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Sindi H, Almuzaini S, Mubarak A, Hakeem FF, Campus G, Fadel HT, Lingström P. Oral Health in Individuals After Bariatric Surgery: A Systematic Scoping Review. Obes Surg 2025; 35:1878-1899. [PMID: 40106168 PMCID: PMC12065770 DOI: 10.1007/s11695-025-07793-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Revised: 02/28/2025] [Accepted: 03/07/2025] [Indexed: 03/22/2025]
Abstract
This scoping review appraises the available literature that investigates oral health after bariatric surgery (BS). Forty-two records were included (33 original studies and 9 systematic reviews). Bariatric surgery had a negative impact on the oral health related quality of life (three out of six studies). Relatively few studies found improvement following BS, probing pocket depth (2/10), clinical attachment level (1/9), bleeding on probing (3/10) and plaque (3/8). Conversely, BS was negatively associated with the DMFT (4/6), tooth wear (4/6) and oral radiographic findings (1/1). There was conflicting evidence regarding salivary parameters. To conclude, the literature on oral health in bariatric surgery patients is continuously growing. Positive as well as negative associations between oral health parameters and bariatric surgery are observed.
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Affiliation(s)
- Hisham Sindi
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, AlMadinah AlMunawwarah, Saudi Arabia.
| | - Sarah Almuzaini
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Mubarak
- College of Dentistry Hospital, Taibah University, AlMadinah AlMunawwarah, Saudi Arabia
| | - Faisal F Hakeem
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, AlMadinah AlMunawwarah, Saudi Arabia
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
| | - Guglielmo Campus
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hani T Fadel
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, AlMadinah AlMunawwarah, Saudi Arabia.
| | - Peter Lingström
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gómez-Ambrosi J. Recent Progress in the Management of Obesity: Advances and Insights from the Latest Research. Nutrients 2025; 17:1225. [PMID: 40218983 PMCID: PMC11990567 DOI: 10.3390/nu17071225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Accepted: 03/03/2025] [Indexed: 04/14/2025] Open
Abstract
The field of obesity research continues to evolve rapidly, driven by new insights into metabolic regulation, behavioral interventions, and disparities in treatment outcomes [...].
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Affiliation(s)
- Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 31008 Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
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Vasilieva ME, Kashchenko VA, Shmidt EV, Mizeva IA, Dolotovskaya PM, Zaytsev VV, Margaryants NB, Kamshilin AA. Improvement of Microvascular Function in Patients with Morbid Obesity After Bariatric Surgery Revealed by Imaging Photoplethysmography. Obes Surg 2025; 35:1001-1008. [PMID: 39934520 DOI: 10.1007/s11695-025-07741-8] [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: 11/23/2024] [Revised: 01/29/2025] [Accepted: 02/04/2025] [Indexed: 02/13/2025]
Abstract
BACKGROUND Morbid obesity leads to serious complications such as diabetes mellitus, arterial hypertension, and atherosclerosis. Bariatric surgery aims to reduce body weight and correct metabolic disorders and associated macro- and microvascular dysfunction. Metabolic disturbances can be assessed by biochemical markers, whereas microvascular function can be assessed by the response to provocative stimuli. The aim of this work is to quantitatively assess the cutaneous microcirculatory change caused by bariatric surgery using imaging photoplethysmography. METHODS The study included 20 patients with obesity whose body mass index (BMI) was greater than 40 kg/m2 who underwent bariatric surgery and 20 control subjects. Microvascular function was assessed twice, before and 6 months after surgery, by measuring the perfusion response to local forearm heating up to 40 °C using imaging photoplethysmography. RESULTS The perfusion response to local heating was found to be significantly lower in patients with obesity before surgery compared to the control group, but 6 months after surgery, it approaches indicators of the control group, along with a decrease in BMI from 48 ± 5 to 36 ± 5 kg/m2, P < 0.001. Besides, bariatric surgery improves biochemical markers of metabolic syndrome (glycated hemoglobin decreases from 6.3 ± 1.0 to 5.2 ± 0.4% and cholesterol from 5.2 ± 1.4 to 4.2 ± 0.8 mmol/l). CONCLUSION Based on these results, we conclude that microvascular abnormalities caused by obesity could be repaired after bariatric surgery and subsequent conservative treatment.
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Affiliation(s)
- Maria E Vasilieva
- North-Western District Scientific and Clinical Center Named After L.G. Sokolov, FMBA, Saint Petersburg, Russian Federation
| | - Victor A Kashchenko
- North-Western District Scientific and Clinical Center Named After L.G. Sokolov, FMBA, Saint Petersburg, Russian Federation
- Saint Petersburg State University, Saint Petersburg, Russian Federation
- Beloostrov Clinic, Vsevolozhsk District, Leningrad Region, Russian Federation
| | - Elena V Shmidt
- North-Western District Scientific and Clinical Center Named After L.G. Sokolov, FMBA, Saint Petersburg, Russian Federation
- Saint Petersburg State University, Saint Petersburg, Russian Federation
| | - Irina A Mizeva
- Institute of Continuous Media Mechanics, Perm, Russian Federation
| | | | - Valery V Zaytsev
- North-Western District Scientific and Clinical Center Named After L.G. Sokolov, FMBA, Saint Petersburg, Russian Federation
| | | | - Alexei A Kamshilin
- North-Western District Scientific and Clinical Center Named After L.G. Sokolov, FMBA, Saint Petersburg, Russian Federation.
- Institute of Automation and Control Processes, Primorskiy, Russian Federation.
