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Wong JH, Burch AE, DeMaria EJ, Pories WJ, Irish WD. Disparities in Access to Bariatric Surgery in North Carolina. Am Surg 2024:31348241248807. [PMID: 38652146 DOI: 10.1177/00031348241248807] [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] [Indexed: 04/25/2024]
Abstract
BACKGROUND This study sought to identify factors that contribute to disparities in access to bariatric surgery in North Carolina (NC). METHODS Using the rate of bariatric surgery in the county with the best health outcome as the reference, we calculated the Surgical Equity Index (SEI) in the remaining counties in NC. RESULTS Approximately 2.95 million individuals (29%) were obese in NC. There were 992 (.5%) bariatric procedures performed on a population of 194 209 individuals with obesity in the Reference County (RC). The mean SEI for bariatric surgery in NC was .47 (SD .17, range .15-.95). A statistically significant difference was observed in 89 counties. Univariable analyses identified the following variables to be significantly associated with the SEI: percent of population living in rural areas (% rural) (relative rate change in SEI [RR] = .994, 95% CI .92-.997; <.0001), median household income (RR = 1.0, 95% CI = 1.0-1.0; P = .0002), prevalence of diabetes (RR = .947, 95% CI .917-.977; .0006), the primary care physician ratio (RR = .995, 95% CI .991-.998; P = .006), and percent uninsured adults (RR = .955, 95% CI .927-.985; P = .003). By multivariable hierarchical regression analysis, only the % rural remained statistically associated with a low SEI (RR = .995 per 1% increase in % rural, 95% CI = .992, .998; P = .0002). DISCUSSION The percent rural is the most significant predictor of disparities in access to bariatric surgery. For every 1% increase in % rural, the rate of surgery decreased by .5%. Understanding the characteristics of rurality that are barriers to access is crucial to mitigate disparities in bariatric surgical access in NC.
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Affiliation(s)
- Jan H Wong
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina, Greenville, NC, USA
| | - Ashley E Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, USA
- Department of Cardiology, East Carolina University, Greenville, NC, USA
| | - Eric J DeMaria
- Division of General Minimally Invasive and Bariatric Surgery, Department of Surgery, Brody School of Medicine at East Carolina, Greenville, NC, USA
| | - Walter J Pories
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina, Greenville, NC, USA
| | - William D Irish
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina, Greenville, NC, USA
- Department of Public Health, East Carolina University, Greenville, NC, USA
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Miller ZC, Kang BK, Cooke SW, Ashley LW, Pories WJ. The Obesity Epidemic Is Not the Victims' Fault. Obes Surg 2024; 34:688-689. [PMID: 38194012 DOI: 10.1007/s11695-023-06978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
The Centers for Disease Control and Prevention recently issued two statements that 1) maintain that obesity causes diabetes and other expressions of the metabolic syndrome and 2) that imply obesity is the victim's fault. Both statements are incorrect and potentially harmful.
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Affiliation(s)
- Zachary C Miller
- Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Brian K Kang
- Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Spencer W Cooke
- Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Lucas W Ashley
- Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Walter J Pories
- Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
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3
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Broskey NT, Pories WJ, DeMaria EJ, Jones TE, Tanner CJ, Zheng D, Krassovskaia PM, Mitchell LA, Matarese LE, O'Brien KF, Cortright RN, Dohm GL, Houmard JA. Fasting plasma lactate as a possible early clinical marker for metabolic disease risk. Diabetes Metab Syndr 2024; 18:102955. [PMID: 38310736 PMCID: PMC10997452 DOI: 10.1016/j.dsx.2024.102955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/17/2024] [Accepted: 01/28/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND AND AIM Elevated fasting plasma lactate concentrations are evident in individuals with metabolic diseases. However, it has yet to be determined if these associations exist in a young, healthy population as a possible early marker for metabolic disease risk. The purpose of this study was to determine if indices of the metabolic syndrome are related to plasma lactate concentrations in this population. METHODS Fifty (29 ± 7 yr) men (n = 19) and women (n = 31) classified as overweight (26.4 ± 1.8 kg/m2) participated in this observational study. Blood pressure and blood metabolites were measured after an overnight fast. Lactate was also measured before and after a three-day eucaloric high-fat (70 %) diet. The homeostatic model assessment for insulin resistance (HOMA-IR) was calculated as a measure of insulin resistance. Visceral adipose tissue mass was determined via dual X-ray absorptiometry. RESULTS Triglycerides (r = 0.55, p=<0.0001), HOMA-IR (r = 0.53, p=<0.0001), and systolic and diastolic (both, r = 0.36, p = 0.01) blood pressures associated with fasting plasma lactate. No differences in visceral adipose tissue existed between the sexes (p = 0.41); however, the relationship between visceral adipose tissue and lactate existed only in females (r = 0.59, p = 0.02) but not in males (p = 0.53). Fasting lactate and HOMA-IR increased in males (p = 0.01 and p = 0.02, respectively), but not females, following a three-day high-fat diet. CONCLUSION Indices of the metabolic syndrome associated with fasting plasma lactates in young relatively healthy individuals. Fasting lactate also increased in a sex-specific manner after a three-day high fat diet. Thus, lactate could become a clinical marker for metabolic disease risk.
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Affiliation(s)
- Nicholas T Broskey
- Departments of Kinesiology, East Carolina University, Greenville, NC, USA; Surgery, East Carolina University, Greenville, NC, USA; Human Performance Laboratory, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA.
| | - Walter J Pories
- Surgery, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | | | - Terry E Jones
- Physical Therapy, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | - Charles J Tanner
- Departments of Kinesiology, East Carolina University, Greenville, NC, USA; Human Performance Laboratory, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | - Donghai Zheng
- Departments of Kinesiology, East Carolina University, Greenville, NC, USA; Human Performance Laboratory, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | - Polina M Krassovskaia
- Departments of Kinesiology, East Carolina University, Greenville, NC, USA; Human Performance Laboratory, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | | | - Laura E Matarese
- Surgery, East Carolina University, Greenville, NC, USA; Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Kevin F O'Brien
- Public Health, East Carolina University, Greenville, NC, USA
| | - Ronald N Cortright
- Departments of Kinesiology, East Carolina University, Greenville, NC, USA; Human Performance Laboratory, East Carolina University, Greenville, NC, USA; Physiology, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | - G Lynis Dohm
- Physiology, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | - Joseph A Houmard
- Departments of Kinesiology, East Carolina University, Greenville, NC, USA; Surgery, East Carolina University, Greenville, NC, USA; Human Performance Laboratory, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
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4
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Swift DL, McGee JE, Grammer EE, Huff AC, Clunan MC, Hursey N, Brown TT, Osborne BG, Houmard JA, Carels RA, Pories WJ, Matarese LE. The effect of exercise training level on arterial stiffness after clinically significant weight loss. Clin Obes 2023; 13:e12584. [PMID: 36843503 PMCID: PMC11036368 DOI: 10.1111/cob.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/13/2023] [Accepted: 02/04/2023] [Indexed: 02/28/2023]
Abstract
Arterial stiffness is improved by weight loss. However, no data exist on the impact of aerobic exercise levels on arterial stiffness during weight maintenance. Adults who were overweight or with obesity (N = 39) participated in a 10-week weight loss program. Participants who achieved ≥7% weight loss were randomized to aerobic training at the minimum physical activity guidelines (PA-REC, 550 MET min/week) or weight maintenance guidelines (WM-REC, 970 MET min/week) for 18 additional weeks. Arterial stiffness (carotid-to-femoral pulse wave velocity [cfPWV], augmentation index normalized for 75 beats/min [AIX75]) and blood pressure [aortic and brachial]) were assessed at baseline, the end of the weight loss phase (week 10), and follow-up (week 28). There was a reduction in cfPWV in participants who met the weight loss goal (-0.34 m/s, p = .02) and approached significance for the entire sample (p = .051). Similarly, there were reductions in AIX75, brachial blood pressure, and aortic blood pressure (p < .05) in the full sample. In the weight maintenance phase, no differences were observed between the PA-REC and the WM-REC groups for change in arterial stiffness or blood pressure (p > .05). However, changes in cfPWV were independently associated with changes in LDL (r2 : 0.45, p = .004) and exercise intensity (r2 : 0.17, p = .033). Aerobic exercise level at the minimum physical activity guidelines or weight maintenance guidelines does not affect the change in PWV or the change in cfPWV after clinically significant weight loss. However, interventions which limit increases in LDL cholesterol and promote high-intensity aerobic exercise may prevent increases in stiffness during weight maintenance.
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Affiliation(s)
- Damon L. Swift
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | - Joshua E. McGee
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | - Emily E. Grammer
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | - Anna C. Huff
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | - Marie C. Clunan
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | - Nicole Hursey
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | - Taylor T. Brown
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | | | - Joseph A. Houmard
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | - Robert A. Carels
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Walter J. Pories
- Department of Surgery, East Carolina University, Greenville, North Carolina, USA
| | - Laura E. Matarese
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina, USA
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5
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Jevtovic F, Zheng D, Lopez CA, Kern K, Tanner CJ, Jones TE, Pories WJ, Dohm GL, Houmard JA, May LE, Broskey NT. Greater reliance on glycolysis is associated with lower mitochondrial substrate oxidation and insulin sensitivity in infant myogenic MSCs. Am J Physiol Endocrinol Metab 2023; 325:E207-E213. [PMID: 37467021 PMCID: PMC10511160 DOI: 10.1152/ajpendo.00159.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
Individuals with insulin resistance and obesity display higher skeletal muscle production of nonoxidized glycolytic products (i.e., lactate), and lower complete mitochondrial substrate oxidation to CO2. These findings have also been observed in individuals without obesity and are associated with an increased risk for metabolic disease. The purpose of this study was to determine if substrate preference is evident at the earliest stage of life (birth) and to provide a clinical blood marker (lactate) that could be indicative of a predisposition for metabolic disease later. We used radiolabeled tracers to assess substrate oxidation and insulin sensitivity of myogenically differentiated mesenchymal stem cells (MSCs), a proxy of infant skeletal muscle tissue, derived from umbilical cords of full-term infants. We found that greater production of nonoxidized glycolytic products (lactate, pyruvate, alanine) is directly proportional to lower substrate oxidation and insulin sensitivity in MSCs. In addition, we found an inverse relationship between the ratio of complete glucose oxidation to CO2 and infant blood lactate at 1 mo of age. Collectively, considering that higher lactate was associated with lower MSC glucose oxidation and has been shown to be implicated with metabolic disease, it may be an early indicator of infant skeletal muscle phenotype.NEW & NOTEWORTHY In infant myogenically differentiated mesenchymal stem cells, greater production of nonoxidized glycolytic products was directly proportional to lower substrate oxidation and insulin resistance. Glucose oxidation was inversely correlated with infant blood lactate. This suggests that innate differences in infant substrate oxidation exist at birth and could be associated with the development of metabolic disease later in life. Clinical assessment of infant blood lactate could be used as an early indicator of skeletal muscle phenotype.
