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Mendonça F, Soares P, Moreno T, Freitas P, Rodrigues I, Festas D, Pedro J, Varela A, Fernandes A, Fernandes R, Soares R, Costa EL, Luís C. Distinguishing health-related parameters between metabolically healthy and metabolically unhealthy obesity in women. Int J Obes (Lond) 2024:10.1038/s41366-024-01519-1. [PMID: 38605208 DOI: 10.1038/s41366-024-01519-1] [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] [Received: 01/11/2024] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Obesity represents a global health crisis, yet a dichotomy is emerging with classification according to the metabolic state into metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). This study aimed to identify distinctive systemic clinical/endocrinological parameters between MHO individuals, employing a comprehensive comparative analysis of 50 biomarkers. Our emphasis was on routine analytes, ensuring cost-effectiveness for widespread use in diagnosing metabolic health. SUBJECTS/METHODS The study included 182 women diagnosed with obesity referred for bariatric surgery at the Endocrinology, Diabetes, and Metabolism Service of São João Hospital and University Centre in Portugal. MUO was defined by the presence of at least one of the following metabolic disorders: diabetes, hypertension, or dyslipidemia. Patients were stratified based on the diagnosis of these pathologies. RESULTS Significantly divergent health-related parameters were observed between MHO and MUO patients. Notable differences included: albumin (40.1 ± 2.2 vs 40,98 ± 2.6 g/L, p value = 0.017), triglycerides (110.7 ± 51.1 vs 137.57 ± 82.6 mg/dL, p value = 0.008), glucose (99.49 ± 13.0 vs 119.17 ± 38.9 mg/dL, p value < 0.001), glycated hemoglobin (5.58 ± 0.4 vs 6.15 ± 1.0%, p value < 0.001), urea (31.40 ± 10.0 vs 34.61 ± 10.2 mg/dL, p value = 0.014), total calcium (4.64 ± 0.15 vs 4.74 ± 0.17 mEq/L, 1 mEq/L = 1 mg/L, p value < 0.001), ferritin (100.04 ± 129.1 vs 128.55 ± 102.1 ng/mL, p value = 0.005), chloride (104.68 ± 1.5 vs 103.04 ± 2.6 mEq/L, p value < 0.001), prolactin (13.57 ± 6.3 vs 12.47 ± 7.1 ng/mL, p value = 0.041), insulin (20.36 ± 24.4 vs 23.87 ± 19.6 μU/mL, p value = 0.021), c peptide (3.78 ± 1.8 vs 4.28 ± 1.7 ng/mL, p value = 0.003), albumin/creatinine ratio (15.41 ± 31.0 vs 48.12 ± 158.7 mg/g creatinine, p value = 0.015), and whole-body mineral density (1.27 ± 0.1 vs 1.23 ± 0.1 g/cm2, p value = 0.016). CONCLUSIONS Our findings highlight potential additional parameters that should be taken into consideration alongside the commonly used biomarkers for classifying metabolic health in women. These include albumin, urea, total calcium, ferritin, chloride, prolactin, c-peptide, albumin-creatinine ratio, and whole-body mineral density. Moreover, our results also suggest that MHO may represent a transitional phase preceding the development of the MUO phenotype.
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Affiliation(s)
- Fernando Mendonça
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
- CRIO group-Centro de Responsabilidade Integrado de Obesidade, São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Pietra Soares
- Biochemistry Unit, Biomedicine Department, FMUP-Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal
| | - Telma Moreno
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Paula Freitas
- CRIO group-Centro de Responsabilidade Integrado de Obesidade, São João Hospital and University Centre, 4200-319, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal
| | - Ilda Rodrigues
- Biochemistry Unit, Biomedicine Department, FMUP-Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal
| | - Diana Festas
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
- CRIO group-Centro de Responsabilidade Integrado de Obesidade, São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Jorge Pedro
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
- CRIO group-Centro de Responsabilidade Integrado de Obesidade, São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Ana Varela
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
- CRIO group-Centro de Responsabilidade Integrado de Obesidade, São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Ana Fernandes
- Nuclear Medicine Department, São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Rúben Fernandes
- Faculty of Health Sciences, University Fernando Pessoa, Fernando Pessoa Hospital-School (FCS/HEFP/UFP), Porto, Portugal
| | - Raquel Soares
- Biochemistry Unit, Biomedicine Department, FMUP-Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal
| | - Eduardo Lima Costa
- CRIO group-Centro de Responsabilidade Integrado de Obesidade, São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Carla Luís
- Biochemistry Unit, Biomedicine Department, FMUP-Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal.
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.
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Borges-Canha M, Neves JS, Silva MM, Mendonça F, Moreno T, Ribeiro S, Vale C, Gonçalves J, Ferreira HU, Gil-Santos S, Calheiros R, Meira I, Menino J, Guerreiro V, Pedro J, Sande A, Souto SB, da Costa EL, Carvalho D, Freitas P. Prediabetes remission after bariatric surgery: a 4-years follow-up study. BMC Endocr Disord 2024; 24:7. [PMID: 38200480 PMCID: PMC10782579 DOI: 10.1186/s12902-024-01537-0] [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: 04/21/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Bariatric surgery leads to weight loss and to cardiometabolic risk improvement. Although prediabetes remission after bariatric surgery is biologically plausible, data on this topic is scarce. We aimed to assess prediabetes remission rate and clinical predictors of remission in a 4 year follow up period. METHODS Observational longitudinal study including patients with obesity and prediabetes who had undergone bariatric surgery in our centre. Prediabetes was defined as having a baseline glycated haemoglobin (A1c) between 5.7% and 6.4% and absence of anti-diabetic drug treatment. We used logistic regression models to evaluate the association between the predictors and prediabetes remission rate. RESULTS A total of 669 patients were included, 84% being female. The population had a mean age of 45.4 ± 10.1 years-old, body mass index of 43.8 ± 5.7 kg/m2, and median A1c of 5.9 [5.8, 6.1]%. After bariatric surgery, prediabetes remission rate was 82%, 73%, 66%, and 58%, respectively in the 1st, 2nd, 3rd, and 4th years of follow-up. Gastric sleeve (GS) surgery was associated with higher prediabetes remission rate than Roux-en-Y gastric bypass surgery in the 3rd year of follow-up. Men had a higher remission rate than women, in the 1st and 3nd years of follow-up in the unadjusted analysis. Younger patients presented a higher remission rate comparing to older patients in the 3rd year of follow-up. CONCLUSION We showed a high prediabetes remission rate after bariatric surgery. The remission rate decreases over the follow-up period, although most of the patients maintain the normoglycemia. Prediabetes remission seems to be more significant in patients who had undergone GS, in male and in younger patients.
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Affiliation(s)
- Marta Borges-Canha
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal.
