|
1
|
Baygi F, Gohari K, Djalalinia S, Christensen JR, Nielsen JB, Søndergaard J. Trends and future directions in childhood obesity research in the Nordic countries: a scientometric review. Eur J Public Health 2025:ckaf053. [PMID: 40235108 DOI: 10.1093/eurpub/ckaf053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2025] Open
Abstract
In the Nordic countries, about one in five children aged 5-18 years live with overweight or obesity. This scientometric review analyses the patterns of childhood obesity research in the Nordic region to inform future strategic decisions for researchers and policymakers. Using VOSviewer (version 1.6.20), we conducted a visualization analysis of Nordic childhood obesity literature from Scopus, covering publication up to February 2024. Additionally, R version 4.4.0, and Microsoft Excel 2016 were used to support further analysis. The analysis included trends of scientific outputs, citations, patterns, collaboration network, and leading institutions. In the Nordic countries, 4123 documents were published from 1981 to 2024. A consistent increase was identified in collaborative studies since 1981. Sweden is playing a leading role in childhood obesity research. A strong partnership was noted between Danish and Swedish researchers, as well as between Finnish and Swedish researchers, with Sweden being a central hub of collaboration. The highly cited publications primarily focused on non-pharmacological public health interventions to reduce cardiovascular risk factors. Significant advancement has been achieved in understanding childhood obesity primarily focused on the filed medicine and nursing. Overweight, obesity, and metrics like body mass index have been extensively investigated, but no focus has been placed on medication as treatment. Despite the increasing research in this field, knowledge gaps exist in genetics, molecular biology, emerging pharmacological treatment as well as behavioral and social sciences. Future research should utilize the unique Nordic databases and advanced methods to improve understanding and inform effective public health interventions.
Collapse
Affiliation(s)
- Fereshteh Baygi
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kimiya Gohari
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shirin Djalalinia
- Deputy of Research & Technology, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
|
2
|
Padhy I, Sharma T, Banerjee B, Mohapatra S, Sahoo CR, Padhy RN. Structure based exploration of mitochondrial alpha carbonic anhydrase inhibitors as potential leads for anti-obesity drug development. Daru 2024; 32:907-924. [PMID: 39276204 PMCID: PMC11554982 DOI: 10.1007/s40199-024-00535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 08/11/2024] [Indexed: 09/16/2024] Open
Abstract
BACKGROUND Obesity has emerged as a major health challenge globally in the last two decades. Dysregulated fatty acid metabolism and de novo lipogenesis are prime causes for obesity development which ultimately trigger other co-morbid pathological conditions thereby risking life longevity. Fatty acid metabolism and de novo lipogenesis involve several biochemical steps both in cytosol and mitochondria. Reportedly, the high catalytically active mitochondrial carbonic anhydrases (CAVA/CAVB) regulate the intercellular depot of bicarbonate ions and catalyze the rapid carboxylation of pyruvate and acetyl-co-A to acetyl-co-A and malonate respectively, which are the precursors of fatty acid synthesis and lipogenesis. Several in vitro and in vivo investigations indicate inhibition of mitochondrial carbonic anhydrase isoforms interfere in the functioning of pyruvate, fatty acid and succinate pathways. Targeting of mitochondrial carbonic anhydrase isoforms (CAVA/CAVB) could thereby modulate gluconeogenetic as well as lipogenetic pathways and pave way for designing of novel leads in the development pipeline of anti-obesity medications. METHODS The present review unveils a diverse chemical space including synthetic sulphonamides, sulphamates, sulfamides and many natural bioactive molecules which selectively inhibit the mitochondrial isoform CAVA/CAVB with an emphasis on major state-of-art drug design strategies. RESULTS More than 60% similarity in the structural framework of the carbonic anhydrase isoforms has converged the drug design methods towards the development of isoform selective chemotypes. While the benzene sulphonamide derivatives selectively inhibit CAVA/CAVB in low nanomolar ranges depending on the substitutions on the phenyl ring, the sulpamates and sulpamides potently inhibit CAVB. The virtual screening and drug repurposing methods have also explored many non-sulphonamide chemical scaffolds which can potently inhibit CAVA. CONCLUSION The review could pave way for the development of novel and effective anti-obesity drugs which can modulate the energy metabolism.
Collapse
Affiliation(s)
- Ipsa Padhy
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, 751003, Odisha, India
| | - Tripti Sharma
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, 751003, Odisha, India.
- School of Pharmaceutical Sciences and Research, Chhatrapati Shivaji Maharaj University, Panvel, Navi Mumbai, Maharashtra, 410221, India.
| | - Biswajit Banerjee
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, 751003, Odisha, India
| | - Sujata Mohapatra
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, 751003, Odisha, India
| | - Chita R Sahoo
- ICMR-Regional Medical Research Centre, Department of Health Research, Ministry of Health & Family Welfare, Govt. of India, Bhubaneswar, India
- Central Research Laboratory, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, 751003, Odisha, India
| | - Rabindra Nath Padhy
- Central Research Laboratory, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, 751003, Odisha, India
| |
Collapse
|
|
3
|
Gangemi E, Piervincenzi C, Mallio CA, Spagnolo G, Petsas N, Gallo IF, Sisto A, Quintiliani L, Bruni V, Quattrocchi CC. Impact of Sleeve Gastrectomy on Brain Structural Integrity. Obes Surg 2024; 34:3203-3215. [PMID: 39073675 DOI: 10.1007/s11695-024-07416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 07/04/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Potential brain structural differences in people with obesity (PwO) who achieve over or less than 50% excess weight loss (EWL) after sleeve gastrectomy (SG) are currently unknown. We compared measures of gray matter volume (GMV) and white matter (WM) microstructural integrity of PwO who achieved over or less than 50% EWL after SG with a group of controls with obesity (CwO) without a past history of metabolic bariatric surgery. METHODS Sixty-two PwO underwent 1.5 T MRI scanning: 24 who achieved more than 50% of EWL after SG ("group a"), 18 who achieved less than 50% EWL after SG ("group b"), and 20 CwO ("group c"). Voxel-based morphometry and tract-based spatial Statistics analyses were performed to investigate GMV and WM differences among groups. Multiple regression analyses were performed to investigate relationships between structural and psychological measures. RESULTS Group a demonstrated significantly lower GMV loss and higher WM microstructural integrity with respect to group b and c in some cortical regions and several WM tracts. Positive correlations were observed in group a between WM integrity and several psychological measures; the lower the WM integrity, the higher the mental distress, emotional dysregulation, and binge eating behavior. CONCLUSION The present results gain a new understanding of the neural mechanisms of outcome in patients who undergo SG. We found limited GMV changes and extensive WM microstructural differences between PwO who achieved over or less than 50% EWL after SG, which may be due to higher vulnerability of WM to the metabolic dysfunction present in PwO.
Collapse
Affiliation(s)
- Emma Gangemi
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | - Claudia Piervincenzi
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | - Carlo Augusto Mallio
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Giuseppe Spagnolo
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Nikolaos Petsas
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Ida Francesca Gallo
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Antonella Sisto
- Clinical Psychological Service, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Livia Quintiliani
- Clinical Psychological Service, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Vincenzo Bruni
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy
| |
Collapse
|
|
4
|
Song K, Kong X, Yu Z, Xiao H, Ren Y. Research progress on bariatric surgery for hyperuricemia. BMC Surg 2024; 24:235. [PMID: 39169366 PMCID: PMC11337558 DOI: 10.1186/s12893-024-02525-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024] Open
Abstract
Hyperuricemia is closely linked to obesity. As lifestyles and dietary patterns evolve, the prevalence of hyperuricemia has been on the rise. Bariatric surgery, an efficacious intervention for morbid obesity and its associated metabolic disorders, not only manages the weight of patients with severe obesity but also exerts beneficial therapeutic effects on hyperuricemia and gout. Moreover, it demonstrates substantial efficacy against other obesity-related metabolic conditions. However, the dramatic fluctuations in serum uric acid levels and acute gouty attacks in the immediate postoperative period are issues that should not be overlooked, and effective preventative strategies for some related adverse complications are still underexplored. This review discusses and reviews the advancements in the treatment of obese patients with hyperuricemia through bariatric surgery. By reviewing pertinent literature, it summarizes the short-term and long-term therapeutic outcomes of bariatric surgery for hyperuricemia, as well as common adverse reactions. Furthermore, by discussing preoperative and postoperative interventional measures and influential factors, this review aims to provide novel perspectives for the clinical management of hyperuricemia and offer insights for the prevention of related complications.
Collapse
Affiliation(s)
- Ke Song
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Xiangxin Kong
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Zhenghang Yu
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - He Xiao
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Yixing Ren
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
- General Surgery, Chengdu XinHua Hospital Affiliated to North Sichuan Medical College, Chengdu, 610000, Sichuan Province, China.
| |
Collapse
|
|
5
|
Belloni S, Arrigoni C, Ceruso MH, Giacon C, Magon A, Conte G, Arcidiacono MA, Caruso R. Synbiotics in Oncology: A Scoping Review Protocol on Their Impact and Outcomes in Cancer Care. NURSING REPORTS 2024; 14:675-682. [PMID: 38525697 PMCID: PMC10961746 DOI: 10.3390/nursrep14020051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024] Open
Abstract
Symptom management remains challenging in cancer care. Emerging from nutritional science, nutritional metabolomics has seen exponential growth over recent years, aiming to discern the relationship between dietary habits and health consequences. This protocol aims to present the rationale and methodology for conducting a scoping review to summarize the extent of evidence on synbiotics utilization in cancer symptom management among adults. The scoping review will be undertaken in accordance with the Joanna Briggs Institute (JBI) principles and the research process guided by the PRISMA 2020 scoping reviews extension. The following electronic databases will be searched from the inception: PubMed, Cinahl, Web of Science and Scopus. The authors expect to map the literature regarding the clinical outcomes, including patient-report measures and patient-experience measures, on which the effects of probiotics were tested, and identify potential gaps. This protocol presents a rigorous methodological approach to map the literature on the clinical outcomes that the utilization of synbiotics might improve. This analysis will shape future researchers to examine the efficacy of probiotics on specific clinical outcomes in oncology care. Nurses are uniquely positioned to influence cancer symptom management through the selection and use of appropriate interventions in the field of nutritional supplements, along with nutritional counseling.
