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Bettini S, Quinto G, Neunhaeuserer D, Battista F, Belligoli A, Milan G, Gasperetti A, Vettor R, Ermolao A, Busetto L. Edmonton Obesity Staging System: an improvement by cardiopulmonary exercise testing. Int J Obes (Lond) 2021; 45:1949-1957. [PMID: 33990701 DOI: 10.1038/s41366-021-00856-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Different approaches are used to classify obesity severity. Beyond classical anthropometric measurements, the Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. However, this method has some limitations, principally due to the absence of an objective measure for physical impairment. The aim of our study is thus to overcome this limitation suggesting a new functional parameter obtained by cardiopulmonary exercise testing (CPET), i.e., cardiorespiratory fitness (CRF), expressed as weight-adjusted peak oxygen consumption (VO2peak/kg). SUBJECTS/METHODS This observational cross-sectional study conducted on a population of 843 patients affected by obesity finally enrolled 500 subjects. Every patient underwent clinical, anthropometric, biochemical assessment and CPET. First, participants have been classified according to standard EOSS in five stages. Second, patients were reclassified according to the new modified EOSS (EOSS-CRF) based on their age- and gender-appropriate VO2peak/kg percentiles as reported in the healthy normal-weight population of the FRIEND registry. RESULTS VO2peak/kg was significantly different between standard EOSS classes 1 and 2 and classes 1 and 3 (ANCOVA p model = 0.004), whereas patients in classes 2 and 3 showed similar CRF. The EOSS-CRF classification varied in number of patients in each class compared to EOSS, particularly with a shift from class 2 to class 3. Moreover, CRF showed that physical impairment is less addressed by EOSS when compared to EOSS-CRF. CONCLUSIONS The integration of EOSS with CRF allowed us to assign to each patient a severity index that considers not only clinical parameters, but also their functional impairment through a quantitative and prognostically important parameter (VO2peak/kg). This improvement of the staging system may also provide a better approach to identify individuals at increased risk of mortality leading to targeted therapeutic management and prognostic risk stratification for patients with obesity.
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Affiliation(s)
- Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy
| | - Giulia Quinto
- Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy.
| | - Daniel Neunhaeuserer
- Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy
| | - Francesca Battista
- Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy
| | - Anna Belligoli
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy
| | - Gabriella Milan
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Gasperetti
- Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy
| | - Roberto Vettor
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Regional Center for the Therapeutic Prescription of Exercise in Chronic Disease, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Padova, Italy
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Bertoni L, Valentini R, Zattarin A, Belligoli A, Bettini S, Vettor R, Foletto M, Spinella P, Busetto L. Assessment of Protein Intake in the First Three Months after Sleeve Gastrectomy in Patients with Severe Obesity. Nutrients 2021; 13:nu13030771. [PMID: 33673465 PMCID: PMC7997257 DOI: 10.3390/nu13030771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
An adequate protein intake prevents the loss of fat-free mass during weight loss. Laparoscopic sleeve gastrectomy (SG) jeopardizes protein intake due to post-operative dietary restriction and intolerance to protein-rich foods. The purpose of this study is to evaluate protein intake in the first three months after SG. We evaluated, 1 month and 3 months after surgery, 47 consecutive patients treated with SG. Protein intake, both from foods and from protein supplementation, was assessed through a weekly dietary record. Patients consumed 30.0 ± 10.2 g of protein/day on average from foods in the first month, with a significant increase to 34.9 ± 4.8 g of protein/day in the third month (p = 0.003). The use of protein supplementation significantly increased total protein intake to 42.3 ± 15.9 g protein/day (p < 0.001) in the first month and to 39.6 ± 14.2 g of protein/day (p = 0.002) in the third one. Compliance with supplement consumption was 63.8% in the first month and only 21.3% in the third month. In conclusion, both one and three months after SG, protein intake from foods was not sufficient. The use of modular supplements seems to have a significant impact on protein intake, but nevertheless it remains lower than recommended.
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Affiliation(s)
- Lucrezia Bertoni
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Romina Valentini
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
| | - Alessandra Zattarin
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Anna Belligoli
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Silvia Bettini
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Roberto Vettor
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Mirto Foletto
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
| | - Paolo Spinella
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
| | - Luca Busetto
- Department of Medicine, University of Padova, 35128 Padova, Italy; (L.B.); (R.V.); (A.Z.); (A.B.); (S.B.); (R.V.); (P.S.)