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - João Sérgio Neves
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Maria Manuel Silva
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fernando Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Telma Moreno
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sara Ribeiro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Vale
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Serviço de Medicina Interna do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Juliana Gonçalves
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Helena Urbano Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sara Gil-Santos
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Raquel Calheiros
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Inês Meira
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Menino
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Vanessa Guerreiro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Pedro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Sande
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma B Souto
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eduardo Lima da Costa
- Serviço de Cirurgia Geral do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Moreno T, Ribeiro S, Borges-Canha M, Silva MM, Mendonça F, Urbano Ferreira H, Gonçalves J, Guerreiro V, Meira I, Menino J, Gil-Santos S, Calheiros R, Vale C, Varela A, Souto SB, Pedro J, Rodrigues P, Lima Costa E, Freitas P, Carvalho D. COVID-19 Lockdown and Impact on 2-Year Weight Loss in a Bariatric Center. Obes Facts 2023; 17:90-97. [PMID: 38096794 PMCID: PMC10836933 DOI: 10.1159/000535729] [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: 05/30/2023] [Accepted: 12/04/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to a worldwide lockdown, which affected physical exercise habits, as well as having a detrimental effect on psychological health and follow-up visits of patients submitted to bariatric surgery. The aim of this study was to evaluate the impact of COVID-19 lockdown on the 2-year weight loss of patients submitted to bariatric surgery in our center. METHODS This was an observational study comparing the weight loss of patients who underwent bariatric surgery from January to March 2020 with a control group submitted to surgery between January and March 2017. Percentage of total weight loss (% TWL) and excess weight loss (% EWL) were assessed 6, 12, and 24 months after surgery. RESULTS A total number of 203 patients were included in this study, 102 had bariatric surgery during the selected period in 2020 and 101 underwent surgery during the same period in 2017. There was no statistically significant difference in weight loss between the 2017 and 2020 groups which was reported as % TWL (mean 27.08 ± 7.530 vs. 28.03 ± 7.074, 33.87 ± 8.507 vs. 34.07 ± 8.979 and 34.13 ± 9.340 vs. 33.98 ± 9.993; p = 0.371) and % EWL (mean 66.83 ± 23.004 vs. 69.71 ± 17.021, 83.37 ± 24.059 vs. 84.51 ± 21.640 and 83.47 ± 24.130 vs. 84.27 ± 23.651; p = 0.506) at 6, 12, and 24 months post-surgery. CONCLUSION Despite social limitations imposed by the COVID-19 lockdown, we found no significant difference between weight loss at 2 years postoperatively in the 2020 group when compared with a control group who underwent bariatric surgery in 2017. These results show that the outcomes of bariatric surgery during the COVID-19 lockdown were comparable with those recorded before the pandemic, supporting the efficacy of bariatric procedures' metabolic effects during the first 2 years after surgery, regardless of lifestyle habits.
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Affiliation(s)
- Telma Moreno
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Sara Ribeiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Marta Borges-Canha
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Maria Manuel Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Fernando Mendonça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Helena Urbano Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Juliana Gonçalves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Inês Meira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Menino
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sara Gil-Santos
- Department of Endocrinology, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Raquel Calheiros
- Department of Endocrinology, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Catarina Vale
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Centro de Responsabilidade Integrada de Obesidade, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma B. Souto
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Centro de Responsabilidade Integrada de Obesidade, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Centro de Responsabilidade Integrada de Obesidade, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Rodrigues
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eduardo Lima Costa
- Department of General Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Centro de Responsabilidade Integrada de Obesidade, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Centro de Responsabilidade Integrada de Obesidade, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - The CRIO Group
- Centro de Responsabilidade Integrada de Obesidade, Centro Hospitalar Universitário de São João, Porto, Portugal
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Guerreiro V, Mendonça F, Urbano Ferreira H, Freitas P, Pereira J, Bernardes I, Pinheiro J, Guimarães T, Carvalho D. Incidental versus symptomatic nonfunctioning pituitary adenomas: Are they different? Endocrinol Diabetes Metab 2023; 6:e445. [PMID: 37697708 PMCID: PMC10638623 DOI: 10.1002/edm2.445] [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] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/09/2023] [Accepted: 07/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Nonfunctioning pituitary adenomas (NFPAs) constitute one of the most common tumours in the sellar region and are often discovered only when associated with compressive symptoms. With the frequent use of brain imaging, there has been an increase in the prevalence of incidentally discovered NFPAs. AIM We aim to determine the prevalence of incidental diagnosis with NPAs observed over a decade and compare the analytical, clinical and treatment differences between those who were diagnosed either incidentally or symptomatically. We also intend to evaluate the pathology differences between both groups. METHODS We retrospectively analysed patients aged ≥18 years with an apparent NFPA, defined as a pituitary lesion compatible with pituitary adenoma which is not associated with the clinical or biochemical evidence of a hormone-secreting tumour. Inclusion criteria included normal prolactin level for lesions <9 mm or a prolactin level <100 ng/mL for lesions ≥10 mm in maximal tumour diameter. RESULTS We included 119 patients [53.8% males; mean age: 56.8 years (SD = 16.7)]. Diagnosis was incidental in 47.1% of patients, and many patients had unappreciated signs and symptoms of pituitary disease. In the symptomatic and incidental groups, 66.7% and 41.1% of patients had hypopituitarism, respectively (p = .005). Only 20.4% of patients incidentally diagnosed had microadenoma (p = .060). Hypopituitarism was present in 18.8% of those patients with microadenomas. Most tumours were macroadenomas (87.4%). Half of those patients diagnosed incidentally were submitted to surgery, compared with 75.8% of those who were diagnosed symptomatically (p = .004). CONCLUSIONS Nonfunctioning pituitary adenomas are commonly diagnosed incidentally, with many manifesting symptoms on examination. NFPAs incidentally diagnosed are more commonly macroadenomas and less frequently associated with hypopituitarism than symptomatic. Accordingly, if there was a greater level of knowledge and more suspicion about these pathologies, it might be possible to discover them earlier.
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Affiliation(s)
- Vanessa Guerreiro
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar São João, EPEPortoPortugal
- Faculty of Medicine of the University of PortoPortoPortugal
- Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
| | - Fernando Mendonça
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar São João, EPEPortoPortugal
- Faculty of Medicine of the University of PortoPortoPortugal
- Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
| | - Helena Urbano Ferreira
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar São João, EPEPortoPortugal
- Faculty of Medicine of the University of PortoPortoPortugal
- Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar São João, EPEPortoPortugal
- Faculty of Medicine of the University of PortoPortoPortugal
- Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
| | - Josué Pereira
- Department of NeurosurgeryCentro Hospitalar de São João, EPEPortoPortugal
| | - Irene Bernardes
- Department of NeuroradiologyCentro Hospitalar de São João, EPEPortoPortugal
| | - Jorge Pinheiro
- Department of Anatomic PathologyCentro Hospitalar de São João, EPEPortoPortugal
| | - Tiago Guimarães
- Faculty of Medicine of the University of PortoPortoPortugal
- Department of Clinical PathologyCentro Hospitalar de São João, EPEPortoPortugal
- EPIUnit, Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar São João, EPEPortoPortugal
- Faculty of Medicine of the University of PortoPortoPortugal
- Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
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Mendonça F, Souto S, Dória S, Carvalho D. Klinefelter syndrome: The characterization of the clinical and sociological features of 51 patients. Rev Int Androl 2023; 21:100349. [PMID: 37054629 DOI: 10.1016/j.androl.2023.100349] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/10/2022] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Klinefelter syndrome is the most frequently found aneuploidy among male patients. Its clinical presentation is very heterogeneous, and thus poses a challenge for a timely diagnosis. METHODS A retrospective study was carried out with 51 consecutively selected patients diagnosed with Klinefelter Syndrome from Jan/2010 to Dec/2019. The karyotypes were identified using high resolution GTL banding at the Genetics Department. Multiple clinical and sociological parameters were studied by collecting data from the clinical records. RESULTS 44 (86%) of the 51 patients presented a classical karyotype (47,XXY) and 7 (14%) showed evidence of mosaicism. The mean age at diagnosis was 30.2±14.3 years old. Regarding the level of education (N=44), 26 patients (59.1%) had no secondary education, with 5 (11.4%) patients having concluded university studies. Almost two thirds of the sample revealed learning difficulties (25/38) and some degree of intellectual disability was present in 13.6% (6/44). Half of the patients were either non-qualified workers (19.6%) or workers in industry, construction, and trades (30.4%), which are jobs that characteristically require a low level of education. The proportion of unemployed patients was 6.5%. The main complaints were infertility (54.2%), followed by hypogonadism-related issues (18.7%) and gynecomastia (8.3%). 10 patients (23.8%, N=42) were biological parents. With regards the question of fertility, assisted reproductive techniques were used in 39.6% of the studied subjects (N=48), with a success rate (a take home baby) of 57.9% (11/19), 2 with donor sperm and 9 with the patients' own gametes. Only 41% of the patients (17/41) were treated with testosterone. CONCLUSION This study identifies the most important clinical and sociological findings of Klinefelter syndrome patients that should be considered when deciding workout and disease management.
