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Salminen P, Kow L, Aminian A, Kaplan LM, Nimeri A, Prager G, Behrens E, White KP, Shikora S. IFSO Consensus on Definitions and Clinical Practice Guidelines for Obesity Management-an International Delphi Study. Obes Surg 2024; 34:30-42. [PMID: 37999891 PMCID: PMC10781804 DOI: 10.1007/s11695-023-06913-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity. METHODS A three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable. Consensus was defined as ≥ 70% inter-voter agreement. RESULTS Consensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m2, and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease. CONCLUSIONS In this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach.
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Affiliation(s)
- Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland.
- Division of Digestive Surgery and Urology, Turku University Hospital, P.O. Box 52, 20521, Turku, Finland.
| | - Lilian Kow
- Department of Surgery, Flinders University, Adelaide, SA, Australia
| | - Ali Aminian
- Department of General Surgery, Cleveland Clinic, Bariatric and Metabolic Institute, Cleveland, OH, USA
| | - Lee M Kaplan
- Section On Obesity Medicine, Geisel School of Medicine at Darthmouth, Hanover, NH, USA
| | - Abdelrahman Nimeri
- Division of General & GI Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerhard Prager
- Division of Visceral Surgery, Vienna Medical University, Vienna, Austria
| | | | - Kevin P White
- ScienceRight International Health Research, London, ON, Canada
| | - Scott Shikora
- Division of General & GI Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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Velazquez A, Kaplan LM. Comprehensive Treatment Approaches To Obesity. Gastroenterol Clin North Am 2023; 52:xi-xii. [PMID: 37919027 DOI: 10.1016/j.gtc.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Affiliation(s)
- Amanda Velazquez
- Department of General Surgery, Center for Weight Management and Metabolic Health, Cedars-Sinai Medical Center, 8635 West 3rd Street, #795W, Los Angeles, CA 90048, USA.
| | - Lee M Kaplan
- The Obesity and Metabolism Institute, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Jastreboff AM, Kaplan LM, Hartman ML. Triple-Hormone-Receptor Agonist Retatrutide for Obesity. Reply. N Engl J Med 2023; 389:1629-1630. [PMID: 37888927 DOI: 10.1056/nejmc2310645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
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Jastreboff AM, Kaplan LM, Frías JP, Wu Q, Du Y, Gurbuz S, Coskun T, Haupt A, Milicevic Z, Hartman ML. Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial. N Engl J Med 2023; 389:514-526. [PMID: 37366315 DOI: 10.1056/nejmoa2301972] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [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: 06/28/2023]
Abstract
BACKGROUND Retatrutide (LY3437943) is an agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and glucagon receptors. Its dose-response relationships with respect to side effects, safety, and efficacy for the treatment of obesity are not known. METHODS We conducted a phase 2, double-blind, randomized, placebo-controlled trial involving adults who had a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 30 or higher or who had a BMI of 27 to less than 30 plus at least one weight-related condition. Participants were randomly assigned in a 2:1:1:1:1:2:2 ratio to receive subcutaneous retatrutide (1 mg, 4 mg [initial dose, 2 mg], 4 mg [initial dose, 4 mg], 8 mg [initial dose, 2 mg], 8 mg [initial dose, 4 mg], or 12 mg [initial dose, 2 mg]) or placebo once weekly for 48 weeks. The primary end point was the percentage change in body weight from baseline to 24 weeks. Secondary end points included the percentage change in body weight from baseline to 48 weeks and a weight reduction of 5% or more, 10% or more, or 15% or more. Safety was also assessed. RESULTS We enrolled 338 adults, 51.8% of whom were men. The least-squares mean percentage change in body weight at 24 weeks in the retatrutide groups was -7.2% in the 1-mg group, -12.9% in the combined 4-mg group, -17.3% in the combined 8-mg group, and -17.5% in the 12-mg group, as compared with -1.6% in the placebo group. At 48 weeks, the least-squares mean percentage change in the retatrutide groups was -8.7% in the 1-mg group, -17.1% in the combined 4-mg group, -22.8% in the combined 8-mg group, and -24.2% in the 12-mg group, as compared with -2.1% in the placebo group. At 48 weeks, a weight reduction of 5% or more, 10% or more, and 15% or more had occurred in 92%, 75%, and 60%, respectively, of the participants who received 4 mg of retatrutide; 100%, 91%, and 75% of those who received 8 mg; 100%, 93%, and 83% of those who received 12 mg; and 27%, 9%, and 2% of those who received placebo. The most common adverse events in the retatrutide groups were gastrointestinal; these events were dose-related, were mostly mild to moderate in severity, and were partially mitigated with a lower starting dose (2 mg vs. 4 mg). Dose-dependent increases in heart rate peaked at 24 weeks and declined thereafter. CONCLUSIONS In adults with obesity, retatrutide treatment for 48 weeks resulted in substantial reductions in body weight. (Funded by Eli Lilly; ClinicalTrials.gov number, NCT04881760.).
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Affiliation(s)
- Ania M Jastreboff
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Lee M Kaplan
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Juan P Frías
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Qiwei Wu
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Yu Du
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Sirel Gurbuz
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Tamer Coskun
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Axel Haupt
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Zvonko Milicevic
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
| | - Mark L Hartman
- From the Departments of Medicine (Endocrinology and Metabolism) and Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, CT (A.M.J.); the Obesity and Metabolism Institute and Department of Medicine, Harvard Medical School, Boston (L.M.K.); Velocity Clinical Research, Los Angeles (J.P.F.); and Eli Lilly, Indianapolis (Q.W., Y.D., S.G., T.C., A.H., Z.M., M.L.H.)
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Friedman AN, Schauer PR, Beddhu S, Kramer H, le Roux CW, Purnell JQ, Sunwold D, Tuttle KR, Jastreboff AM, Kaplan LM. Obstacles and opportunities in managing coexisting obesity and CKD: Report of a scientific workshop cosponsored by the National Kidney Foundation and The Obesity Society. Obesity (Silver Spring) 2022; 30:2340-2350. [PMID: 36268562 DOI: 10.1002/oby.23599] [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] [Received: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 01/04/2023]
Abstract
The National Kidney Foundation (NKF) and The Obesity Society (TOS) cosponsored a multispecialty international workshop in April 2021 to advance the understanding and management of obesity in adults with chronic kidney disease (CKD). The underlying rationale for the workshop was the accumulating evidence that obesity is a major contributor to CKD and adverse outcomes in individuals with CKD, and that effective treatment of obesity, including lifestyle intervention, weight loss medications, and metabolic surgery, can have beneficial effects. The attendees included a range of experts in the areas of kidney disease, obesity medicine, endocrinology, diabetes, bariatric/metabolic surgery, endoscopy, transplant surgery, and nutrition, as well as patients with obesity and CKD. The group identified strategies to increase patient and provider engagement in obesity management, outlined a collaborative action plan to engage nephrologists and obesity medicine experts in obesity management, and identified research opportunities to address gaps in knowledge about the interaction between obesity and kidney disease. The workshop's conclusions help lay the groundwork for development of an effective, scientifically based, and multidisciplinary approach to the management of obesity in people with CKD.
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Affiliation(s)
- Allon N Friedman
- Division of Nephrology, School of Medicine, Indiana University Indianapolis, Indiana, USA
| | - Philip R Schauer
- Pennington Biomedical Research Institute, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Srinivasan Beddhu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Holly Kramer
- Department of Public Health Sciences and Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Jonathan Q Purnell
- Division of Cardiovascular Medicine, School of Medicine, Oregon Health & Science University, Oregon, Portland, USA
| | - Duane Sunwold
- Culinary Program, Spokane Community College, Spokane, Washington, USA
| | - Katherine R Tuttle
- Providence Health Care and School of Medicine, University of Washington, Spokane, Washington, USA
| | - Ania M Jastreboff
- Endocrinology & Metabolism, Department of Medicine and Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Lee M Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastroenterology Division, Massachusetts General Hospital, and Medical School, Harvard University, Boston, Massachusetts, USA
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Friedman AN, Schauer PR, Beddhu S, Kramer H, le Roux CW, Purnell JQ, Sunwold D, Tuttle KR, Jastreboff AM, Kaplan LM. Obstacles and Opportunities in Managing Coexisting Obesity and CKD: Report of a Scientific Workshop Cosponsored by the National Kidney Foundation and The Obesity Society. Am J Kidney Dis 2022; 80:783-793. [PMID: 36280397 DOI: 10.1053/j.ajkd.2022.06.007] [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: 02/25/2022] [Accepted: 06/14/2022] [Indexed: 11/06/2022]
Abstract
The National Kidney Foundation (NKF) and The Obesity Society (TOS) cosponsored a multispecialty international workshop in April 2021 to advance the understanding and management of obesity in adults with chronic kidney disease (CKD). The underlying rationale for the workshop was the accumulating evidence that obesity is a major contributor to CKD and adverse outcomes in individuals with CKD, and that effective treatment of obesity, including lifestyle intervention, weight loss medications, and metabolic surgery, can have beneficial effects. The attendees included a range of experts in the areas of kidney disease, obesity medicine, endocrinology, diabetes, bariatric/metabolic surgery, endoscopy, transplant surgery, and nutrition, as well as patients with obesity and CKD. The group identified strategies to increase patient and provider engagement in obesity management, outlined a collaborative action plan to engage nephrologists and obesity medicine experts in obesity management, and identified research opportunities to address gaps in knowledge about the interaction between obesity and kidney disease. The workshop's conclusions help lay the groundwork for development of an effective, scientifically based, and multidisciplinary approach to the management of obesity in people with CKD.
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Affiliation(s)
- Allon N Friedman
- Division of Nephrology, School of Medicine, Indiana University, Indianapolis, Indiana.
| | - Philip R Schauer
- Pennington Biomedical Research Institute, Louisiana State University, Baton Rouge, Louisiana
| | - Srinivasan Beddhu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Holly Kramer
- Department of Public Health Sciences and Medicine, Loyola University Chicago, Maywood, Illinois
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | | | - Duane Sunwold
- Culinary Program, Spokane Community College, Spokane, Washington
| | - Katherine R Tuttle
- Providence Health Care and School of Medicine, University of Washington, Spokane and Seattle, Washington
| | - Ania M Jastreboff
- Endocrinology & Metabolism, Department of Medicine and Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Lee M Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastroenterology Division, Massachusetts General Hospital, and Medical School, Harvard University, Boston, Massachusetts
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Kanwal F, Shubrook JH, Adams LA, Pfotenhauer K, Wai-Sun Wong V, Wright E, Abdelmalek MF, Harrison SA, Loomba R, Mantzoros CS, Bugianesi E, Eckel RH, Kaplan LM, El-Serag HB, Cusi K. Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 2021; 161:1657-1669. [PMID: 34602251 PMCID: PMC8819923 DOI: 10.1053/j.gastro.2021.07.049] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/22/2021] [Accepted: 07/31/2021] [Indexed: 02/07/2023]
Abstract
Find AGA's NASH Clinical Care Pathway App for iOS and Android mobile devices at nash.gastro.org. Scan this QR code to be taken directly to the website.Nonalcoholic fatty liver disease (NAFLD) is becoming increasingly common, currently affecting approximately 37% of US adults. NAFLD is most often managed in primary care or endocrine clinics, where clinicians must determine which patients might benefit from secondary care to address hepatic manifestations, comorbid metabolic traits, and cardiovascular risks of the disease. Because NAFLD is largely asymptomatic, and because optimal timing of treatment depends on accurate staging of fibrosis risk, screening at the primary care level is critical, together with consistent, timely, evidence-based, widely accessible, and testable management processes. To achieve these goals, the American Gastroenterological Association assembled a multidisciplinary panel of experts to develop a Clinical Care Pathway providing explicit guidance on the screening, diagnosis, and treatment of NAFLD. This article describes the NAFLD Clinical Care Pathway they developed and provides a rationale supporting proposed steps to assist clinicians in diagnosing and managing NAFLD with clinically significant fibrosis (stage F2-F4) based on the best available evidence. This Pathway is intended to be applicable in any setting where care for patients with NAFLD is provided, including primary care, endocrine, obesity medicine, and gastroenterology practices.
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Affiliation(s)
- Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Jay H Shubrook
- Touro University California College of Osteopathic Medicine, Vallejo, California
| | - Leon A Adams
- University of Western Australia Medical School, Perth, Western Australia, Australia
| | - Kim Pfotenhauer
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Eugene Wright
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Manal F Abdelmalek
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Rohit Loomba
- NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, California
| | | | | | - Robert H Eckel
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Lee M Kaplan
- Harvard Medical School, Boston, Massachusetts; Gastroenterology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Kenneth Cusi
- University of Florida, Gainesville, Florida; Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida.