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Chen Y, Feng Y, Zhang X, Gifford KA, Elmanzalawi Y, Samuels J, Albaugh VL, English WJ, Flynn CR, Yu D, Zhang R, Ikramuddin S. Bariatric Surgery Is Associated With Reduced Incidence of Mild Cognitive Impairment and Alzheimer Disease and Related Dementias: A Retrospective Cohort Study. ANNALS OF SURGERY OPEN 2025; 6:e541. [PMID: 40134493 PMCID: PMC11932579 DOI: 10.1097/as9.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 12/17/2024] [Indexed: 03/27/2025] Open
Abstract
Objective To evaluate the association of bariatric surgery with reduced incidence and delayed development of mild cognitive impairment (MCI) and Alzheimer disease and related dementias (ADRD) in patients with obesity. Background This retrospective longitudinal study utilized Electronic Health Records from Vanderbilt University Medical Center, covering 5303 patients who underwent bariatric surgery and 10,606 propensity score-matched obese patients who did not, from 2000 to 2023. Patients with prior MCI, ADRD, schizophrenia, alcoholism, gastric cancer, gastric ulcers, inflammatory bowel disease, coagulopathy, stroke, Parkinson disease, or brain cancer were excluded from both groups. Methods Differences in time to MCI/ADRD between surgical and control groups were analyzed using linear regression, and adjusted for confounders: demographics, medical history, and socioeconomic status. Survival probability differences for MCI and ADRD between the 2 groups over time were assessed using Kaplan-Meier curves and log-rank tests. Incidence differences of MCI and ADRD between the groups were evaluated using Fine-Gray subdistribution hazard models, accounting for the competing risk of death and confounders. Results Bariatric surgery was associated with a significantly reduced incidence of ADRD, evidenced by a subdistribution hazard ratio (SHR) of 0.37 (95% confidence interval [CI]: 0.15-0.89; P = 0.03). Similarly, the incidence of MCI was significantly lower in the surgical group, with an SHR of 0.57 (95% CI: 0.39-0.85; P = 0.01). Additionally, patients who underwent bariatric surgery experienced a delay of 2.01 years before developing MCI compared with the control group (95% CI: 0.70-3.50; P = 0.004). Conclusions These findings suggest that bariatric surgery may serve as an effective strategy to delay the onset of MCI and reduce the risk of both MCI and ADRD in patients with obesity.
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Affiliation(s)
- You Chen
- From the Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
- Department of Computer Science, Vanderbilt University, Nashville, TN
| | - Yubo Feng
- Department of Computer Science, Vanderbilt University, Nashville, TN
| | - Xinmeng Zhang
- Department of Computer Science, Vanderbilt University, Nashville, TN
| | | | | | - Jason Samuels
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Vance L. Albaugh
- Metamor Institute, Pennington Biomedical Research Center, Baton Rouge, LA
| | - Wayne J. English
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Charles R. Flynn
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Rui Zhang
- Department of Surgery, University of Minnesota, Minneapolis, MN
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Moreira SHC, Alvarez-Leite JI, Souza RP, Resmini GC, Resende CMM, de Marco L, Bastos-Rodrigues L. Predictors of Successful Weight Loss in Extremely Obese Individuals Undergoing Roux-en-Y Gastric Bypass Surgery. J Obes Metab Syndr 2024; 33:337-347. [PMID: 39472773 PMCID: PMC11704223 DOI: 10.7570/jomes23067] [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: 10/26/2023] [Revised: 04/25/2024] [Accepted: 08/25/2024] [Indexed: 12/31/2024] Open
Abstract
Background Roux-en-Y gastric bypass (RYGB) is a standard treatment for severe obesity, but some patients do not achieve the expected success in weight loss. The aim of this study was to evaluate possible predictors of weight loss after RYGB. Methods Sixty-three patients were included. Pre- and postoperative data were collected from medical records, including comorbidities, anthropometry, energy/macronutrient intake, and physical activity level (PAL). Variants in the brain-derived neurotrophic factor (BDNF; rs6265) and lysophospholipase like 1 (LYPLAL1; rs4846567) genes were investigated. Excess weight loss (EWL) >50% was considered to be successful weight loss (SWL). Logistic regression models were used to verify predictor variables. Results Participants' median preoperative body mass index (BMI) was 53 kg/m2 (interquartile range, 46 to 58). At 12 and 24 months after surgery, EWL was 63% and 67%, and the failure rate was 19% and 16%, respectively. The individuals with insufficient weight loss (IWL) after 12 months had higher preoperative weight, BMI, and overweight. At 24 months, lowest frequency of individuals with SWL in the first year was found in the IWL group. No significant differences were found between the groups in dietary intake and PAL. In the logistic regression, high initial BMI was a predictor of the worst response in both periods, and high initial total weight loss was a predictor of a better response at 24 months. The polymorphism analysis did not show differences between groups in either gene. Conclusion Lower preoperative BMI and greater weight loss at 12 months were predictors of SWL after RYGB.
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Affiliation(s)
| | | | - Renan Pedra Souza
- Department of Genetics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Giulia Carregal Resmini
- Molecular Medicine Technology Center, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Luiz de Marco
- Molecular Medicine Technology Center, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luciana Bastos-Rodrigues
- Molecular Medicine Technology Center, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Lopes KG, Romagna EC, Mattos DMF, Kraemer-Aguiar LG. Disordered Eating Behaviors and Weight Regain in Post-Bariatric Patients. Nutrients 2024; 16:4250. [PMID: 39683644 DOI: 10.3390/nu16234250] [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: 11/18/2024] [Revised: 12/01/2024] [Accepted: 12/06/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND/OBJECTIVE Weight regain has serious health consequences after bariatric surgery, and disordered eating behaviors (EBs) may be involved in it. We compared disordered EB symptoms in post-bariatric patients according to low vs. high ratio of weight regain (RWR) and investigated associations between disordered EB symptoms with weight regain and time since surgery. METHOD We recruited ninety-four patients who had undergone laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. All of them had not attended follow-up with the multidisciplinary healthcare team (including psychological assessment) for at least one year. RWR was calculated with respect to maximal weight loss by the nadir weight achieved after surgery. Patients were divided into two groups: high RWR (≥20%) or low RWR (<20%). At their first visit, we had them complete the Eating Disorder Examination and Repetitive Eating Questionnaires (EDE-Q and Rep(eat)-Q). RESULTS Patients with high RWR reported higher EDE-Q global, dietary restraint and weight concerns without significant group differences in eating and shape concerns. Compared to those patients with low RWR, these patients also indicated greater Rep(eat)-Q global, compulsive grazing and repetitive eating. Global EDE-Q score, eating concern, shape concern, weight concern and all Rep(eat)-Q indexes were positively associated with higher RWR. CONCLUSIONS Disordered EBs occurred more frequently in the group with high RWR. In these patients, eating behavior symptoms and grazing behavior were both correlated to the RWR, suggesting a possible involvement of both conditions in weight regain.