Collapse
Affiliation(s)
- Silvia Belloni
- Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy;
| | | | | | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 Milan, Italy; (A.M.); (G.C.)
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 Milan, Italy; (A.M.); (G.C.)
| | | | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 Milan, Italy; (A.M.); (G.C.)
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| |
Collapse
|
|
6
|
Carlino G, Benson AA, Bove V, Pontecorvi V, De Siena M, Matteo MV, Farina A, Polidori G, Vinti L, Giannetti G, Costamagna G, Spada C, Boškoski I. Impact of Pregnancy on Weight Loss After Endoscopic Sleeve Gastroplasty. Obes Surg 2023; 33:3097-3105. [PMID: 37542617 PMCID: PMC10514179 DOI: 10.1007/s11695-023-06745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/05/2023] [Accepted: 07/14/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Obesity and pregnancy are strictly related: on the one hand, obesity-one of the most common comorbidities in women of reproductive age-contributes to infertility and obesity-related pregnancy complications, whereas pregnancy is a condition in which, physiologically, the pregnant woman undergoes weight gain. Endoscopic sleeve gastroplasty (ESG) may be used for the treatment of obesity in women of childbearing age. MATERIALS AND METHODS A retrospective analysis was conducted to evaluate weight trajectories, the evolution of obesity-related comorbidities, and lifestyle modification in women who became pregnant after ESG. A comparison was made between childbearing-age women who became pregnant after ESG and non-pregnant women. RESULTS A total of 150 childbearing-age women underwent ESG at a large tertiary medical center. Of these, 11 patients (33.4 ± 6.2 years) became pregnant after the procedure, following a mean time interval of 5.5 ± 3.9 months. Three women (two affected by polycystic ovary syndrome) reported difficulty getting pregnant before undergoing ESG. The mean preconception BMI was 31.9±4.0 kg/m2 (-7.24 ± 4.0 kg/m2 after ESG). Total body weight loss (TBWL, %) was 18.08 ± 8.00, 11.00 ± 11.08, and 12.08 ± 8.49, at the beginning of pregnancy, at the delivery, and at the first follow-up (19.6 ± 7.8 months after ESG). TBWL of at least 5% was achieved before pregnancy in all patients (73% reached a TBWL ≥ 10%). No significant differences in weight loss and QoL were found between the pregnancy and non-pregnancy groups up to 24 months after ESG. CONCLUSIONS Endoscopic sleeve gastroplasty allows for adequate weight loss before and after pregnancy in patients with obesity.
Collapse
Affiliation(s)
- Giorgio Carlino
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ariel A. Benson
- Institute of Gastroenterology and Liver Diseases, Department of Internal Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina De Siena
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annarita Farina
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Polidori
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Laila Vinti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giulia Giannetti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
|
7
|
Fortin SM, Chen JC, Petticord MC, Ragozzino FJ, Peters JH, Hayes MR. The locus coeruleus contributes to the anorectic, nausea, and autonomic physiological effects of glucagon-like peptide-1. SCIENCE ADVANCES 2023; 9:eadh0980. [PMID: 37729419 PMCID: PMC10511187 DOI: 10.1126/sciadv.adh0980] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
Increasing the therapeutic potential and reducing the side effects of U.S. Food and Drug Administration-approved glucagon-like peptide-1 receptor (GLP-1R) agonists used to treat obesity require complete characterization of the central mechanisms that mediate both the food intake-suppressive and illness-like effects of GLP-1R signaling. Our studies, in the rat, demonstrate that GLP-1Rs in the locus coeruleus (LC) are pharmacologically and physiologically relevant for food intake control. Furthermore, agonism of LC GLP-1Rs induces illness-like behaviors, and antagonism of LC GLP-1Rs can attenuate GLP-1R-mediated nausea. Electrophysiological and behavioral pharmacology data support a role for LC GLP-1Rs expressed on presynaptic glutamatergic terminals in the control of feeding and malaise. Collectively, our work establishes the LC as a site of action for GLP-1 signaling and extends our understanding of the GLP-1 signaling mechanism necessary for the development of improved obesity pharmacotherapies.
Collapse
Affiliation(s)
- Samantha M. Fortin
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jack C. Chen
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marisa C. Petticord
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Forrest J. Ragozzino
- Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, WA 99164, USA
| | - James H. Peters
- Department of Integrative Physiology and Neuroscience, Washington State University, Pullman, WA 99164, USA
| | - Matthew R. Hayes
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
|
8
|
Mallio CA, Spagnolo G, Piervincenzi C, Petsas N, Boccetti D, Spani F, Gallo IF, Sisto A, Quintiliani L, Di Gennaro G, Bruni V, Quattrocchi CC. Brain functional connectivity differences between responders and non-responders to sleeve gastrectomy. Neuroradiology 2023; 65:131-143. [PMID: 35978042 DOI: 10.1007/s00234-022-03043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/13/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE To compare resting-state functional connectivity (RSFC) of obese patients responders or non-responders to sleeve gastrectomy (SG) with a group of obese patients with no past medical history of metabolic or bariatric surgery. METHODS MR images were acquired at 1.5 Tesla. Resting-state fMRI data were analyzed with statistical significance threshold set at p < 0.05, family-wise error (FWE) corrected. RESULTS Sixty-two subjects were enrolled: 20 controls (age range 25-64; 14 females), 24 responders (excess weight loss > 50%; age range 23-68; 17 females), and 18 non-responders to sleeve gastrectomy (SG) (excess weight loss < 50%; age range 23-67; 13 females). About within-network RSFC, responders showed significantly lower RSFC with respect to both controls and non-responders in the default mode and frontoparietal networks, positively correlating with psychological scores. Non-responders showed significantly higher (p < 0.05, family-wise error (few) corrected) RSFC in regions of the lateral visual network as compared to controls. Regarding between-network RSFC, responders showed significantly higher anti-correlation between executive control and salience networks (p < 0.05, FWE corrected) with respect to both controls and non-responders. Significant positive correlation (Spearman rho = 0.48, p = 0.0012) was found between % of excess weight loss and executive control-salience network RSFC. CONCLUSION There are differences in brain functional connectivity in either responders or non-responders patients to SG. The present results offer new insights into the neural correlates of outcome in patients who undergo SG and expand knowledge about neural mechanisms which may be related to surgical response.
Collapse
Affiliation(s)
- Carlo A Mallio
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Giuseppe Spagnolo
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | | | | | - Danilo Boccetti
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila AQ, L'Aquila, Italy
| | - Federica Spani
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Ida Francesca Gallo
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Antonella Sisto
- Clinical Psychological Service, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Livia Quintiliani
- Clinical Psychological Service, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Chair of Medical Statistics, University of Catanzaro Magna Græcia, Catanzaro, Italy
| | - Vincenzo Bruni
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Carlo C Quattrocchi
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| |
Collapse
|
|
9
|
Sun G, Li L, Zhang X. A visualized and scientometric analysis of research trends of weight loss in overweight/obese children and adolescents (1958-2021). Front Public Health 2022; 10:928720. [PMID: 36339176 PMCID: PMC9632180 DOI: 10.3389/fpubh.2022.928720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
Background Weight loss is an appropriate approach to reduce the health risks associated with overweight/obese children and adolescents, and the optimal method of weight loss requires further research. This study systematically explores scientific co-operation, disciplinary interaction, hotspots and trends in the field of weight loss in overweight/obese children and adolescents (WLOCA), and provides references for further research. Methods Citespace 5.8.R1 (64-bit) was adopted to conduct a comprehensive visualization analysis of the literature on WLOCA from Web of Science Core Collection, including publication, institution, country/region, author, journal, keywords and reference. Results 2,513 papers were found in the Web of Science Core Collection, and the annual number of papers published has increased significantly since 2003. Cincinnati Children's Hospital is the institution with the largest number of publications, while Washington University plays a pivotal role in the collaboration network. In terms of nations, USA has made greater contributions than the rest in terms of the number of publications and global co-operation research. The most influential authors in this field are Thomas H. Inge, Thomas Reinehr, Todd M. Jenkins, Epstein LH, Ogden CL, etc. The most active journals are "Obesity," "International Journal of Obesity," "Obesity Surgery," "Pediatrics," etc. which are characterized by interdisciplinary interactions. Research hot topics mainly include "assessment of obesity and pathophysiological mechanism," "comprehensive intervention," and "bariatric surgery," and there's a gradual shift from "lifestyle intervention" and "pathophysiological mechanism" to "clinical surgical application." In addition, disciplinary integration and comprehensive research, targeted intervention and treatment, and prospective research are the future research trends. Conclusion The overall trend in WLOCA study is positive. The main contribution of this study is to reveal the overall picture of the research in this field with visual maps and detailed data by combining quantitative with qualitative approaches, which can provide valuable references for relevant researchers to quickly understand the status of studies on WLOCA, to seek co-operation, and grasp research hotspots and frontier trends.
Collapse
Affiliation(s)
- Guotao Sun
- School of Physical Education, Chengdu Sport University, Chengdu, China,College of Education and Sports Science, Yangtze University, Jingzhou, China
| | - Long Li
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China,School of Physical Education, Xichang University, Xichang, China
| | - Xiaolin Zhang
- Sport Research Office, Chengdu Sport University, Chengdu, China,*Correspondence: Xiaolin Zhang
| |
Collapse
|
|
10
|
Yuan Q, Haque O, Yeh H, Markmann JF, Dageforde LA. The impact of race and comorbid conditions on adult liver transplant outcomes in obese recipients. Transpl Int 2021; 34:2834-2845. [PMID: 34580936 DOI: 10.1111/tri.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/09/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
Many prior studies comparing liver transplant outcomes between obese and nonobese recipients found no significant differences in survival. However, obesity is intrinsically associated with demographic factors such as race and comorbidities. Thus, this work aimed to analyze the effects of obesity, in conjunction with these factors, on liver transplant outcomes. OPTN data was analyzed to identify adult-only, first-time liver transplants between 1995 and 2019. Obesity was defined by the CDC obesity classification. Race, insurance status, age, and comorbidities were analyzed together with patient survival and graft survival using a multivariable Cox Proportional-Hazards model and long-term survival with Kaplan-Meier curves. The multivariable models found that being black, older than 50 years, having diabetes, or having nonprivate insurance were all risk factors for both patient survival and graft survival after liver transplant. Adjusting for obesity class, black recipients had a 20% lower patient survival and 23% lower graft survival compared with nonblack recipients. Survival curves verified that obese black liver transplant recipients had poorer long-term patient survival and graft survival compared with both obese nonblack and nonobese recipients. In conclusion, obesity compounds known factors associated with poor outcomes after liver transplantation. Further work is critical to understand why these discrepancies persist.