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Syn NL, Cummings DE, Wang LZ, Lin DJ, Zhao JJ, Loh M, Koh ZJ, Chew CA, Loo YE, Tai BC, Kim G, So JBY, Kaplan LM, Dixon JB, Shabbir A. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet 2021; 397:1830-1841. [PMID: 33965067 DOI: 10.1016/s0140-6736(21)00591-2] [Citation(s) in RCA: 199] [Impact Index Per Article: 66.3] [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] [Received: 11/29/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metabolic-bariatric surgery delivers substantial weight loss and can induce remission or improvement of obesity-related risks and complications. However, more robust estimates of its effect on long-term mortality and life expectancy-especially stratified by pre-existing diabetes status-are needed to guide policy and facilitate patient counselling. We compared long-term survival outcomes of severely obese patients who received metabolic-bariatric surgery versus usual care. METHODS We did a prespecified one-stage meta-analysis using patient-level survival data reconstructed from prospective controlled trials and high-quality matched cohort studies. We searched PubMed, Scopus, and MEDLINE (via Ovid) for randomised trials, prospective controlled studies, and matched cohort studies comparing all-cause mortality after metabolic-bariatric surgery versus non-surgical management of obesity published between inception and Feb 3, 2021. We also searched grey literature by reviewing bibliographies of included studies as well as review articles. Shared-frailty (ie, random-effects) and stratified Cox models were fitted to compare all-cause mortality of adults with obesity who underwent metabolic-bariatric surgery compared with matched controls who received usual care, taking into account clustering of participants at the study level. We also computed numbers needed to treat, and extrapolated life expectancy using Gompertz proportional-hazards modelling. The study protocol is prospectively registered on PROSPERO, number CRD42020218472. FINDINGS Among 1470 articles identified, 16 matched cohort studies and one prospective controlled trial were included in the analysis. 7712 deaths occurred during 1·2 million patient-years. In the overall population consisting 174 772 participants, metabolic-bariatric surgery was associated with a reduction in hazard rate of death of 49·2% (95% CI 46·3-51·9, p<0·0001) and median life expectancy was 6·1 years (95% CI 5·2-6·9) longer than usual care. In subgroup analyses, both individuals with (hazard ratio 0·409, 95% CI 0·370-0·453, p<0·0001) or without (0·704, 0·588-0·843, p<0·0001) baseline diabetes who underwent metabolic-bariatric surgery had lower rates of all-cause mortality, but the treatment effect was considerably greater for those with diabetes (between-subgroup I2 95·7%, p<0·0001). Median life expectancy was 9·3 years (95% CI 7·1-11·8) longer for patients with diabetes in the surgery group than the non-surgical group, whereas the life expectancy gain was 5·1 years (2·0-9·3) for patients without diabetes. The numbers needed to treat to prevent one additional death over a 10-year time frame were 8·4 (95% CI 7·8-9·1) for adults with diabetes and 29·8 (21·2-56·8) for those without diabetes. Treatment effects did not appear to differ between gastric bypass, banding, and sleeve gastrectomy (I2 3·4%, p=0·36). By leveraging the results of this meta-analysis and other published data, we estimated that every 1·0% increase in metabolic-bariatric surgery utilisation rates among the global pool of metabolic-bariatric candidates with and without diabetes could yield 5·1 million and 6·6 million potential life-years, respectively. INTERPRETATION Among adults with obesity, metabolic-bariatric surgery is associated with substantially lower all-cause mortality rates and longer life expectancy than usual obesity management. Survival benefits are much more pronounced for people with pre-existing diabetes than those without. FUNDING None.
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Affiliation(s)
- Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, Singapore
| | - David E Cummings
- UW Medicine Diabetes Institute, Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, and Weight Management Program, Veteran Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Louis Z Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; SingHealth Internal Medicine Residency Programme, Singapore General Hospital, Singapore
| | - Daryl J Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marie Loh
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zong Jie Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Claire Alexandra Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Ying Ern Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bee Choo Tai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Guowei Kim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Jimmy Bok-Yan So
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute and Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - John B Dixon
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Asim Shabbir
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore.
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Abstract
Obesity is a leading public health problem that currently affects over 650 million individuals worldwide. Although interest in the adverse effects of obesity has grown exponentially in recent years, less attention has been given to studying its management in individuals with CKD. This relatively unexplored area should be considered a high priority because of the rapid growth and high prevalence of obesity in the CKD population, its broad impact on health and outcomes, and its modifiable nature. This article begins to lay the groundwork in this field by providing a comprehensive overview that critically evaluates the available evidence related to obesity and kidney disease, identifies important gaps in our knowledge base, and integrates recent insights in the pathophysiology of obesity to help provide a way forward in establishing guidelines as a basis for managing obesity in CKD. Finally, the article includes a kidney-centric algorithm for management of obesity that can be used in clinical practice.
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Affiliation(s)
- Allon N. Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lee M. Kaplan
- Obesity, Metabolism, and Nutrition Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Carel W. le Roux
- Diabetes Complications Research Center, University College Dublin, Dublin, Ireland
| | - Philip R. Schauer
- Pennington Biomedical Research Institute, Louisiana State University, Baton Rouge, Louisiana
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Ye Y, Abu El Haija M, Morgan DA, Guo D, Song Y, Frank A, Tian L, Riedl RA, Burnett CML, Gao Z, Zhu Z, Shahi SK, Zarei K, Couvelard A, Poté N, Ribeiro-Parenti L, Bado A, Noureddine L, Bellizzi A, Kievit P, Mangalam AK, Zingman LV, Le Gall M, Grobe JL, Kaplan LM, Clegg D, Rahmouni K, Mokadem M. Endocannabinoid Receptor-1 and Sympathetic Nervous System Mediate the Beneficial Metabolic Effects of Gastric Bypass. Cell Rep 2020; 33:108270. [PMID: 33113371 PMCID: PMC7660289 DOI: 10.1016/j.celrep.2020.108270] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/18/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022] Open
Abstract
The exact mechanisms underlying the metabolic effects of bariatric surgery remain unclear. Here, we demonstrate, using a combination of direct and indirect calorimetry, an increase in total resting metabolic rate (RMR) and specifically anaerobic RMR after Roux-en-Y gastric bypass (RYGB), but not sleeve gastrectomy (SG). We also show an RYGB-specific increase in splanchnic sympathetic nerve activity and "browning" of visceral mesenteric fat. Consequently, selective splanchnic denervation abolishes all beneficial metabolic outcomes of gastric bypass that involve changes in the endocannabinoid signaling within the small intestine. Furthermore, we demonstrate that administration of rimonabant, an endocannabinoid receptor-1 (CB1) inverse agonist, to obese mice mimics RYGB-specific effects on energy balance and splanchnic nerve activity. On the other hand, arachidonoylethanolamide (AEA), a CB1 agonist, attenuates the weight loss and metabolic signature of this procedure. These findings identify CB1 as a key player in energy regulation post-RYGB via a pathway involving the sympathetic nervous system.
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Affiliation(s)
- Yuanchao Ye
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Marwa Abu El Haija
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Donald A Morgan
- Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Deng Guo
- Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Yang Song
- College of Pharmacy, China Medical University, 77 Puhe Rd., Liaoning 110122, P.R. China
| | - Aaron Frank
- The Biomedical Research Department, Diabetes and Obesity Research Division, Cedars Sinai Medical Center, Beverly Hills, CA 90048, USA
| | - Liping Tian
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, P.R. China
| | - Ruth A Riedl
- Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Colin M L Burnett
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Zhan Gao
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Zhiyong Zhu
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Shailesh K Shahi
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Kasra Zarei
- Medical Scientist Training Program, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Anne Couvelard
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France; Department of Pathology, Bichat Hospital, AP-HP, Paris 75018, France
| | - Nicolas Poté
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France; Department of Pathology, Bichat Hospital, AP-HP, Paris 75018, France
| | - Lara Ribeiro-Parenti
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France; Department of General and Digestive Surgery, Bichat Hospital, AP-HP, Paris 75018, France
| | - André Bado
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France
| | - Lama Noureddine
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Andrew Bellizzi
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Paul Kievit
- Division of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR 97006, USA
| | - Ashutosh K Mangalam
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Interdisciplinary Graduate Program in Immunology and Molecular Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Leonid V Zingman
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Fraternal Orders of Eagles Diabetes Research Center, Iowa City, IA 52242, USA; Veterans Affairs Health Care System, Iowa City, IA 52242, USA; Obesity Research & Education Initiative, University of Iowa, Iowa City, IA 52242, USA
| | - Maude Le Gall
- INSERM U1149, Centre de Recherche sur l'Inflammation, Université de Paris, Paris 75018, France
| | - Justin L Grobe
- Departments of Physiology and Biomedical Engineering, Medical College of Wisconsin, Milwaukee, MI 53226, USA
| | - Lee M Kaplan
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; Obesity, Metabolism, and Nutrition Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Deborah Clegg
- College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102, USA
| | - Kamal Rahmouni
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Medical Scientist Training Program, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Fraternal Orders of Eagles Diabetes Research Center, Iowa City, IA 52242, USA; Veterans Affairs Health Care System, Iowa City, IA 52242, USA; Obesity Research & Education Initiative, University of Iowa, Iowa City, IA 52242, USA
| | - Mohamad Mokadem
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Department of Neuroscience and Pharmacology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Fraternal Orders of Eagles Diabetes Research Center, Iowa City, IA 52242, USA; Veterans Affairs Health Care System, Iowa City, IA 52242, USA; Obesity Research & Education Initiative, University of Iowa, Iowa City, IA 52242, USA.
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12
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Kaplan LM, Comuzzie AG. A Call to Better Understanding: Action Will Follow. Obesity (Silver Spring) 2020; 28:1002. [PMID: 32243693 DOI: 10.1002/oby.22792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- The Obesity Society, Silver Spring, Maryland, USA
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13
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Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, Nadglowski J, Ramos Salas X, Schauer PR, Twenefour D, Apovian CM, Aronne LJ, Batterham RL, Berthoud HR, Boza C, Busetto L, Dicker D, De Groot M, Eisenberg D, Flint SW, Huang TT, Kaplan LM, Kirwan JP, Korner J, Kyle TK, Laferrère B, le Roux CW, McIver L, Mingrone G, Nece P, Reid TJ, Rogers AM, Rosenbaum M, Seeley RJ, Torres AJ, Dixon JB. Joint international consensus statement for ending stigma of obesity. Nat Med 2020; 26:485-497. [PMID: 32127716 PMCID: PMC7154011 DOI: 10.1038/s41591-020-0803-x] [Citation(s) in RCA: 374] [Impact Index Per Article: 93.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
People with obesity commonly face a pervasive, resilient form of social stigma. They are often subject to discrimination in the workplace as well as in educational and healthcare settings. Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies. To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and, using a modified Delphi process, developed a joint consensus statement with recommendations to eliminate weight bias. Academic institutions, professional organizations, media, public-health authorities, and governments should encourage education about weight stigma to facilitate a new public narrative about obesity, coherent with modern scientific knowledge.
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Affiliation(s)
- Francesco Rubino
- King's College London, Department of Diabetes, School of Life Course Science, London, UK.
- King's College Hospital, Bariatric and Metabolic Surgery, London, UK.
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA
| | - David E Cummings
- UW Medicine Diabetes Institute, University of Washington, Seattle, WA, USA
- Weight Management Program, Virginia Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Robert H Eckel
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Donna H Ryan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Jeffrey I Mechanick
- The Marie-Josee and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, NY, USA
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ximena Ramos Salas
- Obesity Canada, Edmonton, Canada
- European Association for the Study of Obesity, Teddington, UK
| | - Phillip R Schauer
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | | | - Caroline M Apovian
- Boston University School of Medicine, Boston, MA, USA
- Center for Nutrition and Weight Management, Boston Medical Center, Boston, MA, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Rachel L Batterham
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
- University College London Hospital Foundation Trust, London, UK
- Centre for Obesity Research, Department of Medicine, University College London, London, UK
| | - Hans-Rudolph Berthoud
- Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Centre, Louisiana State University System, Baton Rouge, LA, USA
| | - Camilo Boza
- Centro de Innovación Clinica Las Condes Universidad Adolfo Ibañez, Santiago, Chile
| | - Luca Busetto
- Department of Internal Medicine, University of Padova, Padua, Italy
| | - Dror Dicker
- Hasharon Hospital-Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Obesity Management Task Force, European Association for the Study of Obesity, Teddington, UK
| | - Mary De Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel Eisenberg
- Department of Surgery, Stanford School of Medicine and Palo Alto Virginia Health Care System, Stanford, CA, USA
| | - Stuart W Flint
- School of Psychology, University of Leeds, Leeds, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, UK
| | - Terry T Huang
- Department of Health Policy & Management, Center for Systems & Community Design, New York, NY, USA
- NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, MA, USA
| | - John P Kirwan
- Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Judith Korner
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - LaShawn McIver
- Government Affairs & Advocacy, American Diabetes Association, Arlington, VA, USA
| | - Geltrude Mingrone
- King's College London, Department of Diabetes, School of Life Course Science, London, UK
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Catholic University, Rome, Italy
| | | | - Tirissa J Reid
- Division of Endocrinology, Diabetes & Metabolism, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ann M Rogers
- Pennsylvania State Hershey Medical Center, Hershey, PA, USA
| | | | - Randy J Seeley
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Antonio J Torres
- Hospital Clinico San Carlos. Universidad Complutense de Madrid, Madrid, Spain
| | - John B Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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14
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Couto Alves A, De Silva NMG, Karhunen V, Sovio U, Das S, Taal HR, Warrington NM, Lewin AM, Kaakinen M, Cousminer DL, Thiering E, Timpson NJ, Bond TA, Lowry E, Brown CD, Estivill X, Lindi V, Bradfield JP, Geller F, Speed D, Coin LJM, Loh M, Barton SJ, Beilin LJ, Bisgaard H, Bønnelykke K, Alili R, Hatoum IJ, Schramm K, Cartwright R, Charles MA, Salerno V, Clément K, Claringbould AAJ, van Duijn CM, Moltchanova E, Eriksson JG, Elks C, Feenstra B, Flexeder C, Franks S, Frayling TM, Freathy RM, Elliott P, Widén E, Hakonarson H, Hattersley AT, Rodriguez A, Banterle M, Heinrich J, Heude B, Holloway JW, Hofman A, Hyppönen E, Inskip H, Kaplan LM, Hedman AK, Läärä E, Prokisch H, Grallert H, Lakka TA, Lawlor DA, Melbye M, Ahluwalia TS, Marinelli M, Millwood IY, Palmer LJ, Pennell CE, Perry JR, Ring SM, Savolainen MJ, Rivadeneira F, Standl M, Sunyer J, Tiesler CMT, Uitterlinden AG, Schierding W, O’Sullivan JM, Prokopenko I, Herzig KH, Smith GD, O'Reilly P, Felix JF, Buxton JL, Blakemore AIF, Ong KK, Jaddoe VWV, Grant SFA, Sebert S, McCarthy MI, Järvelin MR. GWAS on longitudinal growth traits reveals different genetic factors influencing infant, child, and adult BMI. Sci Adv 2019; 5:eaaw3095. [PMID: 31840077 PMCID: PMC6904961 DOI: 10.1126/sciadv.aaw3095] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 08/06/2019] [Indexed: 05/29/2023]
Abstract
Early childhood growth patterns are associated with adult health, yet the genetic factors and the developmental stages involved are not fully understood. Here, we combine genome-wide association studies with modeling of longitudinal growth traits to study the genetics of infant and child growth, followed by functional, pathway, genetic correlation, risk score, and colocalization analyses to determine how developmental timings, molecular pathways, and genetic determinants of these traits overlap with those of adult health. We found a robust overlap between the genetics of child and adult body mass index (BMI), with variants associated with adult BMI acting as early as 4 to 6 years old. However, we demonstrated a completely distinct genetic makeup for peak BMI during infancy, influenced by variation at the LEPR/LEPROT locus. These findings suggest that different genetic factors control infant and child BMI. In light of the obesity epidemic, these findings are important to inform the timing and targets of prevention strategies.