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Affiliation(s)
- Filip Jevtovic
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, United States
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
| | - Donghai Zheng
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, United States
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
| | - Christian A Lopez
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, United States
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
| | - Kara Kern
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, United States
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
| | - Charles J Tanner
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, United States
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
| | - Terry E Jones
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, United States
| | - Walter J Pories
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
- Department of Surgery, East Carolina University, Greenville, North Carolina, United States
| | - G Lynis Dohm
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
- Department of Physiology, East Carolina University, Greenville, North Carolina, United States
| | - Joseph A Houmard
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, United States
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
| | - Linda E May
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, United States
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
- Department of Obstetrics and Gynecology, East Carolina University, Greenville, North Carolina, United States
| | - Nicholas T Broskey
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina, United States
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina, United States
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6
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McGee JE, Early KS, Huff AC, Clunan MC, Hursey NR, Osborne B, Bucher C, Tanner C, Brewer SB, Brophy PM, Clark A, Pories WJ, Matarese LE, Houmard JA, Collier D, May LE, McClung JM, Earnest CP, Swift DL. Effects of weight loss and weight loss maintenance on cardiac autonomic function in obesity: a randomized controlled trial. Appl Physiol Nutr Metab 2023; 48:678-691. [PMID: 37229779 PMCID: PMC11042485 DOI: 10.1139/apnm-2023-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
NOVELTY Caloric restriction and exercise exert significant improvements in cardiac autonomic function as measured by HRV in overweight and obesity. Aerobic exercise training, within recommended guidelines coupled with weight loss maintenance, retains cardiac autonomic function benefits from weight loss in previously obese individuals.
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Affiliation(s)
- Joshua E. McGee
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Kate S. Early
- Department of Health, Columbus State University, Columbus, GA, 31907, USA
| | - Anna C. Huff
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Marie C. Clunan
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Nicole R. Hursey
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | | | | | - Charles Tanner
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Savanna B. Brewer
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - Patricia M. Brophy
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
| | - Angela Clark
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
| | - Walter J. Pories
- Department of Surgery, East Carolina University, Greenville, NC 27858, USA
| | - Laura E. Matarese
- Department of Internal Medicine, East Carolina University, Greenville, NC 27858, USA
| | - Joseph A. Houmard
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
| | - David Collier
- Department of Pediatrics, East Carolina University, Greenville, NC 27858, USA
| | - Linda E. May
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, 27858, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
| | - Joseph M. McClung
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27858, USA
- Department of Physiology, East Carolina University, Greenville, NC 27858, USA
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC 27858, USA
| | - Conrad P. Earnest
- Texas A&M University, Department of Health and Kinesiology, College Station, TX 79016, USA
| | - Damon L. Swift
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
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Mitsakos AT, Irish W, DeMaria EJ, Pories WJ, Altieri MS. Body mass index and risk of mortality in patients undergoing bariatric surgery. Surg Endosc 2023; 37:1213-1221. [PMID: 36156736 DOI: 10.1007/s00464-022-09651-7] [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: 02/13/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prior literature has demonstrated that bariatric surgery is a safe approach for patients with morbid obesity. However, the relationship between body mass index (BMI) and risk of mortality in these patients has not been fully elucidated. Primary objective of this study was to evaluate the relationship between BMI and risk of mortality using data obtained from a national database, with a special focus on patients with BMI ≥ 70.0 kg/m2. METHODS A retrospective cohort study of patients with morbid obesity (BMI ≥ 40 kg/m2) undergoing first-time bariatric surgery between 2015 and 2018 was performed using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Primary outcome was intra-operative death or death within 30 days post-operatively. Patients were categorized into quartiles according to BMI. Multivariable analysis was performed to evaluate the association of BMI with risk of mortality. Relative risk (RR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively. RESULTS A total of 463, 436 patients were included with a 30-day mortality rate of 0.11%. Mean BMI (SD) was 48.2 (7.3) kg/m2; 1.5% of patients had BMI ≥ 70.0 kg/m2. On multivariable analysis, highest quartile patients had a significantly higher risk of mortality than lowest quartile patients. For patients with BMI ≥ 70.0 kg/m2, the risk of mortality was more pronounced with an eightfold increase compared to the lowest quartile. In patients with BMI ≥ 70.0 kg/m2, although sleeve gastrectomy (SG) was the most common procedure, the risk of mortality was significantly higher in patients undergoing Roux-en-Y gastric bypass (RYGB). CONCLUSIONS BMI is associated with increased risk of 30-day mortality. The effect of BMI is more pronounced in patients with BMI ≥ 70.0 kg/m2. In these patients, RYGB is associated with increased risk of mortality compared to SG.
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Affiliation(s)
- Anastasios T Mitsakos
- Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA. .,Department of Surgery, Vidant Medical Center, East Carolina University Brody School of Medicine, 2100 Stantonsburg Road, Greenville, NC, 27834, USA.
| | - William Irish
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Eric J DeMaria
- Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Walter J Pories
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Maria S Altieri
- Department of Surgery, Section of GI Surgery, Pennsylvania Hospital/University of Pennsylvania, Philadelphia, PA, USA
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Nowicki KN, Pories WJ. Bacteria with potential: Improving outcomes through probiotic use following Roux-en-Y gastric bypass. Clin Obes 2023; 13:e12552. [PMID: 36127843 PMCID: PMC10078542 DOI: 10.1111/cob.12552] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 01/19/2023]
Abstract
Obesity impairs the gastrointestinal microbiome (GM) and may promote micronutrient deficiencies. Bariatric surgery (BS), the most efficacious treatment for severe obesity, produces sustained weight loss and improvements in obesity-related comorbidities, but might not fully restore microbial balance. Moreover, BS may result in deleterious consequences that affect weight loss and further intensify post-operative micronutrient deficiencies. To date, the use of probiotics appears to be associated with greater weight loss in bariatric patients, improved vitamin synthesis and availability, and decreased instances of small intestinal bacterial overgrowth. Thus, manipulation of the GM through probiotics represents a promising therapeutic approach in bariatric patients. This review aims to highlight the benefits of using probiotics in bariatric surgical patients by addressing the impact of probiotics on the GM, how BS impacts the microbial environment, associations between gastrointestinal dysbiosis and negative health outcomes, how BS contributes to dysbiosis, and how probiotics may prove efficacious in treating patients who undergo Roux-en-Y gastric bypass (RYGB). Based on currently available data, the role of microbial manipulation post-RYGB through probiotics has shown great potential, but a further clinical investigation is warranted to better understand their efficacy.
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9
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Altieri MS, Irish W, Pories WJ, DeMaria EJ. The US Prevalence of Metabolic Surgery in Patients with Obesity and Type 2 Diabetes Has Not Increased Despite Recommendations from the American Diabetes Association. Obes Surg 2022; 32:1086-1092. [PMID: 35032312 DOI: 10.1007/s11695-021-05865-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Metabolic surgery dramatically improves type 2 diabetes mellitus (T2DM). In 2017, the American Diabetes Association (ADA) recommended metabolic surgery as the optimal treatment for patients with T2DM and Body Mass Index (BMI) > 40. We sought to evaluate whether or not that recommendation is being implemented. The purpose of this study was to evaluate the trend of bariatric surgery 2 years prior and 2 years following the ADA statement. MATERIALS AND METHODS A retrospective analysis of primary bariatric procedures on patients with class III obesity (BMI > 40 kg/m2) and T2DM performed between 2015 and 2018, using the Metabolic and Bariatric Surgery Accreditation Quality and Improvement Project (MBSAQIP) database. RESULTS From 2015 to 2018, 164,535 patients with T2DM underwent bariatric surgery. The majority had a BMI > 40 kg/m2 (n = 117,422, 71.4%) and most were not using insulin. Majority of the patients with T2D and class III obesity were female (72.1%), Caucasian (71.5%), and mean age (SD) 48.5 (11.5). Although the numbers of patients with T2DM and class III obesity increased during this time period, there was not a significant change in the overall percentage of patients who were treated with surgery: from 25.99% in 2015 to 24.96% in 2018. In addition, this group is associated with higher rates of complications and mortality compared to patients with BMI > 40 kg/m2 without T2DM. CONCLUSION Utilization of metabolic surgery in patients with obesity and T2DM has not improved following the updated 2017 ADA guidelines. There is a clear need for more awareness of these guidelines among providers, patients, and the public.
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Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - William Irish
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Walter J Pories
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Eric J DeMaria
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
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King WC, White GE, Belle SH, Yanovski SZ, Pomp A, Pories WJ, Wolfe BM, Ahmed B, Courcoulas AP. Changes in Smoking Behavior Before and After Gastric Bypass: A 7-year Study. Ann Surg 2022; 275:131-139. [PMID: 32084036 DOI: 10.1097/sla.0000000000003828] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate smoking history and change in smoking behavior, from 1 year before through 7 years after Roux-en-Y gastric bypass (RYGB) surgery, and to identify risk factors for post-surgery smoking. BACKGROUND Smoking behavior in the context of bariatric surgery is poorly described. METHODS Adults undergoing RYGB surgery entered a prospective cohort study between 2006 and 2009 and were followed up to 7 years until ≤2015. Participants (N = 1770; 80% female, median age 45 years, median body mass index 47 kg/m2) self-reported smoking history pre-surgery, and current smoking behavior annually. RESULTS Almost half of participants (45.2%) reported a pre-surgery history of smoking. Modeled prevalence of current smoking decreased in the year before surgery from 13.7% [95% confidence interval (CI) = 12.1-15.4] to 2.2% (95% CI = 1.5-2.9) at surgery, then increased to 9.6% (95% CI = 8.1-11.2) 1-year post-surgery and continued to increase to 14.0% (95% CI = 11.8-16.0) 7-years post-surgery. Among smokers, mean packs/day was 0.60 (95% CI = 0.44-0.77) at surgery, 0.70 (95% CI = 0.62-0.78) 1-year post-surgery and 0.77 (95% CI = 0.68-0.88) 7-years post-surgery. At 7-years, smoking was reported by 61.7% (95% CI = 51.9-70.8) of participants who smoked 1-year pre-surgery (n = 221), 12.3% (95% CI = 8.5-15.7) of participants who formerly smoked but quit >1 year pre-surgery (n = 507), and 3.8% (95% CI = 2.1-4.9) of participants who reported no smoking history (n = 887). Along with smoking history (ie, less time since smoked), younger age, household income <$25,000, being married or living as married, and illicit drug use were independently associated with increased risk of post-surgery smoking. CONCLUSION Although most adults who smoked 1-year before RYGB quit pre-surgery, smoking prevalence rebounded across 7-years, primarily due to relapse.