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Affiliation(s)
- Fernando Mendonça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; i3s - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal.
| | - Selma Souto
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; i3s - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
| | - Sofia Dória
- i3s - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Department of Genetics, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de S. João, Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; i3s - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal
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Amador F, Mendonça F, da Costa C, Canha M, Neves JS, Pinto R, Amorim S, Souto S, Freitas P, Carvalho D. Total thyroidectomy in a patient awaiting heart transplant with amiodarone-induced thyrotoxicosis: A case report. Clin Case Rep 2023; 11:e6892. [PMID: 36789324 PMCID: PMC9909169 DOI: 10.1002/ccr3.6892] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/13/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023] Open
Abstract
Thyroid function may have a severe impact in cardiac function. Herein, we present the case report of a 53-year-old male patient awaiting heart transplant with amiodarone induced thyrotoxicosis that presented a marked improvement of his cardiac function after total thyroidectomy.
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Affiliation(s)
- Filipa Amador
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Fernando Mendonça
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Catarina da Costa
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Marta Canha
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Roberto Pinto
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Sandra Amorim
- Department of CardiologyCentro Hospitalar e Universitário de São JoãoPortoPortugal
| | - Selma Souto
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar Universitário de São João, Faculty of Medicine e Instituto de Investigação e Inovação em Saude, Universidade do PortoPortoPortugal
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7
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Longatti SC, Silva RW, Baltieri VS, Stefano MA, Silva TLS, Silva ACS, Lisboa J, Mendonça F, Ferreira CES. COLETA DE CD34+ PARA TRANSPLANTE DE MEDULA ÓSSEA. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.521] [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: 11/05/2022] Open
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8
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Guerreiro V, Maia I, Neves JS, Salazar D, Ferreira MJ, Mendonça F, Silva MM, Borges-Canha M, Viana S, Costa C, Pedro J, Varela A, Lau E, Freitas P, Carvalho D. Oral glucose tolerance testing at 1 h and 2 h: relationship with glucose and cardiometabolic parameters and agreement for pre-diabetes diagnosis in patients with morbid obesity. Diabetol Metab Syndr 2022; 14:91. [PMID: 35794584 PMCID: PMC9258114 DOI: 10.1186/s13098-022-00865-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One hour plasma glucose concentration (1hPG) during an oral glucose tolerance test (OGTT) may be an alternative to 2-h plasma glucose concentration (2hPG) in the identification of individuals at increased risk of hyperglycaemia, although its role is not fully understood. AIM We aim to investigate the relationship of these measures with other glucose parameters, as well as their relationship with cardiometabolic risk markers and the level of agreement for prediabetes mellitus diagnosis, in a sample of patients with morbid obesity. METHODS We retrospectively evaluated 656 patients with morbid obesity without diagnosed diabetes. To define prediabetes with 2hPG, 2022 American Diabetes Association guidelines criteria were used, while for 1hPG, glucose ≥ 155 mg/dL was considered. Cohen's Kappa coefficient was used to assess the agreement between both measures of prediabetes mellitus diagnosis. RESULTS A Cohen's Kappa coefficient of 0.405 (p < 0.001) was obtained. The 1hPG were positively correlated with homeostatic model assessment for insulin resistance (HOMA-IR) (ρ = 0.281, p < 0.001), fasting plasma glucose (FPG) (ρ = 0.581, p < 0.001), glycated haemoglobin (Hb1AC) (ρ = 0.347, p < 0.001) and were negatively correlated with homeostatic model assessment for cell-β function (HOMA-β) (ρ = -0.092, p = 0.018). 2hPG were also correlated with the same parameters, except for HOMA-β. CONCLUSION A fair agreement between 1 and 2hPG was verified. 1hPG criteria may be a useful indicator of β-cell dysfunction and insulin resistance in patients with morbid obesity without diabetes diagnosis.
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Affiliation(s)
- Vanessa Guerreiro
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Isabel Maia
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Porto, Portugal
| | - João Sérgio Neves
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Daniela Salazar
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Maria João Ferreira
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Fernando Mendonça
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Maria Manuel Silva
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Marta Borges-Canha
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Consulta de Avaliação Multidisciplinar Do Tratamento Cirúrgico da Obesidade Do Centro Hospitalar Universitário São João, Porto, Portugal
| | - Sara Viana
- Serviço de Medicina Interna, Unidade Local de Saúde Do Norte Alentejano, Portalegre, Portugal
| | - Cláudia Costa
- Serviço de Endocrinologia, Instituto Português de Oncologia, Porto, Portugal
| | - Jorge Pedro
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Ana Varela
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia, Porto, Portugal
| | - Eva Lau
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
- Consulta de Avaliação Multidisciplinar Do Tratamento Cirúrgico da Obesidade Do Centro Hospitalar Universitário São João, Porto, Portugal
| | - Paula Freitas
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
- Consulta de Avaliação Multidisciplinar Do Tratamento Cirúrgico da Obesidade Do Centro Hospitalar Universitário São João, Porto, Portugal
| | - Davide Carvalho
- Departamento de Endocrinologia, Diabetes E Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
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Mendonça F, Ferreira AB, Pinto F, Vasconcelos A, Ferreira S, Rodrigues E, Castro-Correia C, Gil-da-Costa MJ, Bom-Sucesso M. Adrenal carcinoma as the first manifestation of a Li‑Fraumeni syndrome in three paediatric patients. Endokrynol Pol 2022; 73:788-789. [PMID: 35593669 DOI: 10.5603/ep.a2022.0021] [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] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/20/2022] [Indexed: 06/15/2023]
Abstract
Not required for clinical vignette.