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Affiliation(s)
- Alexessander Couto Alves
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - N. Maneka G. De Silva
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Ville Karhunen
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Shikta Das
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - H. Rob Taal
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Nicole M. Warrington
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Alexandra M. Lewin
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Marika Kaakinen
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, London, UK
- Centre for Pharmacology and Therapeutics, Division of Experimental Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Surrey, UK
| | - Diana L. Cousminer
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Institute of Biomedicine, Department of Physiology, University of Eastern Finland, Kuopio, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Elisabeth Thiering
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich Neuherberg, Germany
- Division of Metabolic Diseases and Nutritional Medicine, Dr von Hauner Children’s Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Nicholas J. Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol and NIHR Bristol Biomedical Research Center, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom A. Bond
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Estelle Lowry
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Christopher D. Brown
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xavier Estivill
- Genomics and Disease Group, Bioinformatics and Genomics Programme, Centre for Genomic Regulation (CRG), Barcelona, Catalonia, Spain
- Pompeu Fabra University (UPF), Barcelona, Catalonia, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Virpi Lindi
- Institute of Biomedicine, Department of Physiology, University of Eastern Finland, Kuopio, Finland
| | - Jonathan P. Bradfield
- Center for Applied Genomics, Abramson Research Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Frank Geller
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Doug Speed
- Aarhus Institute of Advanced Studies (AIAS), Aarhus University, Aarhus, Denmark
- UCL Genetics Institute, University College London, London, UK
| | - Lachlan J. M. Coin
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - Marie Loh
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Translational Laboratory in Genetic Medicine (TLGM), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore
| | - Sheila J. Barton
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lawrence J. Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Hans Bisgaard
- COPSAC, The Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC, The Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rohia Alili
- CRNH Ile de France, Hôpital Pitié-Salpêtrière, Paris, France
| | - Ida J. Hatoum
- CRNH Ile de France, Hôpital Pitié-Salpêtrière, Paris, France
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Katharina Schramm
- Institute of Human Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Human Genetics, Technische Universität München, München, Germany
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Institute for Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Marie-Aline Charles
- Inserm, UMR 1153 (CRESS), Paris Descartes University, Villejuif, Paris, France
| | - Vincenzo Salerno
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Karine Clément
- CRNH Ile de France, Hôpital Pitié-Salpêtrière, Paris, France
- Inserm, UMR 1153 (CRESS), Paris Descartes University, Villejuif, Paris, France
| | - Annique A. J. Claringbould
- University Medical Centre Groningen, Department of Genetics, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands
| | - BIOS Consortium
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, Sophia Children’s Hospital, Rotterdam, Netherlands
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, London, UK
- Centre for Pharmacology and Therapeutics, Division of Experimental Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Surrey, UK
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Institute of Biomedicine, Department of Physiology, University of Eastern Finland, Kuopio, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich Neuherberg, Germany
- Division of Metabolic Diseases and Nutritional Medicine, Dr von Hauner Children’s Hospital, Ludwig-Maximilians University Munich, Munich, Germany
- MRC Integrative Epidemiology Unit at the University of Bristol and NIHR Bristol Biomedical Research Center, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Genomics and Disease Group, Bioinformatics and Genomics Programme, Centre for Genomic Regulation (CRG), Barcelona, Catalonia, Spain
- Pompeu Fabra University (UPF), Barcelona, Catalonia, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Sidra Medical and Research Center, Doha, Qatar
- Center for Applied Genomics, Abramson Research Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Aarhus Institute of Advanced Studies (AIAS), Aarhus University, Aarhus, Denmark
- UCL Genetics Institute, University College London, London, UK
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
- Translational Laboratory in Genetic Medicine (TLGM), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
- COPSAC, The Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- CRNH Ile de France, Hôpital Pitié-Salpêtrière, Paris, France
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Institute of Human Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Human Genetics, Technische Universität München, München, Germany
- Institute for Reproductive and Developmental Biology, Imperial College London, London, UK
- Inserm, UMR 1153 (CRESS), Paris Descartes University, Villejuif, Paris, France
- University Medical Centre Groningen, Department of Genetics, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Folkhalsan Research Center, Helsinki, Finland
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK
- National Institute for Health Research, Imperial College Biomedical Research Centre, London, UK
- Health Data Research UK London, Imperial College London, London, UK
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute of Diabetes, Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Psychology, College of Social Science, University of Lincoln Brayford Pool Lincoln, Lincolnshire, UK
- Human Genetics and Medical Genomics, Faculty of Medicine, University of Southampton, Southampton, UK
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Great Ormond Street Hospital Institute of Child Health, University College London, London, UK
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, North Terrace, Adelaide, South Australia, Australia
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Research Unit of Mathematical Sciences, University of Oulu, Oulu, Finland
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Stanford University Medical School, Stanford, CA, USA
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Old Road Campus, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, UK
- School of Public Health and Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Internal Medicine, and Biocenter of Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start—National Science, Challenge, University of Auckland, Auckland, New Zealand
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Headington, Oxford, UK
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Research Unit of Biomedicine, University Oulu, Oulu, Finland
- Medical Research Center and Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, De Crespigny Park, London, UK
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Cornelia M. van Duijn
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Elena Moltchanova
- Department of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
| | - Johan G. Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Folkhalsan Research Center, Helsinki, Finland
| | - Cathy Elks
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Bjarke Feenstra
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Claudia Flexeder
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich Neuherberg, Germany
| | - Stephen Franks
- Institute for Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Timothy M. Frayling
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK
| | - Rachel M. Freathy
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research, Imperial College Biomedical Research Centre, London, UK
- Health Data Research UK London, Imperial College London, London, UK
| | - Elisabeth Widén
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Hakon Hakonarson
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Applied Genomics, Abramson Research Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute of Diabetes, Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew T. Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK
| | - Alina Rodriguez
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- School of Psychology, College of Social Science, University of Lincoln Brayford Pool Lincoln, Lincolnshire, UK
| | - Marco Banterle
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich Neuherberg, Germany
| | - Barbara Heude
- Inserm, UMR 1153 (CRESS), Paris Descartes University, Villejuif, Paris, France
| | - John W. Holloway
- Human Genetics and Medical Genomics, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Albert Hofman
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Elina Hyppönen
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Great Ormond Street Hospital Institute of Child Health, University College London, London, UK
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, North Terrace, Adelaide, South Australia, Australia
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lee M. Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Asa K. Hedman
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Esa Läärä
- Research Unit of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Holger Prokisch
- Institute of Human Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Human Genetics, Technische Universität München, München, Germany
| | - Harald Grallert
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Timo A. Lakka
- Institute of Biomedicine, Department of Physiology, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Debbie A. Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol and NIHR Bristol Biomedical Research Center, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Stanford University Medical School, Stanford, CA, USA
| | - Tarunveer S. Ahluwalia
- COPSAC, The Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marcella Marinelli
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Iona Y. Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Old Road Campus, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, UK
| | - Lyle J. Palmer
- School of Public Health and Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Craig E. Pennell
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - John R. Perry
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Susan M. Ring
- MRC Integrative Epidemiology Unit at the University of Bristol and NIHR Bristol Biomedical Research Center, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Markku J. Savolainen
- Division of Internal Medicine, and Biocenter of Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marie Standl
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich Neuherberg, Germany
| | - Jordi Sunyer
- Pompeu Fabra University (UPF), Barcelona, Catalonia, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Carla M. T. Tiesler
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich Neuherberg, Germany
- Division of Metabolic Diseases and Nutritional Medicine, Dr von Hauner Children’s Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Andre G. Uitterlinden
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Justin M. O’Sullivan
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start—National Science, Challenge, University of Auckland, Auckland, New Zealand
| | - Inga Prokopenko
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, London, UK
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Surrey, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Headington, Oxford, UK
| | - Karl-Heinz Herzig
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Research Unit of Biomedicine, University Oulu, Oulu, Finland
- Medical Research Center and Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol and NIHR Bristol Biomedical Research Center, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul O'Reilly
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, De Crespigny Park, London, UK
| | - Janine F. Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, Sophia Children’s Hospital, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jessica L. Buxton
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
| | - Alexandra I. F. Blakemore
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Ken K. Ong
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Vincent W. V. Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Struan F. A. Grant
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Applied Genomics, Abramson Research Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute of Diabetes, Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sylvain Sebert
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Mark I. McCarthy
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Headington, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Medical Research Center and Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Early Growth Genetics (EGG) Consortium
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, Sophia Children’s Hospital, Rotterdam, Netherlands
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland, Australia
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, London, UK
- Centre for Pharmacology and Therapeutics, Division of Experimental Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Surrey, UK
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Institute of Biomedicine, Department of Physiology, University of Eastern Finland, Kuopio, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich Neuherberg, Germany
- Division of Metabolic Diseases and Nutritional Medicine, Dr von Hauner Children’s Hospital, Ludwig-Maximilians University Munich, Munich, Germany
- MRC Integrative Epidemiology Unit at the University of Bristol and NIHR Bristol Biomedical Research Center, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Genetics and Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Genomics and Disease Group, Bioinformatics and Genomics Programme, Centre for Genomic Regulation (CRG), Barcelona, Catalonia, Spain
- Pompeu Fabra University (UPF), Barcelona, Catalonia, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Sidra Medical and Research Center, Doha, Qatar
- Center for Applied Genomics, Abramson Research Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Aarhus Institute of Advanced Studies (AIAS), Aarhus University, Aarhus, Denmark
- UCL Genetics Institute, University College London, London, UK
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
- Translational Laboratory in Genetic Medicine (TLGM), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
- COPSAC, The Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- CRNH Ile de France, Hôpital Pitié-Salpêtrière, Paris, France
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Institute of Human Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Human Genetics, Technische Universität München, München, Germany
- Institute for Reproductive and Developmental Biology, Imperial College London, London, UK
- Inserm, UMR 1153 (CRESS), Paris Descartes University, Villejuif, Paris, France
- University Medical Centre Groningen, Department of Genetics, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Folkhalsan Research Center, Helsinki, Finland
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK
- National Institute for Health Research, Imperial College Biomedical Research Centre, London, UK
- Health Data Research UK London, Imperial College London, London, UK
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute of Diabetes, Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Psychology, College of Social Science, University of Lincoln Brayford Pool Lincoln, Lincolnshire, UK
- Human Genetics and Medical Genomics, Faculty of Medicine, University of Southampton, Southampton, UK
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Great Ormond Street Hospital Institute of Child Health, University College London, London, UK
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, North Terrace, Adelaide, South Australia, Australia
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Research Unit of Mathematical Sciences, University of Oulu, Oulu, Finland
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Stanford University Medical School, Stanford, CA, USA
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Old Road Campus, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, UK
- School of Public Health and Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Internal Medicine, and Biocenter of Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start—National Science, Challenge, University of Auckland, Auckland, New Zealand
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Headington, Oxford, UK
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Research Unit of Biomedicine, University Oulu, Oulu, Finland
- Medical Research Center and Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, De Crespigny Park, London, UK
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
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15
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Greenway FL, Aronne LJ, Raben A, Astrup A, Apovian CM, Hill JO, Kaplan LM, Fujioka K, Matejkova E, Svacina S, Luzi L, Gnessi L, Navas-Carretero S, Martinez JA, Still CD, Sannino A, Saponaro C, Demitri C, Urban LE, Leider H, Chiquette E, Ron ES, Zohar Y, Heshmati HM. Erratum: A Randomized, Double-Blind, Placebo-Controlled Study of Gelesis100: A Novel Nonsystemic Oral Hydrogel for Weight Loss. Obesity (Silver Spring) 2019; 27:1210. [PMID: 31231960 PMCID: PMC6885974 DOI: 10.1002/oby.22533] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Khera AV, Chaffin M, Wade KH, Zahid S, Brancale J, Xia R, Distefano M, Senol-Cosar O, Haas ME, Bick A, Aragam KG, Lander ES, Smith GD, Mason-Suares H, Fornage M, Lebo M, Timpson NJ, Kaplan LM, Kathiresan S. Polygenic Prediction of Weight and Obesity Trajectories from Birth to Adulthood. Cell 2019; 177:587-596.e9. [PMID: 31002795 PMCID: PMC6661115 DOI: 10.1016/j.cell.2019.03.028] [Citation(s) in RCA: 378] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/07/2018] [Accepted: 03/12/2019] [Indexed: 12/30/2022]
Abstract
Severe obesity is a rapidly growing global health threat. Although often attributed to unhealthy lifestyle choices or environmental factors, obesity is known to be heritable and highly polygenic; the majority of inherited susceptibility is related to the cumulative effect of many common DNA variants. Here we derive and validate a new polygenic predictor comprised of 2.1 million common variants to quantify this susceptibility and test this predictor in more than 300,000 individuals ranging from middle age to birth. Among middle-aged adults, we observe a 13-kg gradient in weight and a 25-fold gradient in risk of severe obesity across polygenic score deciles. In a longitudinal birth cohort, we note minimal differences in birthweight across score deciles, but a significant gradient emerged in early childhood and reached 12 kg by 18 years of age. This new approach to quantify inherited susceptibility to obesity affords new opportunities for clinical prevention and mechanistic assessment.