Collapse
Affiliation(s)
- Qing Yuan
- Department of Urology, Chinese PLA General Hospital, Beijing, China.,Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Omar Haque
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Surgery, Beth Issrael Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Shriners Hospitals for Children, Boston, MA, USA
| | - Heidi Yeh
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - James F Markmann
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Leigh Anne Dageforde
- Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
11
|
Howell RS, Liu HH, Boinpally H, Akerman M, Carruthers E, Brathwaite BM, Petrone P, Brathwaite CEM. Outcomes of Bariatric Surgery: Patients with Body Mass Index 60 or Greater. JSLS 2021; 25:JSLS.2020.00089. [PMID: 34248332 PMCID: PMC8241285 DOI: 10.4293/jsls.2020.00089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: Perioperative outcomes of bariatric surgery in patients with super super obesity (SSO) (BMI ≥ 60 kg/m2) merit further investigation. Methods: A retrospective review was conducted of patients with SSO who underwent surgery from Jun 2005 through Jun 2018 at a Metabolic and Bariatric Surgery Center of Excellence. Quantitative demographic data was summarized using descriptive statistics; categorical variables were compared using Fisher’s exact test. Results: Two hundred fourteen procedures were performed, of which 208 were eligible for inclusion. Majority were female (65.4%). The mean age and BMI was 43 (17–68 years) and 65.9 kg/m2 (60 95 kg/m2), respectively. Comorbidities included: obstructive sleep apnea (74%), hypertension (59%), gastro-esophageal reflux disease (43%), osteoarthritis (41%), and diabetes mellitus (30%). Surgical approach: 97 Roux-en-Y gastric bypasses (46%), 88 laparoscopic sleeve gastrectomies (42%), and 23 adjustable gastric bands (11%). Additional subset included: primary (87%), conversion (7.7%), and revision (5.3%); majority being laparoscopic (75%) and robotic (24%). Complications via Clavien-Dindo classification: one Grade I, one Grade II, three Grade IIIa, three Grade IIIb, and three Grade IVa. Thirty-day events: 11 complications (5.3%; one leak [0.5%], one deep vein thrombosis [0.5%]), six re-admissions (3%), four re-operations (2%): repair of staple-line leak, repair of incisional hernia, uterine dilation and curettage, and cholecystectomy. No mortalities occurred. Complications occurred in 14.8% of conversion/revision cases, 3.9% in primary cases (p = 0.0395) with no difference observed between laparoscopic (4.5%) and robotic (6.1%) modalities (p = 0.7051). Conclusion: Bariatric surgery is feasible in patients with SSO. Revision procedures may increase risk of operative complications.
Collapse
Affiliation(s)
- Raelina S Howell
- Department of Surgery, NYU Langone Hospital-Long Island, Mineola, NY
| | - Helen H Liu
- Department of Surgery, NYU Langone Hospital-Long Island, Mineola, NY
| | - Harika Boinpally
- Department of Surgery, NYU Langone Hospital-Long Island, Mineola, NY
| | - Meredith Akerman
- Department of Biostatistics, NYU Long Island School of Medicine, Mineola, NY
| | | | | | - Patrizio Petrone
- Department of Surgery, NYU Langone Hospital-Long Island, Mineola, NY
| | | |
Collapse
|
|
12
|
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: 0.8] [Reference Citation Analysis] [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.
Collapse
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
| | | |
Collapse
|
|
13
|
Cervantes-Theurel J, Albarran-Sanchez A, Rodriguez-Perez V, Espinosa-Cardenas E, Ramirez-Renteria C, Ferreira-Hermosillo A. Utility of the STOP-Bang and Epworth scales and the neck-to-height ratio to detect severe obstructive apnea-hypopnea syndrome in severe obesity. Surg Obes Relat Dis 2021; 17:257-262. [DOI: 10.1016/j.soard.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/25/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
|
|
14
|
Lu Y, Juo YY, Martin MJ, Dan AG, Banerjee A, Jones DB, Dakin GF, Jain-Spangler K, Chen Y. Analysis of Early Job Market Experiences and Perceptions Among Bariatric Surgery Fellowship Graduates and Bariatric Surgery Program Directors. Obes Surg 2021; 31:1561-1571. [PMID: 33405180 PMCID: PMC7786144 DOI: 10.1007/s11695-020-05150-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Over the past decade, an increasing number of bariatric surgeons are trained in fellowships annually despite only a modest increase in nationwide bariatric surgery volume. The study surveys the bariatric surgery job market trend in order to inform better career-choice decisions for trainees interested in this field. MATERIALS AND METHODS A national retrospective cohort survey over an 11-year period was conducted. Bariatric surgery fellowship graduates from 2008 to 2019 and program directors (PDs) were surveyed electronically. Univariate analysis was performed comparing responses between earlier (2008-2016) and recent graduates (2017-2019). RESULTS We identified a total of 996 graduates and 143 PDs. Response rates were 9% and 20% respectively (n = 88, 29). Sixty-eight percent of graduates felt there are not enough bariatric jobs for new graduates. Seventy-nine percent of PDs felt that it is more difficult to find a bariatric job for their fellows now than 5-10 years ago. Forty-eight percent of PDs felt that we are training too many bariatric fellows. Seventy-seven percent of all graduates want the majority of their practice to be comprised bariatric cases; however, only 42% of them reported achieving this. In the univariate analysis, recent graduates were less likely to be currently employed as a bariatric surgeon (64% vs. 86%, p = 0.02) and were less satisfied with their current case volume (42% vs. 66%, p = 0.01). CONCLUSIONS The temporal increase in bariatric fellowship graduates over the past decade has resulted in a significant decline in the likelihood of employment in a full-time bariatric surgical practice and a decline in surgeons' bariatric case volumes.
Collapse
Affiliation(s)
- Yang Lu
- Department of Surgery, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. 72-227 CHS, Los Angeles, CA, 90095, USA
| | - Yen-Yi Juo
- Department of Surgery, Duke University School of Medicine, 407 Crutchfield St, Durham, NC, 27704, USA
| | - Matthew J Martin
- Department of Surgery, Scripps Mercy Hospital, 4077 5th Avenue, San Diego, CA, 92103, USA
| | - Adrian G Dan
- Department of Surgery, Northeastern Ohio Medical University, Summa Health System, 95 Arch St #240, Akron, OH, 44304, USA
| | - Ambar Banerjee
- Department of Surgery, Indiana University School of Medicine, 11725 N Illinois St, Suite 350, Carmel, IN, 46032, USA
| | - Daniel B Jones
- Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Gregory F Dakin
- Department of Surgery, Weill Cornell Medical College, Cornell University, 525 E 68th St, New York, NY, 10065, USA
| | - Kunoor Jain-Spangler
- Department of Surgery, Duke University, 407 Crutchfield St, Durham, NC, 27704, USA
| | - Yijun Chen
- Department of Surgery, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. 72-227 CHS, Los Angeles, CA, 90095, USA.
| |
Collapse
|
|
15
|
Khaled K, Hundley V, Almilaji O, Koeppen M, Tsofliou F. A Priori and a Posteriori Dietary Patterns in Women of Childbearing Age in the UK. Nutrients 2020; 12:E2921. [PMID: 32987718 PMCID: PMC7598658 DOI: 10.3390/nu12102921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022] Open
Abstract
Poor diet quality is a major cause of maternal obesity. We aimed to investigate a priori and a-posteriori derived dietary patterns in childbearing-aged women in UK. An online survey assessed food intake, physical activity (PA), anthropometry and socio-demographics. An a priori defined diet quality was determined via Mediterranean diet (MD) adherence score and Exploratory Factor Analysis (EFA) derived dietary patterns (DPs). Multiple linear regression explored associations between DPs with anthropometric measures, PA and socio-demographics. Participants (n = 123) had low-to-medium MD adherence (average MD-score: 4.0 (2.0)). Age was positively associated with higher MD adherence (X2 (2) = 13.14, p = 0.01). EFA revealed three DPs: 'fruits, nuts, vegetables and legumes' ("Vegetarian-style" DP); 'sweets, cereals, dairy products and potatoes' ("Dairy, sweets and starchy foods" DP); and 'eggs, seafood and meats' ("Protein-rich" DP). "Vegetarian-style" DP was positively associated with higher maternal educational level (p < 0.01) and PA (p = 0.01), but negatively with white ethnicity (p < 0.01). "Dairy, sweets and starchy foods" DP was positively associated with white ethnicity (p = 0.03) and negatively with age (p = 0.03). "Protein-rich" DP was positively associated with age (p < 0.001) and negatively with PA (p = 0.01). A poor diet quality was found among childbearing-aged women; notably in the younger age category, those of white ethnicity, that were more physically inactive and with a lower socioeconomic background.
Collapse
Affiliation(s)
- Karim Khaled
- Department of Rehabilitation & Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH1 3LT, UK; (K.K.); (M.K.)
| | - Vanora Hundley
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH1 3LT, UK;
| | - Orouba Almilaji
- Department of Medical Science and Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH1 3LT, UK;
| | - Mareike Koeppen
- Department of Rehabilitation & Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH1 3LT, UK; (K.K.); (M.K.)
| | - Fotini Tsofliou
- Department of Rehabilitation & Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH1 3LT, UK; (K.K.); (M.K.)