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Affiliation(s)
- Karynne Grutter Lopes
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
| | - Eline Coan Romagna
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
| | - Diogo Menezes Ferrazani Mattos
- MídiaCom/Postgraduate Program on Electrical and Telecommunications Engineering, Fluminense Federal University, Niteroi 24020-140, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
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Chero-Sandoval L, Higuera-Gómez A, Cuevas-Sierra A, de Cuevillas B, Castejón R, Martínez-Urbistondo M, Mellor-Pita S, Moreno-Torres V, de Luis D, Martínez JA. Body mass index and fat influences the role of Bifidobacterium genus in lupus patients concerning fibrinogen levels. Front Microbiol 2024; 15:1471177. [PMID: 39654674 PMCID: PMC11625790 DOI: 10.3389/fmicb.2024.1471177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 11/07/2024] [Indexed: 12/12/2024] Open
Abstract
Introduction Metabolic disorders and autoimmune diseases elicit distinct yet interconnected manifestations of inflammation, which may be boosted by an excess of body adiposity. The purpose of this investigation was to analyze anthropometric, biochemical, and inflammatory/coagulation variables concerning patients diagnosed with systemic lupus erythematosus (SLE) exploiting low-grade metabolic inflammation (MI), as reference. Methods A population stratification by body mass index (BMI), allowed to assess the impact of adiposity on the putative role of gut microbiota composition on coagulation markers. A total of 127 participants with MI and SLE were categorized into two main groups based on their BMI, following WHO criteria: a low BMI group (<30 kg/m2) and a high BMI group (≥30 kg/m2). Each group included recorded data on demographics, comorbidities, and key clinical markers. Anthropometric and body composition variables, clinical features, and inflammatory/coagulation markers were measured while fecal 16S rRNA sequencing was examined at the genus Bifidobacterium. Regression models were fitted to evaluate the relationship between gut microbiota, inflammatory/coagulation markers, and body weight in these types of diseases. Results The study revealed worse clinical outcomes in anthropometric, body composition, and clinical markers in low-grade MI conditions as compared to SLE. However, inflammatory and coagulation markers such as C-reactive protein (CRP) and fibrinogen were significantly more elevated in patients with SLE, which was exacerbated by high BMI/ body fat as compared to the other screened groups. An interaction analysis revealed that fibrinogen levels showed different trends when Bifidobacterium was increased depending on BMI/adiposity, which evidenced an effect modification by this microorganism in patients with SLE. Discussion These findings underline that gut microbiota composition, particularly the presence of Bifidobacterium, may play a crucial role in modulating inflammation and coagulation processes in patients with SLE and high fat. These insights highlight the potential of targeting gut microbiota as a therapeutic strategy to mitigate inflammation and improve clinical outcomes in SLE patients.
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Affiliation(s)
- Lourdes Chero-Sandoval
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, Madrid, Spain
- Department of Endocrinology and Nutrition, University Clinical Hospital, University of Valladolid, Valladolid, Spain
| | - Andrea Higuera-Gómez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, Madrid, Spain
| | - Amanda Cuevas-Sierra
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, Madrid, Spain
- Health Sciences School and Medical Centre, International University of the Rioja (UNIR), Madrid, Spain
| | - Begoña de Cuevillas
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, Madrid, Spain
- Department of Endocrinology and Nutrition, University Clinical Hospital, University of Valladolid, Valladolid, Spain
| | - Raquel Castejón
- Internal Medicine Service, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | | | - Susana Mellor-Pita
- Internal Medicine Service, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Víctor Moreno-Torres
- Health Sciences School and Medical Centre, International University of the Rioja (UNIR), Madrid, Spain
- Internal Medicine Service, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Daniel de Luis
- Centre of Endocrinology and Nutrition, University of Valladolid, Valladolid, Spain
| | - J. Alfredo Martínez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, Madrid, Spain
- Centre of Endocrinology and Nutrition, University of Valladolid, Valladolid, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Madrid, Spain
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Ibacache-Saavedra P, Martínez-Rosales E, Jerez-Mayorga D, Miranda-Fuentes C, Artero EG, Cano-Cappellacci M. Effects of bariatric surgery on muscle strength and quality: A systematic review and meta-analysis. Obes Rev 2024; 25:e13790. [PMID: 38859617 DOI: 10.1111/obr.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 02/06/2024] [Accepted: 05/20/2024] [Indexed: 06/12/2024]
Abstract
Obesity is a major health burden worldwide. Although bariatric surgery (BS) is recognized as an effective strategy for weight loss and comorbidities improvement, its impact on muscle strength and quality is still unclear. We aimed to examine postoperative changes in muscle strength and quality and their relationship with body mass index (BMI) changes among adults undergoing BS. To this end, we systematically searched the WoS, PubMed, EBSCO, and Scopus databases. The meta-analyses, which included 24 articles (666 participants), showed that BS reduces absolute lower-limb isometric strength (ES = -0.599; 95% CI = -0.972, -0.226; p = 0.002). Subjects who experienced a more significant reduction in BMI after BS also suffered a higher loss of absolute muscle strength. Similarly, absolute handgrip strength showed a significant decrease (ES = -0.376; 95% CI = -0.630, -0.121; p = 0.004). We found insufficient studies investigating medium- and long-term changes in muscle strength and/or quality after BS. This study provides moderate-quality evidence that BS-induced weight loss can reduce the strength of appendicular muscles in the short term, which should be addressed in management these subjects. More high-quality studies are needed to evaluate the impact of BS on muscle strength and the different domains of muscle quality in the medium and long term (registered on PROSPERO CRD42022332581).
