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Evans LL, Lee WG, Karimzada M, Patel VH, Aribindi VK, Kwiat D, Graham JL, Cummings DE, Havel PJ, Harrison MR. Evaluation of a Magnetic Compression Anastomosis for Jejunoileal Partial Diversion in Rhesus Macaques. Obes Surg 2024; 34:515-523. [PMID: 38135738 PMCID: PMC10810932 DOI: 10.1007/s11695-023-07012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Metabolic surgery remains underutilized for treating type 2 diabetes, as less invasive alternative interventions with improved risk profiles are needed. We conducted a pilot study to evaluate the feasibility of a novel magnetic compression device to create a patent limited caliber side-to-side jejunoileal partial diversion in a nonhuman primate model. MATERIALS AND METHODS Using an established nonhuman primate model of diet-induced insulin resistance, a magnetic compression device was used to create a side-to-side jejunoileal anastomosis. Primary outcomes evaluated feasibility (e.g., device mating and anastomosis patency) and safety (e.g., device-related complications). Secondary outcomes evaluated the device's ability to produce metabolic changes associated with jejunoileal partial diversion (e.g., homeostatic model assessment of insulin resistance [HOMA-IR] and body weight). RESULTS Device mating, spontaneous detachment, and excretion occurred in all animals (n = 5). There were no device-related adverse events. Upon completion of the study, ex vivo anastomoses were widely patent with healthy mucosa and no evidence of stricture. At 6 weeks post-device placement, HOMA-IR improved to below baseline values (p < 0.05). Total weight also decreased in a linear fashion (R2 = 0.97) with total weight loss at 6 weeks post-device placement of 14.4% (p < 0.05). CONCLUSION The use of this novel magnetic compression device to create a limited caliber side-to-side jejunoileal anastomosis is safe and likely feasible in a nonhuman primate model. The observed glucoregulatory and metabolic effects of a partial jejunoileal bypass with this device warrant further investigation to validate the long-term glucometabolic impact of this approach.
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Affiliation(s)
- Lauren L Evans
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - William G Lee
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Mohammad Karimzada
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Veeshal H Patel
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Vamsi K Aribindi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Dillon Kwiat
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - James L Graham
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California Davis, Davis, USA
| | - David E Cummings
- Division of Metabolism, Endocrinology and Nutrition, University of Washington and VA Puget Sound Health Care System, Seattle, USA
| | - Peter J Havel
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California Davis, Davis, USA
| | - Michael R Harrison
- Department of Surgery, University of California San Francisco, San Francisco, USA.
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One-anastomosis gastric bypass (OAGB) in patients with BMI < 30 kg/m2 and diabetes mellitus type 2 (DM2). NUTR HOSP 2021; 38:971-977. [PMID: 34105979 DOI: 10.20960/nh.03545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION type-2 diabetes mellitus (DM2) is a major health problem, as it leads to increased morbidity and mortality. Metabolic surgery has shown good results in glycemic control; however, its use has not become popular. OBJECTIVES to evaluate DM2 remission, as well as changes in body mass index (BMI), in overweight diabetic patients after undergoing metabolic surgery. METHODS a retrospective review was carried out of all patients with DM2 and BMI between 25 and 29.9 kg/m2 who underwent laparoscopic one-anastomosis gastric bypass (OAGB) as metabolic procedure between 2016 and 2019. RESULTS a total of 15 patients were included with a mean age of 46.6 ± 11.25 years. Mean BMI was 28.41 ± 0.94 kg/m2. Average duration was 5.4 ± 2.79 years, and presurgical fasting glucose was 288.53 ± 65.22 mg/dL. Preoperative glycated hemoglobin (HbA1c) was 9.58 ± 1.66 %. Two years after surgery HbA1c was 5.21 ± 0.26 %. The remission rate of DM2 was 100 %. All patients maintained a normal BMI range. CONCLUSIONS OAGB is a valid alternative for complete DM2 remission no matter if it is not accompanied by some degree of obesity, since in this case the length of the biliopancreatic limb and common channel is modified to make a less malabsorptive procedure.
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Abstract
PURPOSES Biliopancreatic diversion could improve type 2 diabetes mellitus. Our aim was to investigate the effects of biliary jejunostomy on the improvement of glucose. MATERIALS AND METHODS Twenty-seven type 2 diabetes patients underwent biliary jejunostomy between January 2013 and January 2018 in our hospital and were followed up. Demographic data, operation details, body weight, food intake, effects on diabetes control, and biomedical parameters were collected and analyzed. RESULTS As defined previously, 3 of 27 diabetes patients were "under control," 8 patients were "in remission," and 12 patients were "improved." The fasting glucose decreased from 9.7 ± 2.1 mmol/L before surgery to 7.9 ± 1.8 mmol/L 12 months after surgery (P = 0.001). The level of hemoglobin A1c in these patients was 9.1 ± 2.3% before surgery, and it decreased to 7.2 ± 1.3% 12 months after surgery (P < 0.001). There was no significant difference in the body weight index (P = 0.78) or food intake (P = 0.18) between the time prior to surgery and 12 months afterward. The average level of total bile acids increased significantly after surgery, from 6.7 ± 2.2 μmol/L before surgery to 8.6 ± 2.9 μmol/L 12 months after surgery (P < 0.001). CONCLUSIONS Fasting glucose in type 2 diabetes patients was improved after biliary jejunostomy. Increasing bile acids levels might play an important role in the remission of type 2 diabetes.