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH1 3LT, UK;
| |
Collapse
|
|
16
|
Fortin SM, Chen J, Hayes MR. Hindbrain melanocortin 3/4 receptors modulate the food intake and body weight suppressive effects of the GLP-1 receptor agonist, liraglutide. Physiol Behav 2020; 220:112870. [PMID: 32179053 PMCID: PMC7227776 DOI: 10.1016/j.physbeh.2020.112870] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/14/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
Simultaneously targeting multiple energy balance control systems is a promising direction for the development of obesity pharmacotherapies. Here, we explore the interaction between the GLP-1 and melanocortin system within the dorsal vagal complex (DVC) of the caudal brainstem. Using a pharmacological approach, we demonstrate that the full anorectic potential of liraglutide, an FDA-approved GLP-1 analog for the treatment of obesity, requires DVC melanocortin 3/4 receptor (MC3/4R) signaling. Specifically, the food intake and body weight suppressive effects of liraglutide were attenuated by DVC administration of the MC3/4R antagonist SHU9119. In contrast, the anorectic effects of liraglutide were enhanced by combined activation of DVC MC3/4Rs using the agonist MTII. Our findings highlight the modulation of liraglutide-induced anorexia by DVC MC3/4R signaling, thereby suggesting a site of action at which two important energy balance control systems interact.
Collapse
Affiliation(s)
- Samantha M Fortin
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Jack Chen
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Matthew R Hayes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| |
Collapse
|
|
17
|
Koliaki C, Tzeravini E, Papachristoforou E, Severi I, El Deik E, Karaolia M, Noutsou M, Thanopoulou A, Kountouri A, Balampanis K, Lambadiari V, Tentolouris N, Kokkinos A. Eligibility and Awareness Regarding Metabolic Surgery in Patients With Type 2 Diabetes Mellitus in the Real-World Clinical Setting; Estimate of Possible Diabetes Remission. Front Endocrinol (Lausanne) 2020; 11:383. [PMID: 32582036 PMCID: PMC7292012 DOI: 10.3389/fendo.2020.00383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/14/2020] [Indexed: 01/06/2023] Open
Abstract
Despite high-quality evidence highlighting metabolic surgery as an effective treatment option for type 2 diabetes mellitus (T2DM), the number of patients receiving bariatric surgery (BS) remains low. Since the introduction of the Diabetes Surgery Summit II (DSS-II) eligibility criteria, data on eligibility rates for BS in T2DM cohorts remain scarce. The aims of the present study were to examine in a real-world clinical setting: (i) what is the percentage of T2DM patients visiting diabetes outpatient clinics who meet the DSS-II eligibility criteria, (ii) how many of these have been informed about the option of BS, and (iii) what are the characteristics associated with eligibility and awareness of BS. Demographic, anthropometric, clinical and socioeconomic data were obtained for all patients with T2DM who were consecutively examined in the outpatient clinics of three large-volume university hospitals (n = 1167). A medical registry form was completed to screen for BS eligibility. Patients were considered eligible if the recommendation by DSS-II criteria was either to "consider" or "recommend" BS. Eligible patients were further inquired whether they had ever been informed about the option of BS by their physicians. The advanced DiaRem score (ADRS) was applied to eligible patients to assess their probability of achieving postoperative T2DM remission. A significant percentage of T2DM patients who are routinely assessed in outpatient clinics meet the DSS-II eligibility criteria (15.3%). Eligible patients are younger and more obese, have a shorter T2DM duration, worse glycaemic control and better renal function, compared to non-eligible ones. Among eligible patients, only 39.3% have been medically informed about the option of BS. Informed patients are younger and more severely obese than non-informed ones. A significant percentage of non-informed patients (35%) have an ADRS ≤10, indicating a considerable probability for T2DM remission after BS, and are thus deprived of this opportunity due to lack of appropriate medical counseling. Screening and awareness of BS remain an unmet need in current T2DM management. Future research should focus on intensifying screening for BS eligibility at every medical visit and promoting evidence-based clinical recommendations for patients expected to benefit the most.
Collapse
Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Severi
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Elina El Deik
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Melina Karaolia
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Konstantinos Balampanis
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
- *Correspondence: Alexander Kokkinos
| |
Collapse
|
|
18
|
Pouwels S, Sanches EE, Cagiltay E, Severin R, Philips SA. Perioperative Exercise Therapy in Bariatric Surgery: Improving Patient Outcomes. Diabetes Metab Syndr Obes 2020; 13:1813-1823. [PMID: 32547143 PMCID: PMC7261659 DOI: 10.2147/dmso.s215157] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022] Open
Abstract
Nowadays, obesity and related comorbidities like type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea syndrome are considered one of the medical challenges of the 21st century. Even with the rise of bariatric and metabolic surgery, obesity and metabolic syndrome are reaching endemic proportions. Even in 2020, obesity is still a growing problem. There is increasing evidence that next to bariatric surgery, exercise interventions in the perioperative period could give extra beneficial effects. In this regard, effects on anthropometrics, cardiovascular risk factors and physical fitness. The aim of this review is to summarise effects of preoperative and postoperative exercise, tools for screening and directions for future research and implementations.
Collapse
Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
- Correspondence: Sjaak Pouwels Department of Surgery, Haaglanden Medical Center, P.O. Box 432, 2501 CK, The Hague, the Netherlands Email
| | - Elijah E Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Eylem Cagiltay
- University of Health Sciences Turkey, Sultan Abdulhamid Han Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, Istanbul, Uskudar, 34668, Turkey
| | - Rich Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Shane A Philips
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
|
19
|
Barros LM, Frota NM, de Araújo TM, Tellez M, Ciqueto HHP, Caetano JÁ. Analysis of Portuguese language blogs about bariatric surgery: key doubts of internauts regarding the postoperative period. Eat Weight Disord 2019; 24:1113-1120. [PMID: 29256174 DOI: 10.1007/s40519-017-0465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/13/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The Internet, particularly blogs have become an important tool for patients to disseminate and exchange information on a variety of health topics, including bariatric surgery. By virtue of its interactivity being free of judgement from health care providers, blogs expose gaps in patients' knowledge and understanding. PURPOSE This study analyzes the main doubts expressed in blogs by patients in the postoperative period of bariatric surgery. METHOD This is a qualitative exploratory study of 11 blogs of patients, who underwent bariatric surgery, that were available on the Internet between October 2013 and May 2017. The data were collected through a structured instrument and analyzed according to Bardin's suggestions. The sampling method used was intentional. RESULTS Evolution of diet, weight loss, plateau effect, weight regain, physical exercises, physiological changes, complications, use of contraceptive and pregnancy were the main areas of concern. CONCLUSION More needs to be done to educate and prepare bariatric patients for the postoperative period. The content found in blogs serves towards building better links with patients, helps them make better decisions, and provides them an opportunity to be active participants in their own treatment.
Collapse
Affiliation(s)
- Lívia Moreira Barros
- Graduate Program in Nursing, Federal University of Ceará (UFC), Fortaleza, CE, Brazil.
| | - Natasha Marques Frota
- Graduate Program in Nursing, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Thiago Moura de Araújo
- Nursing Department, University of International Integration of the Afro-Brazilian Lusophony (UNILAB), Redenção, CE, Brazil
| | | | | | | |
Collapse
|
|
20
|
Use of phentermine-topiramate extended release in combination with sleeve gastrectomy in patients with BMI 50 kg/m2 or more. Surg Obes Relat Dis 2019; 15:1039-1043. [DOI: 10.1016/j.soard.2019.04.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/17/2022]
|
|
21
|
Bhandari M, Fobi MAL, Buchwald JN. Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement. Obes Surg 2019; 29:309-345. [PMID: 31297742 DOI: 10.1007/s11695-019-04032-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
Collapse
Affiliation(s)
- Mohit Bhandari
- Department of Surgery, Sri Aurobindo Medical College and Postgraduate Institution, Mohak Bariatric and Robotic Surgery Centre, Indore, MP, India.
| | - M A L Fobi
- Department of Surgery, Sri Aurobindo Medical College and Postgraduate Institution, Mohak Bariatric and Robotic Surgery Centre, Indore, MP, India
| | - Jane N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA
| |
Collapse
|
|
22
|
Liberini CG, Koch-Laskowski K, Shaulson E, McGrath LE, Lipsky RK, Lhamo R, Ghidewon M, Ling T, Stein LM, Hayes MR. Combined Amylin/GLP-1 pharmacotherapy to promote and sustain long-lasting weight loss. Sci Rep 2019; 9:8447. [PMID: 31186439 PMCID: PMC6560126 DOI: 10.1038/s41598-019-44591-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/20/2019] [Indexed: 11/24/2022] Open
Abstract
A growing appreciation of the overlapping neuroendocrine mechanisms controlling energy balance has highlighted combination therapies as a promising strategy to enhance sustained weight loss. Here, we investigated whether amylin- and glucagon-like-peptide-1 (GLP-1)-based combination therapies produce greater food intake- and body weight-suppressive effects compared to monotherapies in both lean and diet-induced obese (DIO) rats. In chow-maintained rats, systemic amylin and GLP-1 combine to reduce meal size. Furthermore, the amylin and GLP-1 analogs salmon calcitonin (sCT) and liraglutide produce synergistic-like reductions in 24 hours energy intake and body weight. The administration of sCT with liraglutide also led to a significant enhancement in cFos-activation in the dorsal-vagal-complex (DVC) compared to mono-therapy, suggesting an activation of distinct, yet overlapping neural substrates in this critical energy balance hub. In DIO animals, long-term daily administration of this combination therapy, specifically in a stepwise manner, results in reduced energy intake and greater body weight loss over time when compared to chronic mono- and combined-treated groups, without affecting GLP-1 receptor, preproglucagon or amylin-receptor gene expression in the DVC.