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, 35128 Padova, Italy;
- Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-8250
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Battista F, Belligoli A, Neunhaeuserer D, Gasperetti A, Bettini S, Compagnin C, Marchese R, Quinto G, Bergamin M, Vettor R, Busetto L, Ermolao A. Metabolic Response to Submaximal and Maximal Exercise in People with Severe Obesity, Prediabetes, and Diabetes. Obes Facts 2021; 14:415-424. [PMID: 34344002 PMCID: PMC8406246 DOI: 10.1159/000517589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Metabolic adaptations to maximal physical exercise in people with obesity (PwO) are scarcely described. This cross-sectional study evaluates the metabolic response to exercise via the respiratory exchange ratio (RER) in PwO and different degrees of glycemic control. METHODS Eighty-five PwO (body mass index 46.0 [39.0-54.0] kg/m2), that is, 32 normoglycemic (Ob-N), 25 prediabetic (Ob-preDM), and 28 diabetic (Ob-T2DM) subjects and 18 healthy subjects performed an incremental, maximal cardiopulmonary exercise test. The RER was measured at rest (RERrest) and at peak exercise (RERpeak). RESULTS RERpeak was significantly higher in healthy subjects than that in PwO. Among those, RERpeak was significantly higher in Ob-N than that in Ob-preDM and Ob-T2DM (1.20 [1.15-1.27] vs. 1.18 [1.10-1.22] p = 0.04 and vs. 1.14 [1.10-1.18] p < 0.001, respectively). Accordingly, ΔRER (RERpeak-RERrest) was lower in Ob-preDM and Ob-T2DM than that in Ob-N (0.32 [0.26-0.39] p = 0.04 and 0.29 [0.24-0.36] p < 0.001 vs. 0.38 [0.32-0.43], respectively), while no significant difference was found in ΔRER between Ob-preDM and Ob-T2DM and not even between Ob-N and healthy subjects. Moreover, ΔRER in PwO correlated with glucose area under curve (p = 0.002). CONCLUSIONS PwO demonstrate restricted metabolic response during maximal exercise. Particularly, those with prediabetes already show metabolic inflexibility during exercise, similarly to those with type 2 diabetes. These findings also suggest a potential role of cardiopulmonary exercise testing in detecting early metabolic alterations in PwO.
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Affiliation(s)
- Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy,
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy,
| | - Anna Belligoli
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
- Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padova, Italy
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
| | - Silvia Bettini
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
- Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padova, Italy
| | - Chiara Compagnin
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
- Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padova, Italy
| | - Riccardo Marchese
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
- Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padova, Italy
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
| | - Marco Bergamin
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
| | - Roberto Vettor
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
- Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padova, Italy
| | - Luca Busetto
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
- Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Center for the Study and the Integrated Treatment of Obesity, Padova Hospital, Padova, Italy
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Bettini S, Belligoli A, Fabris R, Busetto L. Correction to: Diet approach before and after bariatric surgery. Rev Endocr Metab Disord 2020; 21:449. [PMID: 32803692 PMCID: PMC7853030 DOI: 10.1007/s11154-020-09583-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The original version of this article unfortunately, has the incorrect title reported in the published paper.
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Affiliation(s)
- Silvia Bettini
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Anna Belligoli
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Roberto Fabris
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Luca Busetto
- Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy.
- Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128, Padova, Italy.
