disease in Men

Estrogens protect the vascular system in women, but its effect in men is unclear. We evaluated the impact of estrogen on the male cardiovascular system. Of 140 Chinese males, 55 (aged 61.2 ± 3.5) were cases and 60 (aged 59.5 ± 4.6) were controls. Compared with the control group, only serum estradiol ([E2]; P < .01) levels but not testosterone ([T]; P = .21) were significantly lower in the cases. Linear and multiple regression analysis showed that serum T was positively associated with triglycerides ([TG]; r = .439, P < .01) and d-dimer ( r = .258, P < .05) but negatively associated with high-density lipoprotein cholesterol (HDL-C) levels ( r = −.267, P < .05) and C-reactive protein (CRP; r = −.214, P < .05). Estradiol was highly associated with TG ( r = .783, P < .01) and HDL-C ( r = .515, P < .01) but was negatively related with low-density lipoprotein cholesterol (LDL-C; P < .05), total cholesterol/HDL-C ( P < .05), CRP ( P < .01), and d-dimer ( P < .01). In conclusion, serum E2 and T levels affect coronary heart disease risk factors in males.

Ideal lipid profile and genes for an extended life span

PURPOSE OF REVIEW

The world population is aging and a rapid increase is being seen in the very elderly (aged >80 years). Cholesterol levels in general rise with age and high cholesterol has been associated with extreme longevity. The relationship between lipids and cardiovascular events in the extreme elderly is unclear.

RECENT FINDINGS

A number of genetic factors associated with lipid metabolism have also been described as having potential antiaging roles, including the genes encoding lipoprotein-associated factors - apolipoprotein E and cholesterol ester transfer protein; adipose tissue metabolism - adiponectin, leptin, glycaemia; and blood pressure - angiotensinogen. Clinical trials of lipid-lowering therapies have recruited subgroups of moderately elderly patients, but only the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial specifically recruited an elderly population. There is no direct equivalent of the Hypertension in the Very Elderly trial (HYVET) study of antihypertensive patients in the extreme elderly. No heterogeneity has been seen with the effects of statin therapy in the elderly compared with younger age groups on classical cardiovascular endpoints of coronary heart disease and stroke.

SUMMARY

The optimal cholesterol target, long-term tolerability and the specific effects of statins on other vascular-associated diseases of aging, for example arterial aneurysms, microvascular renal and cerebral disease (dementias), remain to be determined.