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Affiliation(s)
- Wendy C King
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gretchen E White
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Sciences University, Portland, Oregon
| | - Bestoun Ahmed
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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11
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Gourash WF, King WC, Shirley E, Hinerman A, Ebel F, Pomp A, Pories WJ, Courcoulas AP. Five-year attrition, active enrollment, and predictors of level of participation in the Longitudinal Assessment of Bariatric Surgery (LABS-2) study. Surg Obes Relat Dis 2021; 18:394-403. [PMID: 35027321 DOI: 10.1016/j.soard.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reporting high-quality bariatric surgery outcomes depends on participant attrition and level of study participation among enrolled participants. OBJECTIVES Our aims are to report participant attrition, active enrollment, and level of participation, and to evaluate pre-surgery sociodemographic, physical health, and psychosocial factors as predictors of attrition and level of participation through 5 years. SETTING The Longitudinal Assessment of Bariatric Surgery-2 study which enrolled 2458 adults undergoing a first bariatric surgical procedure at 1 of 6 US cites from 2006 through 2009. METHODS In-person research assessments were conducted pre-surgery and annually for five years. Extensive retention strategies including offering remote assessments (telephone, email, mail, or a combination) were fully implemented in 2009. Among living participants, including those inactivated, annual follow-up assessments were categorized as in-person, remote or missed through 5 years. RESULTS By year 5, 1.7% of participants had died and 3.2% had withdrawn or were inactivated by the study staff; thus, attrition was 4.9% (n = 121). Controlling for site and calendar year, missed assessments increased from 14.7%-21.8% between years 1 and 2 and then stayed relatively stable (20.8%-19.6%) for years 3-5. Younger age, male sex, White race, lower body mass index, smoking, illicit drug use, and higher weight loss expectations preoperatively were independently associated with a higher likelihood of a missed versus in-person assessment across follow-up. CONCLUSION The LABS-2 participant attrition was low. The percentage of missed assessments did not increase after year 2, perhaps due to implementation of a comprehensive retention plan. Predictors of missed assessments highlight subgroups to target for focused retention efforts.
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Affiliation(s)
- William F Gourash
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Wendy C King
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eleanor Shirley
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amanda Hinerman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Faith Ebel
- Department of Surgery, Division of GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, New York
| | - Alfons Pomp
- Department of Surgery, University of Montreal, Montreal, Canada
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, North Carolina
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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12
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Altieri MS, Irish W, DeMaria EJ, Pories WJ, Wong JH. Understanding Disparities in Surgical Access to Bariatric Surgery in North Carolina. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Fischer LE, Wolfe BM, Fino N, Elman MR, Flum DR, Mitchell JE, Pomp A, Pories WJ, Purnell JQ, Patti ME. Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis 2021; 17:1787-1798. [PMID: 34294589 PMCID: PMC9944569 DOI: 10.1016/j.soard.2021.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Postbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH. OBJECTIVES To examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors. SETTING Multicenter, at 10 US hospitals in 6 geographically diverse clinical centers. METHODS A prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors. RESULTS In all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%-36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%-29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6-3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting. CONCLUSION Hypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.
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Affiliation(s)
- Laura E. Fischer
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,Correspondence: Laura E. Fischer, M.D., M.S., F.A.C.S., Director, OU Metabolic and Bariatric Surgery Program, Assistant Professor, Department of Surgery, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Ste 9000, Oklahoma City, OK 73104. (L.E. Fischer)
| | - Bruce M. Wolfe
- Departments of Medicine, Surgery, and the School of Public Health at Oregon Health & Science University, Portland, Oregon
| | - Nora Fino
- Departments of Medicine, Surgery, and the School of Public Health at Oregon Health & Science University, Portland, Oregon
| | - Miriam R. Elman
- Oregon Health and Science – Portland State University School of Public Health, Portland, Oregon
| | - David R. Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine, Grand Forks, North Dakota
| | - Alfons Pomp
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Walter J. Pories
- Metabolic Surgery Research Group, East Carolina University, Greenville, North Carolina
| | - Jonathan Q. Purnell
- Departments of Medicine, Surgery, and the School of Public Health at Oregon Health & Science University, Portland, Oregon
| | - Mary-Elizabeth Patti
- Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
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14
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Altieri MS, Irish W, Pories WJ, Shah A, DeMaria EJ. Examining the Rates of Obesity and Bariatric Surgery in the United States. Obes Surg 2021; 31:4754-4760. [PMID: 34345959 DOI: 10.1007/s11695-021-05628-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of this study is to evaluate the change in rate of increase of bariatric surgery performed compared to the growth of obesity and severe obesity in the United States (US). MATERIALS AND METHODS The number of primary adult bariatric procedures performed in the US between 2015 and 2018 was obtained from the Metabolic and Bariatric Surgery Accreditation Quality and Improvement Project (MBSAQIP) database. The US Census database was used to derive age-adjusted obesity and severe obesity prevalence among adults. Prevalence of bariatric surgery, by year, was estimated as the ratio of the number of patients undergoing surgery and the projected number of eligible individuals for that year. RESULTS There were 627,386 bariatric procedures performed for body mass index (BMI) ≥ 30 kg/m2, of which 73.3% (n = 459,800) were performed for BMI ≥ 40 kg/m2. Although the rate of obesity increased by 3.32% per year during this period (RR = 1.0332 per year increase; 95% CI = 1.0313, 1.0352), the rate of surgery per eligible population increased by only 2.47% (RR = 1.0247 per year increase; 95% CI = 1.0065, 1.0432). The prevalence of severe obesity increased from 7.70% (n = 17,494,910) in 2015 to 9.95% (n = 23,135,039) in 2018 while the prevalence of surgery decreased from 0.588 per 100 eligible population in 2015 to 0.566 per 100 eligible population in 2018. CONCLUSION The rate of utilization has not kept up with the rate of increase in this disease, our costliest illness. There is a strong need to educate the public, healthcare professionals, insurance carriers, and legislators.
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Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - William Irish
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Walter J Pories
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Anish Shah
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Eric J DeMaria
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
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15
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Abstract
Bariatric surgery has been shown to improve cognition in patients with severe obesity. Bariatric surgery may improve mental function in patient populations with obesity and with cognitive impairment, including nonacquired, dementia, and traumatic brain injury, although studies have been limited. Bariatric surgery provides an opportunity to explore the effects of obesity, type 2 diabetes, dyslipidemias, and other expressions of metabolic syndrome on cognition. It offers the unusual opportunity to study patients with these chronic diseases and, later, those without them. This suggests the need for further studies into the effects of bariatric surgery on patient populations with obesity and with cognitive impairment to look at the effects of the continuing metabolic brain damage in people with severe obesity when earlier intervention could be considered.
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Affiliation(s)
- Michael D Morledge
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Buchwald H, Buchwald JN, Pories WJ, Hoyt DB. Executive Summary: Collected Papers of the American College of Surgeons Metabolic Surgery Symposium. Obes Surg 2021; 30:1961-1970. [PMID: 32072370 DOI: 10.1007/s11695-020-04451-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
On August 9-10, 2017, the American College of Surgeons hosted a symposium on metabolic surgery, with 12 follow-on papers published serially in the Bulletin of the College. The current synopsis outlines the varied contents of these papers, often in the original words of their authors, who are cited within their topic sections. Topics covered include the following: history and definition of metabolic surgery, bariatric surgery, international bariatric surgery, mechanisms of metabolic surgery, diabetes and the metabolic syndrome, frontiers of metabolic surgery, institutional collaborations, accreditations and quality initiatives, professional training, the role of the National Institutes of Health, and advocacy. Based on these insights, an enthusiastic affirmation for the future of metabolic surgery is warranted.
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Affiliation(s)
- Henry Buchwald
- University of Minnesota Medical School, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA.
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA
| | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
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17
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Pories WJ, Jones TE, Houmard JA, DeMaria E, Dohm GL. Ockham's razor and the metabolic syndrome. Surg Obes Relat Dis 2021; 17:1236-1243. [PMID: 33965350 DOI: 10.1016/j.soard.2021.04.004] [Citation(s) in RCA: 3] [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: 02/07/2021] [Revised: 03/21/2021] [Accepted: 04/02/2021] [Indexed: 12/11/2022]
Abstract
The broad effects of bariatric/metabolic surgery on virtually every tissue and organ system remain unexplained. Weight loss, although a major factor, does not fully account for the rapid, full, and durable remission of type 2 diabetes, return of islet function, reduction of the prevalence of cancers, increase in gray matter of the brain, and decrease in all-cause mortality. This review supports the thesis that the metabolic syndrome is not a group of separate diseases but rather multiple expressions of a shared defect in the utilization of carbohydrates and lipids. That error is probably caused by a dysmetabolic signal from the foregut, stimulated by food, that limits entry of 2-carbon fragments into the tricarboxylic acid cycle, the accumulation of lactate and, in turn, increases in glucose and insulin. Surgery limits that signal by reducing contact between food and foregut mucosa. Speciation of that signal(s) may offer a new pathway for drug development.
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Affiliation(s)
- Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
| | - Terry E Jones
- College of Allied Health Sciences, East Carolina University, Greenville, North Carolina
| | - Joseph A Houmard
- Department of Kinesiology, East Carolina University, Greenville, North Carolina
| | - Eric DeMaria
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - G Lynis Dohm
- Department of Physiology, East Carolina University, Greenville, North Carolina
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18
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Pories WJ. Editorial comment. Surg Obes Relat Dis 2021; 17:1235. [PMID: 33795202 DOI: 10.1016/j.soard.2021.02.019] [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] [Received: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 11/18/2022]
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19
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Purnell JQ, Dewey EN, Laferrère B, Selzer F, Flum DR, Mitchell JE, Pomp A, Pories WJ, Inge T, Courcoulas A, Wolfe BM. Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study. J Clin Endocrinol Metab 2021; 106:774-788. [PMID: 33270130 PMCID: PMC7947785 DOI: 10.1210/clinem/dgaa849] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 07/14/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Few studies have examined the clinical characteristics that predict durable, long-term diabetes remission after bariatric surgery. OBJECTIVE To compare diabetes prevalence and remission rates during 7-year follow-up after Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LAGB). DESIGN An observational cohort of adults with severe obesity recruited between 2006 and 2009 who completed annual research assessments for up to 7 years after RYGB or LAGB. SETTING Ten US hospitals. PARTICIPANTS A total sample of 2256 participants, 827 with known diabetes status at both baseline and at least 1 follow-up visit. INTERVENTIONS Roux-en-Y gastric bypass or LAGB. MAIN OUTCOME MEASURES Diabetes rates and associations of patient characteristics with remission status. RESULTS Diabetes remission occurred in 57% (46% complete, 11% partial) after RYGB and 22.5% (16.9% complete, 5.6% partial) after LAGB. Following both procedures, remission was greater in younger participants and those with shorter diabetes duration, higher C-peptide levels, higher homeostatic model assessment of β-cell function (HOMA %B), and lower insulin usage at baseline, and with greater postsurgical weight loss. After LAGB, reduced HOMA insulin resistance (IR) was associated with a greater likelihood of diabetes remission, whereas increased HOMA-%B predicted remission after RYGB. Controlling for weight lost, diabetes remission remained nearly 4-fold higher compared with LAGB. CONCLUSIONS Durable, long-term diabetes remission following bariatric surgery is more likely when performed soon after diagnosis when diabetes medication burden is low and beta-cell function is preserved. A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss contribute to improved beta-cell function after RYGB.Trial Registration clinicaltrials.gov Identifier: NCT00465829.