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Affiliation(s)
- Amit V Khera
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.
| | - Mark Chaffin
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Kaitlin H Wade
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 1TH, UK; Population Health Science, Bristol Medical School, Bristol, Bristol BS8 1TH, UK; Avon Longitudinal Study of Parents and Children, Bristol BS8 1TH, UK
| | - Sohail Zahid
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Joseph Brancale
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; Obesity, Metabolism, and Nutrition Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Rui Xia
- The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Marina Distefano
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA 02139, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Pathology, Harvard Medical School, Cambridge, MA 02115, USA
| | - Ozlem Senol-Cosar
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA 02139, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Pathology, Harvard Medical School, Cambridge, MA 02115, USA
| | - Mary E Haas
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Alexander Bick
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Krishna G Aragam
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Eric S Lander
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Program in Health Sciences and Technology, Harvard Medical School, Boston, MA 02115, USA
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 1TH, UK; Population Health Science, Bristol Medical School, Bristol, Bristol BS8 1TH, UK
| | - Heather Mason-Suares
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA 02139, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Pathology, Harvard Medical School, Cambridge, MA 02115, USA
| | - Myriam Fornage
- The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Matthew Lebo
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA 02139, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Pathology, Harvard Medical School, Cambridge, MA 02115, USA
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 1TH, UK; Population Health Science, Bristol Medical School, Bristol, Bristol BS8 1TH, UK; Avon Longitudinal Study of Parents and Children, Bristol BS8 1TH, UK
| | - Lee M Kaplan
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; Obesity, Metabolism, and Nutrition Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sekar Kathiresan
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.
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Greenway FL, Aronne LJ, Raben A, Astrup A, Apovian CM, Hill JO, Kaplan LM, Fujioka K, Matejkova E, Svacina S, Luzi L, Gnessi L, Navas‐Carretero S, Alfredo Martinez J, Still CD, Sannino A, Saponaro C, Demitri C, Urban LE, Leider H, Chiquette E, Ron ES, Zohar Y, Heshmati HM. A Randomized, Double-Blind, Placebo-Controlled Study of Gelesis100: A Novel Nonsystemic Oral Hydrogel for Weight Loss. Obesity (Silver Spring) 2019; 27:205-216. [PMID: 30421844 PMCID: PMC6587502 DOI: 10.1002/oby.22347] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/02/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aims to assess the efficacy and safety of Gelesis100, a novel, nonsystemic, superabsorbent hydrogel to treat overweight or obesity. METHODS The Gelesis Loss Of Weight (GLOW) study was a 24-week, multicenter, randomized, double-blind, placebo-controlled study in patients with BMI ≥ 27 and ≤ 40 kg/m2 and fasting plasma glucose ≥ 90 and ≤ 145 mg/dL. The co-primary end points were placebo-adjusted weight loss (superiority and 3% margin super-superiority) and at least 35% of patients in the Gelesis100 group achieving ≥ 5% weight loss. RESULTS Gelesis100 treatment caused greater weight loss over placebo (6.4% vs. 4.4%, P = 0.0007), achieving 2.1% superiority but not 3% super-superiority. Importantly, 59% of Gelesis100-treated patients achieved weight loss of ≥ 5%, and 27% achieved ≥ 10% versus 42% and 15% in the placebo group, respectively. Gelesis100-treated patients had twice the odds of achieving ≥ 5% and ≥ 10% weight loss versus placebo (adjusted OR: 2.0, P = 0.0008; OR: 2.1, P = 0.0107, respectively), with 5% responders having a mean weight loss of 10.2%. Patients with prediabetes or drug-naive type 2 diabetes had six times the odds of achieving ≥ 10% weight loss. Gelesis100 treatment had no apparent increased safety risks. CONCLUSIONS Gelesis100 is a promising new nonsystemic therapy for overweight and obesity with a highly desirable safety and tolerability profile.
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Affiliation(s)
- Frank L. Greenway
- Pennington Biomedical Research Center of the Louisiana State University SystemBaton RougeLouisianaUSA
| | - Louis J. Aronne
- Weill Cornell Medicine Comprehensive Weight Control CenterNew YorkNew YorkUSA
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksberg CDenmark
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksberg CDenmark
| | - Caroline M. Apovian
- Department of Medicine, Endocrinology, Diabetes, and NutritionBoston University School of MedicineBostonMassachusettsUSA
| | - James O. Hill
- Department of Pediatrics and MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Lee M. Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal UnitMassachusetts General HospitalBostonMassachusettsUSA
| | - Ken Fujioka
- Scripps Clinic Del MarSan DiegoCaliforniaUSA
| | | | - Stepan Svacina
- Third Internal ClinicCharles UniversityPragueCzech Republic
| | - Livio Luzi
- Department of Endocrinology and MetabolismPoliclinico San Donato, University of MilanMilanItaly
| | - Lucio Gnessi
- Experimental Medicine DepartmentSapienza University of RomeRomeItaly
| | | | - J. Alfredo Martinez
- Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
- CIBERobn and IMDEA Food InstituteMadridSpain
| | - Christopher D. Still
- Center for Nutrition and WeightGeisinger Obesity InstituteDanvillePennsylvaniaUSA
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Klebanoff MJ, Corey KE, Samur S, Choi JG, Kaplan LM, Chhatwal J, Hur C. Cost-effectiveness Analysis of Bariatric Surgery for Patients With Nonalcoholic Steatohepatitis Cirrhosis. JAMA Netw Open 2019; 2:e190047. [PMID: 30794300 PMCID: PMC6484583 DOI: 10.1001/jamanetworkopen.2019.0047] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Obesity is the most common risk factor for nonalcoholic steatohepatitis (NASH), the progressive form of nonalcoholic fatty liver disease that can lead to cirrhosis and hepatocellular carcinoma. Weight loss can be an effective treatment for obesity and may slow the progression of advanced liver disease. OBJECTIVE To assess the cost-effectiveness of bariatric surgery in patients with NASH and compensated cirrhosis. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation study used a Markov-based state-transition model to simulate the benefits and risks of laparoscopic sleeve gastrectomy (SG), laparoscopic Roux-en-Y gastric bypass (GB), and intensive lifestyle intervention (ILI) compared with usual care in patients with NASH and compensated cirrhosis and varying baseline weight (overweight, mild obesity, moderate obesity, and severe obesity). Patients faced varied risks of perioperative mortality and complications depending on the type of surgery they underwent. Data were collected on March 22, 2017. MAIN OUTCOMES AND MEASURES Life-years, quality-adjusted life-years (QALYs), costs (in 2017 $US), and incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS Demographic characteristics of the patient population were based on a previously published prospective study (n = 161). Patients in the model were 41.0% female, and the base case age was 54 years. Compared with usual care, SG was associated with an increase in QALYs of 0.263 to 1.180 (bounds of ranges represent overweight to severe obesity); GB, 0.263 to 1.207; and ILI, 0.004 to 0.216. Sleeve gastrectomy was also associated with an increase in life-years of 0.693 to 1.930; GB, 0.694 to 1.947; and ILI, 0.012 to 0.114. With usual care, expected life-years in overweight, mild obesity, moderate obesity, and severe obesity were 12.939, 11.949, 10.976, and 10.095, respectively. With usual care, QALY in overweight was 6.418; mild obesity, 5.790; moderate obesity, 5.186; and severe obesity, 4.577. Sleeve gastrectomy was the most cost-effective option for patients across all weight classes assessed: ICER for SG in patients with overweight was $66 119 per QALY; mild obesity, $18 716 per QALY; moderate obesity, $10 274 per QALY; and severe obesity, $6563 per QALY. A threshold analysis on the procedure cost of GB found that for GB to be cost-effective, the cost of the surgery must be decreased from its baseline value of $28 734 by $4889 for mild obesity, by $3189 for moderate obesity, and by $2289 for severe obesity. In overweight patients, GB involved fewer QALYs than SG, and thus decreasing the cost of surgery would not result in cost-effectiveness. CONCLUSIONS AND RELEVANCE Bariatric surgery could be highly cost-effective in patients with NASH compensated cirrhosis and obesity or overweight. The findings from this analysis suggest that it can inform clinical trials evaluating the effect of bariatric procedures in patients with NASH cirrhosis, including those with a lower body mass index.
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Affiliation(s)
| | - Kathleen E. Corey
- Gastroenterology Division, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Sumeyye Samur
- Institute for Clinical and Economic Review, Boston, Massachusetts
- Massachusetts General Hospital Institute for Technology Assessment, Boston
| | - Jin G. Choi
- Massachusetts General Hospital Institute for Technology Assessment, Boston
| | - Lee M. Kaplan
- Gastroenterology Division, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Jagpreet Chhatwal
- Gastroenterology Division, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital Institute for Technology Assessment, Boston
| | - Chin Hur
- Division of Digestive and Liver Diseases, Department of Medicine,Columbia University Medical Center, New York, New York
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19
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Srivastava G, Johnson ED, Earle RL, Kadambi N, Pazin DE, Kaplan LM. Reply to "Response to Harris et al.". Obesity (Silver Spring) 2018; 26:1669. [PMID: 30358149 DOI: 10.1002/oby.22299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Gitanjali Srivastava
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Erica D Johnson
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca L Earle
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nitya Kadambi
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dorothy E Pazin
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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20
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Abstract
Mounting evidence indicates that the gut microbiome responds to diet, antibiotics, and other external stimuli with speed and high precision and in ways that impact a variety of metabolic conditions including obesity and non-alcoholic fatty liver disease. Despite a decade of research establishing a strong association between the gut microbiota and obesity in humans, a causal relationship and the underlying mechanism remain outstanding. Several technological and methodological limitations in obesity and microbiome research have made it difficult to establish causality in this complex relationship. Additionally, limited collaborative interaction between microbiome and obesity researchers has delayed progress. Here, we discuss the current status of microbiome research as it relates to understanding obesity from the perspective of both communities, outline the underlying research challenges, and suggest directions to advance the obesity-microbiome field as a whole, with particular emphasis on the development of microbiome-targeted therapies for obesity prevention and treatment.
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Affiliation(s)
- Padma Maruvada
- NIH, National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD, USA
| | - Vanessa Leone
- Department of Medicine, Knapp Center for Biomedical Discovery, University of Chicago, Chicago, IL, USA
| | - Lee M Kaplan
- Obesity, Metabolism, and Nutrition Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Eugene B Chang
- Department of Medicine, Knapp Center for Biomedical Discovery, University of Chicago, Chicago, IL, USA.
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21
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Srivastava G, Johnson ED, Earle RL, Kadambi N, Pazin DE, Kaplan LM. Underdocumentation of Obesity by Medical Residents Highlights Challenges to Effective Obesity Care. Obesity (Silver Spring) 2018; 26:1277-1284. [PMID: 29956489 DOI: 10.1002/oby.22219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 03/13/2015] [Accepted: 05/08/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The goal of this study was to determine attitudes and practices of physicians in training with respect to the evaluation and treatment of obesity. METHODS Resident-generated admission and discharge notes of all 1,765 general medicine hospital admissions during 4 nonconsecutive months were analyzed, and any references to weight, obesity, BMI, adiposity, and body fat were identified. The full general resident cohort was then surveyed for perceptions and behaviors related to obesity. RESULTS Obesity was considered a highly important medical issue by 98.5% of residents; 90% correctly identified a class II obesity Stunkard phenotype, and 80% accurately calculated a BMI given height and weight in metric units. Residents overestimated inpatient obesity prevalence (estimate = 75%; actual = 35%) and the rate of obesity recording in the hospital admission note (estimate = 94%; actual = 49.5%). A BMI or current weight in the admission note or discharge summary was reported in none of the 1,765 patient records, and only 6% of the patients with obesity had obesity noted in either the inpatient admission or discharge assessment or plan. CONCLUSIONS Though residents recognize obesity and its clinical implications, it is underreported in the assessment of inpatients. This low level of documenting obesity and its impact on clinical care planning underscores a missed opportunity to establish appropriate referrals and initiate treatment at a clinically opportune time.
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Affiliation(s)
- Gitanjali Srivastava
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Erica D Johnson
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca L Earle
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nitya Kadambi
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dorothy E Pazin
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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22
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Luther J, Gala MK, Borren N, Masia R, Goodman RP, Moeller IH, DiGiacomo E, Ehrlich A, Warren A, Yarmush ML, Ananthakrishnan A, Corey K, Kaplan LM, Bhatia S, Chung RT, Patel SJ. Hepatic connexin 32 associates with nonalcoholic fatty liver disease severity. Hepatol Commun 2018; 2:786-797. [PMID: 30202815 PMCID: PMC6123534 DOI: 10.1002/hep4.1179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 12/17/2022] Open
Abstract
Emerging data highlight the critical role for the innate immune system in the progression of nonalcoholic fatty liver disease (NAFLD). Connexin 32 (Cx32), the primary liver gap junction protein, is capable of modulating hepatic innate immune responses and has been studied in dietary animal models of steatohepatitis. In this work, we sought to determine the association of hepatic Cx32 with the stages of human NAFLD in a histologically characterized cohort of 362 patients with NAFLD. We also studied the hepatic expression of the genes and proteins known to interact with Cx32 (known as the connexome) in patients with NAFLD. Last, we used three independent dietary mouse models of nonalcoholic steatohepatitis to investigate the role of Cx32 in the development of steatohepatitis and fibrosis. In a univariate analysis, we found that Cx32 hepatic expression associates with each component of the NAFLD activity score and fibrosis severity. Multivariate analysis revealed that Cx32 expression most closely associated with the NAFLD activity score and fibrosis compared to known risk factors for the disease. Furthermore, by analyzing the connexome, we identified novel genes related to Cx32 that associate with NAFLD progression. Finally, we demonstrated that Cx32 deficiency protects against liver injury, inflammation, and fibrosis in three murine models of nonalcoholic steatohepatitis by limiting initial diet-induced hepatoxicity and subsequent increases in intestinal permeability. Conclusion: Hepatic expression of Cx32 strongly associates with steatohepatitis and fibrosis in patients with NAFLD. We also identify novel genes associated with NAFLD and suggest that Cx32 plays a role in promoting NAFLD development. (Hepatology Communications 2018;2:786-797).