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Affiliation(s)
- Fernando Mendonça
- Department of Endocrinology, Diabetes, and Metabolism, São João University and Hospital Centre, Porto, Portugal.
| | - Ana Bernardo Ferreira
- Pediatrics and Neonatology Department, Entre Douro e Vouga Hospital Centre, Santa Maria da Feira, Portugal
| | - Filipa Pinto
- Pediatric Department, Médio Ave Hospital Centre, V.N.Famalicão, Portugal
| | - Alice Vasconcelos
- Genetics Department, São João University and Hospital Centre, Porto, Portugal, Portugal
| | - Sofia Ferreira
- Pediatric Endocrinology Unit, Paediatrics Department, Maternal and Paediatrics Centre, São João University and Hospital Centre, Porto, Portugal, Portugal
| | - Elisabete Rodrigues
- Department of Endocrinology, Diabetes, and Metabolism, São João University and Hospital Centre, Porto, Portugal
| | - Cíntia Castro-Correia
- Pediatric Endocrinology Unit, Paediatrics Department, Maternal and Paediatrics Centre, São João University and Hospital Centre, Porto, Portugal, Portugal
| | | | - Maria Bom-Sucesso
- Pediatric Oncology Department, São João University and Hospital Centre, Porto, Portugal
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10
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Mendonça F, Soares R, Carvalho D, Freitas P. The Impact of Bariatric Surgery on Bone Health: State of the Art and New Recognized Links. Horm Metab Res 2022; 54:131-144. [PMID: 35276738 DOI: 10.1055/a-1767-5581] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bariatric surgery (BS) is the most effective therapy for severe obesity, which improves several comorbidities (such as diabetes, hypertension, dyslipidemia, among others) and results in marked weight loss. Despite these consensual beneficial effects, sleeve gastrectomy and Roux-en-Y gastric bypass (the two main bariatric techniques) have also been associated with changes in bone metabolism and progressive bone loss. The objective of this literature review is to examine the impact of bariatric surgery on bone and its main metabolic links, and to analyze the latest findings regarding the risk of fracture among patients submitted to bariatric surgery.
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Affiliation(s)
- Fernando Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Raquel Soares
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Mendonça F, Neves JS, Silva MM, Salazar D, Ferreira MJ, Guerreiro V, Pedro J, Varela A, Souto S, Lau E, Preto J, Freitas P, Carvalho D. Type 2 Diabetes Mellitus and Bariatric Surgery: Impact on Parathyroid Hormone, Calcium, and Vitamin D Levels. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fernando Mendonça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
| | - Maria Manuel Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Selma Souto
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Eva Lau
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - John Preto
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto (I3S), Porto, Portugal
- Centro de Responsabilidade Integrado em Obesidade, Centro Hospitalar e Universitário de S. João, Porto, Portugal
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12
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Guerreiro V, Maia I, Neves JS, Salazar D, Ferreira MJ, Mendonça F, Silva MM, Viana S, Costa C, Pedro J, Varela A, Lau E, Freitas P, Carvalho D. Adequate magnesium level as an associated factor of pre-diabetes and diabetes mellitus remission in patients with obesity submitted to bariatric surgery. Sci Rep 2021; 11:21223. [PMID: 34707130 PMCID: PMC8551299 DOI: 10.1038/s41598-021-00584-0] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/14/2021] [Indexed: 01/19/2023] Open
Abstract
Bariatric surgery (BS) can lead to remission of type 2 diabetes mellitus (T2DM), however, the evidence on the influence of preoperative serum magnesium levels on this reversal is scarce. To study the influence of preoperative serum magnesium levels on the pre-T2DM and T2DM remission one year after BS. Retrospective study carried out among 1656 patients with obesity who underwent BS in the Centro Hospitalar Universitário São João. T2DM and pre-T2DM remission were defined as being normal glycaemic measures of at least one year's after BS and without pharmacological therapy. To assess the association between preoperative serum magnesium levels and pre- and T2DM remission, logistic regression models, crude and adjusted for sex, age and body mass index were computed. Patients with normoglycaemia presented hypomagnesaemia less often than those patients with pre-T2DM and T2DM (17.0% vs. 21.3% vs. 39.9%) (p < 0.001). One year after BS, 62.9% of patients with pre-T2DM or T2DM before BS showed remission. Adequate magnesium levels were positively associated with T2DM and pre-T2DM remission, one year after BS (OR 1.79; 95% CI 1.34-2.38), independently of sex, age, and body mass index. Adequate preoperative serum magnesium levels showed to be an important clinical parameter for pre-T2DM and T2DM remission.
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Affiliation(s)
- Vanessa Guerreiro
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Faculdade de Medicina da Universidade do Porto, Porto, Portugal. .,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal. .,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
| | - Isabel Maia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - João Sérgio Neves
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Daniela Salazar
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Maria João Ferreira
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Fernando Mendonça
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Maria Manuel Silva
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Sara Viana
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Serviço de Medicina Interna, Unidade de Saúde Local do Norte Alentejo EPE, Alentejo, Portugal
| | - Cláudia Costa
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Serviço de Endocrinologia, Instituto Portugês de Oncologia, Porto, Portugal
| | - Jorge Pedro
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Ana Varela
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Serviço de Endocrinologia, Instituto Portugês de Oncologia, Porto, Portugal
| | - Eva Lau
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Paula Freitas
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Davide Carvalho
- Departamento de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
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Mendonça F, Neves JS, Silva MM, Canha MB, Costa C, Cabral P, Guerreiro V, Lourenço R, Meira P, Ferreira MJ, Salazar D, Pedro J, Varela A, Viana S, Belo S, Lau E, Souto S, Freitas P, Carvalho D. Secondary Hyperparathyroidism Among Bariatric Patients: Unraveling the Prevalence of an Overlooked Foe. J Endocr Soc 2021. [PMCID: PMC8265991 DOI: 10.1210/jendso/bvab048.542] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Introduction: Bariatric surgery (BS) is an effective therapeutic approach for obese patients. It is associated with important gastrointestinal anatomic changes, predisposing these subjects to altered nutrient absorption that impact phosphocalcium metabolism. This study aims to clarify the prevalence of secondary hyperparathyroidism (SHPT) and its predictors in patients submitted to BS. Methods: Retrospective unicentric study of 1431 obese patients who underwent metabolic surgery between January/2010 and June/2017 and who were followed for, at least, a year. In this group, 185 subjects were submitted to laparoscopic adjustable gastric banding (LAGB), 830 underwent Roux-en-Y gastric bypass (RYGB) and 416 sleeve gastrectomy (SG). Data comprising 4 years of follow-up were available for 333 patients. We compared the clinical and analytical characteristics of patients with and without secondary hyperparathyroidism (considering SHPT a PTH˃69pg/mL), taking also into account the type of surgery. A multiple logistic regression was performed to study the predictors of SHPT after BS. Results: The overall prevalence of SHPT before surgery was 24.9%, 11.2% one year after surgery and 21.3% four years after surgery. At 12 months after surgery, LAGB had the highest prevalence of patients with SHPT (19.4%, N=36), RYGB had 12.8% (N=274) and SG 5.3% (N=131). At 48 months after surgery, RYGB had the highest prevalence of SHPT (27.0%, N=222), LAGB had 13.2% (N=53) and SG 6.9% (N=58). Multi-variate logistic analysis showed that increased body mass index and age, decreased levels of vitamin D and RYGB were independent predictors of SHPT one year after surgery. The only independent predictor of SHPT four years after surgery was RYGB. Conclusion: The prevalence of SHPT is considerably higher before and four years after BS than 1 year after surgery. This fact raises some questions about the efficacy of the implemented follow-up plans of vitamin D supplementation on the long term, mainly among patients submitted to RYGB.