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Affiliation(s)
- Jonathan Q Purnell
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Correspondence and Reprint Requests: Jonathan Q Purnell, MD, Knight Cardiovascular Institute, HRC5N, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239. E-mail:
| | - Elizabeth N Dewey
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Blandine Laferrère
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Faith Selzer
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - James E Mitchell
- Department of Clinical Neuroscience, University of North Dakota, Fargo, ND, USA
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, NC, USA
| | - Thomas Inge
- Department of Surgery, University of Colorado, Denver, CO, USA
| | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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20
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Wong JH, Irish WD, DeMaria EJ, Vohra NA, Pories WJ, Brownstein MR, Altieri MS, Akram W, Haisch CE, Leeser DB, Tuttle JE. Development and Assessment of a Systematic Approach for Detecting Disparities in Surgical Access. JAMA Surg 2021; 156:239-245. [PMID: 33326009 DOI: 10.1001/jamasurg.2020.5668] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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 Although optimal access is accepted as the key to quality care, an accepted methodology to ascertain potential disparities in surgical access has not been defined. Objective To develop a systematic approach to detect surgical access disparities. Design, Setting, and Participants This cross-sectional study used publicly available data from the Health Cost and Utilization Project State Inpatient Database from 2016. Using the surgical rate observed in the 5 highest-ranked counties (HRCs), the expected surgical rate in the 5 lowest-ranked counties (LRCs) in North Carolina were calculated. Patients 18 years and older who underwent an inpatient general surgery procedure and patients who underwent emergency inpatient cholecystectomy, herniorrhaphy, or bariatric surgery in 2016 were included. Data were collected from January to December 2016, and data were analyzed from March to July 2020. Exposures Health outcome county rank as defined by the Robert Wood Johnson Foundation. Main Outcomes and Measures The primary outcome was the proportional surgical ratio (PSR), which was the disparity in surgical access defined as the observed number of surgical procedures in the 5 LRCs relative to the expected number of procedures using the 5 HRCs as the standardized reference population. Results In 2016, approximately 1.9 million adults lived in the 5 HRCs, while approximately 246 854 lived in the 5 LRCs. A total of 28 924 inpatient general surgical procedures were performed, with 4521 being performed in those living in the 5 LRCs and 24 403 in those living in the 5 HRCs. The rate of general surgery in the 5 HRCs was 13.09 procedures per 1000 population. Using the 5 HRCs as the reference, the PSR for the 5 LRCs was 1.40 (95% CI, 1.35-1.44). For emergent/urgent cholecystectomy, the PSR for the 5 LRCs was 2.26 (95% CI, 2.02-2.51), and the PSR for emergent/urgent herniorrhaphy was 1.83 (95% CI, 1.33-2.45). Age-adjusted rate of obesity (body mass index [calculated as weight in kilograms divided by height in meters squared] greater than 30), on average, was 36.6% (SD, 3.4) in the 5 LRCs vs 25.4% (SD, 4.6) in the 5 HRCs (P = .002). The rate of bariatric surgery in the 5 HRCs was 33.07 per 10 000 population with obesity. For the 5 LRCs, the PSR was 0.60 (95% CI, 0.51-0.69). Conclusions and Relevance The PSR is a systematic approach to define potential disparities in surgical access and should be useful for identifying, investigating, and monitoring interventions intended to mitigate disparities in surgical access that effects the health of vulnerable populations.
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Affiliation(s)
- Jan H Wong
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - William D Irish
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.,Department of Public Health, East Carolina University, Greenville, North Carolina
| | - Eric J DeMaria
- Division of General Minimal Invasive and Bariatric Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Nasreen A Vohra
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Walter J Pories
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Michelle R Brownstein
- Division of Trauma and Critical Care, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Maria S Altieri
- Division of General Minimal Invasive and Bariatric Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Warqaa Akram
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Carl E Haisch
- Division of Surgical Immunology and Transplantation, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - David B Leeser
- Division of Surgical Immunology and Transplantation, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Janet E Tuttle
- Division of Surgical Immunology and Transplantation, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
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21
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Dainelli L, Luo DR, Cohen SS, Marczewska A, Ard JD, Coburn SL, Lewis KH, Loper J, Matarese LE, Pories WJ, Rothberg AE. Health-Related Quality of Life in Weight Loss Interventions: Results from the OPTIWIN Trial. Int J Environ Res Public Health 2021; 18:ijerph18041785. [PMID: 33673158 PMCID: PMC7917903 DOI: 10.3390/ijerph18041785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/02/2022]
Abstract
Obesity is highly prevalent and associated with several adverse outcomes including health-related quality-of-life (HRQoL), work productivity, and activity impairment. The objective of this study is to examine group differences in HRQoL and labor-related health outcomes among participants in the OPTIWIN program, which compared the effectiveness of two intensive behavioral weight loss interventions. Participants (n = 273) were randomized to OPTIFAST®(OP) or food-based (FB) dietary interventions for 52 weeks. HRQoL and labor-related health outcomes were measured at baseline, week 26, and week 52, using two questionnaires. At baseline, there were no differences between groups on the Impact of Weight on Quality-of-Life Questionnaire (IWQOL-Lite). At week 26, the OP group had statistically significant differences towards better HRQoL for Physical Function, Self-Esteem, and the total score compared with the FB group. At week 52, the OP group showed better HRQoL in the total score (p = 0.0012) and in all but one domain. Moreover, the adjusted change-from-baseline normalized total score at week 52 was −5.9 points (p = 0.0001). Finally, the mean IWQOL-Lite normalized score showed that HRQoL improves by 0.4442 units (p < 0.0001) per kg lost, and that greater weight reduction was positively associated with better HRQoL. No statistically significant group differences were found with the Work Productivity and Activity Impairment (General Health) (WPAI-GH) Questionnaire. HRQoL improves with highly intensive, well-structured weight loss interventions. Greater weight loss lead to larger improvements. The lack of negative effect on productivity and activity suggests that these interventions may be compatible with an active work lifestyle.
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Affiliation(s)
- Livia Dainelli
- Nestlé Research, Nestlé, 1000 Lausanne, Switzerland; (L.D.); (D.R.L.)
| | - Dan Roberto Luo
- Nestlé Research, Nestlé, 1000 Lausanne, Switzerland; (L.D.); (D.R.L.)
| | | | | | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (J.D.A.); (K.H.L.)
| | | | - Kristina H. Lewis
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; (J.D.A.); (K.H.L.)
| | - Judy Loper
- The Central Ohio Nutrition Center, Inc., Gohanna, OH 43230, USA;
| | - Laura E. Matarese
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC 27101, USA; (L.E.M.); (W.J.P.)
| | - Walter J. Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC 27101, USA; (L.E.M.); (W.J.P.)
| | - Amy E. Rothberg
- Department of Nutritional Sciences, School of Public Health and Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Harbour, MI 48109-2029, USA
- Correspondence:
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22
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Broskey NT, Pories WJ, Jones TE, Tanner CJ, Zheng D, Cortright RN, Yang ZW, Khang N, Yang J, Houmard JA, Lynis Dohm G. The association between lactate and muscle aerobic substrate oxidation: Is lactate an early marker for metabolic disease in healthy subjects? Physiol Rep 2021; 9:e14729. [PMID: 33527749 PMCID: PMC7851428 DOI: 10.14814/phy2.14729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/24/2022] Open
Abstract
Fasting plasma lactate concentrations are elevated in individuals with metabolic disease. The aim of this study was to determine if the variance in fasting lactate concentrations were associated with factors linked with cardiometabolic health even in a young, lean cohort. Young (age 22 ± 0.5; N = 30) lean (BMI (22.4 ± 0.4 kg/m2) women were assessed for waist‐to‐hip ratio, aerobic capacity (VO2peak), skeletal muscle oxidative capacity (near infrared spectroscopy; fat oxidation from muscle biopsies), and fasting glucose and insulin (HOMA‐IR). Subjects had a mean fasting lactate of 0.9 ± 0.1 mmol/L. The rate of deoxygenation of hemoglobin/myoglobin (R2 = .23, p = .03) in resting muscle and skeletal muscle homogenate fatty acid oxidation (R2 = .72, p = .004) were inversely associated with fasting lactate. Likewise, cardiorespiratory fitness (time to exhaustion during the VO2peak test) was inversely associated with lactate (R2 = .20, p = .05). Lactate concentration was inversely correlated with HDL:LDL (R2 = .57, p = .02) and positively correlated with the waist to hip ratio (R2 = .52, p = .02). Plasma lactate was associated with various indices of cardiometabolic health. Thus, early determination of fasting lactate concentration could become a common biomarker used for identifying individuals at early risk for metabolic diseases.
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Affiliation(s)
- Nicholas T Broskey
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA.,Department of Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA.,Department of Diabetes, Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Walter J Pories
- Department of Diabetes, Obesity Institute, East Carolina University, Greenville, North Carolina, USA.,Department of Surgery, East Carolina University, Greenville, North Carolina, USA
| | - Terry E Jones
- Department of Diabetes, Obesity Institute, East Carolina University, Greenville, North Carolina, USA.,Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - Charles J Tanner
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA.,Department of Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA.,Department of Diabetes, Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Donghai Zheng
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA.,Department of Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA.,Department of Diabetes, Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Ronald N Cortright
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA.,Department of Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA.,Department of Diabetes, Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - Zhen W Yang
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA.,Department of Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | - Nkaujyi Khang
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA.,Department of Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA
| | - Josh Yang
- Department of Physiology, East Carolina University, Greenville, North Carolina, USA
| | - Joseph A Houmard
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA.,Department of Human Performance Laboratory, East Carolina University, Greenville, North Carolina, USA.,Department of Diabetes, Obesity Institute, East Carolina University, Greenville, North Carolina, USA
| | - G Lynis Dohm
- Department of Diabetes, Obesity Institute, East Carolina University, Greenville, North Carolina, USA.,Department of Physiology, East Carolina University, Greenville, North Carolina, USA
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23
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McGlennon TW, Buchwald JN, Pories WJ, Yu F, Roberts A, Ahnfeldt EP, Menon R, Buchwald H. PART 3 Bypassing TBI: Metabolic Surgery and the Link Between Obesity and Traumatic Brain Injury-a Review. Obes Surg 2021; 31:477-480. [PMID: 33398623 DOI: 10.1007/s11695-020-05176-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be a most effective therapy for TBI.
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Affiliation(s)
- T W McGlennon
- Statistics Division, McGlennon MotiMetrics, Maiden Rock, WI, USA
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
| | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Eric P Ahnfeldt
- Uniformed Services University of the Health Sciences, Bethesda, MA, USA
| | - Rukmini Menon
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Henry Buchwald
- Surgery and Biomedical Engineering, Owen H. & Sarah Davidson Wangensteen Chair in Experimental Surgery, Emeritus, University of Minnesota Medical School, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA.
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24
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McGlennon TW, Buchwald JN, Pories WJ, Yu F, Roberts A, Ahnfeldt EP, Menon R, Buchwald H. Part 2: Bypassing TBI-Metabolic Surgery and the Link Between Obesity and Traumatic Brain Injury-A Review. Obes Surg 2021; 31:26-35. [PMID: 33405185 DOI: 10.1007/s11695-020-05142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be the most effective therapy for TBI.
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Affiliation(s)
- T W McGlennon
- Statistics Division, McGlennon MotiMetrics, Maiden Rock, WI, USA
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
| | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Eric P Ahnfeldt
- Uniformed Services University of the Health Sciences, Bethesda, MA, USA
| | - Rukmini Menon
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Henry Buchwald
- University of Minnesota Medical School, Minneapolis, MN, USA.