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Affiliation(s)
- Jay Luther
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Clinical and Translational Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Obesity, Metabolism, and Nutrition InstituteMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Manish K. Gala
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Clinical and Translational Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Nynke Borren
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Ricard Masia
- Pathology Unit, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Russell P. Goodman
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Ida Hatoum Moeller
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Obesity, Metabolism, and Nutrition InstituteMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Erik DiGiacomo
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Alyssa Ehrlich
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | | | - Martin L. Yarmush
- Center for Engineering in Medicine, Shriner's HospitalHarvard Medical SchoolBostonMA
| | - Ashwin Ananthakrishnan
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Kathleen Corey
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Lee M. Kaplan
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Obesity, Metabolism, and Nutrition InstituteMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | | | - Raymond T. Chung
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Suraj J. Patel
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
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23
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Kaplan LM, Golden A, Jinnett K, Kolotkin RL, Kyle TK, Look M, Nadglowski J, O'Neil PM, Parry T, Tomaszewski KJ, Stevenin B, Lilleøre SK, Dhurandhar NV. Perceptions of Barriers to Effective Obesity Care: Results from the National ACTION Study. Obesity (Silver Spring) 2018; 26:61-69. [PMID: 29086529 DOI: 10.1002/oby.22054] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [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] [Received: 06/19/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE ACTION (Awareness, Care, and Treatment in Obesity maNagement) examined obesity-related perceptions, attitudes, and behaviors among people with obesity (PwO), health care providers (HCPs), and employer representatives (ERs). METHODS A total of 3,008 adult PwO (BMI ≥ 30 by self-reported height and weight), 606 HCPs, and 153 ERs completed surveys in a cross-sectional design. RESULTS Despite several weight loss (WL) attempts, only 23% of PwO reported 10% WL during the previous 3 years. Many PwO (65%) recognized obesity as a disease, but only 54% worried their weight may affect future health. Most PwO (82%) felt "completely" responsible for WL; 72% of HCPs felt responsible for contributing to WL efforts; few ERs (18%) felt even partially responsible. Only 50% of PwO saw themselves as "obese," and 55% reported receiving a formal diagnosis of obesity. Despite HCPs' reported comfort with weight-related conversations, time constraints deprioritized these efforts. Only 24% of PwO had a scheduled follow-up to initial weight-related conversations. Few PwO (17%) perceived employer-sponsored wellness offerings as helpful in supporting WL. CONCLUSIONS Although generally perceived as a disease, obesity is not commonly treated as such. Divergence in perceptions and attitudes potentially hinders better management. This study highlights inconsistent understanding of the impact of obesity and need for both self-directed and medical management.
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Affiliation(s)
- Lee M Kaplan
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | | | - Michelle Look
- San Diego Sports Medicine and Family Health Center, San Diego, California, USA
| | | | - Patrick M O'Neil
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas Parry
- Integrated Benefits Institute, San Francisco, California, USA
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24
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Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Surg Obes Relat Dis 2017; 12:1144-62. [PMID: 27568469 DOI: 10.1016/j.soard.2016.05.018] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
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Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO
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25
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Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: a Joint Statement by International Diabetes Organizations. Obes Surg 2017; 27:2-21. [PMID: 27957699 DOI: 10.1007/s11695-016-2457-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m2) and in those with class II obesity (BMI 35.0-39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m2 for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
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Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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26
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Staiger D, Golden AK, Dhurandha NV, Jinnett K, Kaplan LM, Kolotkin RL, Kyle TK, Nadglowski J, Parry T, Tomaszewski KJ, Guerrero G, Lilleøre SK, Kienhöfer J, Look M. Einsichten und Sichtweisen der Adipositas-Behandlung bei Menschen mit Adipositas: Ergebnisse der nationalen ACTION Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601671] [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: 10/19/2022]
Affiliation(s)
| | - AK Golden
- NP from Home, LLC., Munds Park, United States
| | | | - K Jinnett
- Integrated Benefits Institute, San Francisco, United States
| | - LM Kaplan
- Massachusetts General Hospital, Boston, United States
| | - RL Kolotkin
- Quality of Life Consulting, Durham, United States
| | - TK Kyle
- Conscience Health, Pittsburgh, United States
| | | | - T Parry
- Integrated Benefits Institute, San Francisco, United States
| | | | - G Guerrero
- Novo Nordisk Inc., Plainsboro, United States
| | | | | | - M Look
- San Diego Sports Medicine and Family Health, San Diego, United States
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27
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Klebanoff MJ, Corey KE, Chhatwal J, Kaplan LM, Chung RT, Hur C. Bariatric surgery for nonalcoholic steatohepatitis: A clinical and cost-effectiveness analysis. Hepatology 2017; 65:1156-1164. [PMID: 27880977 DOI: 10.1002/hep.28958] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [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: 05/13/2016] [Revised: 10/11/2016] [Accepted: 11/18/2016] [Indexed: 12/14/2022]
Abstract
UNLABELLED Nonalcoholic steatohepatitis (NASH) affects 2%-3% of the US population and is expected to become the leading indication for liver transplantation in the next decade. Bariatric surgery may be an effective but expensive treatment for NASH. Using a state-transition model, our analysis assessed the effectiveness and cost-effectiveness of surgery to manage NASH. We simulated the benefits and harms of laparoscopic Roux-en-Y gastric bypass surgery in patients defined by weight class (overweight, mild obesity, moderate obesity, and severe obesity) and fibrosis stage (F0-F3). Comparators included intensive lifestyle intervention (ILI) and no treatment. Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios were calculated. Our results showed that surgery and ILI in obese patients (with F0-F3) increased QALYs by 0.678-2.152 and 0.452-0.618, respectively, compared with no treatment. Incremental cost-effectiveness ratios for surgery in all F0-F3 patients with mild, moderate, or severe obesity were $48,836/QALY, $24,949/QALY, and $19,222/QALY, respectively. In overweight patients (with F0-F3), surgery increased QALYs by 0.050-0.824 and ILI increased QALYs by 0.031-0.164. In overweight patients, it was cost-effective to reserve treatment only for F3 patients; the incremental cost-effectiveness ratios for providing surgery or ILI only to F3 patients were $30,484/QALY and $25,367/QALY, respectively. CONCLUSIONS Surgery was both effective and cost-effective for obese patients with NASH, regardless of fibrosis stage; in overweight patients, surgery increased QALYs for all patients regardless of fibrosis stage, but was cost-effective only for patients with F3 fibrosis; our results highlight the promise of bariatric surgery for treating NASH and underscore the need for clinical trials in this area. (Hepatology 2017;65:1156-1164).
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Affiliation(s)
- Matthew J Klebanoff
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.,Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.,Yale University School of Medicine, New Haven, CT
| | - Kathleen E Corey
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jagpreet Chhatwal
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.,Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Lee M Kaplan
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Raymond T Chung
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Chin Hur
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA.,Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Abstract
Bariatric surgical procedures, including gastric bypass, vertical sleeve gastrectomy, and biliopancreatic diversion, are the most effective and durable treatments for obesity. In addition, These operations induce metabolic changes that provide weight-independent improvement in type 2 diabetes, fatty liver disease and other metabolic disorders. Initially thought to work by mechanical restriction of food intake or malabsorption of ingested nutrients, these procedures are now known to work through complex changes in neuroendocrine and immune signals emanating from the gut, including peptide hormones, bile acids, vagal nerve activity, and metabolites generated by the gut microbiota, all collaborating to reregulate appetite, food preference, and energy expenditure. Development of less invasive means of achieving these benefits would allow much greater dissemination of effective, gastrointestinal (GI)-targeted therapies for obesity and metabolic disorders. To reproduce the benefits of bariatric surgery, however, these endoscopic procedures and devices will need to mimic the physiological rather than the mechanical effects of these operations.
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Affiliation(s)
- Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, 149 13th Street, Room 8219, Boston, MA 02129, USA.
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Affiliation(s)
- Matthew J. Klebanoff
- Institute for Technology Assessment, Massachusetts General Hospital, Boston2Division of Gastroenterology, Massachusetts General Hospital, Boston3Now at Yale School of Medicine, New Haven, Connecticut
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston2Division of Gastroenterology, Massachusetts General Hospital, Boston4Harvard Medical School, Boston, Massachusetts
| | - Jacob D. Nudel
- Harvard Medical School, Boston, Massachusetts5Now at Department of Surgery, Boston University, Boston, Massachusetts
| | - Kathleen E. Corey
- Division of Gastroenterology, Massachusetts General Hospital, Boston4Harvard Medical School, Boston, Massachusetts
| | - Lee M. Kaplan
- Division of Gastroenterology, Massachusetts General Hospital, Boston4Harvard Medical School, Boston, Massachusetts
| | - Chin Hur
- Institute for Technology Assessment, Massachusetts General Hospital, Boston2Division of Gastroenterology, Massachusetts General Hospital, Boston4Harvard Medical School, Boston, Massachusetts
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Rajagopalan H, Cherrington AD, Thompson CC, Kaplan LM, Rubino F, Mingrone G, Becerra P, Rodriguez P, Vignolo P, Caplan J, Rodriguez L, Galvao Neto MP. Endoscopic Duodenal Mucosal Resurfacing for the Treatment of Type 2 Diabetes: 6-Month Interim Analysis From the First-in-Human Proof-of-Concept Study. Diabetes Care 2016; 39:2254-2261. [PMID: 27519448 DOI: 10.2337/dc16-0383] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [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: 02/23/2016] [Accepted: 06/08/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess procedural safety and glycemic indices at 6 months in a first-in-human study of duodenal mucosal resurfacing (DMR), a novel, minimally invasive, upper endoscopic procedure involving hydrothermal ablation of the duodenal mucosa, in patients with type 2 diabetes and HbA1c ≥7.5% (58 mmol/mol) on one or more oral antidiabetic agents. RESEARCH DESIGN AND METHODS Using novel balloon catheters, DMR was conducted on varying lengths of duodenum in anesthetized patients at a single medical center. RESULTS A total of 39 patients with type 2 diabetes (screening HbA1c 9.5% [80 mmol/mol]; BMI 31 kg/m2) were treated and included in the interim efficacy analysis: 28 had a long duodenal segment ablated (LS; ∼9.3 cm treated) and 11 had a short segment ablated (SS; ∼3.4 cm treated). Overall, DMR was well tolerated with minimal gastrointestinal symptoms postprocedure. Three patients experienced duodenal stenosis treated successfully by balloon dilation. HbA1c was reduced by 1.2% at 6 months in the full cohort (P < 0.001). More potent glycemic effects were observed among the LS cohort, who experienced a 2.5% reduction in mean HbA1c at 3 months postprocedure vs. 1.2% in the SS group (P < 0.05) and a 1.4% reduction at 6 months vs. 0.7% in the SS group (P = 0.3). This occurred despite net medication reductions in the LS cohort between 0 and 6 months. Among LS patients with a screening HbA1c of 7.5-10% (58-86 mmol/mol) and on stable antidiabetic medications postprocedure, HbA1c was reduced by 1.8% at 6 months (P < 0.01). CONCLUSIONS Single-procedure DMR elicits a clinically significant improvement in hyperglycemia in patients with type 2 diabetes in the short-term, with acceptable safety and tolerability. Long-term safety, efficacy, and durability and possible mechanisms of action require further investigation.