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Affiliation(s)
| | | | | | | | - Cláudia Costa
- Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro Cabral
- Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | | | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Patricia Meira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | | | - Daniela Salazar
- Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Jorge Pedro
- Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Ana Varela
- Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Sara Viana
- Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Sandra Belo
- Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Eva Lau
- Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Selma Souto
- Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Paula Freitas
- Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Davide Carvalho
- Centro Hospitalar e Universitário de S. João, Porto, Portugal
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Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, Cabral P, Guerreiro V, Lourenço R, Meira P, Salazar CD, Ferreira MJ, Pedro J, Sande A, Belo S, Souto SSB, Lau E, Freitas P, Carvalho D. Is Insulin Resistance at Baseline a Predictor of Weight Loss After Bariatric Surgery? J Endocr Soc 2021. [PMCID: PMC8089685 DOI: 10.1210/jendso/bvab048.034] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Obesity is a multifactorial disease that is strongly associated to other metabolic disorders, such as insulin resistance and type 2 diabetes. Bariatric surgery is nowadays considered the most effective treatment of morbid obesity. The role of insulin resistance (IR) in weight loss after bariatric surgery is highly unknown. Aim: To evaluate the association between Insulin Resistance (IR) and percentage of excess weight loss (EWL%) one, two, three and four years after bariatric surgery in patients with morbid obesity. Methods: Retrospective longitudinal study in patients with morbid obesity followed in our centre between January 2010 and July 2018 were included. Patients were excluded if they had diabetes. We evaluated baseline Homeostatic Model Assessment of IR (HOMA-IR), Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index (QUICKI) and Matsuda and DeFronzo index, and performed a linear regression concerning each year’s EWL%. Results: After applying the exclusion criteria, 1723 patients were included in this analysis. The logarithm of HOMA-beta was negatively associated with EWL% at second-, third- and fourth-years post-surgery (β=-1.04 [-1.82 to -0.26], p<0.01; β=-1.16 [-2.13 to -0.19], p=0.02; β=-1.29 [-2.64 to 0.06], p=0.061, respectively), adjusting for age, sex, body mass index and type of surgery. This was not observed in the first-year post-surgery nor for the other indexes. Glycaemia at baseline was also positively associated to EWL% at second- and third-years post-surgery. Conclusion: IR at baseline seems to be associated to long term weight loss, explicitly after the first year post bariatric surgery.
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Affiliation(s)
| | | | | | | | - Cláudia Costa
- Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro Cabral
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Rita Lourenço
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Patrícia Meira
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | | | - Jorge Pedro
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Ana Sande
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Sandra Belo
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Selma S B Souto
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Eva Lau
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Paula Freitas
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Davide Carvalho
- Centro Hospitalar e Universitário de São João, Porto, Portugal
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15
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Gonçalves VG, Maia I, Mendonça F, Silva MM, Neves JS, Pedro JP, Salazar CD, Ferreira MJS, Costa CF, Canha MB, Lau E, Freitas P, Carvalho DM. Type 2 Diabetes Mellitus Remission in Obese Patients Under Bariatric Surgery: The Role of Preoperative Triglycerides Levels. J Endocr Soc 2021. [PMCID: PMC8089763 DOI: 10.1210/jendso/bvab048.076] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: There is abundant evidence reporting the relationship between triglycerides levels and type 2 diabetes mellitus, however few studies confirmed the influence of triglycerides levels on the incidence of diabetes. Bariatric surgery may lead to the remission of type 2 diabetes mellitus, but the effect of basal serum triglycerides levels on this reversal is unknown. This study aimed to assess the association between preoperative triglycerides levels and pre- and type 2 diabetes mellitus remission in obese patients one year after bariatric surgery. Methods: A retrospective study was conducted among 1959 obese patients who underwent bariatric surgery in our entre. Data on socio-demographic and clinical characteristics were used. Pre-diabetes and type 2 diabetes mellitus remission was defined as normal glycaemic measures at least one year’s duration without pharmacological therapy. Logistic regression models, crude and adjusted for sex, age, preoperative serum triglycerides levels and type of bariatric surgery, were used. Results: The median of preoperative serum triglycerides level was 121.00 (SD=75.00) mg/dL, and 34.7% and 30.0% of patients presented pre- and type 2 diabetes mellitus, respectively, at baseline. Preoperative serum triglycerides levels were higher in type 2 diabetes mellitus patients (139.00 vs. 106.00 mg/dL, in normal glycaemic patients; p<0.001) and showed to be significantly correlated with fasting glycaemia, glycated haemoglobin, homeostasis model assessment of insulin resistance and homeostasis model assessment of β-cell function. One year after bariatric surgery, 62.5% of patients with pre- or type 2 diabetes at baseline showed remission. Preoperative serum triglycerides levels were negatively associated with this remission (OR: 0.997; 95%CI=0.995–0.998), independently of, sex, age and type of bariatric surgery. Conclusions: One year after bariatric surgery, 62.5% of patients showed pre- or type 2 diabetes mellitus remission, being the preoperative serum triglycerides levels an important clinical parameter for remission. Keywords: triglycerides, diabetes, remission, obesity, bariatric surgery
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Eva Lau
- Hospital de São João, Porto, Portugal
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16
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Mendonça F, Souto S, Magalhães D, Portugal R, Coelho AR, Fernandes AS, Falcão V, Tavares S, Portugal I, Beires J, Carvalho D. Hyperandrogenism, oligomenorrhea, and erythrocytosis caused by an ovarian Leydig cell tumor: A case report. Clin Case Rep 2021; 9:e04001. [PMID: 34026130 PMCID: PMC8117810 DOI: 10.1002/ccr3.4001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/09/2020] [Accepted: 01/02/2021] [Indexed: 12/31/2022] Open
Abstract
Leydig cell tumors are rare ovarian neoplasms. Affected individuals typically present with amenorrhea/oligomenorrhea and rapidly progressive features of virilization. Erythrocytosis can also occur as a result of high testosterone levels.
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Affiliation(s)
- Fernando Mendonça
- Serviço de Endocrinologia Diabetes e Metabolismo Centro Hospitalar e Universitário de S. João Porto Portugal.,Faculdade de Medicina da Universidade do Porto Porto Portugal.,i3S - Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal
| | - Selma Souto
- Serviço de Endocrinologia Diabetes e Metabolismo Centro Hospitalar e Universitário de S. João Porto Portugal.,Faculdade de Medicina da Universidade do Porto Porto Portugal.,i3S - Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal
| | | | - Raquel Portugal
- Serviço de Anatomia Patológica Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Ana Rita Coelho
- Serviço de Anatomia Patológica Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Ana Sofia Fernandes
- Serviço de Ginecologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Vera Falcão
- Serviço de Ginecologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Sara Tavares
- Serviço de Ginecologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Inês Portugal
- Serviço de Radiologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Jorge Beires
- Serviço de Ginecologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia Diabetes e Metabolismo Centro Hospitalar e Universitário de S. João Porto Portugal.,Faculdade de Medicina da Universidade do Porto Porto Portugal.,i3S - Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal
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17
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Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, M. Cabral P, Guerreiro V, Lourenço R, Meira P, Salazar D, Ferreira MJ, Pedro J, Barkoudah E, Sande A, Lau E, B. Souto S, Preto J, Freitas P, Carvalho D. Beta Cell Function as a Baseline Predictor of Weight Loss After Bariatric Surgery. Front Endocrinol (Lausanne) 2021; 12:714173. [PMID: 34456871 PMCID: PMC8387593 DOI: 10.3389/fendo.2021.714173] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/22/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Obesity is a multifactorial disease, which is strongly associated to other metabolic disorders. Bariatric surgery is the most effective treatment of morbid obesity. The role of beta cell function in weight loss after bariatric surgery is uncertain. AIM To evaluate the association between beta cell function and percentage of total body weight loss (TBWL%) 1, 2, 3, and 4 years after bariatric surgery in patients with morbid obesity. METHODS Retrospective longitudinal study in patients with morbid obesity followed in our center between January 2010 and July 2018. Patients were excluded if they had diabetes at baseline or missing data on the needed parameters. We evaluated baseline Homeostatic Model Assessment of IR, Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index, and Matsuda and DeFronzo index, and TBWL% at years 1 to 4. Linear regression models were used to evaluate the association of indexes of insulin resistance with TBWL% (unadjusted and adjusted for age, sex, BMI, and type of surgery). RESULTS There were 1,561 patients included in this analysis. HOMA-beta was negatively associated with TBWL% at second, third, and fourth years post-surgery (β = -1.04 [-1.82 to -0.26], p<0.01; β = -1.16 [-2.13 to -0.19], p=0.02; β = -1.29 [-2.64 to 0.06], p=0.061, respectively). This was not observed in the first year post-surgery nor for the other indexes. Glycemia at baseline was positively associated to EWL% at second and third years post-surgery. CONCLUSION β-cell function at baseline seems to be associated to long-term weight loss, explicitly after the first year post bariatric surgery. This might be a helpful predictor of weight loss in clinical practice.