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Affiliation(s)
- Paulina Ibacache-Saavedra
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Elena Martínez-Rosales
- Department of Education & SPORT Research Group (CTS-1024), CIBIS Research Center, University of Almería, Almería, Spain
| | - Daniel Jerez-Mayorga
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Claudia Miranda-Fuentes
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Enrique G Artero
- Department of Education & SPORT Research Group (CTS-1024), CIBIS Research Center, University of Almería, Almería, Spain
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Li X, Huang Y, Chen M. Correlation of weight-adjusted waist index with diabetic retinopathy in US adults aged ≥ 40 years: the NHANES 2005-2008. Sci Rep 2024; 14:19369. [PMID: 39169035 PMCID: PMC11339398 DOI: 10.1038/s41598-024-69404-5] [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: 06/29/2023] [Accepted: 08/05/2024] [Indexed: 08/23/2024] Open
Abstract
The effect of obesity on diabetic retinopathy (DR) has been under scrutiny in recent years. The weight-adjusted waist index (WWI) has been reported to better assess the degree of centripetal obesity in humans, with a higher WWI indicating a higher amount of body fat. The present study is the first to investigate the relationship between WWI and DR and to assess the difference in the predictive ability of WWI and other obesity indices for DR. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008. Researchers collected complete anthropometric data (weight and waist circumference), dilated fundus images, and adult baseline information. Independent interactions between WWI and DR were investigated using multivariate regression and subgroup analyses. In addition, nonlinear associations and threshold effects between WWI and DR were searched for by smoothed curve fitting and by two-stage linear regression modeling. Finally, the receiver operating characteristic curve (ROC) was plotted to compare the predictive power of WWI with other indices of obesity for DR. A total of 1228 eligible patients with diabetes were collected in this study. There were 631 (51.38%) males and 597 (48.62%) females. Among them, 545 (44.38%) were without diabetic retinopathy, 555 (45.20%) had mild diabetic retinopathy, 100 (8.14%) had moderate/severe diabetic retinopathy and 28 (2.28%) had proliferative diabetic retinopathy (PDR). In the fully adjusted model, each unit increase in WWI was associated with a corresponding 31% reduction in the prevalence of DR [OR (95% CI) = 0.69 (0.58, 0.83)]. Compared with subjects in the lowest quartile (quartile 1), subjects in the highest quartile of WWI levels (quartile 4) were 45% less likely to have DR [OR (95% CI) = 0.55 (0.38, 0.78)]. In the case of female participants, a U-shaped correlation was observed between WWI and DR with an inflection point of 11.49. WWI also possesses a better predictive ability for DR compared to obesity indicators such as weight, BMI, and ABSI. This study showed a negative association between WWI and DR in the U.S. population aged 40 years and older.
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Affiliation(s)
- Xiao Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanqin Huang
- Department of Endocrinology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Meirong Chen
- Department of Ophthalmology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
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Bullo V, Pavan D, Gobbo S, Bortoletto A, Cugusi L, Di Blasio A, Pippi R, Cruz-Diaz D, Bocalini DS, Gasperetti A, Vettor R, Ermolao A, Bergamin M. From surgery to functional capacity: muscle strength modifications in women post sleeve gastrectomy. BMC Sports Sci Med Rehabil 2024; 16:118. [PMID: 38802963 PMCID: PMC11131216 DOI: 10.1186/s13102-024-00910-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Severe obesity is characterized by excessive accumulation of fat generating a general health decline. Multidisciplinary treatment of obesity leads to significant weight loss in a few patients; therefore, many incur bariatric surgery. The main purpose of the study is to evaluate changes in functional capacity of people with obesity undergoing bariatric surgery and, in parallel, to correlate pre-surgery functional capacity with weight loss to improve exercise prescription during pre-operatory stage. METHODS sixty women with diagnosed obesity were included. Maximal oxygen consumption, upper and lower limb strength and level of physical activity were recorded 1 month before and 6 months after sleeve gastrectomy. RESULTS significant reduction on body weight (-30.1 kg) and Body Mass Index (-11.4 kg/m2) were highlighted after surgery. Absolute grip strength decreased significantly (-1.1 kg), while body weight normalized grip and lower limb strength increased significantly. The level of physical activity increased especially in leisure time (+ 593 METs/week) and active transport (+ 189.3 METs/week). Pre-surgery BMI and age predicted the amount of weight loss after surgery. CONCLUSIONS Sleeve gastrectomy induces a reduction of muscle strength despite the increase of time spent in physical activity. Further research is necessary to integrate these results with data on body composition, and objective evaluation of physical activity level to define useful information for exercise prescription in terms of surgery pre-habilitation. TRIAL REGISTRATION Padova University Hospital Board (protocol n. 2027 dated January 12, 2017).
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Affiliation(s)
- Valentina Bullo
- Department of Medicine, University of Padova, Via Giustiniani, 2, Padova, 35128, Italy
| | - Davide Pavan
- GymHub S.r.l, Spin-off of the University of Padova, Via O. Galante 67/a, Padova, 35129, Italy
| | - Stefano Gobbo
- Department of Medicine, University of Padova, Via Giustiniani, 2, Padova, 35128, Italy.
| | - Alessandro Bortoletto
- Department of Medicine, University of Padova, Via Giustiniani, 2, Padova, 35128, Italy
| | - Lucia Cugusi
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/B, Sassari, 07100, Italy
| | - Andrea Di Blasio
- Department of Medicine and Sciences of Aging, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, Chieti, 66100, Italy
| | - Roberto Pippi
- Department of Medicine and Surgery, Healthy Lifestyle Institute, C.U.R.I.A.Mo. (Centro Universitario Ricerca Interdipartimentale Attività Motoria), University of Perugia, Via G. Bambagioni, 19, Perugia, 06126, Italy
| | - David Cruz-Diaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jean, Spain
| | - Danilo Sales Bocalini
- Laboratorio de Fisiologia e Bioquimica Experimental, Centro de Educacao Fisica e Deportos, Universida-Federal do Espirito Santo (UFES), Av. Fernando Ferrari, 514, Goiabeiras, Vitória, Espírito Santo, 29075-910, Brazil
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, Padova, 35128, Italy
| | - Roberto Vettor
- Department of Medicine, Azienda Ospedaliera Padova, University of Padova, Clinica Medica 3, Padova, 35122, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, Padova, 35128, Italy
| | - Marco Bergamin
- Department of Medicine, University of Padova, Via Giustiniani, 2, Padova, 35128, Italy
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11
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Janssen JAMJL. Overnutrition, Hyperinsulinemia and Ectopic Fat: It Is Time for A Paradigm Shift in the Management of Type 2 Diabetes. Int J Mol Sci 2024; 25:5488. [PMID: 38791525 PMCID: PMC11121669 DOI: 10.3390/ijms25105488] [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: 04/15/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
The worldwide incidence of prediabetes/type 2 has continued to rise the last 40 years. In the same period, the mean daily energy intake has increased, and the quality of food has significantly changed. The chronic exposure of pancreatic β-cells to calorie excess (excessive energy intake) and food additives may increase pancreatic insulin secretion, decrease insulin pulses and/or reduce hepatic insulin clearance, thereby causing chronic hyperinsulinemia and peripheral insulin resistance. Chronic calorie excess and hyperinsulinemia may promote lipogenesis, inhibit lipolysis and increase lipid storage in adipocytes. In addition, calorie excess and hyperinsulinemia can induce insulin resistance and contribute to progressive and excessive ectopic fat accumulation in the liver and pancreas by the conversion of excess calories into fat. The personal fat threshold hypothesis proposes that in susceptible individuals, excessive ectopic fat accumulation may eventually lead to hepatic insulin receptor resistance, the loss of pancreatic insulin secretion, hyperglycemia and the development of frank type 2 diabetes. Thus, type 2 diabetes seems (partly) to be caused by hyperinsulinemia-induced excess ectopic fat accumulation in the liver and pancreas. Increasing evidence further shows that interventions (hypocaloric diet and/or bariatric surgery), which remove ectopic fat in the liver and pancreas by introducing a negative energy balance, can normalize insulin secretion and glucose tolerance and induce the sustained biochemical remission of type 2 diabetes. This pathophysiological insight may have major implications and may cause a paradigm shift in the management of type 2 diabetes: avoiding/reducing ectopic fat accumulation in the liver and pancreas may both be essential to prevent and cure type 2 diabetes.