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Sanna M, Borgo C, Compagnin C, Favaretto F, Vindigni V, Trento M, Bettini S, Comin A, Belligoli A, Rugge M, Bassetto F, Donella-Deana A, Vettor R, Busetto L, Milan G. White Adipose Tissue Expansion in Multiple Symmetric Lipomatosis Is Associated with Upregulation of CK2, AKT and ERK1/2. Int J Mol Sci 2020; 21:ijms21217933. [PMID: 33114687 PMCID: PMC7662313 DOI: 10.3390/ijms21217933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023] Open
Abstract
Multiple symmetric lipomatosis (MSL) is a rare disorder characterized by overgrowing lipomatous tissue (LT) in the subcutaneous adipose tissue (SAT). What LT is and how it expands are not completely understood; previous data suggested that it could derive from brown AT precursors. In six MSL type I patients, we compared LT morphology by histological and immunohistochemistry (IHC) analysis, gene expression, by qPCR, kinase activity, by Western Blot and in vitro assay to paired-control SAT using AT from patients with pheochromocytoma as a human browning reference. In the stromal vascular fraction (SVF), we quantified adipose stem cells (ASCs) by flow cytometry, the proliferation rate, white and beige adipogenic potential and clonogenicity and adipogenicity by a limiting dilution assay. LT displayed white AT morphology and expression pattern and did not show increased levels of the brown-specific marker UCP1. In LT, we evidenced AKT, CK2 and ERK1/2 hyperactivation. LT-SVF contained increased ASCs, proliferated faster, sprouted clones and differentiated into adipocytes better than the control, displaying enhanced white adipogenic potential but not increased browning compared to SAT. In conclusion, LT is a white AT depot expanding by hyperplasia through increased stemness and enhanced white adipogenesis upregulating AKT, CK2 and ERK1/2, which could represent new targets to counteract MSL.
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Affiliation(s)
- Marta Sanna
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Christian Borgo
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy; (C.B.); (A.D.-D.)
| | - Chiara Compagnin
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Francesca Favaretto
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Vincenzo Vindigni
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padua, 35128 Padua, Italy; (V.V.); (F.B.)
| | - Mariangela Trento
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy; (M.T.); (M.R.)
| | - Silvia Bettini
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Alessandra Comin
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Anna Belligoli
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Massimo Rugge
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy; (M.T.); (M.R.)
| | - Franco Bassetto
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padua, 35128 Padua, Italy; (V.V.); (F.B.)
| | - Arianna Donella-Deana
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy; (C.B.); (A.D.-D.)
| | - Roberto Vettor
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Luca Busetto
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
| | - Gabriella Milan
- Endocrine-Metabolic Laboratory, Department of Medicine, Internal Medicine 3, University of Padua, 35128 Padua, Italy; (M.S.); (C.C.); (F.F.); (S.B.); (A.C.); (A.B.); (R.V.); (L.B.)
- Correspondence: ; Tel.: +39-049-8218550; Fax: +39-049-8218555
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Abstract
Bariatric surgery (BS) is today the most effective therapy for inducing long-term weight loss and for reducing comorbidity burden and mortality in patients with severe obesity. On the other hand, BS may be associated to new clinical problems, complications and side effects, in particular in the nutritional domain. Therefore, the nutritional management of the bariatric patients requires specific nutritional skills. In this paper, a brief overview of the nutritional management of the bariatric patients will be provided from pre-operative to post-operative phase. Patients with severe obesity often display micronutrient deficiencies when compared to normal weight controls. Therefore, nutritional status should be checked in every patient and correction of deficiencies attempted before surgery. At present, evidences from randomized and retrospective studies do not support the hypothesis that pre-operative weight loss could improve weight loss after BS surgery, and the insurance-mandated policy of a preoperative weight loss as a pre-requisite for admission to surgery is not supported by medical evidence. On the contrary, some studies suggest that a modest weight loss of 5-10% in the immediate preoperative period could facilitate surgery and reduce the risk of complications. Very low calories diet (VLCD) and very low calories ketogenic diets (VLCKD) are the most frequently used methods for the induction of a pre-operative weight loss today. After surgery, nutritional counselling is recommended in order to facilitate the adaptation of the eating habits to the new gastro-intestinal physiology. Nutritional deficits may arise according to the type of bariatric procedure and they should be prevented, diagnosed and eventually treated. Finally, specific nutritional problems, like dumping syndrome and reactive hypoglycaemia, can occur and should be managed largely by nutritional manipulation. In conclusion, the nutritional management of the bariatric patients requires specific nutritional skills and the intervention of experienced nutritionists and dieticians.
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Affiliation(s)
- Silvia Bettini
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Anna Belligoli
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Roberto Fabris
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Luca Busetto
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy.
- Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, Padova, 35128, Italy.