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25
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Barberio MD, Dohm GL, Pories WJ, Gadaleta NA, Houmard JA, Nadler EP, Hubal MJ. Type 2 Diabetes Modifies Skeletal Muscle Gene Expression Response to Gastric Bypass Surgery. Front Endocrinol (Lausanne) 2021; 12:728593. [PMID: 34690929 PMCID: PMC8526857 DOI: 10.3389/fendo.2021.728593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/13/2021] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) is an effective treatment for type 2 diabetes mellitus (T2DM) that can result in remission of clinical symptoms, yet mechanisms for improved skeletal muscle health are poorly understood. We sought to define the impact of existing T2DM on RYGB-induced muscle transcriptome changes. METHODS Vastus lateralis biopsy transcriptomes were generated pre- and 1-year post-RYGB in black adult females with (T2D; n = 5, age = 51 ± 6 years, BMI = 53.0 ± 5.8 kg/m2) and without (CON; n = 7, 43 ± 6 years, 51.0 ± 9.2 kg/m2) T2DM. Insulin, glucose, and HOMA-IR were measured in blood at the same time points. ANCOVA detected differentially expressed genes (p < 0.01, fold change < |1.2|), which were used to identify enriched biological pathways. RESULTS Pre-RYGB, 95 probes were downregulated with T2D including subunits of mitochondrial complex I. Post-RYGB, the T2D group had normalized gene expression when compared to their non-diabetic counterparts with only three probes remaining significantly different. In the T2D, we identified 52 probes upregulated from pre- to post-RYGB, including NDFUB7 and NDFUA1. CONCLUSION Black females with T2DM show extensive downregulation of genes across aerobic metabolism pathways prior to RYGB, which resolves 1 year post-RYGB and is related to improvements in clinical markers. These data support efficacy of RYGB for improving skeletal muscle health, especially in patients with T2DM.
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Affiliation(s)
- Matthew D. Barberio
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, United States
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - G. Lynis Dohm
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Walter J. Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Natalie A. Gadaleta
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Joseph A. Houmard
- Human Performance Laboratory, Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC, United States
| | - Evan P. Nadler
- Division of Pediatric Surgery, Children’s National Hospital, Washington, DC, United States
| | - Monica J. Hubal
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, United States
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN, United States
- *Correspondence: Monica J. Hubal,
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26
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Ard JD, Lewis KH, Cohen SS, Rothberg AE, Coburn SL, Loper J, Matarese L, Pories WJ, Periman S. Differences in treatment response to a total diet replacement intervention versus a food-based intervention: A secondary analysis of the OPTIWIN trial. Obes Sci Pract 2020; 6:605-614. [PMID: 33354339 PMCID: PMC7746973 DOI: 10.1002/osp4.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/30/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE For every weight loss treatment, there are usually groups of people who lose less than expected. This study sought to determine if response rates to a total diet replacement (TDR) differed from those of a calorie-restricted, food-based (FB) diet. METHODS Data from OPTIWIN, a 12-month multicenter trial in adults with a BMI of 30-55 kg/m2, with 26-week weight-loss and weight-maintenance phases, were utilized. Participants (n = 330) were randomized to the OPTIFAST programme (OP) or to a reduced-energy FB diet. Treatment non-responders were defined as those who lost <3% of initial weight at months 6 or 12. RESULTS There were 103 (76%) responders in the OP compared with 78 (57%) in the FB group at 12 months. The odds of treatment response at 12 months among participants who were non-responders at 3 months was not significantly different between the OP and FB groups (p = 0.64). Race, type 2 diabetes status and previous weight loss attempts were significantly associated with responder status. OP responders had higher meal plan adherence and non-caloric fluid intake compared with FB responders. CONCLUSION Early treatment response is more likely and better sustained with TDR compared with an FB diet. Individual and treatment level factors appear to influence early treatment response to behavioural interventions for weight reduction.
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Affiliation(s)
- Jamy D. Ard
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kristina H. Lewis
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | - Amy E. Rothberg
- Department of Internal MedicineMichigan MedicineAnn ArborMichiganUSA
| | | | - Judy Loper
- The Central Ohio Nutrition Center, Inc.GahannaOhioUSA
| | - Laura Matarese
- Department of SurgeryEast Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Walter J. Pories
- Department of SurgeryEast Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Seletha Periman
- Nestlé Health Science, Global Research & DevelopmentBridgewaterNew JerseyUSA
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27
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Harrod CS, Elman MR, Vesco KK, Wolfe BM, Mitchell JE, Pories WJ, Pomp A, Boone-Heinonen J, Purnell JQ. Associations of Pregnancy After Bariatric Surgery with Long-Term Weight Trajectories and Birth Weight: LABS-2 Study. Obesity (Silver Spring) 2020; 28:2209-2215. [PMID: 32918404 PMCID: PMC7650043 DOI: 10.1002/oby.22944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/26/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to examine whether pregnancy following bariatric surgery affects long-term maternal weight change and offspring birth weight. METHODS Using data from the Longitudinal Assessment of Bariatric Surgery (LABS)-2 study, linear regression was used to evaluate percent change in total body weight over a 5-year follow-up period among reproductive-aged women who underwent Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding as well as evaluate the association of bariatric procedure type and offspring birth weight. RESULTS Of 727 women with preoperative age of 36.1 (6.3) years (mean [SD]) and BMI of 46.9 (7.0) kg/m2 , 80 (11%) reported at least one pregnancy. After adjusting for covariates, percent change in total body weight was not significantly different between women who became pregnant and those who did not during a 5-year follow-up period (β = 2.02; 95% CI: -1.03 to 5.07; P = 0.19). Additionally, mean birth weight was not significantly different between mothers who underwent Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding (P = 0.99). CONCLUSIONS Postoperative pregnancy did not diminish long-term weight loss in women in the LABS-2 study. The finding of comparable weight loss is relevant for providers counseling women of reproductive age on weight-loss expectations and family planning following bariatric surgery.
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Affiliation(s)
| | - Miriam R Elman
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Bruce M Wolfe
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Alfons Pomp
- Weill Cornell University Medical Center, New York, New York, USA
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28
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McGlennon TW, Buchwald JN, Pories WJ, Yu F, Roberts A, Ahnfeldt EP, Menon R, Buchwald H. Bypassing TBI: Metabolic Surgery and the Link between Obesity and Traumatic Brain Injury-a Review. Obes Surg 2020; 30:4704-4714. [PMID: 33125676 DOI: 10.1007/s11695-020-05065-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be a most effective therapy for TBI.
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Affiliation(s)
- T W McGlennon
- Statistics Division, McGlennon MotiMetrics, Maiden Rock, WI, USA
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite, Maiden Rock, WI, USA
| | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Eric P Ahnfeldt
- Uniformed Services University of the Health Sciences, Bethesda, MA, USA
| | - Rukmini Menon
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Henry Buchwald
- Surgery and Biomedical Engineering, Owen H. & Sarah Davidson Wangensteen Chair in Experimental Surgery, Emeritus, University of Minnesota Medical School, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA.
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29
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Zou K, Turner K, Zheng D, Hinkley JM, Kugler BA, Hornby PJ, Lenhard J, Jones TE, Pories WJ, Dohm GL, Houmard JA. Impaired glucose partitioning in primary myotubes from severely obese women with type 2 diabetes. Am J Physiol Cell Physiol 2020; 319:C1011-C1019. [PMID: 32966127 DOI: 10.1152/ajpcell.00157.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/26/2022]
Abstract
The purpose of this study was to determine whether intramyocellular glucose partitioning was altered in primary human myotubes derived from severely obese women with type 2 diabetes. Human skeletal muscle cells were obtained from lean nondiabetic and severely obese Caucasian females with type 2 diabetes [body mass index (BMI): 23.6 ± 2.6 vs. 48.8 ± 1.9 kg/m2, fasting glucose: 86.9 ± 1.6 vs. 135.6 ± 12.0 mg/dL, n = 9/group]. 1-[14C]-Glucose metabolism (glycogen synthesis, glucose oxidation, and nonoxidized glycolysis) and 1- and 2-[14C]-pyruvate oxidation were examined in fully differentiated myotubes under basal and insulin-stimulated conditions. Tricarboxylic acid cycle intermediates were determined via targeted metabolomics. Myotubes derived from severely obese individuals with type 2 diabetes exhibited impaired insulin-mediated glucose partitioning with reduced rates of glycogen synthesis and glucose oxidation and increased rates of nonoxidized glycolytic products, when compared with myotubes derived from the nondiabetic individuals (P < 0.05). Both 1- and 2-[14C]-pyruvate oxidation rates were significantly blunted in myotubes from severely obese women with type 2 diabetes compared with myotubes from the nondiabetic controls. Lastly, concentrations of tricarboxylic acid cycle intermediates, namely, citrate (P < 0.05), cis-aconitic acid (P = 0.07), and α-ketoglutarate (P < 0.05), were lower in myotubes from severely obese women with type 2 diabetes. These data suggest that intramyocellular insulin-mediated glucose partitioning is intrinsically altered in the skeletal muscle of severely obese women with type 2 diabetes in a manner that favors the production of glycolytic end products. Defects in pyruvate dehydrogenase and tricarboxylic acid cycle may be responsible for this metabolic derangement associated with type 2 diabetes.
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Affiliation(s)
- Kai Zou
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Kristen Turner
- Department of Kinesiology, East Carolina University, Greenville, North Carolina.,Human Performance Laboratory, East Carolina University, Greenville, North Carolina.,East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Donghai Zheng
- Department of Kinesiology, East Carolina University, Greenville, North Carolina.,Human Performance Laboratory, East Carolina University, Greenville, North Carolina.,Department of Physiology, East Carolina University, Greenville, North Carolina
| | - J Matthew Hinkley
- Department of Kinesiology, East Carolina University, Greenville, North Carolina.,Human Performance Laboratory, East Carolina University, Greenville, North Carolina.,East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Benjamin A Kugler
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Pamela J Hornby
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - James Lenhard
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Terry E Jones
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, North Carolina.,East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - G Lynis Dohm
- Department of Physiology, East Carolina University, Greenville, North Carolina.,East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Joseph A Houmard
- Department of Kinesiology, East Carolina University, Greenville, North Carolina.,Human Performance Laboratory, East Carolina University, Greenville, North Carolina.,East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
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30
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Zomorodian LM, Pories WJ. Letter to the Editor Re: "Evaluation of Liver Function Tests and Risk Score Assessment to Screen Patients for Significant Liver Disease Prior to Bariatric and Metabolic Surgery". Obes Surg 2020; 30:3210-3211. [PMID: 32424792 DOI: 10.1007/s11695-020-04596-z] [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: 10/24/2022]
Affiliation(s)
- Laila M Zomorodian
- Department of Surgery, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
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31
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Pories WJ, Dohm GL. Letter to the Editor Re: Sera of Obese Type 2 Diabetic Patients Undergoing Metabolic Surgery Instead of Conventional Treatment Exert Beneficial Effects on Beta Cell Survival and Function: Results of a Randomized Clinical Study. Obes Surg 2020; 30:3603-3604. [PMID: 32410152 DOI: 10.1007/s11695-020-04665-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
| | - G Lynis Dohm
- Department of Surgery, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA
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32
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Abstract
Severe obesity has many psychiatric consequences that can be influenced by bariatric surgery. The goal of this article is to review these challenges, including the mental health status of patients with severe obesity, the evaluation of surgical candidates, and the early and late effects of the operations, and to offer some recommendations to manage these challenges. The failure of the insurance-mandated preoperative psychosocial evaluation is also discussed.