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Affiliation(s)
| | | | | | | | | | | | - Pablo Becerra
- CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
| | | | - Paulina Vignolo
- CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
| | | | | | - Manoel P Galvao Neto
- Gastro Obeso Center, São Paulo, Brazil.,Florida International University, Miami, FL
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Hatoum IJ, Blackstone R, Hunter TD, Francis DM, Steinbuch M, Harris JL, Kaplan LM. Clinical Factors Associated With Remission of Obesity-Related Comorbidities After Bariatric Surgery. JAMA Surg 2016; 151:130-7. [PMID: 26465084 DOI: 10.1001/jamasurg.2015.3231] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Little is known about comorbidity remission after bariatric surgery during typical clinical care across diverse and geographically distributed populations. OBJECTIVE To estimate the improvement in obesity-related comorbidities after bariatric surgery and to identify clinical factors associated with these responses using a large representative population of patients. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included all patients (N = 33,718) with a recorded Current Procedural Terminology code for Roux-en-Y gastric bypass (RYGB) or adjustable gastric banding (AGB) in the MarketScan Commercial Claims and Encounters Medicare Supplemental Databases from January 1, 2005, to June 30, 2010, and who had continuous enrollment from 6 months or more before to 12 months after surgery. MAIN OUTCOMES AND MEASURES Comorbidities before and after surgery were identified using both diagnoses (from International Classification of Diseases, Ninth Revision [ICD-9] codes) and prescription drug fills. Remission was based on a record of the comorbidity within 6 months before surgery, without record of the condition 18 months after surgery, using both ICD-9 codes and medication fills, as applicable. Multivariable logistic regression models were developed to identify factors associated with remission of diabetes and hypertension. RESULTS Among the 33,718 patients, 13 comorbidities with at least 1% prevalence before surgery were identified. Both RYGB and AGB led to statistically and clinically significant reductions in these comorbidities; remission rates for all comorbidities were higher after RYGB than AGB. For comorbidities that could be defined using both ICD-9 and prescription drug fill codes, prevalence was higher before and lower after surgery when measured by fill codes. Diagnoses using ICD-9 codes, but not prescription fill codes, increased in the 3 months before surgery. In multivariable logistic regression models for remission of diabetes mellitus after RYGB and AGB, age (RYGB: odds ratio [OR], 0.976; 95% CI, 0.965-0.988 and AGB: OR, 0.982; 95% CI, 0.971-0.933), procedure year (RYGB: OR, 1.11; 95% CI, 1.012-1.218 and AGB: OR, 1.185; 95% CI, 1.039-1.351), preoperative insulin use (RYGB: OR, 0.14; 95% CI, 0.114-0.171; AGB: OR, 0.174; 95% CI, 0.131-0.230), preoperative sulfonylurea use (RYGB: OR, 0.616; 95% CI, 0.505-0.752 and AGB: OR, 0.449; 95% CI, 0.357-0.566), and other antidiabetic medication use (RYGB: OR, 0.747; 95% CI, 0.568-0.981 and AGB: OR, 0.506; 95% CI, 0.359-0.715) were significantly associated with response after both procedures. For remission of hypertension, age (RYGB: OR, 0.964; 95% CI, 0.957-0.972 and AGB: OR, 0.968; 95% CI, 0.959-0.977), number of preoperative antihypertensive medications (RYGB: OR, 0.104; 95% CI, 0.067-0.161 and AGB: OR, 0.239; 95% CI, 0.140-0.408), and preoperative diuretic use (RYGB: OR, 1.729; 95% CI, 1.462-2.045 and AGB: OR, 1.648; 95% CI, 1.380-1.967) were significantly associated with response after both procedures. CONCLUSIONS AND RELEVANCE Analysis of a large, representative administrative database confirmed established predictors and revealed novel variables associated with comorbidity remission after bariatric surgery. Incorporating these factors into clinical tools to assess an individual patient's risk-to-benefit profile for these procedures could enhance patient selection and the overall use of surgery for the treatment of obesity and metabolic disease.
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Affiliation(s)
- Ida J Hatoum
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston2Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | - Diane M Francis
- Ethicon Inc, Cincinnati, Ohio6Johnson & Johnson, New Brunswick, New Jersey
| | - Michael Steinbuch
- Ethicon Inc, Cincinnati, Ohio6Johnson & Johnson, New Brunswick, New Jersey
| | - Jason L Harris
- Ethicon Inc, Cincinnati, Ohio6Johnson & Johnson, New Brunswick, New Jersey
| | - Lee M Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston2Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care 2016; 39:861-77. [PMID: 27222544 DOI: 10.2337/dc16-0236] [Citation(s) in RCA: 539] [Impact Index Per Article: 67.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
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Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO
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Carmody JS, Muñoz R, Yin H, Kaplan LM. Peripheral, but not central, GLP-1 receptor signaling is required for improvement in glucose tolerance after Roux-en-Y gastric bypass in mice. Am J Physiol Endocrinol Metab 2016; 310:E855-61. [PMID: 27026085 PMCID: PMC4888530 DOI: 10.1152/ajpendo.00412.2015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 03/28/2016] [Indexed: 01/06/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) causes profound weight loss and remission of diabetes by influencing metabolic physiology, yet the mechanisms behind these clinical improvements remain undefined. After RYGB, levels of glucagon-like peptide-1 (GLP-1), a hormone that enhances insulin secretion and promotes satiation, are substantially elevated. Because GLP-1 signals in both the periphery and the brain to influence energy balance and glucose regulation, we aimed to determine the relative requirements of these systems to weight loss and improved glucose tolerance following RYGB surgery in mice. By pharmacologically blocking peripheral or central GLP-1R signaling, we examined whether GLP-1 action is necessary for the metabolic improvements observed after RYGB. Diet-induced obese mice underwent RYGB or sham operation and were implanted with osmotic pumps delivering the GLP-1R antagonist exendin-(9-39) (2 pmol·kg(-1)·min(-1) peripherally; 0.5 pmol·kg(-1)·min(-1) centrally) for up to 10 wk. Blockade of peripheral GLP-1R signaling partially reversed the improvement in glucose tolerance after RYGB. In contrast, fasting glucose and insulin sensitivity, as well as body weight, were unaffected by GLP-1R antagonism. Central GLP-1R signaling did not appear to be required for any of the metabolic improvements seen after this operation. Collectively, these results suggest a detectable but only modest role for GLP-1 in mediating the effects of RYGB and that this role is limited to its well-described action on glucose regulation.
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Affiliation(s)
- Jill S Carmody
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Rodrigo Muñoz
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and Departamento de Cirugia Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Huali Yin
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and
| | - Lee M Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and
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Yu EW, Carmody JS, Brooks DJ, LaJoie S, Kaplan LM, Bouxsein ML. Cortical and trabecular deterioration in mouse models of Roux-en-Y gastric bypass. Bone 2016; 85:23-8. [PMID: 26806052 PMCID: PMC4792678 DOI: 10.1016/j.bone.2016.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 01/07/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) is a profoundly effective treatment for severe obesity, but results in significant bone loss in patients. Developing a murine model that recapitulates this skeletal phenotype will provide a robust tool with which to study the physiologic mechanisms of this bone loss. We studied adult male C57BL/6J mice who underwent either RYGB or sham operation. Twelve weeks after surgery, we characterized biochemical bone markers (parathyroid hormone, PTH; C-telopeptide, CTX; and type 1 procollagen, P1NP) and bone microarchitectural parameters as measured by microcomputed tomography. RYGB-treated mice had significant trabecular and cortical bone deficits compared with sham-operated controls. Although adjustment for final body weight eliminated observed cortical differences, the trabecular bone volume fraction remained significantly lower in RYGB mice even after weight adjustment. PTH levels were similar between groups, but RYGB mice had significantly higher indices of bone turnover than sham controls. These data demonstrate that murine models of RYGB recapitulate patterns of bone loss and turnover that have been observed in human clinical studies. Future studies that exploit this murine model will help delineate the alterations in bone metabolism and mechanisms of bone loss after RYGB.
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Affiliation(s)
| | - Jill S. Carmody
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital
| | - Daniel J. Brooks
- Endocrine Unit, Massachusetts General Hospital
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center
| | - Scott LaJoie
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital
| | - Lee M. Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center
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Carmody JS, Ahmad NN, Machineni S, Lajoie S, Kaplan LM. Weight Loss After RYGB Is Independent of and Complementary to Serotonin 2C Receptor Signaling in Male Mice. Endocrinology 2015; 156:3183-91. [PMID: 26066076 PMCID: PMC4541621 DOI: 10.1210/en.2015-1226] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) typically leads to substantial, long-term weight loss (WL) and diabetes remission, although there is a wide variation in response to RYGB among individual patients. Defining the pathways through which RYGB works should aid in the development of less invasive anti-obesity treatments, whereas identifying weight-regulatory pathways unengaged by RYGB could facilitate the development of therapies that complement the beneficial effects of surgery. Activation of serotonin 2C receptors (5-HT2CR) by serotonergic drugs causes WL in humans and animal models. 5-HT2CR are located on neurons that activate the melanocortin-4 receptors, which are essential for WL after RYGB. We therefore sought to determine whether 5-HT2CR signaling is also essential for metabolic effects of RYGB or whether it is a potentially complementary pathway, the activation of which could extend the benefits of RYGB. Diet-induced obese male mice deficient for the 5-HT2CR and their wild-type littermates underwent RYGB or sham operation. Both groups lost similar amounts of weight after RYGB, demonstrating that the improved metabolic phenotype after RYGB is 5-HT2CR independent. Consistent with this hypothesis, wild-type RYGB-treated mice lost additional weight after the administration of the serotonergic drugs fenfluramine and meta-chlorophenylpiperazine but not the nonserotonergic agent topiramate. The fact that RYGB does not depend on 5-HT2CR signaling suggests that there are important WL mechanisms not fully engaged by surgery that could potentially be harnessed for medical treatment. These results suggest a rational basis for designing medical-surgical combination therapies to optimize clinical outcomes by exploiting complementary physiological mechanisms of action.
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Affiliation(s)
- Jill S Carmody
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit (J.S.C., N.N.A., S.M., S.L., L.M.K.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Medicine (J.S.C., N.N.A., S.M., L.M.K.), Harvard Medical School, Boston, Massachusetts 02115
| | - Nadia N Ahmad
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit (J.S.C., N.N.A., S.M., S.L., L.M.K.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Medicine (J.S.C., N.N.A., S.M., L.M.K.), Harvard Medical School, Boston, Massachusetts 02115
| | - Sriram Machineni
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit (J.S.C., N.N.A., S.M., S.L., L.M.K.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Medicine (J.S.C., N.N.A., S.M., L.M.K.), Harvard Medical School, Boston, Massachusetts 02115
| | - Scott Lajoie
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit (J.S.C., N.N.A., S.M., S.L., L.M.K.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Medicine (J.S.C., N.N.A., S.M., L.M.K.), Harvard Medical School, Boston, Massachusetts 02115
| | - Lee M Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit (J.S.C., N.N.A., S.M., S.L., L.M.K.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Medicine (J.S.C., N.N.A., S.M., L.M.K.), Harvard Medical School, Boston, Massachusetts 02115
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Stanford FC, Johnson ED, Claridy MD, Earle RL, Kaplan LM. The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians. Int J Family Med 2015; 2015:841249. [PMID: 26339506 PMCID: PMC4539067 DOI: 10.1155/2015/841249] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 07/22/2015] [Indexed: 06/05/2023]
Abstract
Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH). We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20-39) were more likely to have received some obesity training than those aged 40-49 (OR: 0.08, 95% CI: 0.008-0.822) or those 50+ (OR: 0.03, 95% CI: 0.004-0.321). Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight.
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Affiliation(s)
- Fatima Cody Stanford
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Harvard Kennedy School of Government, Cambridge, MA 02138, USA
| | - Erica D. Johnson
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Mechelle D. Claridy
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Rebecca L. Earle
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lee M. Kaplan
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
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Arora P, Reingold J, Baggish A, Guanaga DP, Wu C, Ghorbani A, Song Y, Chen-Tournaux A, Khan AM, Tainsh LT, Buys ES, Williams JS, Heublein DM, Burnett JC, Semigran MJ, Bloch KD, Scherrer-Crosbie M, Newton-Cheh C, Kaplan LM, Wang TJ. Weight loss, saline loading, and the natriuretic peptide system. J Am Heart Assoc 2015; 4:e001265. [PMID: 25595796 PMCID: PMC4330054 DOI: 10.1161/jaha.114.001265] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background In epidemiologic studies, obesity has been associated with reduced natriuretic peptide (NP) concentrations. Reduced NP production could impair the ability of obese individuals to respond to salt loads, increasing the risk of hypertension and other disorders. We hypothesized that weight loss enhances NP production before and after salt loading. Methods and Results We enrolled 15 obese individuals (mean BMI 45±5.4 kg/m2) undergoing gastric bypass surgery. Before and 6 months after surgery, subjects were admitted to the clinical research center and administered a large‐volume intravenous saline challenge. Echocardiography and serial blood sampling were performed. From the pre‐operative visit to 6 months after surgery, subjects had a mean BMI decrease of 27%. At the 6‐month visit, N‐terminal pro‐atrial NP (Nt‐proANP) levels were 40% higher before, during, and after the saline infusion, compared with levels measured at the same time points during the pre‐operative visit (P<0.001). The rise in Nt‐pro‐ANP induced by the saline infusion (≈50%) was similar both before and after surgery (saline, P<0.001; interaction, P=0.2). Similar results were obtained for BNP and Nt‐proBNP; resting concentrations increased by 50% and 31%, respectively, after gastric bypass surgery. The increase in NP concentrations after surgery was accompanied by significant decreases in mean arterial pressure (P=0.004) and heart rate (P<0.001), and an increase in mitral annular diastolic velocity (P=0.02). Conclusion In obese individuals, weight loss is associated with a substantial increase in the “setpoint” of circulating NP concentrations. Higher NP concentrations could contribute to an enhanced ability to handle salt loads after weight loss.
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Affiliation(s)
- Pankaj Arora
- Cardiology Division, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL (P.A.)
| | - Jason Reingold
- Atlanta Cardiology and Primary Care, Saint Joseph's Research Institute, Atlanta, GA (J.R.)
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Derek P Guanaga
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Connie Wu
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA (C.W., L.T.T., E.S.B., K.D.B.)
| | - Anahita Ghorbani
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Yanna Song
- Department of Biostatistics, Vanderbilt University, Nashville, TN (Y.S.)
| | | | - Abigail May Khan
- Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (A.M.K.)
| | - Laurel T Tainsh
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA (C.W., L.T.T., E.S.B., K.D.B.)
| | - Emmanuel S Buys
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA (C.W., L.T.T., E.S.B., K.D.B.)
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham & Women's Hospital, Boston, MA (J.S.W.)
| | | | - John C Burnett
- Division of Cardiology, Mayo Clinic, Rochester, MN (D.M.H., J.C.B.)
| | - Marc J Semigran
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Kenneth D Bloch
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.) Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA (C.W., L.T.T., E.S.B., K.D.B.)