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Abstract
PURPOSE OF REVIEW Bariatric surgery is today the most effective therapy for weight loss and reduction of comorbidity burden in patients with severe obesity. However, bariatric surgery does not benefit equally all the patients. A consistent variability in outcomes has been observed. Predicting responses to bariatric surgery could be an important tool in clinical practice, by improving patients' selection or by identifying patients in which more aggressive follow-up and post-operative intervention should be applied. Predictive factors for weight loss, weight regain, diabetes remission and recurrence are briefly reviewed in this paper. RECENT FINDINGS Many pre-operative factors have been proposed as negative or positive predictors of body weight reduction after surgery. However, none of these factors has been consistently demonstrated to have a sufficiently strong predictive power to influence eligibility to bariatric surgery itself. Weight regain can occur after bariatric surgery and its probability seems to be more influenced by post-operative behavioral factors than by pre-operative predictors. Several effective scores have been developed to predict diabetes remission after surgery, however long-term maintenance and diabetes recurrence after surgery seem again more influenced by post-operative behaviors and weight loss maintenance. In general, more attention and active interventions to pre-operative and post-operative eating behaviors and lifestyle modifications are probably more important at the clinical level than the search of pre-operative predictors of long-term outcomes.
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Affiliation(s)
- Anna Belligoli
- Center for the Study and the Integrated Treatment of Obesity, Padova University Hospital, Padova, Italy
| | - Silvia Bettini
- Center for the Study and the Integrated Treatment of Obesity, Padova University Hospital, Padova, Italy
| | - Gianni Segato
- Department of Surgery, "San Bortolo" Hospital, Vicenza, Italy
| | - Luca Busetto
- Center for the Study and the Integrated Treatment of Obesity, Padova University Hospital, Padova, Italy.
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Reggiani F, Carraro M, Belligoli A, Sanna M, dal Prà C, Favaretto F, Ferrari C, Vettor R, Tosatto SCE. In silico prediction of blood cholesterol levels from genotype data. PLoS One 2020; 15:e0227191. [PMID: 32040480 PMCID: PMC7010235 DOI: 10.1371/journal.pone.0227191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Abstract
In this work we present a framework for blood cholesterol levels prediction from genotype data. The predictor is based on an algorithm for cholesterol metabolism simulation available in literature, implemented and optimized by our group in the R language. The main weakness of the former simulation algorithm was the need of experimental data to simulate mutations in genes altering the cholesterol metabolism. This caveat strongly limited the application of the model in the clinical practice. In this work we present how this limitation could be bypassed thanks to an optimization of model parameters based on patient cholesterol levels retrieved from literature. Prediction performance has been assessed taking into consideration several scoring indices currently used for performance evaluation of machine learning methods. Our assessment shows how the optimization phase improved model performance, compared to the original version available in literature.
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Affiliation(s)
- Francesco Reggiani
- Department of Biomedical Sciences, University of Padua, Padua, Italy
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Marco Carraro
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Anna Belligoli
- Clinica Medica 3, Department of Medicine—DIMED, School of Medicine, University of Padua, Padua, Italy
| | - Marta Sanna
- Clinica Medica 3, Department of Medicine—DIMED, School of Medicine, University of Padua, Padua, Italy
| | - Chiara dal Prà
- Clinica Medica 3, Department of Medicine—DIMED, School of Medicine, University of Padua, Padua, Italy
| | - Francesca Favaretto
- Clinica Medica 3, Department of Medicine—DIMED, School of Medicine, University of Padua, Padua, Italy
| | - Carlo Ferrari
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine—DIMED, School of Medicine, University of Padua, Padua, Italy
| | - Silvio C. E. Tosatto
- Department of Biomedical Sciences, University of Padua, Padua, Italy
- CNR Institute of Neuroscience, Padua, Italy
- * E-mail:
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Neunhaeuserer D, Ortolan S, Patti A, Gasperetti A, Savalla F, Battista F, Gobbo S, Bettini S, Belligoli A, Ermolao A. Functional Evaluation and VO2-kinetics in Obese Patients Before and After Sleeve Gastrectomy. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561758.11944.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bettini S, Bordigato E, Milan G, Dal Pra' C, Favaretto F, Belligoli A, Sanna M, Serra R, Foletto M, Prevedello L, Busetto L, Fassina G, Vettor R, Fabris R. SCCA-IgM as a Potential Biomarker of Non-Alcoholic Fatty Liver Disease in Patients with Obesity, Prediabetes and Diabetes Undergoing Sleeve Gastrectomy. Obes Facts 2019; 12:291-306. [PMID: 31104052 PMCID: PMC6696770 DOI: 10.1159/000499717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/16/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has a high prevalence in obesity and its presence should be screened. Laparoscopic sleeve gastrectomy (LSG) is an effective treatment for obesity, but its effects on NAFLD are still to be firmly established. The diagnosis of non-alcoholic steatohepatitis (NASH) is currently performed by liver biopsy, a costly and invasive procedure. Squamous cell carcinoma antigen-IgM (SCCA-IgM) is a biomarker of viral hepatitis to hepatocellular carcinoma development and its role in NAFLD to NASH progression has not yet been investigated. OBJECTIVE The aim of this study was to evaluate SCCA-IgM as a non-invasive biomarker of NAFLD/NASH in patients with different degrees of metabolic-complicated obesity before and after LSG. METHOD Fifty-six patients with obesity were studied before and 12 months after LSG; anthropometric, biochemical, clinical, and imaging data were collected. RESULTS At baseline steatosis was strongly associated with the glycaemic profile (p = 0.016) and was already present in prediabetic patients with obesity (82%). Only 3 patients had an SCCA-IgM level above the normal cut-off. SCCA-IgM titre did not change according to glycaemic profile or steatosis. Metabolic and inflammatory factors and transaminases significantly reduced after LSG-induced weight loss, except for SCCA-IgM. The ALT/AST ratio decreased post-LSG correlated with BMI (r = 0.297, p = 0.031), insulin (r = 0.354, p = 0.014), and triglycerides (r = 0.355, p = 0.009) reduction. CONCLUSIONS Our results confirm the tight link between NAFLD and metabolic complications, suggesting prediabetes as a new risk factor of steatosis. SCCA-IgM does not seem to have a role in the identification and prognosis of NAFLD.
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MESH Headings
- Adult
- Antigens, Neoplasm/blood
- Antigens, Neoplasm/immunology
- Biomarkers/blood
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/surgery
- Female
- Follow-Up Studies
- Gastrectomy/methods
- Gastrectomy/rehabilitation
- Humans
- Immunoglobulin M/blood
- Male
- Middle Aged
- Non-alcoholic Fatty Liver Disease/blood
- Non-alcoholic Fatty Liver Disease/complications
- Non-alcoholic Fatty Liver Disease/diagnosis
- Non-alcoholic Fatty Liver Disease/surgery
- Obesity/blood
- Obesity/complications
- Obesity/diagnosis
- Obesity/surgery
- Obesity, Morbid/blood
- Obesity, Morbid/complications
- Obesity, Morbid/diagnosis
- Obesity, Morbid/surgery
- Prediabetic State/blood
- Prediabetic State/complications
- Prediabetic State/diagnosis
- Prediabetic State/surgery
- Prognosis
- Risk Factors
- Serpins/blood
- Serpins/immunology
- Treatment Outcome
- Weight Loss
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Affiliation(s)
- Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy,
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy,
| | - Emanuel Bordigato
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Gabriella Milan
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Chiara Dal Pra'
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Francesca Favaretto
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Anna Belligoli
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Marta Sanna
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Roberto Serra
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Mirto Foletto
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Luca Prevedello
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | | | - Roberto Vettor
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Roberto Fabris
- Center for the Study and Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- Internal Medicine 3, Department of Medicine, University Hospital of Padua, Padua, Italy
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Bettini S, Favaretto F, Compagnin C, Belligoli A, Sanna M, Fabris R, Serra R, Dal Prà C, Prevedello L, Foletto M, Vettor R, Milan G, Busetto L. Resting Energy Expenditure, Insulin Resistance and UCP1 Expression in Human Subcutaneous and Visceral Adipose Tissue of Patients With Obesity. Front Endocrinol (Lausanne) 2019; 10:548. [PMID: 31440209 PMCID: PMC6692889 DOI: 10.3389/fendo.2019.00548] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/23/2019] [Indexed: 01/31/2023] Open
Abstract