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Sun F, Zhao Z, Li Q, Zhou X, Li Y, Zhang H, Yan Z, He H, Ke Z, Gao Y, Li F, Tong W, Zhu Z. Detrimental Effect of C-Reactive Protein on the Cardiometabolic Cells and Its Rectifying by Metabolic Surgery in Obese Diabetic Patients. Diabetes Metab Syndr Obes 2020; 13:1349-1358. [PMID: 32425567 PMCID: PMC7195578 DOI: 10.2147/dmso.s250294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND High-sensitivity C-reactive protein (hs-CRP) has been regarded as a biomarker of low-degree inflammation in illness; however, whether CRP exerts its pathogenic effect on the cardiometabolic system remains unknown. Aside from the beneficial effects of metabolic surgery on cardiometabolic system, its impact on inflammation still worth examining. Thus, this study aims to investigate the effect of CRP on adipose and vascular cells, and their responses to metabolic surgery in obese diabetic patients. PATIENTS AND METHODS The expression of CRP and RAS- and ERK-related factors in the adipocytes and VSMCs were measured. Obese patients with type 2 diabetes who underwent metabolic surgery were followed up for 2 years thereafter. Laboratory tests, which included serum hs-CRP levels and visceral fat thickness (VFT), were obtained before and after surgery. RESULTS CRP administration significantly and dose-dependently increased the intracellular-free calcium concentration ([Ca2+]i) in cultured adipocytes and in the VSMCs. CRP administration significantly increased ACE, Ang II, AT1R and p-ERK expressions, but reduced ACE2 expression in both the adipocytes and VSMCs. Clinical study showed that VFT was closely associated with serum hs-CRP. Furthermore, VFT and serum hs-CRP were found to be highly associated with blood pressure. Finally, metabolic surgery remarkably decreased blood pressure, visceral fat and serum hs-CRP levels. CONCLUSION CRP has a detrimental effect on cardiometabolic cells, aside from functioning merely as a biomarker. Serum hs-CRP levels are highly associated with hypertension and visceral obesity, which can be antagonized by metabolic surgery in obese diabetic patients.
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Affiliation(s)
- Fang Sun
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing400042, People’s Republic of China
| | - Zhigang Zhao
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing400042, People’s Republic of China
| | - Qiang Li
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing400042, People’s Republic of China
| | - Xunmei Zhou
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing400042, People’s Republic of China
| | - Yingsha Li
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing400042, People’s Republic of China
| | - Hexuan Zhang
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing400042, People’s Republic of China
| | - Zhencheng Yan
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing400042, People’s Republic of China
| | - Hongbo He
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing400042, People’s Republic of China
| | - Zhigang Ke
- Department of General Surgery, Daping Hospital, Third Military Medical University, Chongqing400042, People’s Republic of China
| | - Yu Gao
- Department of General Surgery, Daping Hospital, Third Military Medical University, Chongqing400042, People’s Republic of China
| | - Fan Li
- Department of General Surgery, Daping Hospital, Third Military Medical University, Chongqing400042, People’s Republic of China
| | - Weidong Tong
- Department of General Surgery, Daping Hospital, Third Military Medical University, Chongqing400042, People’s Republic of China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Daping Hospital, Third Military Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing400042, People’s Republic of China
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Torquati A, Shantavasinkul PC, Omotosho P, Corsino L, Spagnoli A. Perioperative changes in prouroguanylin hormone response in severely obese subjects after bariatric surgery. Surgery 2019; 166:456-459. [PMID: 31472974 DOI: 10.1016/j.surg.2019.06.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/22/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Prouroguanylin is a gut hormone converted into uroguanylin in the hypothalamus. Uroguanylin induces satiety through guanylyl-cyclase-2C receptor signaling. However, little is known about the role of this hormone in regulating human food intake. METHODS In prospective-cohort study, prouroguanylin profile changes were determined during meal stimulation in obese patients 2 weeks before and 2 weeks after Roux-en-Y gastric bypass surgery. We also investigated whether these changes play a role in the anorexigenic effect of Roux-en-Y gastric bypass. RESULTS The study enrolled 8 healthy lean volunteers and 10 obese patients with type 2 diabetes. Prouroguanylin levels were postprandially decreased at 30 minutes (P = .04) and 60 minutes (P = .008) in obese patients before surgery, and they were increased at 60 minutes (P = .003), 90 minutes (P = .008), and 120 minutes (P = .009) after surgery. We observed a significant difference (P = .001) in fasting prouroguanylin levels before (8.82 ± 1.2 ng/mL) and after (6.05 ± 1.2 ng/mL) Roux-en-Y gastric bypass. Hunger ratings in the fasted state did not change after Roux-en-Y gastric bypass. Instead, subjects demonstrated significantly (P = .01) lower hunger visual analog scale scores than before Roux-en-Y gastric bypass. No correlations between circulating prouroguanylin levels and hunger perception were found before or after Roux-en-Y gastric bypass. CONCLUSION Prouroguanylin levels decrease after meal stimulation in obese patients, and they increase after Roux-en-Y gastric bypass, but no correlations exist with hunger visual analog scale scores.