Collapse
Affiliation(s)
- Claudia G Liberini
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA
| | - Kieran Koch-Laskowski
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA
| | - Evan Shaulson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA
| | - Lauren E McGrath
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA
| | - Rachele K Lipsky
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA
| | - Rinzin Lhamo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA
| | - Misgana Ghidewon
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA
| | - Tyler Ling
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA
| | - Lauren M Stein
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA
| | - Matthew R Hayes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA.
| |
Collapse
|
|
23
|
Osmundsen TC, Dahl U, Kulseng B. Enhancing knowledge and coordination in obesity treatment: a case study of an innovative educational program. BMC Health Serv Res 2019; 19:278. [PMID: 31046766 PMCID: PMC6498688 DOI: 10.1186/s12913-019-4119-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 04/24/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Currently, there is a lack of knowledge, organisation and structure in modern health care systems to counter the global trend of obesity, which has become a major risk factor for noncommunicable diseases. Obesity increases the risk of diabetes, cardiovascular diseases, musculoskeletal disorders and cancer. There is a need to strengthen integrated care between primary and secondary health care and to enhance care delivery suited for patients with complex, long-term problems such as obesity. This study aimed to explore how an educational program for General Practitioners (GPs) can contribute to increased knowledge and improved coordination between primary and secondary care in obesity treatment, and reports on these impacts as perceived by the informants. METHODS In 2010, an educational program for the specialist training of GPs was launched at three hospitals in Central Norway opting for improved care delivery for patients with obesity. In contrast to the usual programs, this educational program was tailored to the needs of GPs by offering practice and training with a large number of patients with obesity and type 2 diabetes for an extended period of time. In order to investigate the outcomes of the program, a qualitative design was applied involving interviews with 13 GPs, head physicians and staff at the hospitals and in one municipality. RESULTS Through the program, participants strengthened care delivery by building knowledge and competence. They developed relations between primary and secondary care providers and established shared understanding and practices. The program also demonstrated improvement opportunities, especially concerning the involvement of municipalities. CONCLUSIONS The educational program promoted integrated care between primary and secondary care by establishing formal and informal relations, by improving service delivery through increased competence and by fostering shared understanding and practices between care levels. The educational program illustrates the combination of advanced high-quality training with the development of integrated care.
Collapse
Affiliation(s)
| | - Unni Dahl
- Norwegian Hospital Construction Agency, Klæbuveien 118, 7031 Trondheim, Norway
| | - Bård Kulseng
- Centre for Obesity Research (ObeCe), Clinic of Surgery, St. Olavs University Hospital, 7006 Trondheim, Norway
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, N-7489 Trondheim, Norway
| |
Collapse
|
|
24
|
Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: Development of standards for patient safety and efficacy. Metabolism 2018; 79:97-107. [PMID: 29307519 DOI: 10.1016/j.metabol.2017.12.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 12/22/2017] [Accepted: 12/23/2017] [Indexed: 01/03/2023]
Abstract
Weight loss surgery, also referred to as bariatric surgery, has been in existence since the 1950's. Over the decades, it has been demonstrated to successfully achieve meaningful and sustainable weight loss in a large number of patients who undergo these procedures. Additionally, the benefits observed across a number of metabolic disorders such as type 2 diabetes mellitus and hyperlipidemia, are often to a degree, independent of the weight loss, thus the term "metabolic bariatric surgery (MBS)" has become a better descriptor. Throughout its long history, MBS has evolved from an era of high morbidity and mortality to one of laudable safety despite the high-risk nature of the patients undergoing these major gastrointestinal procedures. This article will describe the historic evolution of MBS and concentrate on those events that were instrumental in reducing the morbidity of these operations.
Collapse
Affiliation(s)
- Blaine T Phillips
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States; Harvard Medical School, Harvard University, Boston, Massachusetts, United States; Division of Metabolic and Bariatric Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Scott A Shikora
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States; Division of Metabolic and Bariatric Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States.
| |
Collapse
|
|
25
|
Impact of super obesity on perioperative outcomes after hepatectomy: The weight of the risk. Surgery 2017; 162:1026-1031. [PMID: 28866313 DOI: 10.1016/j.surg.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/07/2017] [Accepted: 07/13/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND We evaluated perioperative outcomes in super obese patients (body mass index >50 kg/m2) undergoing liver resection using the American College of Surgeons National Surgical Quality Improvement Program. METHODS Patients undergoing hepatectomy recorded in the American College of Surgeons National Surgical Quality Improvement Program dataset from 2005 to 2015 were analyzed. Out of 21,228 hepatectomies in the National Surgical Quality Improvement Program dataset, 146 were performed on super obese patients. RESULTS Seventy-two percent of the super obese patients were female with a median age of 50.6 years, and 10% were classified as American College of Surgeons Class ≥III. In this group, 69.2% were hypertensive, 38.4% were diabetics, and 17.8% had dyspnea. The median operation time was 248 minutes in the super obese group, greater than any other body mass index class. Twenty-two percent of these patients required perioperative transfusion, although 74% underwent partial hepatectomies. Body mass index >50 kg/m2 significantly increased morbidity in patients undergoing hepatectomies, almost 2-fold. Infectious complications increased by 86%, and the risk of developing critical care complications increased by 63%. CONCLUSION Our data show that super obesity (body mass index >50 kg/m2) is the strongest independent predictor of perioperative morbidity. These patients also are at much greater risk of infectious complications and critical care complications. Future studies should be conducted using weight loss strategies in extreme obese patients to reduce their risk of life-threatening complications after hepatectomy.
Collapse
|
|
26
|
GPR88 is a critical regulator of feeding and body composition in mice. Sci Rep 2017; 7:9912. [PMID: 28855710 PMCID: PMC5577241 DOI: 10.1038/s41598-017-10058-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/20/2017] [Indexed: 12/21/2022] Open
Abstract
GPR88 is an orphan G-protein-coupled receptor with predominant expression in reward-related areas in the brain. While the lack of GPR88 has been demonstrated to induce behavioral deficits, the potential function of the receptor in the control of food intake and energy balance remains unexplored. In this work, the role of GPR88 in energy homeostasis was investigated in Gpr88−/− mice fed either standard chow or high fat diet (HFD). Gpr88−/− mice showed significantly reduced adiposity accompanied with suppressed spontaneous food intake, particularly pronounced under HFD treatment. While energy expenditure was likewise lower in Gpr88−/− mice, body weight gain remained unchanged. Furthermore, deregulation in glucose tolerance and insulin responsiveness in response to HFD was attenuated in Gpr88−/− mice. On the molecular level, distinct changes in the hypothalamic mRNA levels of cocaine-and amphetamine-regulated transcript (Cartpt), a neuropeptide involved in the control of feeding and reward, were observed in Gpr88−/− mice. In addition, GPR88 deficiency was associated with altered expressions of the anorectic Pomc and the orexigenic Npy in the arcuate nucleus, especially under HFD condition. Together, our results indicate that GPR88 signalling is not only important for reward processes, but also plays a role in the central regulatory circuits for energy homeostasis.
Collapse
|
|
27
|
Hosseini SV, Hosseini SA, Al-Hurry AMAH, Khazraei H, Ganji F, Sadeghi F. Comparison of Early Results and Complications between Multi-and Single-Port Sleeve Gastrectomy: A Randomized Clinical Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2017; 42:251-257. [PMID: 28533573 PMCID: PMC5429493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In recent years, laparoscopic sleeve gastrectomy (LSG) has become more acceptable for obese patients. Single-port sleeve gastrectomy (SPSG) is more popular since each abdominal incision carries the risk of bleeding, hernia, and internal organ injury as well as exponentially affecting cosmesis. This cross-sectional study aimed at comparing multi-port sleeve gastrectomy (MPSG) and SPSG in terms of their early results and complications. METHODS Out of129 obese patients candidated for LSG, 102 patients were assigned to 2 groups of SPSG and MPSG. Complications and demographic data such as body mass index (BMI), age, gender, operation time, and hospital stay were measured. All surgeries were carried out between2013 and 2015 in Shiraz, Iran. Data analysis was performed using SPSS, version 16 for Windows (SPSS Inc., Chicago, IL). The continuous and categorical variables were compared using the Student t-test and the Chi-square test or the Fisher exact test, respectively. RESULTS The patients' data from both groups were similar in terms of age, intraoperative and postoperative bleeding volume, and length of hospital stay. Mean BMI was 42.8±0.7 in the SPSG group and 45.3±1.2 in the MPSG group. Duration of surgery was significantly lower in the SPSG group (P<0.001). Only 1 patient from the SPSG group and 5 patients from the MPSG group had bleeding as an early complication. CONCLUSION The differences in each complication between the groups were not statistically significant. SPSG seems to be safe and is the same as MPSG in terms of major postoperative complications. TRIAL REGISTRATION NUMBER IRCT201512229936N12 The abstract was presented in the 4th International Congress of Minimally Invasive Surgery, Iran, as a poster and published in Iran J Med Sci Journal as a supplement (May 2015; Vol. 40, No. 3).
Collapse
Affiliation(s)
| | - Seyed Ali Hosseini
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hajar Khazraei
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Hajar Khazraei, PharmD, PhD, Colorectal Research Center, Shahid Faghihi Hospital, Zand Blvd., Shiraz, Iran Tel\Fax: +98 71 36281453
| | - Fatemeh Ganji
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Sadeghi
- Department of Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
|
28
|
Yang NY, Wolever RQ, Roberts R, Perlman A, Dolor RJ, Abrams DI, Ginsburg GS, Simmons LA. Integrative health care services utilization as a function of body mass index: A BraveNet practice-based research network study. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
|
29
|
Alvarez J, Mei X, Daily M, Shah M, Grigorian A, Berger J, Marti F, Gedaly R. Tipping the Scales: Liver Transplant Outcomes of the Super Obese. J Gastrointest Surg 2016; 20:1628-35. [PMID: 27311983 DOI: 10.1007/s11605-016-3185-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/04/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We aim to study outcomes in liver transplant recipients with body mass index (BMI) ≥50 using the United Network for Organ Sharing (UNOS) database. METHODS We reviewed patients undergoing liver transplantation recorded in the UNOS database from 1988 to 2013. Of 104,250 liver transplant procedures, 123 were performed on super obese patients. RESULTS Sixty-four percent of the super obese patients are female (64 %) and had a mean age 47 years (20-71). The mean BMI was 53.5 (50-72.86) and 16 % had diabetes. The mean Model for End-Stage Disease (MELD) score at transplant was 29.1 (6-53). It was found that BMI ≥50 increased 1.6-fold the risk of death within 30 days after liver transplantation. Graft failure was increased by 52 % and overall mortality was by 62 %. A 1:1 propensity score-matched analysis demonstrated that patients with BMI <50 have significantly better graft and overall patient survival than the super obese. CONCLUSIONS Overall, our data shows that BMI ≥50 is an independent predictor of perioperative mortality and graft and overall patient survival. Further studies are necessary to better understand predictors of outcomes in super obese patients.