Determinants of resting energy expenditure (REE) in humans are still under investigation, especially the association with insulin resistance. Brown adipose tissue (AT) regulates energy expenditure through the activity of the uncoupling protein 1 (UCP1). White AT browning is the process by which some adipocytes within AT depots acquire properties of brown adipocytes ("brite" adipocytes) and it correlates with metabolic improvement. We analyzed determinants of REE in patients with obesity and assessed UCP1 expression as a "brite" marker in abdominal subcutaneous AT (SAT) and visceral omental AT (VAT). Clinical data, REE, free fat mass (FFM), and fat mass (FM) were determined in 209 patients with obesity. UCP1, PPARG coactivator 1 alpha (PPARGC1A), transcription factor A, mitochondrial (TFAM), T-box transcription factor 1 (TBX1), and solute carrier family 27 member 1 (SLC27A1) expression was assayed in SAT and VAT samples, obtained during sleeve gastrectomy from 62 patients with obesity. REE and body composition data were also available for a subgroup of 35 of whom. In 209 patients with obesity a multiple regression model was computed with REE as the dependent variable and sex, waist, FFM, FM, homeostasis model assessment-insulin resistance (HOMA), interleukin-6 and High Density Lipoprotein-cholesterol as the independent variables. Only FFM, FM and HOMA were independently correlated with REE (r = 0.787, AdjRsqr = 0.602). In each patient VAT displayed a higher UCP1, PPARGC1A, TFAM, TBX1, and SLC27A1 expression than SAT and UCP1 expression in VAT (UCP1-VAT) correlated with Body Mass Index (BMI) (r = 0.287, p < 0.05). Introducing UCP1-VAT in the multivariate model, we showed that FFM, HOMA, interleukin-6, High Density Lipoprotein-cholesterol, and UCP1-VAT were independent factors correlated with REE (r = 0.736, AdjRsqr = 0.612). We confirmed that REE correlates with FFM, FM and HOMA in a large cohort of patients. Our results clearly showed that UCP1-VAT expression was significantly increased in severe human obesity (BMI > 50 kg/m2) and that it behaved as an independent predictor of REE. Lastly, we suggest that an increased REE and browning in metabolically complicated severe obesity could represent an effort to counteract further weight gain.
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Affiliation(s)
- Silvia Bettini
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
- *Correspondence: Silvia Bettini
| | - Francesca Favaretto
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Chiara Compagnin
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Anna Belligoli
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Marta Sanna
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Roberto Fabris
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Roberto Serra
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Chiara Dal Prà
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Luca Prevedello
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Mirto Foletto
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Roberto Vettor
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Gabriella Milan
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Luca Busetto
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, Padua, Italy
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
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Belligoli A, Sanna M, Serra R, Fabris R, Pra' CD, Conci S, Fioretto P, Prevedello L, Foletto M, Vettor R, Busetto L. Incidence and Predictors of Hypoglycemia 1 Year After Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 27:3179-3186. [PMID: 28547566 DOI: 10.1007/s11695-017-2742-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Hypoglycemia is a known adverse event following gastric bypass. The incidence of hypoglycemia after laparoscopic sleeve gastrectomy (LSG) is still under investigation. The aim of our study was to verify the presence of oral glucose tolerance test (OGTT)-related hypoglycemia after LSG and to identify any baseline predictors of its occurrence. METHODS We analyzed 197 consecutive non-diabetic morbid obese patients that underwent LSG. All patients were studied before and 12 months after LSG. Evaluation included anthropometric parameters, 3-h OGTT for blood glucose (BG), insulin and c-peptide, lipid profile, interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), highly sensitive C-reactive protein (hsCRP), and leptin. Hypoglycemia was defined as BG ≤ 2.7 mmol/l. RESULTS After surgery, 180 patients completed the OGTT. Eleven patients did not complete the test for gastric intolerance, and in six patients, the test was stopped earlier for the onset of severe symptomatic hypoglycemia. Of the patients, 61/186 (32.8%) had at least one OGTT-related hypoglycemia. The highest frequency of hypoglycemic events occurred 150' after glucose load (20.2%). At baseline, patients with hypoglycemic events after surgery (Hypo) were younger (40 ± 11 vs 46 ± 10 years; p < 0.001), less obese (BMI 46 ± 5.7 vs 48.4 ± 7.9 kg/m2; p < 0.05), and had a worse lipid profile as compared to patients without hypoglycemic events (N-Hypo). Moreover, after LSG, Hypo patients compared with N-Hypo presented a higher weight loss (%EBMIL 80 ± 20 vs 62 ± 21%; p < 0.001). Low age, low fasting glucose, and high triglyceride levels before LSG were independent predictors of hypoglycemia development after surgery (r 2 = 0.131). CONCLUSION These findings confirm the high incidence of post-prandial hypoglycemia 1 year after LSG. Hypoglycemia is more frequent in younger patients with lower fasting glucose and higher triglyceride levels before surgery.