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Affiliation(s)
- Michael D Morledge
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Walker E, Elman M, Takemoto EE, Fennern E, Mitchell JE, Pories WJ, Ahmed B, Pomp A, Wolfe BM. Bariatric Surgery Among Medicare Subgroups: Short- and Long-Term Outcomes. Obesity (Silver Spring) 2019; 27:1820-1827. [PMID: 31562705 PMCID: PMC6832742 DOI: 10.1002/oby.22613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study sought to examine weight change, postoperative adverse events, and related outcomes of interest among age-qualified (AQ) and disability-qualified (DQ) Medicare recipients compared with non-Medicare (NM) patients undergoing an initial bariatric procedure. METHODS The Longitudinal Assessment of Bariatric Surgery (LABS-2) is an observational cohort study of 2,458 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) bariatric surgery. Weight, percentage body fat, functional status, and comorbidities, as well as postoperative adverse events, were assessed at baseline and annually for 5 years. The 1,943 participants who reported insurance type were categorized into the following groups: AQ, DQ, or NM. RESULTS The median preoperative BMI ranged from 45 to 48 kg/m2 across groups. For RYGB, 5-year BMI loss was approximately 30% for all groups, and for LAGB, BMI loss was 12% to 15%. Diabetes remission after 5 years was also similar across groups within procedure types (RYGB: 33%-40%; LAGB: 13%-19%). The frequency of adverse events after RYGB ranged from 4.1% for NM participants to 6.7% for DQ participants. After LAGB, there were no adverse events for the AQ group, whereas 3% of DQ participants and 1.8% of NM participants had at least one adverse event. CONCLUSIONS Medicare participants experienced substantial BMI loss and diabetes remission, with a frequency of adverse events similar to that of NM participants.
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Affiliation(s)
- Elizaveta Walker
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Miriam Elman
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Erin E. Takemoto
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Erin Fennern
- Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota, Chaska, MN
| | - Walter J. Pories
- Department of Surgery, East Carolina University, Greenville, NC, USA
| | - Bestoun Ahmed
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Bruce M. Wolfe
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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Turner M, Vigneswaran Y, Dewey E, Wolfe BM, Stroud AM, Spight D, Flum DR, Courcoulas A, Mitchell JE, Pories WJ, Pomp A, Husain FA. Weight loss and co-morbidity resolution between different races and ethnicities after gastric bypass. Surg Obes Relat Dis 2019; 15:1943-1948. [DOI: 10.1016/j.soard.2019.09.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/27/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
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Ahmed B, King WC, Gourash W, Hinerman A, Belle SH, Pomp A, Pories WJ, Courcoulas AP. Proximal Roux-en-Y gastric bypass: Addressing the myth of limb length. Surgery 2019; 166:445-455. [PMID: 31378475 PMCID: PMC6778033 DOI: 10.1016/j.surg.2019.05.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Received: 02/16/2019] [Revised: 04/11/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Some studies suggest that changes in weight or metabolic outcomes are affected by the lengths of the gastrointestinal limbs in the Roux-en-Y gastric bypass. METHODS Participants (N = 1,770) underwent primary Roux-en-Y gastric bypass and were followed ≤7 years in the Longitudinal Assessment of Bariatric Surgery-2, a multicenter US cohort study. Alimentary limb and biliopancreatic limb lengths were measured according to research protocol; common channel was measured in a subsample (N = 547). Aimentary limb, biliopancreatic limb, and common channel ratio to total small bowel length were calculated. RESULTS Median presurgery body mass index was 46 (25th-75th percentile: 43-51) kg/m2. Medians (25th-75th percentiles) for alimentary limb length were 125 cm (100-150), for biliopancreatic limb length were 50 cm (50-60), and common channel length were 410 cm (322-520). Statistics for ratios to the small bowel length were 0.23 (0.18-0.27) for alimentary limb, 0.09 (0.07-0.10) for biliopancreatic limb, and 0.69 (0.63-0.73) for common length. There were no significant associations between alimentary limb, biliopancreatic limb, common channel, alimentary limb ratio, biliopancreatic limb ratio or common channel ratio, and either weight loss or improvement in cardiometabolic outcomes. CONCLUSION The common channel length in Roux-en-Y gastric bypass is highly variable between individuals. None of the limb lengths in this study, nor alimentary limb, biliopancreatic limb, or common channel ratios, seem to be related to weight loss or metabolic improvements >7 years.
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Affiliation(s)
- Bestoun Ahmed
- Department of Surgery, Division of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Wendy C King
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - William Gourash
- Department of Surgery, Division of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Amanda Hinerman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Steven H Belle
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Alfons Pomp
- Department of Surgery, Division of GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, NY
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Anita P Courcoulas
- Department of Surgery, Division of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Courcoulas AP, King WC, Belle SH, Berk P, Flum DR, Garcia L, Gourash W, Horlick M, Mitchell JE, Pomp A, Pories WJ, Purnell JQ, Singh A, Spaniolas K, Thirlby R, Wolfe BM, Yanovski SZ. Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study. JAMA Surg 2019; 153:427-434. [PMID: 29214306 DOI: 10.1001/jamasurg.2017.5025] [Citation(s) in RCA: 402] [Impact Index Per Article: 80.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance More information is needed about the durability of weight loss and health improvements after bariatric surgical procedures. Objective To examine long-term weight change and health status following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Design, Setting, and Participants The Longitudinal Assessment of Bariatric Surgery (LABS) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing bariatric surgical procedures as part of clinical care between 2006 and 2009 were recruited and followed up until January 31, 2015. Participants completed presurgery, 6-month, and annual research assessments for up to 7 years. Main Outcome and Measures Percentage of weight change from baseline, diabetes, dyslipidemia, and hypertension, determined by physical measures, laboratory testing, and medication use. Results Of 2348 participants, 1738 underwent RYGB (74%) and 610 underwent LAGB (26%). For RYBG, the median age was 45 years (range, 19-75 years), the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 47 (range, 34-81), 1389 participants (80%) were women, and 257 participants (15%) were nonwhite. For LAGB, the median age was 48 years (range, 18-78), the body mass index was 44 (range, 33-87), 465 participants (76%) were women, and 63 participants (10%) were nonwhite. Follow-up weights were obtained in 1300 of 1569 (83%) eligible for a year-7 visit. Seven years following RYGB, mean weight loss was 38.2 kg (95% CI, 36.9-39.5), or 28.4% (95% CI, 27.6-29.2) of baseline weight; between years 3 and 7 mean weight regain was 3.9% (95% CI, 3.4-4.4) of baseline weight. Seven years after LAGB, mean weight loss was 18.8 kg (95% CI, 16.3-21.3) or 14.9% (95% CI, 13.1-16.7), with 1.4% (95% CI, 0.4-2.4) regain. Six distinct weight change trajectory patterns for RYGB and 7 for LAGB were identified. Most participants followed trajectories in which weight regain from 3 to 7 years was small relative to year-3 weight loss, but patterns were variable. Compared with baseline, dyslipidemia prevalence was lower 7 years following both procedures; diabetes and hypertension prevalence were lower following RYGB only. Among those with diabetes at baseline (488 of 1723 with RYGB [28%]; 175 of 604 with LAGB [29%]), the proportion in remission at 1, 3, 5, and 7 years were 71.2% (95% CI, 67.0-75.4), 69.4% (95% CI, 65.0-73.8), 64.6% (95% CI, 60.0-69.2), and 60.2% (95% CI, 54.7-65.6), respectively, for RYGB and 30.7% (95% CI, 22.8-38.7), 29.3% (95% CI, 21.6-37.1), 29.2% (95% CI, 21.0-37.4), and 20.3% (95% CI, 9.7-30.9) for LAGB. The incidence of diabetes at all follow-up assessments was less than 1.5% for RYGB. Bariatric reoperations occurred in 14 RYGB and 160 LAGB participants. Conclusions and Relevance Following bariatric surgery, different weight loss patterns were observed, but most participants maintained much of their weight loss with variable fluctuations over the long term. There was some decline in diabetes remission over time, but the incidence of new cases is low following RYGB. Trial Registration clinicaltrials.gov Identifier: NCT00465829.
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Affiliation(s)
- Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Paul Berk
- Columbia University, New York, New York
| | - David R Flum
- Department of Surgery, University of Washington, Seattle
| | - Luis Garcia
- University of North Dakota, Neuropsychiatric Research Institute, Grand Forks
| | - William Gourash
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary Horlick
- National Institute of Diabetes and Digestive and Kidney Diseases, New York, New York
| | | | - Alfons Pomp
- Weill Cornell Medical College, New York, New York
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, Greenville, North Carolina
| | | | - Ashima Singh
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | | | - Bruce M Wolfe
- Department of Surgery, Oregon Health and Science University, Portland
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Affiliation(s)
- Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Louis J Aronne
- Comprehensive Weight Control Program, Weill Cornell Medical College, New York, New York, USA
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Zou K, Hinkley JM, Park S, Zheng D, Jones TE, Pories WJ, Hornby PJ, Lenhard J, Dohm GL, Houmard JA. Altered tricarboxylic acid cycle flux in primary myotubes from severely obese humans. Int J Obes (Lond) 2019; 43:895-905. [PMID: 29892037 DOI: 10.1038/s41366-018-0137-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 01/10/2018] [Revised: 04/27/2018] [Accepted: 05/10/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVE The partitioning of glucose toward glycolytic end products rather than glucose oxidation and glycogen storage is evident in skeletal muscle with severe obesity and type 2 diabetes. The purpose of the present study was to determine the possible mechanism by which severe obesity alters insulin-mediated glucose partitioning in human skeletal muscle. SUBJECTS/METHODS Primary human skeletal muscle cells (HSkMC) were isolated from lean (BMI = 23.6 ± 2.6 kg/m2, n = 9) and severely obese (BMI = 48.8 ± 1.9 kg/m2, n = 8) female subjects. Glucose oxidation, glycogen synthesis, non-oxidized glycolysis, pyruvate oxidation, and targeted TCA cycle metabolomics were examined in differentiated myotubes under basal and insulin-stimulated conditions. RESULTS Myotubes derived from severely obese subjects exhibited attenuated response of glycogen synthesis (20.3%; 95% CI [4.7, 28.8]; P = 0.017) and glucose oxidation (5.6%; 95% CI [0.3, 8.6]; P = 0.046) with a concomitant greater increase (23.8%; 95% CI [5.7, 47.8]; P = 0.004) in non-oxidized glycolytic end products with insulin stimulation in comparison to the lean group (34.2% [24.9, 45.1]; 13.1% [8.6, 16.4], and 2.9% [-4.1, 12.2], respectively). These obesity-related alterations in glucose partitioning appeared to be linked with reduced TCA cycle flux, as 2-[14C]-pyruvate oxidation (358.4 pmol/mg protein/min [303.7, 432.9] vs. lean 439.2 pmol/mg protein/min [393.6, 463.1]; P = 0.013) along with several TCA cycle intermediates, were suppressed in the skeletal muscle of severely obese individuals. CONCLUSIONS These data suggest that with severe obesity the partitioning of glucose toward anaerobic glycolysis in response to insulin is a resilient characteristic of human skeletal muscle. This altered glucose partitioning appeared to be due, at least in part, to a reduction in TCA cycle flux.
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Affiliation(s)
- Kai Zou
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.
- Department of Kinesiology, East Carolina University, Greenville, NC, USA.
- Human Performance Laboratory, East Carolina University, Greenville, NC, USA.