Collapse
Affiliation(s)
- Jose Alvarez
- Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA
| | - Xioanon Mei
- Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA
| | - Michael Daily
- Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA
| | - Malay Shah
- Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA
| | - Alla Grigorian
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jonathan Berger
- Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA
| | - Francesc Marti
- Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA
| | - Roberto Gedaly
- Department of Surgery, University of Kentucky College of Medicine Transplant Center, 800 Rose Street, C451, Lexington, KY, 40536-0293, USA.
| |
Collapse
|
|
30
|
Schnell O, Weng J, Sheu WHH, Watada H, Kalra S, Soegondo S, Yamamoto N, Rathod R, Zhang C, Grzeszczak W. Acarbose reduces body weight irrespective of glycemic control in patients with diabetes: results of a worldwide, non-interventional, observational study data pool. J Diabetes Complications 2016; 30:628-37. [PMID: 26935335 DOI: 10.1016/j.jdiacomp.2016.01.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this study is to examine the effect of acarbose, an alpha-glucosidase inhibitor, on body weight in a real-life setting by pooling data from post-marketing surveillance. METHODS Data from 10 studies were pooled (n=67,682) and the effect of acarbose on body weight was analysed taking into account baseline body weight, glycemic parameters and other baseline characteristics. RESULTS The mean relative reduction in body weight was 1.45 ± 3.24% at the 3-month visit (n=43,510; mean baseline 73.4 kg) and 1.40 ± 3.28% at the last visit (n=54,760; mean baseline 73.6 kg) (both p<0.0001). These reductions were dependent on baseline body weight (overweight: -1.33 ± 2.98% [n=13,498; mean baseline 71.6 kg]; obese: -1.98 ± 3.40% [n=20,216; mean baseline 81.3 kg]). When analysed by baseline glycemic parameter quartiles, the reduction was independent of fasting plasma glucose (FPG), postprandial plasma glucose (PPG), glycated hemoglobin (HbA1c) and postprandial glucose excursion (PPGE). A bivariate analysis of covariance identified female sex, South East Asian and East Asian ethnicity, younger age, higher body mass index, short duration of diabetes, and no previous treatment as factors likely to impact positively on body weight reduction with acarbose. CONCLUSIONS This post-hoc analysis showed that acarbose treatment reduces body weight independent of glycemic control status but dependent on baseline body weight.
Collapse
Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e.V. at the Helmholtz Center Munich, Munich, Germany.
| | - Jianping Weng
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou; Department of Endocrinology and Metabolic Disease, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Wayne H-H Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Hirotaka Watada
- Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Sanjay Kalra
- Bharti Research Institute of Diabetes & Endocrinology, Karnal, India.
| | | | | | | | | | | |
Collapse
|
|
31
|
Amylin-mediated control of glycemia, energy balance, and cognition. Physiol Behav 2016; 162:130-40. [PMID: 26922873 DOI: 10.1016/j.physbeh.2016.02.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/20/2016] [Accepted: 02/22/2016] [Indexed: 12/26/2022]
Abstract
Amylin, a peptide hormone produced in the pancreas and in the brain, has well-established physiological roles in glycemic regulation and energy balance control. It improves postprandial blood glucose levels by suppressing gastric emptying and glucagon secretion; these beneficial effects have led to the FDA-approved use of the amylin analog pramlintide in the treatment of diabetes mellitus. Amylin also acts centrally as a satiation signal, reducing food intake and body weight. The ability of amylin to promote negative energy balance, along with its unique capacity to cooperatively facilitate or enhance the intake- and body weight-suppressive effects of other neuroendocrine signals like leptin, have made amylin a leading target for the development of novel pharmacotherapies for the treatment of obesity. In addition to these more widely studied effects, a growing body of literature suggests that amylin may play a role in processes related to cognition, including the neurodegeneration and cognitive deficits associated with Alzheimer's disease (AD). Although the function of amylin in AD is still unclear, intriguing recent reports indicate that amylin may improve cognitive ability and reduce hallmarks of neurodegeneration in the brain. The frequent comorbidity of diabetes mellitus and obesity, as well as the increased risk for and occurrence of AD associated with these metabolic diseases, suggests that amylin-based pharmaceutical strategies may provide multiple therapeutic benefits. This review will discuss the known effects of amylin on glycemic regulation, energy balance control, and cognitive/motivational processes. Particular focus will be devoted to the current and/or potential future clinical use of amylin pharmacotherapies for the treatment of diseases in each of these realms.
Collapse
|
|
32
|
Marques LM, de Souza TF, Grecco E, Neto MDPG, Ramos FM, Vieira FM, Garcia VG, Freitas CE. Proposed Treatment of Adjustable Intragastric Balloon Contaminated with Candida. Bariatr Surg Pract Patient Care 2015. [DOI: 10.1089/bari.2015.0029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Eduardo Grecco
- Department of Endoscopy, ABC Medical School, Santo André/SP, Brazil
| | | | | | | | | | | |
Collapse
|
|
33
|
Amianto F, Ercole R, Abbate Daga G, Fassino S. Exploring Parental Bonding in BED and Non-BED Obesity Compared with Healthy Controls: Clinical, Personality and Psychopathology Correlates. EUROPEAN EATING DISORDERS REVIEW 2015; 24:187-96. [DOI: 10.1002/erv.2419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 09/25/2015] [Accepted: 10/26/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Federico Amianto
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| | - Roberta Ercole
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| | - Giovanni Abbate Daga
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| | - Secondo Fassino
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| |
Collapse
|
|
34
|
Maternal health and eating habits: metabolic consequences and impact on child health. Trends Mol Med 2015; 21:126-33. [PMID: 25662028 DOI: 10.1016/j.molmed.2014.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 12/21/2022]
Abstract
Apart from direct inheritance and the effects of a shared environment, maternal health, eating habits and diet can affect offspring health by developmental programming. Suboptimal maternal nutrition (i.e., either a reduction or an increase above requirement) or other insults experienced by the developing fetus can induce significant changes in adipose tissue and brain development, energy homeostasis, and the structure of vital organs. These can produce long-lasting adaptations that influence later energy balance, and increase the susceptibility of that individual to obesity and the components of the metabolic syndrome. Studies that elucidate the mechanisms behind these associations will have a positive impact on the health of the future adult population and may help to contain the obesity epidemic.
Collapse
|
|
35
|
Nongonierma AB, FitzGerald RJ. The scientific evidence for the role of milk protein-derived bioactive peptides in humans: A Review. J Funct Foods 2015. [DOI: 10.1016/j.jff.2015.06.021] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
|
36
|
Barros LM, Moreira RAN, Frota NM, Caetano JÁ. Identificação dos diagnósticos de enfermagem da classe de respostas cardiovasculares/pulmonares em pacientes submetidos à cirurgia bariátrica. AQUICHAN 2015. [DOI: 10.5294/aqui.2015.15.2.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
O objetivo deste estudo foi identificar as respostas humanas apresentadas por pacientes no pós-operatório de cirurgia bariátrica que se configurem como diagnósticos de enfermagem da classe respostas cardiovasculares/pulmonares. Estudo observacional de caráter transversal realizado no período de julho de 2010 a maio de 2011, em um hospital referência em cirurgia bariátrica em Fortaleza-CE. Os diagnósticos de enfermagem identificados foram: risco de perfusão gastrintestinal ineficaz (87,9%), risco de intolerância à atividade (70,7%), perfusão tissular periférica ineficaz (67,2%), risco de choque (63,8%), débito cardíaco diminuído (60,3%), risco de perfusão tissular cardíaca diminuída (58,6%), intolerância à atividade (51,7%), risco de perfusão tissular cerebral ineficaz (48,3%), ventilação espontânea prejudicada (46,5%), risco de perfusão renal ineficaz (43,1%), padrão respiratório ineficaz (37,9%) e resposta disfuncional ao desmame ventilatório (36,2%). Assim, com base nesses resultados será possível direcionar a assistência de enfermagem prestada aos pacientes submetidos à cirurgia bariátrica e, consequentemente, reduzir complicações pós-operatórias.
Collapse
|
|
37
|
Reichman TW, Therapondos G, Serrano MS, Seal J, Evers-Meltzer R, Bohorquez H, Cohen A, Carmody I, Ahmed E, Bruce D, Loss GE. “Weighing the risk”: Obesity and outcomes following liver transplantation. World J Hepatol 2015; 7:1484-1493. [PMID: 26085908 PMCID: PMC4462687 DOI: 10.4254/wjh.v7.i11.1484] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/23/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023] Open
Abstract
Obesity is on the rise worldwide. As a result, unprecedented rates of patients are presenting with end stage liver disease in the setting of non-alcoholic fatty liver disease (NAFLD) and are requiring liver transplantation. There are significant concerns that the risk factors associated with obesity and the metabolic syndrome might have a detrimental effect on the long term outcomes following liver transplantation. In general, short term patient and graft outcomes for both obese and morbidly obese patients are comparable with that of non-obese patients, however, several studies report an increase in peri-operative morbidity and increased length of stay. Continued studies documenting the long-term outcomes from liver transplantation are needed to further examine the risk of recurrent disease (NAFLD) and also further define the role risk factors such cardiovascular disease might play long term. Effective weight reduction in the post liver transplant setting may mitigate the risks associated with the metabolic syndrome long-term.
Collapse
|
|
38
|
Mietlicki-Baase EG, Olivos DR, Jeffrey BA, Hayes MR. Cooperative interaction between leptin and amylin signaling in the ventral tegmental area for the control of food intake. Am J Physiol Endocrinol Metab 2015; 308:E1116-22. [PMID: 25898952 PMCID: PMC4469808 DOI: 10.1152/ajpendo.00087.2015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/15/2015] [Indexed: 12/16/2022]
Abstract
Peripheral coadministration of amylin and leptin produces enhanced suppression of food intake and body weight, but the central nuclei mediating these effects remain unclear. Because each of these peptides controls feeding via actions at the ventral tegmental area (VTA), we tested the hypothesis that the VTA is a site of action for the cooperative effects of leptin and amylin on energy balance control. First, we show that intra-VTA injection of amylin and leptin at doses of each peptide that are effective in reducing food intake and body weight when administered separately produces an enhanced suppression of feeding when administered in combination. We also demonstrate that subthreshold doses of both amylin and leptin cause significant hypophagia and body weight loss when coadministered into the VTA. Additionally, we provide evidence that VTA amylin receptor blockade significantly attenuates the ability of intra-VTA leptin to reduce feeding and body weight gain. Together, these data provide the first evidence that the VTA mediates the interaction of amylin and leptin to cooperatively promote negative energy balance.