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Christopher Newton-Cheh
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Lee M Kaplan
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA (L.M.K.)
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.)
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Nieuwdorp M, Gilijamse PW, Pai N, Kaplan LM. Role of the microbiome in energy regulation and metabolism. Gastroenterology 2014; 146:1525-33. [PMID: 24560870 DOI: 10.1053/j.gastro.2014.02.008] [Citation(s) in RCA: 263] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/25/2014] [Accepted: 02/16/2014] [Indexed: 02/06/2023]
Abstract
Intestinal microbes regulate metabolic function and energy balance; an altered microbial ecology is believed to contribute to the development of several metabolic diseases. Relative species abundance and metabolic characteristics of the intestinal microbiota change substantially in those who are obese or have other metabolic disorders and in response to ingested nutrients or therapeutic agents. The mechanisms through which the intestinal microbiota and its metabolites affect host homeostasis are just beginning to be understood. We review the relationships between the intestinal microbiota and host metabolism, including energy intake, use, and expenditure, in relation to glucose and lipid metabolism. These associations, along with interactions among the intestinal microbiota, mucus layer, bile acids, and mucosal immune responses, reveal potential mechanisms by which the microbiota affect metabolism. We discuss how controlled studies involving direct perturbations of microbial communities in human and animal models are required to identify effective therapeutic targets in the microbiota.
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Affiliation(s)
- Max Nieuwdorp
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Wallenberg Laboratory, Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Göteborg, Göteborg, Sweden.
| | - Pim W Gilijamse
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nikhil Pai
- Department of Pediatric Gastroenterology & Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Obesity, Metabolism and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Yu EW, Bouxsein ML, Roy AE, Baldwin C, Cange A, Neer RM, Kaplan LM, Finkelstein JS. Bone loss after bariatric surgery: discordant results between DXA and QCT bone density. J Bone Miner Res 2014; 29:542-50. [PMID: 23929784 PMCID: PMC3918250 DOI: 10.1002/jbmr.2063] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/11/2013] [Accepted: 07/26/2013] [Indexed: 01/06/2023]
Abstract
Several studies, using dual-energy X-ray absorptiometry (DXA), have reported substantial bone loss after bariatric surgery. However, profound weight loss may cause artifactual changes in DXA areal bone mineral density (aBMD) results. Assessment of volumetric bone mineral density (vBMD) by quantitative computed tomography (QCT) may be less susceptible to such artifacts. We assessed changes in BMD of the lumbar spine and proximal femur prospectively for 1 year using DXA and QCT in 30 morbidly obese adults undergoing Roux-en-Y gastric bypass surgery and 20 obese nonsurgical controls. At 1 year, subjects who underwent gastric bypass surgery lost 37 ± 2 kg compared with 3 ± 2 kg lost in the nonsurgical controls (p < 0.0001). Spine BMD declined more in the surgical group than in the nonsurgical group whether assessed by DXA (-3.3 versus -1.1%, p = 0.034) or by QCT (-3.4 versus 0.2%, p = 0.010). Total hip and femoral neck aBMD declined significantly in the surgical group when assessed by DXA (-8.9 versus -1.1%, p < 0.0001 for the total hip and -6.1 versus -2.0%, p = 0.002 for the femoral neck), but no changes in hip vBMD were noted using QCT. Within the surgical group, serum P1NP and CTX levels increased by 82% ± 10% and by 220% ± 22%, respectively, by 6 months and remained elevated over 12 months (p < 0.0001 for all). Serum calcium, vitamin D, and PTH levels remained stable in both groups. We conclude that moderate vertebral bone loss occurs in the first year after gastric bypass surgery. However, striking declines in DXA aBMD at the proximal femur were not confirmed with QCT vBMD measurements. These discordant results suggest that artifacts induced by large changes in body weight after bariatric surgery affect DXA and/or QCT measurements of bone, particularly at the hip.
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Affiliation(s)
- Elaine W Yu
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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Abstract
Obesity is a rapidly growing health problem that is associated with more than 65 comorbidities and results in substantially increased all-cause mortality. The increase of obesity has played an important role in the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), the most common cause of liver disease in the United States. Understanding the prevalence, comorbidities, and pathogenesis of obesity provides an essential foundation for clinicians who care for individuals with NAFLD.
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Affiliation(s)
- Kathleen E Corey
- Gastrointestinal Unit, Weight Center, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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41
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Liou AP, Paziuk M, Luevano JM, Machineni S, Turnbaugh PJ, Kaplan LM. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med 2013; 5:178ra41. [PMID: 23536013 DOI: 10.1126/scitranslmed.3005687] [Citation(s) in RCA: 671] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) results in rapid weight loss, reduced adiposity, and improved glucose metabolism. These effects are not simply attributable to decreased caloric intake or absorption, but the mechanisms linking rearrangement of the gastrointestinal tract to these metabolic outcomes are largely unknown. Studies in humans and rats have shown that RYGB restructures the gut microbiota, prompting the hypothesis that some of the effects of RYGB are caused by altered host-microbial interactions. To test this hypothesis, we used a mouse model of RYGB that recapitulates many of the metabolic outcomes in humans. 16S ribosomal RNA gene sequencing of murine fecal samples collected after RYGB surgery, sham surgery, or sham surgery coupled to caloric restriction revealed that alterations to the gut microbiota after RYGB are conserved among humans, rats, and mice, resulting in a rapid and sustained increase in the relative abundance of Gammaproteobacteria (Escherichia) and Verrucomicrobia (Akkermansia). These changes were independent of weight change and caloric restriction, were detectable throughout the length of the gastrointestinal tract, and were most evident in the distal gut, downstream of the surgical manipulation site. Transfer of the gut microbiota from RYGB-treated mice to nonoperated, germ-free mice resulted in weight loss and decreased fat mass in the recipient animals relative to recipients of microbiota induced by sham surgery, potentially due to altered microbial production of short-chain fatty acids. These findings provide the first empirical support for the claim that changes in the gut microbiota contribute to reduced host weight and adiposity after RYGB surgery.
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Affiliation(s)
- Alice P Liou
- Obesity, Metabolism & Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114, USA
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Hatoum IJ, Kaplan LM. Advantages of percent weight loss as a method of reporting weight loss after Roux-en-Y gastric bypass. Obesity (Silver Spring) 2013; 21:1519-25. [PMID: 23670991 PMCID: PMC3744630 DOI: 10.1002/oby.20186] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/07/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Although Roux-en-Y gastric bypass (RYGB) is an effective treatment for severe obesity, weight loss (WL) after this operation is highly variable. Accurate predictors of outcome would thus be useful in identifying those patients who would most benefit from this invasive therapy. WL has been characterized using several different metrics, including the number of BMI units lost (ΔBMI), percent baseline WL (%WL), and percent excess body WL (%EBWL). To identify clinically relevant predictors most sensitively, it is necessary to avoid confounding by other factors, including preoperative BMI (pBMI), the strongest known predictor of RYGB-induced WL. DESIGN AND METHODS To determine the WL measure least associated with pBMI, outcomes of 846 patients undergoing RYGB were analyzed. RESULTS Patients in this cohort had an average pBMI of 50.0 kg/m(2) at baseline. At weight nadir, they lost an average 19.4 kg/m(2), 38.7% WL, and 81.2% EBWL. pBMI was strongly and positively associated with ΔBMI at both 1 year (r = 0.56, P = 4.7 × 10(-51)) and nadir (r = 0.58, P = 2.8 × 10(-77)) and strongly but negatively associated with %EBWL at 1 year (r = -0.52, P = 3.8 × 10(-44)) and nadir (r = -0.45, P = 7.2×10(-43)). In contrast, pBMI was not significantly associated with %WL at 1 year (r = 0.04, P = 0.33) and only weakly associated at nadir (r = 0.13, P = 0.0002). CONCLUSIONS Of the metrics examined, %WL is the parameter describing WL after RYGB least influenced by pBMI. It thus improves comparison of WL outcomes across studies of patients undergoing surgery and facilitates the most sensitive identification of novel predictors of surgery-induced WL. We therefore is recommend that %WL be adopted more broadly in reporting weight loss after RYGB.
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Affiliation(s)
- Ida J. Hatoum
- Obesity, Metabolism & Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Lee M. Kaplan
- Obesity, Metabolism & Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Thompson CC, Chand B, Chen YK, DeMarco DC, Miller L, Schweitzer M, Rothstein RI, Lautz DB, Slattery J, Ryan MB, Brethauer S, Schauer P, Mitchell MC, Starpoli A, Haber GB, Catalano MF, Edmundowicz S, Fagnant AM, Kaplan LM, Roslin MS. Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology 2013; 145:129-137.e3. [PMID: 23567348 DOI: 10.1053/j.gastro.2013.04.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [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: 08/03/2012] [Revised: 03/29/2013] [Accepted: 04/01/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Weight regain or insufficient loss after Roux-en-Y gastric bypass (RYGB) is common. This is partially attributable to dilatation of the gastrojejunostomy (GJ), which diminishes the restrictive capacity of RYGB. Endoluminal interventions for GJ reduction are being explored as alternatives to revision surgery. We performed a randomized, blinded, sham-controlled trial to evaluate weight loss after sutured transoral outlet reduction (TORe). METHODS Patients with weight regain or inadequate loss after RYGB and GJ diameter greater than 2 cm were assigned randomly to groups that underwent TORe (n = 50) or a sham procedure (controls, n = 27). Intraoperative performance, safety, weight loss, and clinical outcomes were assessed. RESULTS Subjects who received TORe had a significantly greater mean percentage weight loss from baseline (3.5%; 95% confidence interval, 1.8%-5.3%) than controls (0.4%; 95% confidence interval, 2.3% weight gain to 3.0% weight loss) (P = .021), using a last observation carried forward intent-to-treat analysis. As-treated analysis also showed greater mean percentage weight loss in the TORe group than controls (3.9% and 0.2%, respectively; P = .014). Weight loss or stabilization was achieved in 96% subjects receiving TORe and 78% of controls (P = .019). The TORe group had reduced systolic and diastolic blood pressure (P < .001) and a trend toward improved metabolic indices. In addition, 85% of the TORe group reported compliance with the healthy lifestyle eating program, compared with 53.8% of controls; 83% of TORe subjects said they would undergo the procedure again, and 78% said they would recommend the procedure to a friend. The groups had similar frequencies of adverse events. CONCLUSIONS A multicenter randomized trial provides Level I evidence that TORe reduces weight regain after RYGB. These results were achieved using a superficial suction-based device; greater levels of weight loss could be achieved with newer, full-thickness suturing devices. TORe is one approach to avoid weight regain; a longitudinal multidisciplinary approach with dietary counseling and behavioral changes are required for long-term results. ClinicalTrials.gov identifier: NCT00394212.
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Affiliation(s)
| | - Bipan Chand
- Loyola University Medical Center, Maywood, Illinois
| | - Yang K Chen
- Division of Gastroenterology, University of Colorado Hospital, Aurora, Colorado
| | - Daniel C DeMarco
- Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas
| | - Larry Miller
- Section of Gastroenterology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Michael Schweitzer
- Department of Bariatric Surgery, John Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Richard I Rothstein
- Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David B Lautz
- Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - James Slattery
- Division of Gastroenterology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Michele B Ryan
- Division of Gastroenterology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Stacy Brethauer
- Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Phillip Schauer
- Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mack C Mitchell
- Division of Gastroenterology, John Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Anthony Starpoli
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York
| | - Gregory B Haber
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York
| | - Marc F Catalano
- Division of Gastroenterology, St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Steven Edmundowicz
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Lee M Kaplan
- MGH Weight Center and Gastrointestinal Unit, Massachusetts General Hospital; Boston, Massachusetts
| | - Mitchell S Roslin
- Department of General Surgery, Lenox Hill Hospital, New York, New York
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Hatoum IJ, Greenawalt DM, Cotsapas C, Daly MJ, Reitman ML, Kaplan LM. Weight loss after gastric bypass is associated with a variant at 15q26.1. Am J Hum Genet 2013; 92:827-34. [PMID: 23643386 DOI: 10.1016/j.ajhg.2013.04.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/02/2013] [Accepted: 04/08/2013] [Indexed: 12/26/2022] Open
Abstract
The amount of weight loss attained after Roux-en-Y gastric bypass (RYGB) surgery follows a wide and normal distribution, and recent evidence indicates that this weight loss is due to physiological, rather than mechanical, mechanisms. To identify potential genetic factors associated with weight loss after RYGB, we performed a genome-wide association study (GWAS) of 693 individuals undergoing RYGB and then replicated this analysis in an independent population of 327 individuals undergoing RYGB. We found that a 15q26.1 locus near ST8SIA2 and SLCO3A1 was significantly associated with weight loss after RYGB. Expression of ST8SIA2 in omental fat of these individuals at baseline was significantly associated with weight loss after RYGB. Gene expression analysis in RYGB and weight-matched, sham-operated (WMS) mice revealed that expression of St8sia2 and Slco3a1 was significantly altered in metabolically active tissues in RYGB-treated compared to WMS mice. These findings provide strong evidence for specific genetic influences on weight loss after RYGB and underscore the biological nature of the response to RYGB.