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA.
| | - J Matthew Hinkley
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL, USA
| | - Sanghee Park
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | - Donghai Zheng
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | - Terry E Jones
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA
| | - Walter J Pories
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
- Department of Surgery, East Carolina University, Greenville, NC, USA
| | | | - James Lenhard
- Janssen Research & Development LLC, Spring House, PA, USA
| | - G Lynis Dohm
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
- Department of Physiology, East Carolina University, Greenville, NC, USA
| | - Joseph A Houmard
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
- Human Performance Laboratory, East Carolina University, Greenville, NC, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
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Ard JD, Lewis KH, Rothberg A, Auriemma A, Coburn SL, Cohen SS, Loper J, Matarese L, Pories WJ, Periman S. Effectiveness of a Total Meal Replacement Program (OPTIFAST Program) on Weight Loss: Results from the OPTIWIN Study. Obesity (Silver Spring) 2019; 27:22-29. [PMID: 30421863 PMCID: PMC6587830 DOI: 10.1002/oby.22303] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 06/01/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to test the effectiveness of the OPTIFAST program (OP), a total meal replacement dietary intervention, compared with a food-based (FB) dietary plan for weight loss. METHODS Participants with BMI 30 to 55 kg/m2 , age 18 to 70 years old, were randomized to OP or FB dietary and lifestyle interventions for 26 weeks, followed by a weight-maintenance phase. Outcomes were percent change in body weight (%WL) from baseline to weeks 26 and 52, associated changes in body composition (using dual energy x-ray absorptiometry), and adverse events. Primary analysis used repeated-measures multivariable linear mixed models to compare outcomes between groups in a modified intention-to-treat fashion (mITT). RESULTS A total of 273 participants (83% of randomized; 135 OP, 138 FB) made up the mITT population. Mean age was 47.1 ± 11.2 years; 82% were female and 71% non-Hispanic white. Baseline BMI was 38.8 ± 5.9 kg/m2 . At 26 weeks, OP %WL was 12.4% ± 0.6% versus 6.0% ± 0.6% in FB (P < 0.001). At 52 weeks, OP %WL was 10.5% ± 0.6% versus 5.5% ± 0.6% in FB (P < 0.001). Fat mass loss was greater for OP; lean mass loss was proportional to total weight loss. There was no difference in serious adverse event rates between groups. CONCLUSIONS Compared with an FB approach, OP was more effective with greater sustained weight loss.
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Affiliation(s)
- Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Kristina H. Lewis
- Department of Epidemiology and Prevention, Wake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Amy Rothberg
- Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborMichiganUSA
| | - Anthony Auriemma
- AMITA Health, Alexian Brothers Weight Loss SolutionsElk Grove VillageIllinoisUSA
| | | | | | - Judy Loper
- The Central Ohio Nutrition Center, Inc.GahannaOhioUSA
| | - Laura Matarese
- Department of SurgeryEast Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Walter J. Pories
- Department of SurgeryEast Carolina University Brody School of MedicineGreenvilleNorth CarolinaUSA
| | - Seletha Periman
- Nestlé Health Science, U.S. Clinical OperationsBridgewaterNew JerseyUSA
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Gordon KH, King WC, White GE, Belle SH, Courcoulas AP, Ebel FE, Engel SG, Flum DR, Hinojosa MW, Pomp A, Pories WJ, Spaniolas D, Wolfe BM, Yanovski SZ, Mitchell JE. A longitudinal examination of suicide-related thoughts and behaviors among bariatric surgery patients. Surg Obes Relat Dis 2018; 15:269-278. [PMID: 31010651 DOI: 10.1016/j.soard.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/19/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Past research suggests self-harm/suicidality are more common among adults who have undergone bariatric surgery than the general population. OBJECTIVES To compare prevalence of self-harm/suicidal ideation over time and identify presurgery risk factors for postsurgery self-harm/suicidal ideation. SETTING The Longitudinal Assessment of Bariatric Surgery-2 is a cohort study with presurgery and annual postsurgery assessments conducted at 10 U.S. hospitals. METHODS Adults with severe obesity undergoing bariatric surgery between March 2006 and April 2009 (n = 2458). Five-year follow-up is reported. Self-reported history of suicidality assessed retrospectively via the Suicide Behavior Questionnaire-Revised (SBQ-R) and self-reported self-harm/suicidal ideation assessed prospectively via the Beck Depression Inventory-Version 1 (BDI-1). RESULTS The SBQ-R was completed by 1540 participants; 2217 completed the BDI-1 pre- and postsurgery. Over 75% of participants were female, with a median age of 46 years and body mass index of 45.9 kg/m2. Approximately one fourth of participants (395/1534) reported a presurgery history of suicidal thoughts or behavior (SBQ-R). The prevalence of self-harm/suicidal ideation (BDI-1) was 5.3% (95% confidence interval [CI], 3.7-6.8) presurgery and 3.8% (95% CI, 2.5-5.1) at year 1 postsurgery (P = .06). Prevalence increased over time postsurgery to 6.6% (95% CI, 4.6-8.6) at year 5 (P = .001) but was not significantly different than presurgery (P = .12). CONCLUSIONS A large cohort of adults with severe obesity who underwent bariatric surgery had a prevalence of self-harm/suicidal ideation that may have decreased in the first postoperative year but increased over time to presurgery levels, suggesting screening for self-harm/suicidality is warranted throughout long-term postoperative care. Several risk factors were identified that may help with enhanced monitoring.
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Affiliation(s)
- Kathryn H Gordon
- Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Psychology, North Dakota State University, Fargo, North Dakota.
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Gretchen E White
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Dave R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | | | | | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Dino Spaniolas
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon
| | - Susan Z Yanovski
- Office of Obesity Research, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Marek RJ, Steffen KJ, Flum DR, Pomp A, Pories WJ, Rubin JP, Wolfe BM, Mitchell JE. Psychosocial functioning and quality of life in patients with loose redundant skin 4 to 5 years after bariatric surgery. Surg Obes Relat Dis 2018; 14:1740-1747. [DOI: 10.1016/j.soard.2018.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/17/2018] [Accepted: 07/25/2018] [Indexed: 11/16/2022]
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Mishriky BM, Cummings DM, Tanenberg R, Pories WJ. Re-examining insulin compared to non-insulin therapies for type 2 diabetes: when in the disease trajectory is insulin preferable? Postgrad Med 2018; 130:653-659. [DOI: 10.1080/00325481.2018.1533381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Basem M. Mishriky
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Doyle M. Cummings
- Department of Family Medicine, East Carolina University, Greenville, NC, USA
| | - Robert Tanenberg
- Division of Endocrinology, East Carolina University, Greenville, NC, USA
| | - Walter J. Pories
- Department of Surgery, East Carolina University, Greenville, NC, USA
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Evans KM, Longshore SW, Lake B, Toschlog EA, Pories WJ, Walsh DS. Stop the Bleed: An Assessment of Medical Student Knowledge of Bleeding Control Techniques. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Seridi L, Leo GC, Dohm GL, Pories WJ, Lenhard J. Time course metabolome of Roux-en-Y gastric bypass confirms correlation between leptin, body weight and the microbiome. PLoS One 2018; 13:e0198156. [PMID: 29851973 PMCID: PMC5979615 DOI: 10.1371/journal.pone.0198156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/15/2018] [Indexed: 12/17/2022] Open
Abstract
Roux-en-Y gastric bypass (RYGB) is an effective way to lose weight and reverse type 2 diabetes. We profiled the metabolome of 18 obese patients (nine euglycemic and nine diabetics) that underwent RYGB surgery and seven lean subjects. Plasma samples from the obese patients were collected before the surgery and one week and three months after the surgery. We analyzed the metabolome in association to five hormones (Adiponectin, Insulin, Ghrelin, Leptin, and Resistin), four peptide hormones (GIP, Glucagon, GLP1, and PYY), and two cytokines (IL-6 and TNF). PCA showed samples cluster by surgery time and many microbially driven metabolites (indoles in particular) correlated with the three months after the surgery. Network analysis of metabolites revealed a connection between carbohydrate (mannosamine and glucosamine) and glyoxylate and confirms glyoxylate association to diabetes. Only leptin and IL-6 had a significant association with the measured metabolites. Leptin decreased immediately after RYGB (before significant weight loss), whereas IL-6 showed no consistent response to RYGB. Moreover, leptin associated with tryptophan in support of the possible role of leptin in the regulation of serotonin synthesis pathways in the gut. These results suggest a potential link between gastric leptin and microbial-derived metabolites in the context of obesity and diabetes.
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Affiliation(s)
- Loqmane Seridi
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
- * E-mail:
| | - Gregory C. Leo
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - G. Lynis Dohm
- Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
| | - Walter J. Pories
- Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
| | - James Lenhard
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
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Barberio MD, Lynis Dohm G, Pories WJ, Nadler EP, Hubal MJ. Skeletal Muscle DNA Methylation Changes following Gastric Bypass in Women with Type 2 Diabetes. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535579.80221.b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gavin TP, Ernst JM, Kwak HB, Caudill SE, Reed MA, Garner RT, Nie Y, Weiss JA, Pories WJ, Dar M, Lin CT, Hubal MJ, Neufer PD, Kuang S, Dohm GL. High Incomplete Skeletal Muscle Fatty Acid Oxidation Explains Low Muscle Insulin Sensitivity in Poorly Controlled T2D. J Clin Endocrinol Metab 2018; 103:882-889. [PMID: 29155999 DOI: 10.1210/jc.2017-01727] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/03/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Almost 50% of type 2 diabetic (T2D) patients are poorly controlled [glycated hemoglobin (HbA1c) ≥ 7%]; however, the mechanisms responsible for progressively worsening glycemic control are poorly understood. Lower skeletal muscle mitochondrial respiratory capacity is associated with low insulin sensitivity and the development of T2D. OBJECTIVE We investigated if skeletal muscle insulin sensitivity (SI) was different between well-controlled T2D (WCD) and poorly controlled T2D (PCD) and if the difference was associated with differences resulting from mitochondrial respiratory function. DESIGN Vastus lateralis muscle mitochondrial respiration, mitochondrial content, mitochondrial enzyme activity, and fatty acid oxidation (FAO) were measured. SI and the acute response to glucose (AIRg) were calculated by MINMOD analysis from glucose and insulin obtained during a modified, frequently sampled, intravenous glucose tolerance test. RESULTS SI and AIRg were lower in PCD than WCD. Muscle incomplete FAO was greater in PCD than WCD and greater incomplete FAO was associated with lower SI and higher HbA1c. Hydroxyacyl-coenzyme A dehydrogenase expression and activity were greater in PCD than WCD. There was no difference in maximal mitochondrial respiration or content between WCD and PCD. CONCLUSION The current results suggest that greater skeletal muscle incomplete FAO in poorly controlled T2D is due to elevated β oxidation and is associated with worsening muscle SI.