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Affiliation(s)
- Marta Borges-Canha
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- *Correspondence: Marta Borges-Canha, ; orcid.org/0000-0003-2929-3751
| | - João Sérgio Neves
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Fernando Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria Manuel Silva
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cláudia Costa
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto, Francisco Gentil, EPE, Porto, Portugal
| | - Pedro M. Cabral
- Serviço de Patologia Clínica do Centro Hospitalar Universitário Cova da Beira, EPE, Covilhã, Portugal
| | - Vanessa Guerreiro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Patrícia Meira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria João Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Pedro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ebrahim Barkoudah
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Ana Sande
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eva Lau
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma B. Souto
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - John Preto
- Serviço de Cirurgia Geral do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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18
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Mendonça F, Silva MM, Salazar D, Ferreira MJ, Pedro J, Guerreiro V, Viana S, Neves JS, Belo S, Varela A, Freitas P, Carvalho D. Bariatric Surgery Impact on Cardiovascular Risk Factors: Is Age a Factor to Consider? Obes Facts 2021; 14:72-77. [PMID: 33321490 PMCID: PMC7983533 DOI: 10.1159/000511737] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite the abundance of data addressing the influence of patient's age on surgery-related complications, its impact on cardiometabolic outcomes following bariatric surgery has been overlooked. METHODS Retrospective unicentric study of 1,728 obese patients who underwent bariatric surgery between January 2010 and June 2015. Patients were divided in 3 age groups, according to their age at surgery: ˂40 (n = 751), 40-59 (n = 879), and ≥60 years (n = 98). Parameters with cardiometabolic impact, such as body anthropometric measures, lipid profile, and glycemic status, before and 24 months after surgery, were compared between these groups. A multiple linear regression was performed, adjusting differences between groups for sex, surgery type, and body mass index variation. RESULTS The group ˂40 years presented more weight loss (-35.4 ± 9.0 kg, p ˂ 0.001), greater BMI reduction (-15.8 ± 6.1 kg/m2, p ˂ 0.001), and larger changes in waist (-34 ± 13.8 cm, p ˂ 0.001) and hip circumferences (-28.7 ± 11.9 cm, p ˂ 0.05). The group of ≥60 years presented the heaviest reduction in fasting glucose (-17.7 ± 32.8 mg/dL, p ˂ 0.001) and HbA1c (0.7 ± 1.0, p ˂ 0.001), and also had a tendency to have the biggest changes in systolic blood pressure (-14.7 ± 18.7 mm Hg, p = 0.071). CONCLUSION Patients with ≥60 years benefit the most from bariatric surgery regarding cardiometabolic parameters, presenting heavier reductions in fasting glucose, as well as HbA1c and a tendency towards a higher decrease in systolic blood pressure. No clinically significant differences in lipid profile were observed between groups.
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Affiliation(s)
- Fernando Mendonça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal,
- Faculty of Medicine, Universidade do Porto, Porto, Portugal,
| | - Maria Manuel Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Sara Viana
- Unidade Local de Saúde do Norte Alentejano EPE, Évora, Portugal
| | - Joao Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Sandra Belo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de S. João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
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19
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Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, Cabral PM, Guerreiro V, Lourenço R, Meira P, Salazar D, Ferreira MJ, Pedro J, Leite AR, von-Hafe M, Vale C, Viana S, Sande A, Belo S, Lau E, Freitas P, Carvalho D. The Impact of Vitamin D in Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study in Patients with Morbid Obesity. Diabetes Metab Syndr Obes 2021; 14:487-495. [PMID: 33568925 PMCID: PMC7868234 DOI: 10.2147/dmso.s286334] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/21/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE We aimed to evaluate the association between vitamin D status and hepatic function parameters and scores: Fatty Liver Index (FLI, predictor of hepatic steatosis) and BARD (BMI, AST/ALT ratio and DM, predictor of hepatic fibrosis) in patients with morbid obesity. PATIENTS AND METHODS Cross-sectional study including patients with morbid obesity followed in our centre between January 2010 and July 2018. Patients with missing vitamin D levels or hepatic profile parameters were excluded. We divided the population according to two cut-offs of vitamin D levels (12ng/mL and 20ng/mL). RESULTS The included population (n=1124) had an average age of 43.3±10.7 years and 84.3% were female. Seventy-point eight percent of the population had vitamin D levels lower than 20ng/mL and 34.8% lower than 12ng/dL. Patients with lower vitamin D levels (<12ng/mL) had higher BMI, hip and waist circumferences and higher prevalence of hypertension. Higher FLI scores [OR= 0.77 (0.07), p<0.01] and ALP levels [β= -0.03 (-0.06, -0.01), p<0.01] associated to lower vitamin D levels. CONCLUSION Vitamin D deficiency is associated with a higher risk of hepatic steatosis in individuals with morbid obesity. Correction of vitamin D deficiency may have a beneficial role in the management of NAFLD in patients with morbid obesity.