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Affiliation(s)
| | | | | | - Leonor Corsino
- Division of Endocrinology, Metabolism, and Nutrition, Duke University, Durham, NC
| | - Anna Spagnoli
- Department of Pediatrics, University of Nebraska Medical Center, Omaha
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Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) is increasing in prevalence and associated with numerous metabolic complications leading to increased mortality and costs. Metabolic surgery, or surgery to treat T2DM and obesity, is effective at achieving remission from T2DM. This review discusses the most commonly used surgical options including the adjustable gastric band, the Roux-en-Y gastric bypass, the sleeve gastrectomy, and the biliopancreatic diversion with duodenal switch and their ability to treat and prevent T2DM. RECENT FINDINGS There is an increasing body of literature that justifies the inclusion of metabolic surgery into the treatment algorithm for patients with obesity and T2DM. Metabolic procedures should be performed at centers that offer comprehensive treatment of metabolic disorders and have expertise in gastrointestinal surgery. The incremental improvement in the quality and safety of metabolic surgery has significantly reduced the risk of serious post-operative complications. Metabolic surgery is a safe and effective treatment option for obese patients with T2DM.
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Affiliation(s)
- Eric Rachlin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM 390, Houston, TX, 77030, USA
| | - Carlos Galvani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM 390, Houston, TX, 77030, USA.
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Boettcher BR. Gastric bypass surgery mimetic approaches. Drug Discov Today 2017; 22:1242-1249. [PMID: 28576430 DOI: 10.1016/j.drudis.2017.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/11/2017] [Accepted: 04/18/2017] [Indexed: 01/10/2023]
Abstract
Gastric bypass surgery is effectively a polypharmacological approach for treatment of obesity, type 2 diabetes and nonalcoholic steatohepatitis (NASH). The gastric bypass mimetic approaches reviewed are fixed-dose combinatorial pharmacological approaches. There are two key concepts incorporated into these gastric bypass surgery mimetic approaches. The first key concept is that the combination of glucagon-like peptide 1 (GLP-1) and fibroblast growth factor 21 (FGF21) is essential for success of any gastric bypass surgery mimetic approach. This combination affords the potential for durable weight loss, glycemic control and reduction in liver lipids. The second key concept is that a fixed-dose combination approach is preferred over post-approval combination of the individual components because the individual components alone often lack sufficient efficacy for development.
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Posovszky C, Wabitsch M. Regulation of appetite, satiation, and body weight by enteroendocrine cells. Part 2: therapeutic potential of enteroendocrine cells in the treatment of obesity. Horm Res Paediatr 2015; 83:11-8. [PMID: 25592084 DOI: 10.1159/000369555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022] Open
Abstract
Obesity is an epidemic and medical issue. Investigating the pathways regulating appetite, food intake, and body weight is crucial to find strategies for the prevention and treatment of obesity. In the context of therapeutic strategies, we focus here on the potential of enteroendocrine cells (EECs) and their secreted hormones in the regulation of body weight. We review the role of the enteroendocrine system during weight loss after lifestyle intervention or after bariatric surgery. We discuss the therapeutic potential of EECs and their hormones as targets for new treatment strategies. In fact, targeting nutrient receptors of EECs with a nutritional approach, pharmaceutical agents or prebiotics delivered to the lumen may provide a promising new approach.
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Affiliation(s)
- Carsten Posovszky
- University Outpatient Clinic for Pediatric Gastroenterology and Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
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Malik S, Mitchell JE, Steffen K, Engel S, Wiisanen R, Garcia L, Malik SA. Recognition and management of hyperinsulinemic hypoglycemia after bariatric surgery. Obes Res Clin Pract 2015; 10:1-14. [PMID: 26522879 DOI: 10.1016/j.orcp.2015.07.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/17/2015] [Accepted: 07/06/2015] [Indexed: 02/06/2023]
Abstract
Hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGB) due to the changes in gut hormonal milieu. Physicians should be aware of this complication to ensure timely and effective treatment of post-RYGB patients, who present to them with hypoglycemic symptoms. Possible causes of hypoglycemia in these patients include late dumping syndrome, nesidioblastosis and rarely insulinoma. Systematic evaluation including history, biochemical analysis, and diagnostic testing might help in distinguishing among these diagnoses. Continuous glucose monitoring is also a valuable tool, revealing the episodes in the natural environment and can also be used to monitor treatment success. Treatment should begin with strict low carbohydrate diet, followed by medication therapy. Therapy with diazoxide, acarbose, calcium channel blockers and octreotide have been proven to be beneficial, but the response apparently is highly variable. When other treatment options fail, surgical options can be considered.