Collapse
Affiliation(s)
- Elizabeth G Mietlicki-Baase
- Translational Neuroscience Program, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diana R Olivos
- Translational Neuroscience Program, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brianne A Jeffrey
- Translational Neuroscience Program, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew R Hayes
- Translational Neuroscience Program, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
|
39
|
Ponce J, Woodman G, Swain J, Wilson E, English W, Ikramuddin S, Bour E, Edmundowicz S, Snyder B, Soto F, Sullivan S, Holcomb R, Lehmann J. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surg Obes Relat Dis 2014; 11:874-81. [PMID: 25868829 DOI: 10.1016/j.soard.2014.12.006] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Saline-filled intragastric balloon devices are reversible endoscopic devices designed to occupy stomach volume and reduce food intake. OBJECTIVE To evaluate the safety and effectiveness of a dual balloon system plus diet and exercise in the treatment of obesity compared to diet and exercise alone. SETTING Academic and community practice, United States. METHODS Participants (n = 326) with body mass index (BMI) 30-40 kg/m(2) were randomized to endoscopic DBS treatment plus diet and exercise (DUO, n = 187) or sham endoscopy plus diet and exercise alone (DIET, n = 139). Co-primary endpoints were a between-group comparison of percent excess weight loss (%EWL) and DUO subject responder rate, both at 24 weeks. Thereafter DUO patients had the DBS retrieved followed by 24 additional weeks of counseling; DIET patients were offered DBS treatment. RESULTS Mean BMI was 35.4. Both primary endpoints were met. DUO weight loss was over twice that of DIET. DUO patients had significantly greater %EWL at 24 weeks (25.1% intent-to-treat (ITT), 27.9% completed cases (CC, n = 167) compared with DIET patients (11.3% ITT, P = .004, 12.3% CC, n = 126). DUO patients significantly exceeded a 35% response rate (49.1% ITT, P<.001, 54.5% CC) for weight loss dichotomized at 25%EWL. Accommodative symptoms abated rapidly with support and medication. Balloon deflation occurred in 6% without migrations. Early retrieval for nonulcer intolerance occurred in 9%. Gastric ulcers were observed; a minor device change led to significantly reduced ulcer size and frequency (10%). CONCLUSION The DBS was significantly more effective than diet and exercise in causing weight loss with a low adverse event profile.
Collapse
Affiliation(s)
- Jaime Ponce
- Chattanooga Bariatrics, Chattanooga, TN, and Hamilton Weight Management Center, Hamilton Medical Center, Dalton, GA.
| | - George Woodman
- MidSouth Bariatrics, Memphis, TN, and Baptist Memorial Hospital, Memphis, TN
| | - James Swain
- Scottsdale Healthcare Bariatric Center, Scottsdale Healthcare System, Scottsdale, AZ
| | - Erik Wilson
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX
| | - Wayne English
- Department of Surgery, Marquette General Hospital, Marquette, MI
| | | | - Eric Bour
- Department of Surgery, Greenville Health System, Greenville, SC
| | | | - Brad Snyder
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX
| | - Flavia Soto
- Department of Surgery, Marquette General Hospital, Marquette, MI
| | - Shelby Sullivan
- Division of Gastroenterology, Washington University, St Louis, MO
| | | | | | | |
Collapse
|
|
40
|
Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg 2014; 24:437-55. [PMID: 24374842 PMCID: PMC3916703 DOI: 10.1007/s11695-013-1160-3] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We performed a meta-analysis of weight loss and remission of type 2 diabetes mellitus (T2DM) evaluated in randomized controlled trials (RCTs) and observational studies of bariatric surgery vs conventional medical therapy. English articles published through June 10, 2013 that compared bariatric surgery with conventional therapy and included T2DM endpoints with ≥12-month follow-up were systematically reviewed. Body mass index (BMI, in kilogram per square meter), glycated hemoglobin (HbA1C, in degree), and fasting plasma glucose (FPG, in milligram per deciliter) were analyzed by calculating weighted mean differences (WMDs) and pooled standardized mean differences and associated 95 % confidence intervals (95 % CI). Aggregated T2DM remission event data were analyzed by calculating the pooled odds ratio (POR) and 95 % CI. Random effects assumptions were applied throughout; I(2) ≥ 75.0 % was considered indicative of significant heterogeneity. Systematic review identified 512 articles: 47 duplicates were removed, 446 failed inclusion criteria (i.e., n < 10 per arm, animal studies, reviews, case reports, abstracts, and kin studies). Of 19 eligible articles, two not focused on diagnosed T2DM and one with insufficient T2DM data were excluded. In the final 16 included papers, 3,076 patients (mean BMI, 40.9; age, 47.0; 72.0 % female) underwent bariatric surgery; 3,055 (39.4; 48.6, 69.0 %) received conventional or no weight-loss therapy. In bariatric surgery vs conventional therapy groups, the mean 17.3 ± 5.7 month BMI WMD was 8.3 (7.0, 9.6; p < 0.001; I(2) = 91.8), HbA(1C) was 1.1 (0.6, 1.6; p < 0.001; I(2) = 91.9), and FPG, 24.9 (15.9, 33.9; p < 0.001; I(2) = 84.8), with significant differences favoring surgery. The overall T2DM remission rate for surgery vs conventional group was 63.5 vs 15.6 % (p < 0.001). The Peto summary POR was 9.8 (6.1, 15.9); inverse variance summary POR was 15.8 (7.9, 31.4). Of the included studies, 94.0 % demonstrated a significant statistical advantage favoring surgery. In a meta-analysis of 16 studies (5 RCTs) with 6,131 patients and mean 17.3-month follow-up, bariatric surgery was significantly more effective than conventional medical therapy in achieving weight loss, HbA(1C) and FPG reduction, and diabetes remission. The odds of bariatric surgery patients reaching T2DM remission ranged from 9.8 to 15.8 times the odds of patients treated with conventional therapy.
Collapse
Affiliation(s)
- G Ribaric
- European Surgical Institute, Ethicon Endo-Surgery (Europe) GmbH, Hamburg, Germany,
| | | | | |
Collapse
|
|
41
|
Walker AM, Cubbon RM, Kearney MT. Contemporary treatment strategies for Type 2 diabetes-related macrovascular disease. Expert Rev Endocrinol Metab 2014; 9:641-658. [PMID: 30736201 DOI: 10.1586/17446651.2014.941356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes mellitus poses a major challenge to healthcare providers in the coming years as its prevalence increases across the globe. The disease doubles the risk of cardiovascular morbidity and mortality, with 70% of sufferers dying from a cardiac cause. Large clinical trials of current glucose-lowering therapies for Type 2 diabetes have shown no benefit in reducing the risk of macrovascular events. Blood pressure control, angiotensin-converting enzyme inhibitor therapy and improvement of dyslipidemia with statins have proven benefit in reducing cardiovascular risk in Type 2 diabetes. A growing understanding of the importance of pathological processes including endothelial dysfunction, abnormal growth factor biology, oxidative stress, dysregulation of adipokines and deficient vascular repair and regeneration in insulin-resistant states promises new treatments to combat the problem.
Collapse
Affiliation(s)
- Andrew Mn Walker
- a Leeds Multidisciplinary Cardiovascular Research Centre, LIGHT laboratories, The University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
| | - Richard M Cubbon
- a Leeds Multidisciplinary Cardiovascular Research Centre, LIGHT laboratories, The University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK
| | | |
Collapse
|
|
42
|
Billy HT, Sarwer DB, Ponce J, Ng-Mak DS, Shi R, Cornell C, Okerson T. Quality of life after laparoscopic adjustable gastric banding (LAP-BAND): APEX interim 3-year analysis. Postgrad Med 2014; 126:131-40. [PMID: 25141251 DOI: 10.3810/pgm.2014.07.2791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity is often associated with diminished health-related quality of life (HRQOL), but significant gains in HRQOL have been observed after bariatric surgery. Laparoscopic adjustable gastric banding has been established as a safe, effective treatment to reduce weight in patients with obesity. This report summarizes interim 3-year changes in HRQOL and body weight, as well as safety postimplantation of the LAP-BAND AP (LBAP) system. METHODS The LAP-BAND AP EXperience (APEX) trial, an ongoing, prospective, 5-year, open-label study, assessed changes in HRQOL (Obesity and Weight-Loss Quality of Life [OWLQOL] questionnaire) and body weight, and safety after placement of LBAP. This interim analysis represents patients with evaluable OWLQOL data at baseline and at 3 years (n = 183). RESULTS The OWLQOL total score and individual scores significantly improved within 6 months post-LBAP and continued to improve during a 3 year period (P < 0.0001, both). Total score improved from 71.0 to 34.0 (mean improvement from baseline, 52%; range, 18%-65%); mean change in individual scores was -2.2 (range, -0.7 to -3.0). Percent weight loss was maintained through 3 years (19.4%; n = 174). Improvement in OWLQOL was associated with percent weight loss at 3 years (r = -0.5407; P < 0.0001). Revisions and explants were performed in 7 (3.8%) and 20 (10.9%) out of 183 patients, respectively. CONCLUSIONS Meaningful improvement in quality of life occurred through clinically significant weight loss after LBAP placement, extending throughout the 3 years of this analysis.