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Affiliation(s)
- Anna Belligoli
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy. .,Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35100, Padova, Italy.
| | - Marta Sanna
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Roberto Serra
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Roberto Fabris
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Chiara Dal Pra'
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Scilla Conci
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Paola Fioretto
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Luca Prevedello
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Mirto Foletto
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Roberto Vettor
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
| | - Luca Busetto
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padova, Padova, Italy
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Bettini S, Bordigato E, Fabris R, Serra R, Dal Pra’ C, Belligoli A, Sanna M, Compagnin C, Foletto M, Prevedello L, Fioretto P, Vettor R, Busetto L. Modifications of Resting Energy Expenditure After Sleeve Gastrectomy. Obes Surg 2018. [DOI: 10.1007/s11695-018-3190-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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14
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Wright LE, Vecellio Reane D, Milan G, Terrin A, Di Bello G, Belligoli A, Sanna M, Foletto M, Favaretto F, Raffaello A, Mammucari C, Nitti D, Vettor R, Rizzuto R. Increased mitochondrial calcium uniporter in adipocytes underlies mitochondrial alterations associated with insulin resistance. Am J Physiol Endocrinol Metab 2017; 313:E641-E650. [PMID: 28790027 PMCID: PMC6109647 DOI: 10.1152/ajpendo.00143.2016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 01/14/2023]
Abstract
Intracellular calcium influences an array of pathways and affects cellular processes. With the rapidly progressing research investigating the molecular identity and the physiological roles of the mitochondrial calcium uniporter (MCU) complex, we now have the tools to understand the functions of mitochondrial Ca2+ in the regulation of pathophysiological processes. Herein, we describe the role of key MCU complex components in insulin resistance in mouse and human adipose tissue. Adipose tissue gene expression was analyzed from several models of obese and diabetic rodents and in 72 patients with obesity as well as in vitro insulin-resistant adipocytes. Genetic manipulation of MCU activity in 3T3-L1 adipocytes allowed the investigation of the role of mitochondrial calcium uptake. In insulin-resistant adipocytes, mitochondrial calcium uptake increased and several MCU components were upregulated. Similar results were observed in mouse and human visceral adipose tissue (VAT) during the progression of obesity and diabetes. Intriguingly, subcutaneous adipose tissue (SAT) was spared from overt MCU fluctuations. Furthermore, MCU expression returned to physiological levels in VAT of patients after weight loss by bariatric surgery. Genetic manipulation of mitochondrial calcium uptake in 3T3-L1 adipocytes demonstrated that changes in mitochondrial calcium concentration ([Ca2+]mt) can affect mitochondrial metabolism, including oxidative enzyme activity, mitochondrial respiration, membrane potential, and reactive oxygen species formation. Finally, our data suggest a strong relationship between [Ca2+]mt and the release of IL-6 and TNFα in adipocytes. Altered mitochondrial calcium flux in fat cells may play a role in obesity and diabetes and may be associated with the differential metabolic profiles of VAT and SAT.