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Affiliation(s)
- Joseph A M J L Janssen
- Department of Internal Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
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12
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Guglielmi V, Dalle Grave R, Leonetti F, Solini A. Female obesity: clinical and psychological assessment toward the best treatment. Front Endocrinol (Lausanne) 2024; 15:1349794. [PMID: 38765954 PMCID: PMC11099266 DOI: 10.3389/fendo.2024.1349794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Obesity is a heterogeneous condition which results from complex interactions among sex/gender, sociocultural, environmental, and biological factors. Obesity is more prevalent in women in most developed countries, and several clinical and psychological obesity complications show sex-specific patterns. Females differ regarding fat distribution, with males tending to store more visceral fat, which is highly correlated to increased cardiovascular risk. Although women are more likely to be diagnosed with obesity and appear more motivated to lose weight, as confirmed by their greater representation in clinical trials, males show better outcomes in terms of body weight and intra-abdominal fat loss and improvements in the metabolic risk profile. However, only a few relatively recent studies have investigated gender differences in obesity, and sex/gender is rarely considered in the assessment and management of the disease. This review summarizes the evidence of gender differences in obesity prevalence, contributing factors, clinical complications, and psychological challenges. In addition, we explored gender differences in response to obesity treatments in the specific context of new anti-obesity drugs.
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Affiliation(s)
- Valeria Guglielmi
- Unit of Internal Medicine and Obesity Center, Department of Systems Medicine, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, VR, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
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13
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Becerril S, Cienfuegos JA, Rodríguez A, Catalán V, Ramírez B, Valentí V, Moncada R, Unamuno X, Gómez-Ambrosi J, Frühbeck G. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy generates sustained improvement of glycemic control compared with sleeve gastrectomy in the diet-induced obese rat model. J Physiol Biochem 2024; 80:149-160. [PMID: 37935948 PMCID: PMC10810039 DOI: 10.1007/s13105-023-00993-x] [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: 03/14/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023]
Abstract
Bariatric surgery has become a recognized and effective procedure for treating obesity and type 2 diabetes (T2D). Our objective was to directly compare the caloric intake-independent effects of sleeve gastrectomy (SG) and single anastomosis duodenoileal bypass with SG (SADI-S) on glucose tolerance in rats with diet-induced obesity (DIO) and to elucidate the differences between bariatric surgery and caloric restriction.A total of 120 adult male Wistar rats with DIO and insulin resistance were randomly assigned to surgical (sham operation, SG, and SADI-S) and dietary (pair-feeding the amount of food eaten by animals undergoing the SG or SADI-S surgeries) interventions. Body weight and food intake were weekly monitored, and 6 weeks after interventions, fasting plasma glucose, oral glucose and insulin tolerance tests, plasma insulin, adiponectin, GIP, GLP-1, and ghrelin levels were determined.The body weight of SADI-S rats was significantly (p < 0.001) lower as compared to the sham-operated, SG, and pair-fed groups. Furthermore, SADI-S rats exhibited decreased whole body fat mass (p < 0.001), lower food efficiency rates (p < 0.001), and increased insulin sensitivity, as well as improved glucose and lipid metabolism compared to that of the SG and pair-fed rats.SADI-S was more effective than SG, or caloric restriction, in improving glycemic control and metabolic profile, with a higher remission of insulin resistance as well as long-term weight loss.
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Affiliation(s)
- Sara Becerril
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain.
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
| | - Javier A Cienfuegos
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Department of Surgery, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Víctor Valentí
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Department of Surgery, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Rafael Moncada
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Department of Anesthesia, Clínica Universidad de Navarra, Pamplona, Spain
| | - Xabier Unamuno
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Medical Engineering Laboratory, University of Navarra, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain.
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Avda. Pío XII, 36, Pamplona, Spain.
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14
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Perdomo CM, Landecho MF, Valentí V, Moncada R, Frühbeck G. Clinical Perspectives, Eligibility, and Success Criteria for Bariatric/Metabolic Surgery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1460:677-695. [PMID: 39287869 DOI: 10.1007/978-3-031-63657-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Obesity is a worldwide chronic, complex, and progressive disease that poses a challenge for physicians to pursue optimal therapeutic decision making. This chapter focuses on the definition of obesity, based on excessive fat accumulation, and thus underscores the importance of body composition, and the clinical tools used to diagnose it in the context of excess weight, metabolic alteration, and obesity-associated comorbidity development. Additionally, it addresses the indications for surgery that are currently applicable and the description of the different types of patients who could benefit the most from the surgical management of excessive body fat and its associated metabolic derangements and quality of life improvement. Furthermore, it also highlights plausible underlying mechanisms of action for the beneficial effects following bariatric/metabolic surgery.