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Affiliation(s)
- Marta Borges-Canha
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Correspondence: Marta Borges-Canha Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, PortugalTel +351918935390 Email
| | - João Sérgio Neves
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Fernando Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria Manuel Silva
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cláudia Costa
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro M Cabral
- Serviço de Patologia Clínica do Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - Vanessa Guerreiro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Patrícia Meira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria João Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Pedro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Rita Leite
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Madalena von-Hafe
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Catarina Vale
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sara Viana
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Sande
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Belo
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eva Lau
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação Em Saúde (I3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação Em Saúde (I3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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20
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Costa CF, Salazar CD, Ferreira MJS, Pedro JP, Neves JS, Maia I, Gonçalves VG, Canha M, Viana S, Silva MM, Mendonça F, Cabral P, Lourenço R, Meira P, Belo S, Varela A, Lau E, Oliveira J, Santos AP, Torres I, Freitas P, Carvalho DM. MON-584 Albuminuria and Obesity - Which Are the Associated Factors? J Endocr Soc 2020. [PMCID: PMC7209737 DOI: 10.1210/jendso/bvaa046.246] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction The association between obesity and renal dysfunction has been widely studied. Albuminuria is a cardiovascular risk factor and the most prevalent marker of kidney injury in people with obesity. Despite the higher prevalence of hypertension and diabetes in those patients, other contributing factors are still unknown. We aimed to explore the factors related to albuminuria in obesity, analyzing its variation after bariatric surgery. Methods We evaluated 2518 patients undergoing bariatric surgery, of those, 1243 with preoperative albuminuria measurement were included in this study. Albuminuria was determined by the albumin-creatinine ratio (RAC) in an occasional urine sample (mg/g) or by the 24-hour urine albumin excretion rate (TEA) (mg/24h). Means and medians were compared using Student’s T-test or Mann-Whitney tests, respectively. Spearman correlation was used. Results Age (ρ = 0.073; p = 0.010), body mass index (BMI) (ρ = 0.139; p <0.001), waist circumference (WC) (ρ = 0.220; p <0.001), glycated hemoglobin (HbA1C) (ρ = 0.221; p <0.001), systolic blood pressure (SBP) (ρ = 0.203; p <0.001), diastolic blood pressure (DBP) (ρ = 0.134; p <0.001), uricemia (ρ = 0.141; p <0.001) and C-reactive protein (CRP) levels (ρ = 0.090; p = 0.017) were positively correlated with albuminuria.Patients with albuminuria (TEA / RAC≥30) had higher BMI (45.0 ± 6.0 vs.43.2 ± 5.6kg / m2; p <0.001), WC (129.3 ± 13.1 vs. 122.0 ± 12.9cm; p <0.001), SBP (142.7 ± 18.0 vs.134.1 ± 16.5mmHg; p <0.001), DBP (88.0 ± 12.6 vs.83, 2 ± 10.3mmHg; p <0.001), uricemia (6.1 ± 1.5 vs.5.4 ± 1.4mg / dL; p <0.001) and CRP (11.3 (16.4) vs.8, 3 (9.6) mg / L; p <0.001).Excluding patients with diabetes and hypertension, BMI and WC remained statistically positively correlated with urinary albumin excretion. After surgery, the decrease of albuminuria was correlated with the reduction of HbA1C (ρ = 0.144; p <0.001) and CRP (ρ = 0.113; p = 0.037). Conclusion Anthropometric, inflammatory and metabolic factors, namely WC, CRP and uricemia, may be involved in the etiopathogenesis of albuminuria in obese patients. Bariatric surgery is the most effective method to reverse obesity and it has been shown to be a promising therapy on the treatment of associated renal dysfunction.
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Affiliation(s)
| | | | | | | | | | | | | | - Marta Canha
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sara Viana
- Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | | | | | - Pedro Cabral
- Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Patrícia Meira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Sandra Belo
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Varela
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eva Lau
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Joana Oliveira
- Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Ana Paula Santos
- Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Isabel Torres
- Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Paula Freitas
- Centro Hospitalar Universitário de São João, Porto, Portugal
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Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, Cabral PM, Gonçalves VG, Lourenço R, Patrícia M, Salazar CD, Maria FJS, Pedro JP, Belo S, Lau E, Sande A, Viana S, Freitas P, Carvalho DM. MON-592 The Impact of Bariatric Surgery on the Risk of Non-Alcoholic Fatty Liver Disease in Morbidly Obese Patients. J Endocr Soc 2020. [PMCID: PMC7209430 DOI: 10.1210/jendso/bvaa046.590] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Introduction: Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity, and the prevalence of both diseases is increasing notably. The lack of effective treatment options for NAFLD is leading to a great consideration towards the identification of new approaches.
Aim: We aimed to evaluate the change one year after bariatric surgery of parameters of hepatic function and in the hepatic scores, Fatty Liver Index (FLI, predictor of hepatic steatosis), and BARD, BMI, AST/ALT ratio and DM, (predictor of hepatic fibrosis).
Methods: Observational retrospective cohort study in morbidly obese patients that underwent bariatric surgery between January 2010 and July 2018. We excluded patients missing hepatic function parameters before or one year after the surgical procedure. We used two linear regression models: 1) unadjusted; 2) adjusted for surgery type (gastric sleeve, gastric band and gastric bypass), sex, age, body mass index, diabetes and dyslipidaemia.
Results: The included population (n=1955) had an average age of 43.1±10 years and 85.8% were female. We observed a relevant decrease in transaminases (pre-operative AST and ALT, 24.8±12.4 and 29.5±19.5U/L, vs 22.4 ± 11.1 and 22.2±14.7 post-operatively, respectively, p<0.01) and gamma-glutamyltransferase (36.9±35.4 vs 21.4±22.0U/L, p<0.01), and an increase in alkaline phosphatase (77.8±23.5 vs 80.8±25.4U/L, p<0.01) and total bilirubin (0.56±0.23 vs 0.68±0.24mg/dL, p<0.01). Both FLI and BARD markedly decrease one year after surgery (p<0.01). Comparing the surgical procedures, gastric sleeve was associated with a greater reduction of hepatic enzymes and of both FLI and BARD comparing with gastric band. Comparing with gastric bypass, sleeve was associated with a greater reduction of transaminases and alkaline phosphatase, but a smaller reduction of FLI and BARD.
Conclusion: Bariatric surgery is associated with a reduction of the hepatic enzymes and an improvement of FLI and BARD. Bariatric surgery may represent an effective therapeutic approach to NAFLD.
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Affiliation(s)
| | | | | | | | - Cláudia Costa
- Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro M Cabral
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Rita Lourenço
- Faculdade de Nutrição da Universidade do Porto, Porto, Portugal
| | - Meira Patrícia
- Faculdade de Nutrição da Universidade do Porto, Porto, Portugal
| | | | | | | | - Sandra Belo
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Eva Lau
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Ana Sande
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Sara Viana
- Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Paula Freitas
- Centro Hospitalar e Universitário de São João, Porto, Portugal
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Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, Cabral PM, Guerreiro V, Lourenço R, Meira P, Salazar D, Ferreira MJ, Pedro J, Leite A, Viana S, Sande A, Belo S, Lau E, Freitas P, Carvalho D. The Impact of Bariatric Surgery on Hepatic Function and Predictors of Liver Steatosis and Fibrosis. Obes Surg 2020; 30:2935-2941. [DOI: 10.1007/s11695-020-04622-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Pedro J, Neves JS, Ferreira MJ, Guerreiro V, Salazar D, Viana S, Mendonça F, Silva MM, Brandão I, Belo S, Freitas P, Varela A, Carvalho D. Impact of Depression on Weight Variation after Bariatric Surgery: A Three-Year Observational Study. Obes Facts 2020; 13:213-220. [PMID: 32229734 PMCID: PMC7250340 DOI: 10.1159/000506404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/29/2019] [Accepted: 02/09/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The association between obesity and depression has been repeatedly established. However, little is known about the impact that the diagnosis of depression before bariatric surgery (DDBS) may have on weight loss. OBJECTIVE To evaluate the impact of DDBS on weight outcomes. METHODS Retrospective study of patients submitted to BS. Patients with no weight, no current medication data, or those submitted to revision surgery were excluded. Patients were considered to have DDBS based on taking antidepressants prior to BS or if there was a medical history of past or current depression. Patients with and without a depression history were compared using independent t test. A multivariate logistic regression model was created to evaluate predictors of weight variation (variables included: age, sex, and type of surgery). RESULTS A total of 616 patients did not have a history of depression and 230 had DDBS. There was a statistically significant difference in the BMI variation between groups. On average, individuals with DDBS lost 1.4 kg/m2 less than those without DDBS. In the multivariate analysis, the group with DDBS, compared with the group without DDBS, presented on average less -0.9 kg/m2 (95% CI -1.7 to -0.2, p = 0.018) BMI variation. CONCLUSION DDBS is a predictor of lower weight loss after the surgical procedure. Even after adjusting for confounding variables such as age, sex, and BS type, this effect remains.