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Affiliation(s)
- Sarah Malik
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | - James E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States.
| | - Kristine Steffen
- Neuropsychiatric Research Institute, Fargo, ND, United States; North Dakota State University, United States
| | - Scott Engel
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | | | | | - Shahbaz Ali Malik
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
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Zhang X, Cheng Z, Xiao Z, Du X, Du J, Li Y, Long Y, Yu H, Zhang X, Tian H. Comparison of Short- and Mid-term Efficacy and the Mechanisms of Gastric Bypass Surgeries on Managing Obese and Nonobese Type 2 Diabetes Mellitus: A Prospective Study. Arch Med Res 2015; 46:303-9. [PMID: 26087171 DOI: 10.1016/j.arcmed.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 06/09/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS We targeted to investigate the efficacy and the mechanisms of two gastric bypass surgeries, Roux-en-y Gastric Bypass (RYGB) and Billroth II gastrojejunostomy on managing obese patients with T2DM and nonobese T2DM patients, respectively. METHODS Seven nonobese T2DM patients with gastric cancer submitted to Billroth II gastrojejunostomy were compared with nine obese T2DM patients undergoing RYGB about their baseline characteristics, weight loss and glycemic control, 3 months and 2 years after surgery. Meanwhile, β-cell function, glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and gastric inhibitory polypeptide (GIP) levels were also investigated. RESULTS Significant weight loss and improvement of glycemic control were observed in both groups and in the two follow-up periods. Reduction of body mass index was greater in obese patients with T2DM. The efficacy of Billroth II gastrojejunostomy on controlling blood glucose of nonobese T2DM was similar to that of RYGB on managing obese T2DM. Insulin levels and HOMA-IR were decreased in obese T2DM patients, whereas they remained unchanged in nonobese T2DM patients. Generally, levels of GLP-1 and PYY were increased, whereas GIP levels were decreased in both groups. CONCLUSIONS Glycemic control efficacy of Billroth II gastrojejunostomy on managing nonobese T2DM is similar to that of RYGB on treating obese T2DM in the short- and mid-term. The underlying mechanisms of both surgeries may be related to weight loss and gut hormone modulations.
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Affiliation(s)
- Xiaojuan Zhang
- Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhu Xiao
- Department of Endocrinology and Metabolism, The First People's Hospital of Chengdu, Chengdu, Sichuan, People's Republic of China
| | - Xiao Du
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Juan Du
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yang Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yang Long
- Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hongling Yu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiangxun Zhang
- Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Stojsavljević S, Gomerčić Palčić M, Virović Jukić L, Smirčić Duvnjak L, Duvnjak M. Adipokines and proinflammatory cytokines, the key mediators in the pathogenesis of nonalcoholic fatty liver disease. World J Gastroenterol 2014; 20:18070-18091. [PMID: 25561778 PMCID: PMC4277948 DOI: 10.3748/wjg.v20.i48.18070] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/22/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a condition in which excess fat accumulates in the liver of a patient with no history of alcohol abuse or other causes for secondary hepatic steatosis. The pathogenesis of NAFLD and nonalcoholic steatohepatitis (NASH) has not been fully elucidated. The “two-hit“ hypothesis is probably a too simplified model to elaborate complex pathogenetic events occurring in patients with NASH. It should be better regarded as a multiple step process, with accumulation of liver fat being the first step, followed by the development of necroinflammation and fibrosis. Adipose tissue, which has emerged as an endocrine organ with a key role in energy homeostasis, is responsive to both central and peripheral metabolic signals and is itself capable of secreting a number of proteins. These adipocyte-specific or enriched proteins, termed adipokines, have been shown to have a variety of local, peripheral, and central effects. In the current review, we explore the role of adipocytokines and proinflammatory cytokines in the pathogenesis of NAFLD. We particularly focus on adiponectin, leptin and ghrelin, with a brief mention of resistin, visfatin and retinol-binding protein 4 among adipokines, and tumor necrosis factor-α, interleukin (IL)-6, IL-1, and briefly IL-18 among proinflammatory cytokines. We update their role in NAFLD, as elucidated in experimental models and clinical practice.
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Finelli C, Padula MC, Martelli G, Tarantino G. Could the improvement of obesity-related co-morbidities depend on modified gut hormones secretion? World J Gastroenterol 2014; 20:16649-16664. [PMID: 25469034 PMCID: PMC4248209 DOI: 10.3748/wjg.v20.i44.16649] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/27/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Obesity and its associated diseases are a worldwide epidemic disease. Usual weight loss cures - as diets, physical activity, behavior therapy and pharmacotherapy - have been continuously implemented but still have relatively poor long-term success and mainly scarce adherence. Bariatric surgery is to date the most effective long term treatment for morbid obesity and it has been proven to reduce obesity-related co-morbidities, among them nonalcoholic fatty liver disease, and mortality. This article summarizes such variations in gut hormones following the current metabolic surgery procedures. The profile of gut hormonal changes after bariatric surgery represents a strategy for the individuation of the most performing surgical procedures to achieve clinical results. About this topic, experts suggest that the individuation of the crosslink among the gut hormones, microbiome, the obesity and the bariatric surgery could lead to new and more specific therapeutic interventions for severe obesity and its co-morbidities, also non surgical.