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Affiliation(s)
- Carolina M Perdomo
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, University of Navarra, IdiSNA, Pamplona, Spain
- CIBEROBN, Instituto de Salud Carlos III, Pamplona, Spain
| | - Manuel F Landecho
- Department of Internal Medicine, Health Check-Up Area, Clínica Universidad de Navarra, University of Navarra, IdISNA, Pamplona, Spain
| | - Víctor Valentí
- CIBEROBN, Instituto de Salud Carlos III, Pamplona, Spain
- Department of Surgery, Clínica Universidad de Navarra, University of Navarra, IdISNA, Pamplona, Spain
| | - Rafael Moncada
- CIBEROBN, Instituto de Salud Carlos III, Pamplona, Spain
- Department of Anesthesia, Clínica Universidad de Navarra, University of Navarra, IdISNA, Pamplona, Spain
| | - Gema Frühbeck
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, University of Navarra, IdiSNA, Pamplona, Spain.
- CIBEROBN, Instituto de Salud Carlos III, Pamplona, Spain.
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15
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Pakhare M, Anjankar A. Critical Correlation Between Obesity and Cardiovascular Diseases and Recent Advancements in Obesity. Cureus 2024; 16:e51681. [PMID: 38314003 PMCID: PMC10838385 DOI: 10.7759/cureus.51681] [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: 07/26/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Scientific literature has investigated and well-documented the complex relationship between obesity and cardiovascular diseases. Obese people are much more likely to have atrial fibrillation, dyslipidemia, diabetes, and coronary artery disease, among other cardiovascular conditions. Additionally, obesity poses a severe risk for diseases like hypertension, heart failure, and atherosclerotic heart diseases, affecting various aspects relating to their underlying mechanisms, diagnosis, and clinical effects. This article summarizes recent developments in our understanding of and response to obesity. Pharmacotherapy, gut microbiome research, bariatric surgery, digital health solutions, behavioral interventions, and precision medicine are just a few of the fields in which these developments have been made. While liposuction offers a less invasive option for redistributing volume and getting positive results, bariatric surgery remains the most effective treatment for severe obesity. Emphasis is placed on the pathophysiological mechanisms that underlie the complex interactions between obesity and a number of diseases, such as atrial fibrillation, diabetes, hypertension, dyslipidemia, and coronary artery disease. The significance of lifestyle changes in reducing the cardiovascular risks associated with obesity, such as atrial fibrillation and heart disease, is emphasized. To improve overall cardiovascular health and achieve better clinical outcomes, obesity must be promptly identified and actively managed. Investigations into how the gut microbiome affects obesity, the creation of novel pharmacological treatments for appetite suppression and metabolic enhancement, improvements in bariatric surgery methods that emphasize patient success and safety, as well as creative digital health solutions and behavioral treatments, are some examples of emerging research fields. In addition, precision medicine approaches, including the modulation of the gut microbiome through dietary changes and supplements, hold great promise in combating obesity and its associated comorbidities and have the potential to revolutionize the management of obesity by tailoring treatments to the specific needs of individual patients.
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Affiliation(s)
- Mahesh Pakhare
- Medical Education, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Anjankar
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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16
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MacAskill W, Gillanders T, Wylie N, Pinidiyapathirage J. Finding what works-Patients' long-term experiences of weight maintenance post bariatric surgery: A systematic review and thematic synthesis of qualitative studies. Obes Rev 2023; 24:e13608. [PMID: 37519095 DOI: 10.1111/obr.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/29/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
Individuals with obesity can attain significant weight loss in a relatively short timeframe following bariatric surgery; however, new healthy behaviors must be sustained in perpetuity to maintain weight loss. This study investigates patients' views on the facilitators and barriers to long-term weight loss maintenance following bariatric surgery. Systematic searches of Medline, PsycINFO, and CINAHL databases identified 403 studies with 15 fitting the study inclusion criteria. Included studies were independently appraised using Critical Appraisal Skills Program (CASP). Data extraction and thematic synthesis generated three themes: changing food relationships, navigating inter- and intrapersonal influences, and caring health professionals. These appeared across six organizing sub-themes: building new food relationships, creating healthy habits, relationships with others, internalized stressors, finding and defining success, and ongoing patient education. Patients experienced a variety of barriers and facilitators to weight loss maintenance, with some facilitators diminishing over time. The findings demonstrate the importance of considering patients' perspectives and individual contexts to assist them to negotiate and overcome challenges to long-term weight loss maintenance post-bariatric surgery.
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Affiliation(s)
- William MacAskill
- Griffith University Rural Clinical School, Toowoomba, Queensland, Australia
- Rural Medical Education Australia, Toowoomba, Queensland, Australia
| | - Tobias Gillanders
- Griffith University Rural Clinical School, Toowoomba, Queensland, Australia
- Rural Medical Education Australia, Toowoomba, Queensland, Australia
| | - Neil Wylie
- Darling Downs General Surgery, St. Andrew's Hospital, Toowoomba, Queensland, Australia
| | - Janani Pinidiyapathirage
- Griffith University Rural Clinical School, Toowoomba, Queensland, Australia
- Rural Medical Education Australia, Toowoomba, Queensland, Australia
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17
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Aguas-Ayesa M, Yárnoz-Esquíroz P, Olazarán L, Gómez-Ambrosi J, Frühbeck G. Precision nutrition in the context of bariatric surgery. Rev Endocr Metab Disord 2023; 24:979-991. [PMID: 36928810 PMCID: PMC10020075 DOI: 10.1007/s11154-023-09794-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Bariatric surgery (BS) is the most effective long-term treatment for severe obesity. This review summarizes the main nutritional deficiencies before and after BS, as well as current dietary and supplementation recommendations to avoid them. Likewise, we have reviewed all those aspects that in recent years have been shown to be related to postoperative weight loss (WL) and its subsequent maintenance, such as hormonal changes, dietary patterns, changes in food preference, adherence to recommendations and follow-up, genetic factors and microbiota, among others. Despite all the knowledge, nutritional deficiencies and weight regain after BS are frequent. It is essential to continue studying in this field in order to establish more precise recommendations according to the individual characteristics of patients. It is also a major objective to understand more deeply the role of the factors involved in WL and its maintenance. This will allow the development of precision treatments and nutrition for patients with obesity, optimizing their benefit after BS.
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Affiliation(s)
- Maite Aguas-Ayesa
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 31008, Pamplona, Spain.
| | - Patricia Yárnoz-Esquíroz
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain
| | - Laura Olazarán
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 31008, Pamplona, Spain
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 31008, Pamplona, Spain.