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Affiliation(s)
- Timothy P Gavin
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
- Max E. Wastl Human Performance Laboratory; Purdue University, West Lafayette, Indiana
| | - Jacob M Ernst
- Department of Kinesiology, East Carolina University, Greenville, North Carolina
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina
| | - Hyo-Bum Kwak
- Department of Kinesiology, Inha University, Incheon, Korea
| | - Sarah E Caudill
- Department of Kinesiology, East Carolina University, Greenville, North Carolina
- Human Performance Laboratory, East Carolina University, Greenville, North Carolina
| | - Melissa A Reed
- Department of Kinesiology, West Chester University, West Chester, Pennsylvania
| | - Ron T Garner
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
- Max E. Wastl Human Performance Laboratory; Purdue University, West Lafayette, Indiana
| | - Yaohui Nie
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
- Max E. Wastl Human Performance Laboratory; Purdue University, West Lafayette, Indiana
- Department of Animal Sciences, Purdue University, West Lafayette, Indiana
| | - Jessica A Weiss
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
- Max E. Wastl Human Performance Laboratory; Purdue University, West Lafayette, Indiana
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, North Carolina
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Moahad Dar
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
- Department of Medicine, East Carolina University, Greenville, North Carolina
| | - Chien-Te Lin
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
- Department of Physiology, East Carolina University, Greenville, North Carolina
| | - Monica J Hubal
- Departments of Integrative Systems Biology and Exercise and Nutrition Sciences, George Washington University, Washington, DC
| | - P Darrell Neufer
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
- Department of Physiology, East Carolina University, Greenville, North Carolina
| | - Shihuan Kuang
- Department of Animal Sciences, Purdue University, West Lafayette, Indiana
| | - G Lynis Dohm
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
- Department of Physiology, East Carolina University, Greenville, North Carolina
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Friedman AN, Wahed AS, Wang J, Courcoulas AP, Dakin G, Hinojosa MW, Kimmel PL, Mitchell JE, Pomp A, Pories WJ, Purnell JQ, le Roux C, Spaniolas K, Steffen KJ, Thirlby R, Wolfe B. Effect of Bariatric Surgery on CKD Risk. J Am Soc Nephrol 2018; 29:1289-1300. [PMID: 29335242 DOI: 10.1681/asn.2017060707] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [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: 06/29/2017] [Accepted: 12/15/2017] [Indexed: 12/12/2022] Open
Abstract
Obesity is linked to the development and progression of CKD, but whether bariatric surgery protects against CKD is poorly understood. We, therefore, examined whether bariatric surgery influences CKD risk. The study included 2144 adults who underwent bariatric surgery from March of 2006 to April of 2009 and participated in the Longitudinal Assessment of Bariatric Surgery-2 Study cohort. The primary outcome was CKD risk categories as assessed by the Kidney Disease Improving Global Outcomes (KDIGO) consortium criteria using a combination of eGFR and albuminuria. Patients were 79% women and 87% white, with a median age of 46 years old. Improvements were observed in CKD risk at 1 and 7 years after surgery in patients with moderate baseline CKD risk (63% and 53%, respectively), high baseline risk (78% and 56%, respectively), and very high baseline risk (59% and 23%, respectively). The proportion of patients whose CKD risk worsened was ≤10%; five patients developed ESRD. Sensitivity analyses using year 1 as baseline to minimize the effect of weight loss on serum creatinine and differing eGFR equations offered qualitatively similar results. Treatment with bariatric surgery associated with an improvement in CKD risk categories in a large proportion of patients for up to 7 years, especially in those with moderate and high baseline risk. These findings support consideration of CKD risk in evaluation for bariatric surgery and further study of bariatric surgery as a treatment for high-risk obese patients with CKD.
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Affiliation(s)
- Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis Indiana;
| | - Abdus S Wahed
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Junyao Wang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gregory Dakin
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Marcelo W Hinojosa
- Department of Surgery, University of California, Irvine Medical Center, Irvine, California
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic diseases, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Alfons Pomp
- Department of Surgery, University of California, Irvine Medical Center, Irvine, California
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, Greenville, North Carolina
| | - Jonathan Q Purnell
- Department of Medicine, Oregon Health Sciences University, Portland, Oregon
| | - Carel le Roux
- Department of Pathology, University College Dublin, Dublin, Ireland
| | | | - Kristine J Steffen
- Department of Pharmaceutical Sciences, North Dakota State University College of Health Professions, Fargo, North Dakota
| | - Richard Thirlby
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington; and
| | - Bruce Wolfe
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon
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Mitchell JE, Christian NJ, Flum DR, Pomp A, Pories WJ, Wolfe BM, Courcoulas AP, Belle SH. Postoperative Behavioral Variables and Weight Change 3 Years After Bariatric Surgery. JAMA Surg 2017; 151:752-7. [PMID: 27096225 DOI: 10.1001/jamasurg.2016.0395] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [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
IMPORTANCE Severe obesity (body mass index ≥35 [calculated as weight in kilograms divided by height in meters squared]) is associated with significant medical comorbidity and increased mortality. Bariatric surgery induces weight loss, the extent of which can vary. Postoperative predictors of weight loss have not been adequately examined. OBJECTIVE To describe postoperative eating behaviors and weight control and their effects on 3-year change in weight. DESIGN, SETTING, AND PARTICIPANTS The Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing first-time bariatric surgical procedures as part of routine clinical care were recruited between 2006 and 2009 and followed up until September 2012. Participants completed detailed surveys regarding eating and weight control behaviors prior to surgery and then annually after surgery for 3 years. MAIN OUTCOMES AND MEASURES Twenty-five postoperative behaviors related to eating behavior, eating problems, weight control practices, and the problematic use of alcohol, smoking, and illegal drugs. Behaviors examined were divided into those that were never present (preoperatively or postoperatively), those that were always present (preoperatively and postoperatively), and those that underwent a healthy change after surgery (development of a positive behavior or omission of a negative behavior). RESULTS The sample included a total of 2022 participants (median age, 47 years [interquartile range, 38-55 years]; median BMI, 46 [interquartile range, 42-51]; 78% women): 1513 who had undergone Roux-en-Y gastric bypass and 509 who had undergone laparoscopic adjustable gastric banding. If we consider the cumulative effects of the 3 behaviors that explain most of the variability (16%) in 3-year percent weight change following Roux-en-Y gastric bypass, ie, weekly self-weighing, continuing to eat when feeling full more than once a week, and eating continuously during the day, a participant who postoperatively started to self-weigh, stopped eating when feeling full, and stopped eating continuously during the day after surgery would be predicted to lose a mean (SE) of 38.8% (0.8%) of their baseline weight. This average is about 14% greater weight loss compared with participants who made no positive changes in these variables (mean [SE], -24.6% [1.6%]; mean difference, -14.2%; 95% CI, -18.7% to -9.8%; P < .001) and 6% greater weight loss compared with participants who always reported positive on these healthy behaviors (mean [SE], -33.2% [0.6%]; mean difference, -5.7%; 95% CI, -7.8% to -3.5%; P < .001). CONCLUSIONS AND RELEVANCE The results suggest the importance of assessing behaviors related to eating behavior, eating problems, weight control practices, and the problematic use of alcohol, smoking, and illegal drugs in bariatric surgery candidates and patients who have undergone bariatric surgery, and they suggest that the utility of programs to modify problematic eating behaviors and eating patterns should be addressed in research.
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Affiliation(s)
- James E Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota2University of North Dakota School of Medicine and Health Sciences, Grand Forks
| | - Nicholas J Christian
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - David R Flum
- Department of Surgery, University of Washington, Seattle
| | - Alfons Pomp
- Department of Surgery, Weill-Cornell Medical Center, New York, New York
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, North Carolina
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health and Science University, Portland
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Steven H Belle
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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King WC, Chen JY, Belle SH, Courcoulas AP, Dakin GF, Flum DR, Hinojosa MW, Kalarchian MA, Mitchell JE, Pories WJ, Spaniolas K, Wolfe BM, Yanovski SZ, Engel SG, Steffen KJ. Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surg Obes Relat Dis 2017; 13:1337-1346. [PMID: 28579202 DOI: 10.1016/j.soard.2017.04.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited evidence suggests bariatric surgery may not reduce opioid analgesic use, despite improvements in pain. OBJECTIVE To determine if use of prescribed opioid analgesics changes in the short and long term after bariatric surgery and to identify factors associated with continued and postsurgery initiated use. SETTING Ten U.S. hospitals. METHODS The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Assessments were conducted presurgery, 6 months postsurgery, and annually postsurgery for up to 7 years until January 2015. Opioid use was defined as self-reported daily, weekly, or "as needed" use of a prescribed medication classified as an opioid analgesic. RESULTS Of 2258 participants with baseline data, 2218 completed follow-up assessment(s) (78.7% were female, median body mass index: 46; 70.6% underwent Roux-en-Y gastric bypass). Prevalence of opioid use decreased after surgery from 14.7% (95% CI: 13.3-16.2) at baseline to 12.9% (95% CI: 11.5-14.4) at month 6 but then increased to 20.3%, above baseline levels, as time progressed (95% CI: 18.2-22.5) at year 7. Among participants without baseline opioid use (n = 1892), opioid use prevalence increased from 5.8% (95% CI: 4.7-6.9) at month 6 to 14.2% (95% CI: 12.2-16.3) at year 7. Public versus private health insurance, more pain presurgery, undergoing subsequent surgeries, worsening or less improvement in pain, and starting or continuing nonopioid analgesics postsurgery were significantly associated with higher risk of postsurgery initiated opioid use. CONCLUSION After bariatric surgery, prevalence of prescribed opioid analgesic use initially decreased but then increased to surpass baseline prevalence, suggesting the need for alternative methods of pain management in this population.
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Affiliation(s)
- Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
| | - Jia-Yuh Chen
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | | | - Melissa A Kalarchian
- Department of Psychiatry, University of Pittsburgh School of Medicine, and Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | | | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Konstantinos Spaniolas
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Kristine J Steffen
- Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
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50
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King WC, Chen JY, Courcoulas AP, Dakin GF, Engel SG, Flum DR, Hinojosa MW, Kalarchian MA, Mattar SG, Mitchell JE, Pomp A, Pories WJ, Steffen KJ, White GE, Wolfe BM, Yanovski SZ. Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surg Obes Relat Dis 2017; 13:1392-1402. [PMID: 28528115 DOI: 10.1016/j.soard.2017.03.021] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) after bariatric surgery is limited. OBJECTIVE To report SUD-related outcomes after RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes. SETTING 10 U.S. hospitals METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to 7 years through January 2015. RESULTS Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age: 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95% confidence interval (CI): 18.5-23.3), 7.5% (95% CI: 6.1-9.1), and 3.5% (95% CI: 2.6-4.8), respectively, post-RYGB, and 11.3% (95% CI: 8.5-14.9), 4.9% (95% CI: 3.1-7.6), and .9% (95% CI: .4-2.5) post-LAGB. Undergoing RYGB versus LAGB was associated with higher risk of incident AUD symptoms (adjusted hazard ratio or AHR = 2.08 [95% CI: 1.51-2.85]), illicit drug use (AHR = 1.76 [95% CI: 1.07-2.90]) and SUD treatment (AHR = 3.56 [95% CI: 1.26-10.07]). CONCLUSIONS Undergoing RYGB versus LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.
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Affiliation(s)
- Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
| | - Jia-Yuh Chen
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | | | - Melissa A Kalarchian
- Department of Psychiatry, University of Pittsburgh School of Medicine, and Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | - Samer G Mattar
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon
| | | | - Alfons Pomp
- Weill Cornell Medical College, New York, New York
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Kristine J Steffen
- Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
| | - Gretchen E White
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Bruce M Wolfe
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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