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Bala V, Rajagopal S, Kumar DP, Nalli AD, Mahavadi S, Sanyal AJ, Grider JR, Murthy KS. Release of GLP-1 and PYY in response to the activation of G protein-coupled bile acid receptor TGR5 is mediated by Epac/PLC-ε pathway and modulated by endogenous H2S. Front Physiol 2014; 5:420. [PMID: 25404917 PMCID: PMC4217307 DOI: 10.3389/fphys.2014.00420] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/11/2014] [Indexed: 12/19/2022] Open
Abstract
Activation of plasma membrane TGR5 receptors in enteroendocrine cells by bile acids is known to regulate gastrointestinal secretion and motility and glucose homeostasis. The endocrine functions of the gut are modulated by microenvironment of the distal gut predominantly by sulfur-reducing bacteria of the microbiota that produce H2S. However, the mechanisms involved in the release of peptide hormones, GLP-1 and PYY in response to TGR5 activation by bile acids and the effect of H2S on bile acid-induced release of GLP-1 and PYY are unclear. In the present study, we have identified the signaling pathways activated by the bile acid receptor TGR5 to mediate GLP-1 and PYY release and the mechanism of inhibition of their release by H2S in enteroendocrine cells. The TGR5 ligand oleanolic acid (OA) stimulated Gαs and cAMP formation, and caused GLP-1 and PYY release. OA-induced cAMP formation and peptide release were blocked by TGR5 siRNA. OA also caused an increase in PI hydrolysis and intracellular Ca2+. Increase in PI hydrolysis was abolished in cells transfected with PLC-ε siRNA. 8-pCPT-2′-O-Me-cAMP, a selective activator of Epac, stimulated PI hydrolysis, and GLP-1 and PYY release. L-Cysteine, which activates endogenous H2S producing enzymes cystathionine-γ-lyase and cystathionine-β-synthase, and NaHS and GYY4137, which generate H2S, inhibited PI hydrolysis and GLP-1 and PYY release in response to OA or 8-pCPT-2′-O-Me-cAMP. Propargylglycine, an inhibitor of CSE, reversed the effect of L-cysteine on PI hydrolysis and GLP-1 and PYY release. We conclude: (i) activation of Gαs-coupled TGR5 receptors causes stimulation of PI hydrolysis, and release of GLP-1 and PYY via a PKA-independent, cAMP-dependent mechanism involving Epac/PLC-ε/Ca2+ pathway, and (ii) H2S has potent inhibitory effects on GLP-1 and PYY release in response to TGR5 activation, and the mechanism involves inhibition of PLC-ε/Ca2+ pathway.
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Affiliation(s)
- Vanitha Bala
- Gastroenterology Division, Department of Internal Medicine, Virginia Commonwealth University Richmond, VA, USA
| | - Senthilkumar Rajagopal
- Department of Physiology, VCU Program in Enteric Neuromuscular Sciences, Virginia Commonwealth University Richmond, VA, USA
| | - Divya P Kumar
- Department of Physiology, VCU Program in Enteric Neuromuscular Sciences, Virginia Commonwealth University Richmond, VA, USA
| | - Ancy D Nalli
- Department of Physiology, VCU Program in Enteric Neuromuscular Sciences, Virginia Commonwealth University Richmond, VA, USA
| | - Sunila Mahavadi
- Department of Physiology, VCU Program in Enteric Neuromuscular Sciences, Virginia Commonwealth University Richmond, VA, USA
| | - Arun J Sanyal
- Gastroenterology Division, Department of Internal Medicine, Virginia Commonwealth University Richmond, VA, USA
| | - John R Grider
- Department of Physiology, VCU Program in Enteric Neuromuscular Sciences, Virginia Commonwealth University Richmond, VA, USA
| | - Karnam S Murthy
- Department of Physiology, VCU Program in Enteric Neuromuscular Sciences, Virginia Commonwealth University Richmond, VA, USA
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Wang KC, Huang KH, Lan YT, Fang WL, Lo SS, Li AFY, Wu CW. Outcome after curative surgery for gastric cancer patients with type 2 diabetes. World J Surg 2014; 38:431-8. [PMID: 24132827 DOI: 10.1007/s00268-013-2291-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bariatric surgery has been adapted to the management of morbid obesity, leading to not only loss of body weight but also improvement of type 2 diabetes mellitus (DM). The goal of our study was to evaluate the effect of gastrectomy in gastric cancer patients with type 2 DM. METHODS From 1989 to 2011, a total of 69 gastric cancer patients receiving curative surgery were enrolled in this study. They were diagnosed with type 2 DM preoperatively and all are alive without tumor recurrence. The clinical characteristics were compared between groups with improved or unimproved DM, and groups were also analyzed based on the extent of gastrectomy and different reconstruction methods. RESULTS Of the 69 patients, 58 received subtotal gastrectomy and 11 received total gastrectomy. The frequency of DM improvement was significantly higher after total gastrectomy than subtotal gastrectomy (81.8 vs. 36.2 %; p = 0.007). Patients with DM duration of less than 5 years tended to experience DM improvement after surgery more frequently than patients with DM duration of more than 5 years (p = 0.028). Roux-en-Y esophagojejunostomy (R-Ye) led to a higher rate of DM improvement than did R-Y gastrojejunostomy (R-Yg), especially in patients with DM duration more than 5 years. Among patients receiving duodenal bypass after gastrectomy, R-Ye was associated with a higher frequency of DM improvement than R-Yg and B-II. CONCLUSIONS The extent of gastrectomy rather than the reconstruction method played an important role in DM improvement after curative surgery for gastric cancer.