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Affiliation(s)
- Ida J Hatoum
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114, USA
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Qatanani M, Tan Y, Dobrin R, Greenawalt DM, Hu G, Zhao W, Olefsky JM, Sears DD, Kaplan LM, Kemp DM. Inverse regulation of inflammation and mitochondrial function in adipose tissue defines extreme insulin sensitivity in morbidly obese patients. Diabetes 2013; 62:855-63. [PMID: 23223024 PMCID: PMC3581230 DOI: 10.2337/db12-0399] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Obesity is associated with insulin resistance, a major risk factor for type 2 diabetes and cardiovascular disease. However, not all obese individuals are insulin resistant, which confounds our understanding of the mechanistic link between these conditions. We conducted transcriptome analyses on 835 obese subjects with mean BMI of 48.8, on which we have previously reported genetic associations of gene expression. Here, we selected ~320 nondiabetic (HbA(1c) <7.0) subjects and further stratified the cohort into insulin-resistant versus insulin-sensitive subgroups based on homeostasis model assessment-insulin resistance. An unsupervised informatics analysis revealed that immune response and inflammation-related genes were significantly downregulated in the omental adipose tissue of obese individuals with extreme insulin sensitivity and, to a much lesser extent, in subcutaneous adipose tissue. In contrast, genes related to β-oxidation and the citric acid cycle were relatively overexpressed in adipose of insulin-sensitive patients. These observations were verified by querying an independent cohort of our published dataset of 37 subjects whose subcutaneous adipose tissue was sampled before and after treatment with thiazolidinediones. Whereas the immune response and inflammation pathway genes were downregulated by thiazolidinedione treatment, β-oxidation and citric acid cycle genes were upregulated. This work highlights the critical role that omental adipose inflammatory pathways might play in the pathophysiology of insulin resistance, independent of body weight.
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MESH Headings
- Adult
- Biopsy
- Body Mass Index
- Citric Acid Cycle/drug effects
- Cohort Studies
- Diabetes Mellitus, Type 2/complications
- Gene Expression Profiling
- Gene Expression Regulation, Enzymologic/drug effects
- Humans
- Hypoglycemic Agents/therapeutic use
- Insulin Resistance
- Intra-Abdominal Fat/drug effects
- Intra-Abdominal Fat/immunology
- Intra-Abdominal Fat/metabolism
- Intra-Abdominal Fat/pathology
- Mitochondria/drug effects
- Mitochondria/metabolism
- Mitochondria/pathology
- Mitochondrial Proteins/genetics
- Mitochondrial Proteins/metabolism
- Obesity, Morbid/complications
- Obesity, Morbid/immunology
- Obesity, Morbid/metabolism
- Obesity, Morbid/pathology
- Oligonucleotide Array Sequence Analysis
- Oxidative Phosphorylation/drug effects
- RNA, Messenger/metabolism
- Subcutaneous Fat, Abdominal/drug effects
- Subcutaneous Fat, Abdominal/immunology
- Subcutaneous Fat, Abdominal/metabolism
- Subcutaneous Fat, Abdominal/pathology
- Thiazolidinediones/therapeutic use
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Affiliation(s)
- Mohammed Qatanani
- Discovery and Preclinical Sciences, Merck Research Laboratories, Rahway, New Jersey
- Diabetes and Endocrinology, Merck Research Laboratories, Rahway, New Jersey
| | - Yejun Tan
- Discovery and Preclinical Sciences, Merck Research Laboratories, Rahway, New Jersey
- Informatics and Analysis, Merck Research Laboratories, Rahway, New Jersey
| | - Radu Dobrin
- Discovery and Preclinical Sciences, Merck Research Laboratories, Rahway, New Jersey
- Informatics and Analysis, Merck Research Laboratories, Rahway, New Jersey
| | - Danielle M. Greenawalt
- Discovery and Preclinical Sciences, Merck Research Laboratories, Rahway, New Jersey
- Informatics and Analysis, Merck Research Laboratories, Rahway, New Jersey
| | - Guanghui Hu
- Discovery and Preclinical Sciences, Merck Research Laboratories, Rahway, New Jersey
- Informatics and Analysis, Merck Research Laboratories, Rahway, New Jersey
| | - Wenqing Zhao
- Discovery and Preclinical Sciences, Merck Research Laboratories, Rahway, New Jersey
- Informatics and Analysis, Merck Research Laboratories, Rahway, New Jersey
| | - Jerrold M. Olefsky
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Dorothy D. Sears
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Lee M. Kaplan
- Gastrointestinal Metabolism Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel M. Kemp
- Discovery and Preclinical Sciences, Merck Research Laboratories, Rahway, New Jersey
- Diabetes and Endocrinology, Merck Research Laboratories, Rahway, New Jersey
- Corresponding author: Daniel M. Kemp,
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Muñoz R, Carmody JS, Stylopoulos N, Davis P, Kaplan LM. Isolated duodenal exclusion increases energy expenditure and improves glucose homeostasis in diet-induced obese rats. Am J Physiol Regul Integr Comp Physiol 2012; 303:R985-93. [PMID: 22972837 DOI: 10.1152/ajpregu.00262.2012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) in rodent models reduces food intake (FI), increases resting energy expenditure (EE), and improves glycemic control. We have shown that mimicking the duodenal component of RYGB by implantation of a 10-cm endoluminal sleeve device (ELS-10) induces weight loss and improves glycemic control in diet-induced obese (DIO) rats. We sought to determine the mechanisms and structural requirements of these effects. We examined the effects of ELS-10 devices implanted in male DIO rats on body weight, food intake (FI), meal patterns, total and resting EE, and multiple parameters of glucose homeostasis, comparing them with sham-operated (SO) rats and with SO rats weight matched to the ELS-10-treated group. To determine the extent of duodenal exclusion required to influence metabolic outcomes, we compared the effects of implanting 10-, 4-, or 1-cm ELS devices. ELS-10 rats exhibited 13% higher total and 9% higher resting EE than SO controls. ELS-10 rats also exhibited enhanced postprandial GLP-1 secretion and improved glucose tolerance and insulin sensitivity out of proportion to the effects of weight loss alone. Implantation of 4- or 1-cm ELS devices had no effect on EE and limited effects on glucose homeostasis. Complete duodenal exclusion with ELS-10 induces weight loss by decreasing FI and increasing EE and improves glycemic control through weight loss-independent mechanisms. Thus signals originating in the proximal small intestine appear to exert a direct influence on the physiological regulation of EE and glucose homeostasis. Their selective manipulation could provide effective new therapies for obesity and diabetes that mimic the benefits of RYGB.
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Affiliation(s)
- Rodrigo Muñoz
- Obesity, Metabolism & Nutritional Institute and Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02129, USA
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Kaplan LM, Fallon JA, Mun EC, Harvey AM, Kastrinakis WV, Johnson EQ, Nierman RS, Keroack CR. Coding and Reimbursement for Weight Loss Surgery: Best Practice Recommendations. ACTA ACUST UNITED AC 2012; 13:290-300. [PMID: 15800286 DOI: 10.1038/oby.2005.39] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To review the use and usefulness of billing codes for services related to weight loss surgery (WLS) and to examine third party reimbursement policies for these services. RESEARCH METHODS AND PROCEDURES The Task Group carried out a systematic search of MEDLINE, the Internet, and the trade press for publications on WLS, coding, reimbursement, and coding and reimbursement policy. Twenty-eight articles were each reviewed and graded using a system based on established evidence-based models. The Massachusetts Dietetics Association provided reimbursement data for nutrition services. Three suppliers of laparoscopic WLS equipment provided summaries of coding and reimbursement information. WLS program directors were surveyed for information on use of procedure codes related to WLS. RESULTS Recommendations focused on correcting or improving on the current lack of congruity among coding practices, reimbursement policies, and accepted clinical practice; lack of uniform coding and reimbursement data across institutions; inconsistent and/or inaccurate diagnostic and billing codes; inconsistent insurance reimbursement criteria; and inability to leverage reimbursement and coding data to track outcomes, identify best practices, and perform accurate risk-benefit analyses. DISCUSSION Rapid changes in the prevalence of obesity, our understanding of its clinical impact, and the technologies for surgical treatment have yet to be adequately reflected in coding, coverage, and reimbursement policies. Issues identified as key to effective change include improved characterization of the risks, benefits, and costs of WLS; anticipation and monitoring of technological advances; encouragement of consistent patterns of insurance coverage; and promotion of billing codes for WLS procedures that facilitate accurate tracking of clinical use and outcomes.
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Affiliation(s)
- Lee M Kaplan
- Massachusetts General Hospital Weight Center, Massachusetts General Hospital, 50 Staniford Street, Fourth Floor, Boston, MA 02114, USA.
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Hatoum IJ, Stylopoulos N, Vanhoose AM, Boyd KL, Yin DP, Ellacott KLJ, Ma LL, Blaszczyk K, Keogh JM, Cone RD, Farooqi IS, Kaplan LM. Melanocortin-4 receptor signaling is required for weight loss after gastric bypass surgery. J Clin Endocrinol Metab 2012; 97:E1023-31. [PMID: 22492873 PMCID: PMC3387412 DOI: 10.1210/jc.2011-3432] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/12/2012] [Indexed: 01/14/2023]
Abstract
CONTEXT Roux-en-Y gastric bypass (RYGB) is one of the most effective long-term therapies for the treatment of severe obesity. Recent evidence indicates that RYGB effects weight loss through multiple physiological mechanisms, including changes in energy expenditure, food intake, food preference, and reward pathways. OBJECTIVE Because central melanocortin signaling plays an important role in the regulation of energy homeostasis, we investigated whether genetic disruption of the melanocortin-4 receptor (MC4R) in rodents and humans affects weight loss after RYGB. METHODS AND RESULTS Here we report that MC4R(-/-) mice lost substantially less weight after surgery than wild-type animals, indicating that MC4R signaling is necessary for the weight loss effects of RYGB in this model. Mice heterozygous for MC4R remain fully responsive to gastric bypass. To determine whether mutations affect surgically induced weight loss in humans, we sequenced the MC4R gene in 972 patients undergoing RYGB. Patients heterozygous for MC4R mutations exhibited the same magnitude and distribution of postoperative weight loss as patients without such mutations, suggesting that although two normal copies of the MC4R gene are necessary for normal weight regulation, a single normal copy of the MC4R gene is sufficient to mediate the weight loss effects of RYGB. CONCLUSIONS MC4R is the first gene identified that is required for the sustained effects of bariatric surgery. The need for MC4R signaling for the weight loss effects of RYGB in mice underscores the physiological mechanisms of action of this procedure and demonstrates that RYGB both influences and is dependent on the normal pathways that regulate energy balance.
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Affiliation(s)
- Ida J Hatoum
- Massachusetts General Hospital, 149 13th Street, Room 8219, Charlestown, Massachusetts 02129, USA
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Hurt RT, Frazier TH, McClave SA, Kaplan LM. Obesity epidemic: overview, pathophysiology, and the intensive care unit conundrum. JPEN J Parenter Enteral Nutr 2012; 35:4S-13S. [PMID: 21881014 DOI: 10.1177/0148607111415110] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Obesity is one of the leading causes of preventable death in the United States, second only to smoking. The annual number of deaths attributed to obesity is estimated to be as high as 400,000. Nearly 70% of the adult U.S. population is overweight or obese. The historical viewpoint toward obesity has deemed it to be a lifestyle choice or characterological flaw. However, given the emerging research into the development of obesity and its related complications, our perspective is changing. It is now clear that obesity is a heterogeneous disease with many different subtypes, which involves an interplay between genetic and environmental factors. The current epidemic of obesity is the result of an obesogenic environment (which includes energy-dense foods and a lack of physical activity) in individuals who have a genetic susceptibility for developing obesity. The pathophysiology associated with weight gain is much more complex than originally thought. The heterogeneous nature of the disease makes the development of treatment strategies for obesity difficult. Obesity in general is associated with increased all-cause mortality and cause-specific mortality (from cardiovascular, diabetic, hepatic, and neoplastic causes). Yet despite increased overall mortality rates, current evidence suggests that when these same patients are admitted to the intensive care unit (ICU), the obesity provides some protection against mortality. At present, there is no clear explanation for this obesity conundrum in critical illness.
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Affiliation(s)
- Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Rosenblum JL, Castro VM, Moore CE, Kaplan LM. Calcium and vitamin D supplementation is associated with decreased abdominal visceral adipose tissue in overweight and obese adults. Am J Clin Nutr 2012; 95:101-8. [PMID: 22170363 PMCID: PMC3238453 DOI: 10.3945/ajcn.111.019489] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several studies suggest that calcium and vitamin D (CaD) may play a role in the regulation of abdominal fat mass. OBJECTIVE This study investigated the effect of CaD-supplemented orange juice (OJ) on weight loss and reduction of visceral adipose tissue (VAT) in overweight and obese adults (mean ± SD age: 40.0 ± 12.9 y). DESIGN Two parallel, double-blind, placebo-controlled trials were conducted with either regular or reduced-energy (lite) orange juice. For each 16-wk trial, 171 participants were randomly assigned to 1 of 2 groups. The treatment groups consumed three 240-mL glasses of OJ (regular or lite) fortified with 350 mg Ca and 100 IU vitamin D per serving, and the control groups consumed either unfortified regular or lite OJ. Computed tomography scans of VAT and subcutaneous adipose tissue were performed by imaging a single cut at the lumbar 4 level. RESULTS After 16 wk, the average weight loss (∼2.45 kg) did not differ significantly between groups. In the regular OJ trial, the reduction of VAT was significantly greater (P = 0.024) in the CaD group (-12.7 ± 25.0 cm(2)) than in the control group (-1.3 ± 13.6 cm(2)). In the lite OJ trial, the reduction of VAT was significantly greater (P = 0.039) in the CaD group (-13.1 ± 18.4 cm(2)) than in the control group (-6.4 ± 17.5 cm(2)) after control for baseline VAT. The effect of calcium and vitamin D on VAT remained highly significant when the results of the 2 trials were combined (P = 0.007). CONCLUSIONS The findings suggest that calcium and/or vitamin D supplementation contributes to a beneficial reduction of VAT. This trial is registered at clinicaltrial.gov as NCT00386672, NCT01363115.
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Affiliation(s)
- Jennifer L Rosenblum
- Massachusetts General Hospital Weight Center and Gastrointestinal Unit, Massachusetts General Hospital, Boston, USA
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