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Affiliation(s)
- Lauren E Wright
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | | | - Gabriella Milan
- Endocrine-Metabolic Laboratory, Department of Medicine, University of Padua, Padua, Italy; and
| | - Anna Terrin
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Giorgia Di Bello
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Anna Belligoli
- Endocrine-Metabolic Laboratory, Department of Medicine, University of Padua, Padua, Italy; and
| | - Marta Sanna
- Endocrine-Metabolic Laboratory, Department of Medicine, University of Padua, Padua, Italy; and
| | - Mirto Foletto
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, and Surgery Branch, Padua Hospital, Padua, Italy
| | - Francesca Favaretto
- Endocrine-Metabolic Laboratory, Department of Medicine, University of Padua, Padua, Italy; and
| | - Anna Raffaello
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | | | - Donato Nitti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, and Surgery Branch, Padua Hospital, Padua, Italy
| | - Roberto Vettor
- Endocrine-Metabolic Laboratory, Department of Medicine, University of Padua, Padua, Italy; and
| | - Rosario Rizzuto
- Department of Biomedical Sciences, University of Padua, Padua, Italy;
- Neuroscience Institute, National Research Council, Padua, Italy
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Nannipieri M, Belligoli A, Guarino D, Busetto L, Moriconi D, Fabris R, Mari A, Baldi S, Anselmino M, Foletto M, Vettor R, Ferrannini E. Risk Factors for Spontaneously Self-Reported Postprandial Hypoglycemia After Bariatric Surgery. J Clin Endocrinol Metab 2016; 101:3600-3607. [PMID: 27336358 DOI: 10.1210/jc.2016-1143] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT Postprandial hypoglycemia (PPHG) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. Data on PPHG after laparoscopic sleeve gastrectomy (LSG) are scant. OBJECTIVE The objective of the study was to identify preoperative predictors of PPHG in subjects spontaneously self-reporting PPHG after RYGB or LSG. Patients, Setting, and Intervention: Nondiabetic patients spontaneously self-reporting symptoms/signs of PPHG (PPHG group, 21 RYGB and 11 LSG) were compared in a case-control design with subjects who never experienced spontaneous or oral glucose tolerance test (OGTT)-induced hypoglycemia over 24 months after surgery (No-PPHG group, 13 RYGB and 40 LSG). Paired pre- and postoperative 3-hour OGTTs were analyzed in all participants. MAIN OUTCOME MEASURES Insulin sensitivity was assessed by the oral glucose insulin sensitivity index and β-cell function by mathematical modeling of the C-peptide response to glucose. RESULTS Before surgery, the body mass index was lower in PPHG than No-PPHG patients in the RYGB (P = .002) and trended similarly in the LSG group (P = .08). Fasting glycemia and the glucose-OGTT nadir were lower in the PPHG than the No-PPHG subjects in both surgery groups. Before surgery, insulin sensitivity was higher in PPHG than No-PPHG in the RYGB (393 ± 55 vs 325 ± 44 mL/min-1 · m-2, P = .001) and LSG groups (380 ± 48 vs 339 ± 60 mL/min-1 · m-2, P = .05) and improved to a similar extent in all groups after surgery. Before surgery, β-cell glucose sensitivity was higher in PPHG than No-PPHG in both RYGB (118 ± 67 vs 65 ± 24 pmol/min-1 · m2 · mM-1) and LSG patients (114 ± 32 vs 86 ± 33) (both P = .02) and improved in all subjects after surgery. CONCLUSIONS In subjects self-reporting PPHG after surgery, lower presurgery plasma glucose concentrations, higher insulin sensitivity, and better β-cell glucose sensitivity are significant predictors of PPHG after both RYGB and LSG.
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Affiliation(s)
- Monica Nannipieri
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Anna Belligoli
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Daniela Guarino
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Luca Busetto
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Diego Moriconi
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Roberto Fabris
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Andrea Mari
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Simona Baldi
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Marco Anselmino
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Mirto Foletto
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Roberto Vettor
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
| | - Ele Ferrannini
- Department of Clinical and Experimental Medicine (M.N., D.G., D.M., S.B.), University of Pisa, 56126 Pisa, Italy; Departments of Medicine (A.B., L.B., R.F., R.V.) and Oncology and Surgery Science (M.F.), University of Padua, 35122 Padua, Italy; National Research Council Institute of Neurosciences (A.M.), Padua, Italy; Bariatric Surgery Unit (M.A.), Santa Chiara Hospital, 56100 Pisa, Italy; National Research Council Institute of Clinical Physiology (E.F.), 56124 Pisa, Italy
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Mioni R, Xamin N, Zuliani L, Belligoli A, Pierobon A, Bleve L, Granzotto M, Maffei P, Sicolo N, Vettor R, Fallo F. 9.7 Insulin-Resistance and Altered Circadian Blood Pressure Profile in Normotensive Young Women with Polycystic Ovary Syndrome. High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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