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Affiliation(s)
- Kuo-Chung Wang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 201 Section 2 Shih-Pai Road, Taipei, 11217, Taiwan
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15
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Calcaterra V, Pelizzo G, Nakib G, Larizza D, Fonte ML, De Amici M, Cena H. Hunger hormone profile monitoring after gastroplication in an adolescent. Horm Res Paediatr 2014; 80:213-6. [PMID: 24008238 DOI: 10.1159/000354301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Gut and adipose tissue hormones play an important role in energy balance control, particularly through the regulation at either short- or long-term food intake after bariatric surgery. CASE A 15-year-old obese female (BMI 42.2) who was unresponsive to medical treatment underwent gastroplication. Hunger hormone levels (leptin, ghrelin and insulin), weight loss and eating behavior were monitored at 3, 6 and 12 months after surgery. RESULTS Weight loss was obtained, progressively achieving a loss of 45.6 kg 1 year after surgery. A strong reduction in insulin concentration and insulin resistance was documented. At 3 months after the operation, a surprising leptin level drop was observed. During the following months a progressive increase in leptin levels and leptin/kg of fat mass were documented. Fasting ghrelin levels increased in the first 3 months, then fell over the next 6 months. Up to 6 months after gastroplication, we observed a less marked drop in plasma ghrelin after meal ingestion, while the values after 1 year showed a substantial fall in the postprandial period despite a further fasting ghrelin increased level. Early achievement of satiety was found. CONCLUSION Hunger hormones level changes seem to be involved in weight loss and eating behavior after gastroplication in adolescents.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric Unit, Department of the Mother and Child Health, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy
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16
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Koehestanie P, Dogan K, Berends F, Janssen I, Wahab P, Groenen M, Müller M, de Wit N. Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels. Endosc Int Open 2014; 2:E21-7. [PMID: 26134609 PMCID: PMC4423279 DOI: 10.1055/s-0034-1365222] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/08/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic implantation of a duodenal-jejunal bypass liner (DJBL) is a novel bariatric technique to induce weight loss and remission of type 2 diabetes mellitus. Placement of the DJBL mimics the bypass component of the Roux-en-Y gastric bypass (RYGB) procedure. In this observational study, we evaluated improvement of glycemic control and weight loss in the course of the treatment (0 - 24 weeks after DJBL implantation) and analyzed accompanying gut hormone responses. PATIENTS AND METHODS 12 obese individuals with type 2 diabetes were selected for DJBL implantation. Body weight, fat mass, and fasting plasma levels of glucose, insulin, C-peptide, and glycated hemoglobin (HbA1c), were analyzed at 0, 1, 4 and 24 weeks post-implant. Fasting ghrelin, gastric inhibitory peptide (GIP), and glucagon-like peptide (GLP-1) were determined at 0, 1 and 4 weeks post-implant. RESULTS Besides significant weight loss, fat mass, fasting insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) index were also significantly decreased after DJBL implantation and a 42 % reduction was found in diabetes medication (P < 0.05). The fasting GLP-1 response in the first 4 weeks post-implant was significantly correlated with the fasting insulin and HOMA-IR response. Fasting ghrelin was found to be significantly elevated, in contrast to the decrease in ghrelin that is found after RYGB surgery. CONCLUSIONS DJBL implantation provoked significant weight loss, a decrease in fat mass, and an early remission of type 2 diabetes, comparable to results seen after RYGB surgery. Gut hormone analyses revealed a potential role of fasting GLP-1 in early remission of type 2 diabetes. Interestingly, the DJBL-induced elevation of ghrelin contradicts the suggested role of reduced ghrelin levels after RYGB in improvement of glycemic control.