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
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18
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Young MC, Bhandarkar AR, Portela RC, Jarrah R, Bydon M, Clapp B, Kumar A, Ghanem OM. Bariatric surgery reduces odds of perioperative complications after inpatient hysterectomy: Analysis from a national database, 2016 to 2018. Surgery 2023; 174:766-773. [PMID: 37516562 DOI: 10.1016/j.surg.2023.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/18/2023] [Accepted: 06/18/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Increased body mass index is a known risk factor for increased adverse events post-hysterectomy. The effects of previous bariatric surgery on outcomes after inpatient hysterectomy are not well elucidated. METHODS The 2016 to 2018 National Inpatient Sample was queried for patients who underwent hysterectomy using International Classification of Disease 10 Procedure Codes before a matched analysis was performed to neutralize the potential confounding effects of comorbidities, body mass index, and age. Patients were divided into the following 2 groups: a case group (those with a history of bariatric surgery) and a control group (those without a history of bariatric surgery). Patients in the respective groups were matched 1:2 by age, Elixhauser comorbidity score, and body mass index at the time of surgery to analyze the risk of complications and mean length of stay. RESULTS When 1:2 case-control matching was performed, women with a history of bariatric surgery (N = 595) had significantly fewer complications and decreased mean length of stay than the non-bariatric group (N = 1,190), even after controlling for body mass index at the time of hysterectomy. CONCLUSIONS When matched for age, body mass index, and comorbidity score, patients with previous bariatric surgery had fewer complications and shorter lengths of stay than patients without a history of bariatric surgery. Women with a body mass index ≥40 kg/m2 requiring non-urgent hysterectomy may benefit from undergoing bariatric surgery first.
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Affiliation(s)
| | - Archis R Bhandarkar
- Mayo Clinic Alix School of Medicine, Rochester, MN; Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
| | | | - Ryan Jarrah
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN
| | - Mohamad Bydon
- Mayo Clinic Department of Neurosurgery, Rochester, MN
| | - Benjamin Clapp
- Texas Tech University Department of Surgery, El Paso, TX
| | - Amanika Kumar
- Mayo Clinic Department of Obstetrics and Gynecology, Rochester, MN
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19
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Pereira SS, Guimarães M, Monteiro MP. Towards precision medicine in bariatric surgery prescription. Rev Endocr Metab Disord 2023; 24:961-977. [PMID: 37129798 PMCID: PMC10492755 DOI: 10.1007/s11154-023-09801-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 05/03/2023]
Abstract
Obesity is a complex, multifactorial and chronic disease. Bariatric surgery is a safe and effective treatment intervention for obesity and obesity-related diseases. However, weight loss after surgery can be highly heterogeneous and is not entirely predictable, particularly in the long-term after intervention. In this review, we present and discuss the available data on patient-related and procedure-related factors that were previously appointed as putative predictors of bariatric surgery outcomes. In addition, we present a critical appraisal of the available evidence on which factors could be taken into account when recommending and deciding which bariatric procedure to perform. Several patient-related features were identified as having a potential impact on weight loss after bariatric surgery, including age, gender, anthropometrics, obesity co-morbidities, eating behavior, genetic background, circulating biomarkers (microRNAs, metabolites and hormones), psychological and socioeconomic factors. However, none of these factors are sufficiently robust to be used as predictive factors. Overall, there is no doubt that before we long for precision medicine, there is the unmet need for a better understanding of the socio-biological drivers of weight gain, weight loss failure and weight-regain after bariatric interventions. Machine learning models targeting preoperative factors and effectiveness measurements of specific bariatric surgery interventions, would enable a more precise identification of the causal links between determinants of weight gain and weight loss. Artificial intelligence algorithms to be used in clinical practice to predict the response to bariatric surgery interventions could then be created, which would ultimately allow to move forward into precision medicine in bariatric surgery prescription.
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Affiliation(s)
- Sofia S Pereira
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Marta Guimarães
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
- Department of General Surgery, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido Pinho, 4050-220, Santa Maia da Feira, Portugal
| | - Mariana P Monteiro
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal.
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal.
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20
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van Loon SLM, Gensen C, Nienhuijs SW, Biter LU, Klaassen RA, van 't Hof G, Faneyte IF, Scharnhorst V, Boer AK. The Metabolic Health Index Identifies Patients That Will Benefit From Metabolic Surgery. J Surg Res 2023; 285:211-219. [PMID: 36696708 DOI: 10.1016/j.jss.2022.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/17/2022] [Accepted: 10/16/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Metabolic syndrome is a modern world's major health hazard related to comorbidities like type 2 diabetes and cardiovascular disease. Bariatric surgery is well known to lower this health risk in patients with obesity. There is a need for an objective measure to assess the intended reduction in health hazard and indirectly the eligibility for bariatric surgery. The Metabolic Health Index (MHI) quantitatively summarizes the cumulative impact of the metabolic syndrome on health status on a scale from 1 to 6. This study describes the use of the MHI as a supportive tool in the decision for and outcome assessment of bariatric surgery. METHODS The general usability of the MHI was tested by extending its application to patient data of five other bariatric centers in the Netherlands. Retrospective laboratory and national bariatric quality registry data of 11,501 patients were collected. RESULTS The quantification of (improvement in) metabolic health burden as measured by the MHI was independent of the dataset that was used to derive the MHI model. Patients with MHI > 2.8 prior to surgery improved significantly more in MHI 12 mo after surgery compared to patients with MHI ≤ 2.8 (1.1 compared to 0.4 MHI points, respectively; P < 0.001). CONCLUSIONS The MHI is robust between centers and is suitable for general use in clinical decision-making. As changes in MHI over time reflect metabolic health alterations, it is suitable as an outcome measure of surgery. An MHI cut-off value of 2.8 helps to predict the likelihood of significant improvement after surgery, independent of body mass index and known metabolic comorbidities.