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Affiliation(s)
- Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal,
- Faculty of Medicine, University of Porto, Porto, Portugal,
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal,
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Daniela Salazar
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Sara Viana
- Department of Internal Medicine, Unidade Local de Saúde do Norte Alentejano, Évora, Portugal
| | - Fernando Mendonça
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Maria Manuel Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Isabel Brandão
- Department of Psychiatry and Mental Health, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Belo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
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Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, Cabral PM, Guerreiro V, Lourenço R, Meira P, Salazar D, Ferreira MJ, Pedro J, Leite A, Von-Hafe M, Vale C, Viana S, Sande A, Belo S, Lau E, Freitas P, Carvalho D. Thyroid Function and the Risk of Non-Alcoholic Fatty Liver Disease in Morbid Obesity. Front Endocrinol (Lausanne) 2020; 11:572128. [PMID: 33193088 PMCID: PMC7655985 DOI: 10.3389/fendo.2020.572128] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/02/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An association between hypothyroidism and the risk of Non-alcoholic Fatty Liver Disease (NAFLD) has been suggested. This association remains to be elucidated in patients with morbid obesity. AIM To evaluate the association between thyroid function and parameters of liver function and hepatic scores in patients with morbid obesity. METHODS Patients with morbid obesity followed in our center between January 2010 and July 2018 were included. The ones without evaluation of liver and thyroid functions were excluded. Fatty Liver Index (FLI) and BARD scores were used as predictors of hepatic steatosis and fibrosis, respectively. RESULTS We observed a positive association between TSH and both BARD (OR 1.14; p = 0.035) and FLI (OR 1.19; p = 0.010) in the unadjusted analysis. We found a negative association between free triiodothyronine levels and BARD (OR 0.70; p<0.01) and a positive association between free triiodothyronine levels and FLI (OR 1.48; p = 0.022). Concerning liver function, we found a positive association between total bilirubin and free thyroxine levels (β = 0.18 [0.02 to 0.35]; p = 0.033) and a negative association between total bilirubin and free triiodothyronine levels (β = -0.07 [-0.14 to -0.002]; p = 0.042). CONCLUSION Higher levels of TSH and free triiodothyronine may be associated with a higher risk of NAFLD, particularly steatosis, in patients with morbid obesity.
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Affiliation(s)
- Marta Borges-Canha
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- *Correspondence: Marta Borges-Canha,
| | - João Sérgio Neves
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Fernando Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria Manuel Silva
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cláudia Costa
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro M. Cabral
- Serviço de Patologia Clínica do Centro Hospitalar, Universitário Cova da Beira, Covilhã, Portugal
| | - Vanessa Guerreiro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Patrícia Meira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria João Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Pedro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Leite
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Madalena Von-Hafe
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Catarina Vale
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sara Viana
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Sande
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Belo
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eva Lau
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Salazar DA, Ferreira MJS, Neves JS, Pedro JMP, Guerreiro VA, e Silva Viana S, Mendonça F, Silva MM, Belo SP, Sande AV, Freitas P, Carvalho DM. Variable Thresholds of Vitamin D Plasma Levels to Suppress PTH: the Effect of Weight and Bariatric Surgery. Obes Surg 2019; 30:1551-1559. [DOI: 10.1007/s11695-019-04351-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Salazar D, Ferreira MJ, Neves JS, Pedro J, Gonçalves V, Viana S, Mendonça F, Silva MM, Belo S, Varela A, Freitas P, Carvalho D. MON-535 Relationship between Vitamin D and PTH: The Effect of Obesity and Weight Loss after Bariatric Surgery. J Endocr Soc 2019. [PMCID: PMC6551129 DOI: 10.1210/js.2019-mon-535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | | | | | - Sara Viana
- Unidade Local de Saúde do Norte Alentejano, Portalegre, , Portugal
| | | | | | | | | | | | - Davide Carvalho
- Centro Hospitalar Universitário de São João, Porto, , Portugal
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Taveira RZ, Moraes J, Silva RMD, Amaral A, Mendonça F, Ponte F, Carvalho F, Pereira A. 026 Evaluation of heat tolerance of Tabapuã bovines in the central region of Brazil. J Anim Sci 2017. [DOI: 10.2527/asasann.2017.026] [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: 11/13/2022] Open
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Mendonça F, Soares R. Obesity and cancer phenotype: Is angiogenesis a missed link? Life Sci 2015; 139:16-23. [PMID: 26297445 DOI: 10.1016/j.lfs.2015.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/28/2015] [Accepted: 08/14/2015] [Indexed: 12/13/2022]
Abstract
Obesity remains nowadays one of the main threats to human health, being a problem of worldwide proportions. It is characterized by augmented storage of fatty acids in an enlarged adipose tissue. This process is possible thanks to a rich capillary network, supported by a mechanism that has also a crucial role on cancer: angiogenesis. Given that several studies point obesity as a risk factor for cancer development, angiogenesis may be approached as the missed link between these two pathologies. Understanding the different pathways behind angiogenesis becomes essential to break this link by developing new anti-angiogenic therapies or improving the actual ones. In the first phase, this paper will focus the structural and cellular changes that adipose tissue suffers in obesity. Then, the main pro-angiogenic players will be reviewed, taking into account the pathways that explain their putative role in obesity-cancer link. Finally, the clinical implications of the presented mechanisms will also be regarded, being the main focus on the anti-angiogenic therapies.
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Affiliation(s)
- Fernando Mendonça
- Department of Biochemistry, Faculty of Medicine, University of Porto, Portugal
| | - Raquel Soares
- Department of Biochemistry, Faculty of Medicine, University of Porto, Portugal; Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Portugal.
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Bakonyi Neto A, Takegawa B, Ortolan E, Galvão F, Mendonça F, Sbragia L, Crepaldi N, Vicente Y, Chaves H, Guimarães J. Demographic of short gut syndrome: increasing demand is not followed by referral of potential candidates for small bowel transplantation. Transplant Proc 2004; 36:259-60. [PMID: 15050127 DOI: 10.1016/j.transproceed.2004.01.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite improvements in small bowel transplantation (SBTx), early referral of patients with irreversible intestinal failure (IF) remains a major obstacle. In this study we evaluated the demand for SBTx among seven surgical pediatric centers located at least 200 km from our center. METHODS From 1997 to 2001, 640 patients have been treated for neonatal diseases, including 248 who underwent a minor or major intestinal resection. Twenty-four patients with major resections presented with short gut syndrome, requiring total parenteral nutrition (TPN). The greatest demand was in postsurgical neonates with necrotizing enterocolitis, gastroschiesis, onphalocoeles, or midgut volvulus, and in three adults with postradiotherapy arteritis (n = 2) and mesenteric vein thromboses (n = 1). The median length of residual bowel after resection was 20 to 30 cm, without an ileocecal valve. Four patients were referred for SBTx evaluation; three died while awaiting a donor; 20 were not referred, among whom 14 died of TPN complications. RESULTS Approximately 62 children per year require nutritional support for IF, most of whom develop complications related to TPN. Because many patients who are TPN-dependent develop complications, we believe that early referral would reduce mortality. CONCLUSIONS Greater medical awareness about the feasibility of SBTx procedures and earlier referral may improve results and quality of life after transplant.
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Affiliation(s)
- A Bakonyi Neto
- Department of Surgery, Botucatu Faculty of Medicine, UNESP, São Paulo, Brazil.
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