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Affiliation(s)
| | - Kemal Dogan
- Department of General Surgery, Rijnstate, Arnhem, The Netherlands
| | - Frits Berends
- Department of General Surgery, Rijnstate, Arnhem, The Netherlands
| | - Ignace Janssen
- Department of General Surgery, Rijnstate, Arnhem, The Netherlands
| | - Peter Wahab
- Department of Gastroenterology, Rijnstate, Arnhem, The Netherlands
| | - Marcel Groenen
- Department of Gastroenterology, Rijnstate, Arnhem, The Netherlands
| | - Michael Müller
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Nicole de Wit
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands,Corresponding author Nicole de Wit, PhD Human Nutrition,Wageningen UniversityBomenweg 2Wageningen 6703 HDThe Netherlands
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Dailey MJ, Moghadam AA, Moran TH. Nutrient-specific feeding and endocrine effects of jejunal infusions in obese animals. Am J Physiol Regul Integr Comp Physiol 2014; 306:R420-8. [PMID: 24452547 DOI: 10.1152/ajpregu.00410.2013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Intestinal nutrient infusions result in variable decreases in food intake and body weight based on the nutrient type and the specific intestinal infusion site. We previously found that intrajejunal infusions of a fatty acid and glucose, but not casein hydrolysate, decreases food intake and body weight in lean chow-fed laboratory rats. To test whether obese, high fat-fed animals would show similar decreases in food intake and body weight in response to intrajejunal infusions of the same nutrients, equal kilocalorie loads of these nutrients (11.4 kcal) or vehicle were infused into the jejunum of obese, high fat-fed male Sprague-Dawley rats over 7 h/day for 5 consecutive days. Food intake was continuously monitored, and body weight was measured daily. After the infusion on the final day, rats were killed and plasma was collected. Similar to lean chow-fed rats, intrajejunal infusions of linoleic acid (LA) and glucose (Glu), but not casein hydrolysate (Cas), suppressed food intake with no compensatory increase in food intake after the infusion period. In contrast to lean chow-fed rats, only the LA, and not the Glu or Cas, produced decreases in body weight in the obese high fat-fed rat. There also were no differences in plasma glucagon-like peptide-1 levels in any of the nutrient infusion groups compared with saline infusion. These results suggest that there is a differential response to the same nutrients in lean vs. obese animals.
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Affiliation(s)
- Megan J Dailey
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois; and
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18
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Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, Bucher HC, Nordmann AJ. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ 2013; 347:f5934. [PMID: 24149519 PMCID: PMC3806364 DOI: 10.1136/bmj.f5934] [Citation(s) in RCA: 870] [Impact Index Per Article: 79.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. DESIGN Systematic review and meta-analysis based on a random effects model. DATA SOURCES Searches of Medline, Embase, and the Cochrane Library from their inception to December 2012 regardless of language or publication status. ELIGIBILITY CRITERIA Eligible studies were randomised controlled trials with ≥ 6 months of follow-up that included individuals with a body mass index ≥ 30, compared current bariatric surgery techniques with non-surgical treatment, and reported on body weight, cardiovascular risk factors, quality of life, or adverse events. RESULTS The meta-analysis included 11 studies with 796 individuals (range of mean body mass index at baseline 30-52). Individuals allocated to bariatric surgery lost more body weight (mean difference -26 kg (95% confidence interval -31 to -21)) compared with non-surgical treatment, had a higher remission rate of type 2 diabetes (relative risk 22.1 (3.2 to 154.3) in a complete case analysis; 5.3 (1.8 to 15.8) in a conservative analysis assuming diabetes remission in all non-surgically treated individuals with missing data) and metabolic syndrome (relative risk 2.4 (1.6 to 3.6) in complete case analysis; 1.5 (0.9 to 2.3) in conservative analysis), greater improvements in quality of life and reductions in medicine use (no pooled data). Plasma triglyceride concentrations decreased more (mean difference -0.7 mmol/L (-1.0 to -0.4) and high density lipoprotein cholesterol concentrations increased more (mean difference 0.21 mmol/L (0.1 to 0.3)). Changes in blood pressure and total or low density lipoprotein cholesterol concentrations were not significantly different. There were no cardiovascular events or deaths reported after bariatric surgery. The most common adverse events after bariatric surgery were iron deficiency anaemia (15% of individuals undergoing malabsorptive bariatric surgery) and reoperations (8%). CONCLUSIONS Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42012003317 (www.crd.york.ac.uk/PROSPERO).