Collapse
|
|
43
|
Wimalawansa SJ. Stigma of obesity: A major barrier to overcome. J Clin Transl Endocrinol 2014; 1:73-76. [PMID: 29159086 PMCID: PMC5685031 DOI: 10.1016/j.jcte.2014.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 11/09/2022] Open
|
|
44
|
Schellekens H, Nongonierma AB, Clarke G, van Oeffelen WE, FitzGerald RJ, Dinan TG, Cryan JF. Milk protein-derived peptides induce 5-HT2C-mediated satiety in vivo. Int Dairy J 2014. [DOI: 10.1016/j.idairyj.2014.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
|
45
|
Systematic Review and Meta-analysis of Medium-Term Outcomes After Banded Roux-en-Y Gastric Bypass. Obes Surg 2014; 24:1536-51. [DOI: 10.1007/s11695-014-1311-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
|
46
|
Orlando G, Gervasi R, Luppino IM, Vitale M, Amato B, Silecchia G, Puzziello A. The role of a multidisciplinary approach in the choice of the best surgery approach in a super-super-obesity case. Int J Surg 2014; 12 Suppl 1:S103-6. [PMID: 24866068 DOI: 10.1016/j.ijsu.2014.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Obesity is a multifactorial chronic disease caused by a combination of hereditary, metabolic, dietary, cultural, social and psychological factors. Conservative treatments, such as diet and physical exercises, revealed a lack of long-term efficacy in patients with an extremely high BMI (>60 kg/m(2)). METHODS We present a multidisciplinary approach in a patient with an extremely high BMI: a twenty-one years old woman with a BMI 102 kg/m(2) (body weight 313 kg × height 175 cm) disabled to walk with severe depression and a psychological pattern of sweet eater and binge eating disorder. She was also amenorrheic and suffered from metabolic syndrome. The psychological assessment and the social-familial support were defined as priorities. Afterward, physical rehabilitation, behavior therapy, hypocaloric diet followed by intragastric balloon were planned as preoperative treatment. Finally a surgical program was scheduled: Sleeve Gastrectomy as first step of Biliopancreatic Diversion with Duodenal Switch. RESULTS Sixteenth months after the Sleeve Gastrectomy the weight was 130 kg (Excess Weight Loss = 74%) with a resumption of the menstrual cycle and a normalization of the metabolic syndrome. CONCLUSION Due to the results obtained with both surgery and an excellent psychological supporting network we decided not to perform the expected Biliopancreatic Diversion with Duodenal Switch. The timing of bariatric surgery in superobesity patients is a milestone, but the cooperation among the specialists is essential for the choice of the best successful surgery. The multidisciplinary team should point to a comprehensive tailored management, considering motivation, compliance and adherence to a long-term follow-up as the keys for surgical success.
Collapse
Affiliation(s)
- Giulio Orlando
- University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Rita Gervasi
- University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Ileana M Luppino
- Gastroenterology and Endoscopy Unit, Annunziata Hospital, 87100 Cosenza, Italy
| | - Mario Vitale
- Dept of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Bruno Amato
- General Surgery Unit, University of Naples Federico II, 80100 Naples, Italy
| | - Gianfranco Silecchia
- General Surgery Unit & Bariatric Center of Excellence-IFSO EC, Dept of Medical and Surgical Biotechnology and Sciences, University la Sapienza, 00100 Roma, Italy
| | | |
Collapse
|
|
47
|
Kotzampassi K, Shrewsbury AD, Papakostas P, Penna S, Tsaousi GG, Grosomanidis V. Looking into the profile of those who succeed in losing weight with an intragastric balloon. J Laparoendosc Adv Surg Tech A 2014; 24:295-301. [PMID: 24438221 DOI: 10.1089/lap.2013.0439] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Weight loss by means of an intragastric balloon is an advantageous procedure, as usage of such a balloon is minimally invasive and of minimal operational risk. Nevertheless, despite the encouraging results referred in to large population studies, its success rate as a treatment option is still questionable. The aim of this study was to classify and analyze all parameters recorded in a database of a treatment protocol concerning obese individuals handled by an intragastric balloon, in an attempt to delineate the comparable profile of those who succeeded to lose weight and those who failed. SUBJECTS AND METHODS Retrospective data collection, including demographic and anthropometric data, social and psychological factors, educational status, and attendance at sessions and the exercise program, was conducted. Using as a criterion for grouping the percentage of excess weight loss (%EWL), the successful (%EWL ≥50%) and the poor (%EWL ≤20%) responders were identified. RESULTS In total, 583 patients were assessed. Initial and ideal body weight (BW), initial body mass index (BMI), and excess weight were significantly lower in the %EWL ≥50% group (P<.001). Upon balloon removal, both groups exhibited a significant difference regarding BW, BW lost, BMI, and %EWL (P<.001). Advanced age (odds ratio [OR]=1.06; P<.001), female gender (OR=3.31; P<.001), basic educational level (OR=3.12; P<.001), and single or divorced marital status (OR=6.00; P<.001) were identified as the most powerful determinants of %EWL ≥50%. Moreover, attendance at more than four monthly interviews and strict exercise program commitment contributed significantly to a favorable outcome. CONCLUSIONS Our findings could serve as an initial step for further research into factors possibly contributing to the early identification of those individuals who will notably benefit from usage of an intragastric balloon regarding BW loss.
Collapse
Affiliation(s)
- Katerina Kotzampassi
- 1 Department of Surgery, Aristotle's University of Thessaloniki , Thessaloniki, Greece
| | | | | | | | | | | |
Collapse
|
|
48
|
Fosgerau K, Raun K, Nilsson C, Dahl K, Wulff BS. Novel α-MSH analog causes weight loss in obese rats and minipigs and improves insulin sensitivity. J Endocrinol 2014; 220:97-107. [PMID: 24204009 PMCID: PMC3888513 DOI: 10.1530/joe-13-0284] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obesity is a major burden to people and to health care systems around the world. The aim of the study was to characterize the effect of a novel selective α-MSH analog on obesity and insulin sensitivity. The subchronic effects of the selective MC4-R peptide agonist MC4-NN1-0182 were investigated in diet-induced obese (DIO) rats and DIO minipigs by assessing the effects on food intake, energy consumption, and body weight. The acute effect of MC4-NN1-0182 on insulin sensitivity was assessed by a euglycemic-hyperinsulinemic clamp study in normal rats. Three weeks of treatment of DIO rats with MC4-NN1-0182 caused a decrease in food intake and a significant decrease in body weight 7±1%, P<0.05 compared with 3±1% increase with the vehicle control. In DIO minipigs, 8 weeks of treatment with MC4-NN1-0182 resulted in a body weight loss of 13.3±2.5 kg (13±3%), whereas the vehicle control group had gained 3.7±1.4 kg (4±1%). Finally, clamp studies in normal rats showed that acute treatment with MC4-NN1-0182 caused a significant increase in glucose disposal (Rd) compared with vehicle control (Rd, mg/kg per min, 17.0±0.7 vs 13.9±0.6, P<0.01). We demonstrate that treatment of DIO rats or minipigs with a selective MC4-R peptide agonist causes weight loss. Moreover, we have demonstrated weight-independent effects on insulin sensitivity. Our observations identify MC4 agonism as a viable target for the treatment of obesity and insulin resistance.
Collapse
Affiliation(s)
- Keld Fosgerau
- Novo Nordisk Diabetes Research Unit, Novo Nordisk A/S, Novo Nordisk Park, DK-2760 Maaloev, Denmark
| | | | | | | | | |
Collapse
|
|
49
|
Ji Y, Wang Y, Zhu J, Shen D. A systematic review of gastric plication for the treatment of obesity. Surg Obes Relat Dis 2013; 10:1226-32. [PMID: 24582413 DOI: 10.1016/j.soard.2013.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 11/19/2013] [Accepted: 12/09/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopic gastric plication (LGP) is a relatively new restrictive bariatric procedure that requires no gastrectomy or foreign body placement. OBJECTIVES The authors' aim in this article is to conduct a systematic review of the currently available literature regarding the outcomes of LGP for the treatment of obesity. SETTING University Hospital, China METHODS The authors' systematic review yielded 14 studies encompassing 1,450 LGP patients. Perioperative data were collected from each study and recorded. RESULTS Mean preoperative body mass index (BMI) ranged from 31.2 to 44.5 kg/m(2), and 80.8% of the patients were female. Operative time ranged from 50 to 117.9 minutes (average 79.2 min). Hospital stay varied from .75 to 5 days (average 2.4 days). The percentage of excessive weight loss (%EWL) for LGP varied from 31.8% to 74.4% with follow-up from 6 months to 24 months. No mortality was reported in these studies and the rate of major complications requiring reoperation ranged from 0% to 15.4% (average 3.7 %). CONCLUSION Early reports with LGP are promising with a favorable short-term safety profile. However, it remains unclear if weight loss following LGP is durable in the long term. Additional prospective comparative trials and long-term follow-up are needed to further define the role of LGP in the surgical management of obesity.
Collapse
Affiliation(s)
- Yun Ji
- Department of General Surgery, Second Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Yuedong Wang
- Department of General Surgery, Second Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China.
| | - Jinhui Zhu
- Department of General Surgery, Second Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Dijian Shen
- Department of General Surgery, Second Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| |
Collapse
|
|
50
|
Seaman DR. Weight gain as a consequence of living a modern lifestyle: a discussion of barriers to effective weight control and how to overcome them. JOURNAL OF CHIROPRACTIC HUMANITIES 2013; 20:27-35. [PMID: 25067929 PMCID: PMC4111078 DOI: 10.1016/j.echu.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this commentary is to discuss modern lifestyle factors that promote weight gain and to suggest methods for clinicians to more effectively educate patients about weight management. DISCUSSION Most adults in the United States are overweight or obese. Multiple factors related to the modern lifestyle appear to play causal roles. In general, the population maintains sedentary lives and overconsumes calorie-dense foods. In particular, refined carbohydrates negatively impact metabolism and stimulate neural addiction mechanisms, which facilitate weight gain. As adipose tissue mass accumulates, satiation centers in the hypothalamus become resistant to insulin and leptin, which leads to increased caloric consumption. Several behavior issues further augment weight gain, such as eating too quickly, a lack of sleep, high stress levels, and a lack of exercise. Finally, adipose tissue accumulation alters the body weight set point, which leads to metabolic changes that function to resist weight loss efforts. Each of these factors may work together to augment weight gain and promote obesity. Health care providers, such as chiropractic physicians, who educate patients on wellness, prevention, and lifestyle changes are well positioned to address these issues. CONCLUSION People need to be educated about the modern lifestyle factors that prevent effective weight management. Without this knowledge and the associated practical application of lifestyle choices that prevent weight gain, becoming overweight or obese appears to be an unavoidable consequence of living a modern lifestyle.
Collapse
Affiliation(s)
- David R. Seaman
- Corresponding author. David R. Seaman, DC, MS, Professor, National University of Health Sciences, SPC-Health Education Center, 7200 66th St N, Pinellas Park, FL 33706. Tel.: + 1 727 803 6129; fax: + 1 727 329 8494.
| |
Collapse
|