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Affiliation(s)
- Viktoria L Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, CH-4031 Basel, Switzerland
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Zhang XJ, Xiao Z, Yu HL, Zhang XX, Cheng Z, Tian HM. Short-term glucose metabolism and gut hormone modulations after Billroth II gastrojejunostomy in nonobese gastric cancer patients with type 2 diabetes mellitus, impaired glucose tolerance and normal glucose tolerance. Arch Med Res 2013; 44:437-43. [PMID: 23973197 DOI: 10.1016/j.arcmed.2013.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 07/19/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Roux-en-Y gastric bypass (RYGB) is effective in controlling blood glucose in obese patients with type 2 diabetes (T2DM). The alterations of gut hormones involving in glucose metabolism may play an important role. Our aim was to explore the short-term effects of Billroth II gastrojejunostomy (a similar type of RYGB) on glucose metabolism and gut hormone modulations in nonobese patients with different levels of blood glucose tolerance. METHODS Twenty one nonobese gastric cancer patients with different levels of blood glucose tolerance were submitted to Billroth II gastrojejunostomy. Among them, seven had T2DM, seven with impaired glucose tolerance (IGT) and the other seven had normal glucose tolerance (NGT). Body weight, glucose parameters, responses of plasma glucagon-like peptide-1 (GLP-1), peptide YY (PYY) and gastric inhibitory polypeptide (GIP) to 75 g glucose were measured at baseline and 3 months after surgery. RESULTS Similar weight losses were observed in all groups. Blood glucose was reduced in T2DM and IGT patients. Fasting and 30-min plasma glucose were increased significantly in NGT. GLP-1 showed insignificant alterations in all groups. PYY was evaluated in T2DM and IGT but remained unchanged in the NGT group. Decreased fasting and AUC GIP were observed in patients with T2DM; however, fasting and 30-min GIP were increased in NGT patients. CONCLUSIONS Billroth II gastrojejunostomy is effective in reducing blood glucose in nonobese patients with T2DM and IGT but could deteriorate early blood glucose in nonobese NGT in a 3-month time period. Variations of glucose and gut hormone changes in the three groups suggest a role of proximal intestine in the pathophysiology of T2DM.
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Affiliation(s)
- Xiao-juan Zhang
- Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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Finelli C, Tarantino G. What is the role of adiponectin in obesity related non-alcoholic fatty liver disease? World J Gastroenterol 2013; 19:802-12. [PMID: 23430039 PMCID: PMC3574877 DOI: 10.3748/wjg.v19.i6.802] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 12/03/2012] [Accepted: 12/15/2012] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is recognized as the most common type of chronic liver disease in Western countries. Insulin resistance is a key factor in the pathogenesis of NAFLD, the latter being considered as the hepatic component of insulin resistance or obesity. Adiponectin is the most abundant adipose-specific adipokine. There is evidence that adiponectin decreases hepatic and systematic insulin resistance, and attenuates liver inflammation and fibrosis. Adiponectin generally predicts steatosis grade and the severity of NAFLD; however, to what extent this is a direct effect or related to the presence of more severe insulin resistance or obesity remains to be addressed. Although there is no proven pharmacotherapy for the treatment of NAFLD, recent therapeutic strategies have focused on the indirect upregulation of adiponectin through the administration of various therapeutic agents and/or lifestyle modifications. In this adiponectin-focused review, the pathogenetic role and the potential therapeutic benefits of adiponectin in NAFLD are analyzed systematically.
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Calcaterra V, Cena H, Nakib G, Fonte M, Vandoni M, Valenti A, Biancotti V, Pelizzo G. Robotic-assisted gastroplication in a morbidly obese adolescent: early improvement in metabolic and neurohormonal parameters. Pediatr Rep 2012; 4:e36. [PMID: 23355936 PMCID: PMC3555206 DOI: 10.4081/pr.2012.e36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/22/2012] [Indexed: 01/07/2023] Open
Abstract
Bariatric surgery has to be considered in the management of severely obese adolescents when all conservative measures have been proven to be unresponsive. Short term metabolic and neurohormonal profile changes after robotic-assisted gastroplication are evaluated. The benefits and the usefulness of this surgical - reversal procedure in adolescent need to be defined. Fiveteen years old girl with body mass index 42.2 kg/m(2), hyperinsulinism, hyperandrogenism, amenorrhea, polycystic ovarian syndrome, hypertension with left ventricular hypertrophy. Gastric volume after surgical procedure reduction was 80-100 mL. One month postoperatively significant weigh loss was obtained. Insulin levels, insulin-resistance, leptin and ghrelin concentration were substantially ameliorated. We can conclude that bariatric surgery should be considered for a minority of severely obese adolescents under the supervision of a multidisciplinary pediatric team. Our experience confirmed that the gastroplication is safe, feasible and effective and furthermore is a reversible technique. The early improvement of the obesity co-morbities is allowed. The increased surgical accuracy in robotic assistance could limit postoperative complications rate in obese adolescents.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine University of Pavia and Department of Pediatrics, IRCCS Policlinico San Matteo Foundation Pavia
| | - Hellas Cena
- Department of Public Health, Neurosciences, Experimental and Forensis Medicine-Section of Human Nutrition
| | - Ghassan Nakib
- Department of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia
| | - Marialuisa Fonte
- Department of Public Health, Neurosciences, Experimental and Forensis Medicine-Section of Human Nutrition
| | - Matteo Vandoni
- Department of Public Health, Neurosciences, Experimental and Forensis Medicine-School of Movement Sciences, Italy
| | - Alessandra Valenti
- Department of Public Health, Neurosciences, Experimental and Forensis Medicine-Section of Human Nutrition
| | - Veronica Biancotti
- Department of Public Health, Neurosciences, Experimental and Forensis Medicine-School of Movement Sciences, Italy
| | - Gloria Pelizzo
- Department of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation and University of Pavia
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