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Affiliation(s)
- Saskia L M van Loon
- General Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry, Eindhoven, the Netherlands; Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Carmen Gensen
- General Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - L Ulas Biter
- Department of Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - René A Klaassen
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Gerhard van 't Hof
- Department of Surgery, Bariatric Center SW Netherlands, Bergen op Zoom, the Netherlands
| | - Ian F Faneyte
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Volkher Scharnhorst
- General Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Arjen-Kars Boer
- General Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
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21
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Liu T, Zou X, Ruze R, Xu Q. Bariatric Surgery: Targeting pancreatic β cells to treat type II diabetes. Front Endocrinol (Lausanne) 2023; 14:1031610. [PMID: 36875493 PMCID: PMC9975540 DOI: 10.3389/fendo.2023.1031610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
Pancreatic β-cell function impairment and insulin resistance are central to the development of obesity-related type 2 diabetes mellitus (T2DM). Bariatric surgery (BS) is a practical treatment approach to treat morbid obesity and achieve lasting T2DM remission. Traditionally, sustained postoperative glycemic control was considered a direct result of decreased nutrient intake and weight loss. However, mounting evidence in recent years implicated a weight-independent mechanism that involves pancreatic islet reconstruction and improved β-cell function. In this article, we summarize the role of β-cell in the pathogenesis of T2DM, review recent research progress focusing on the impact of Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) on pancreatic β-cell pathophysiology, and finally discuss therapeutics that have the potential to assist in the treatment effect of surgery and prevent T2D relapse.
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Affiliation(s)
- Tiantong Liu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Xi Zou
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rexiati Ruze
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Xu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
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22
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Okikawa S, Kashihara H, Shimada M, Yoshikawa K, Tokunaga T, Nishi M, Takasu C, Wada Y, Yoshimoto T. Effect of duodenal-jejunal bypass on diabetes in the early postoperative period. Sci Rep 2023; 13:1856. [PMID: 36726038 PMCID: PMC9892584 DOI: 10.1038/s41598-023-28923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
Metabolic surgery is an effective treatment for patients with type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the effect of duodenal-jejunal bypass (DJB) in a rat model of T2DM during the early postoperative period. A rat model of non-obese T2DM was allocated to two groups: a sham group and a DJB group. On postoperative day 1 (1POD), oral glucose tolerance testing (OGTT) was performed and the changes of glucose transporter expressions in the small intestine was evaluated. [18F]-fluorodeoxyglucose ([18]-FDG) uptake was measured in sham- and DJB-operated rats using positron emission tomography-computed tomography (PET-CT). DJB improved the glucose tolerance of the rats on 1POD. The expression of sodium-glucose cotransporter 1 (SGLT1) and glucose transporter 1 (GLUT1) was high, and that of GLUT2 was low in the alimentary limb (AL) of rats in the DJB group. PET-CT showed that [18F]-FDG uptake was high in the proximal jejunum of DJB-operated rats. These results may show that DJB improve glucose tolerance in very early postoperative period as the result of glucose accumulation in the AL because of changes in glucose transporter expression.
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Affiliation(s)
- Shohei Okikawa
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan
| | - Hideya Kashihara
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan.
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan
| | - Kozo Yoshikawa
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan
| | - Takuya Tokunaga
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan
| | - Masaaki Nishi
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan
| | - Chie Takasu
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan
| | - Yuma Wada
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan
| | - Toshiaki Yoshimoto
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima, Tokushima, 770-8503, Japan
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23
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Juárez-Hernández E, Velázquez-Alemán AP, Castro-Narro G, Uribe M, López-Méndez I. Bariatric endoscopic-surgical therapies for NAFLD. Should they be considered viable options among current treatments? Front Endocrinol (Lausanne) 2022; 13:1026444. [PMID: 36523596 PMCID: PMC9745034 DOI: 10.3389/fendo.2022.1026444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
Nowadays, non-alcoholic fatty liver disease is one of the first causes of liver transplant worldwide; many efforts have been done to find the perfect drug for this multifactorial disease. Presently we just have a few drugs that could be used in specific and limited clinical scenarios. Current evidence suggests that bariatric endoscopic and surgical therapies could be strategies with optimal outcomes, with high impact in quality of life, decrease of cardiovascular risk, and improvement in metabolic profile, despite being considered expensive procedures. This review proposes to consider these therapies early together with liver fibrosis evaluation, with long term cost-effectiveness benefits in the absence of response to lifestyle modifications and pharmacological treatments.
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Affiliation(s)
- Eva Juárez-Hernández
- Translational Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | | | - Graciela Castro-Narro
- Hepatology and Transplants Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Misael Uribe
- Gastroenterology and Obesity Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Iván López-Méndez
- Hepatology and Transplants Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
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24
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Becerril S, Tuero C, Cienfuegos JA, Rodríguez A, Catalán V, Ramírez B, Valentí V, Moncada R, Unamuno X, Gómez-Ambrosi J, Frühbeck G. Improved Adipose Tissue Function after Single Anastomosis Duodeno-Ileal Bypass with Sleeve-Gastrectomy (SADI-S) in Diet-Induced Obesity. Int J Mol Sci 2022; 23:ijms231911641. [PMID: 36232953 PMCID: PMC9570280 DOI: 10.3390/ijms231911641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022] Open
Abstract
Bariatric surgery has been recognized as the safest and most effective procedure for controlling type 2 diabetes (T2D) and obesity in carefully selected patients. The aim of the present study was to compare the effects of Sleeve Gastrectomy (SG) and Single Anastomosis Duodenoileal Bypass with SG (SADI-S) on the metabolic profile of diet-induced obese rats. A total of 35 four-week-old male Wistar rats were submitted to surgical interventions (sham operation, SG and SADI-S) after 4 months of being fed a high-fat diet. Body weight, metabolic profile and the expression of molecules involved in the control of subcutaneous white (SCWAT), brown (BAT) and beige (BeAT) adipose tissue function were analyzed. SADI-S surgery was associated with significantly decreased amounts of total fat pads (p < 0.001) as well as better control of lipid and glucose metabolism compared to the SG counterparts. An improved expression of molecules involved in fat browning in SCWAT and in the control of BAT and BeAT differentiation and function was observed following SADI-S. Together, our findings provide evidence that the enhanced metabolic improvement and their continued durability after SADI-S compared to SG rely, at least in part, on the improvement of the BeAT phenotype and function.
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Affiliation(s)
- Sara Becerril
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Correspondence:
| | - Carlota Tuero
- Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Javier A. Cienfuegos
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Víctor Valentí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Rafael Moncada
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Anesthesia, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Xabier Unamuno
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Medical Engineering Laboratory, University of Navarra, 31008 Pamplona, Spain
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, 31008 Pamplona, Spain
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Kermansaravi M, Rezvani M, Elmi Sadr F, Valizadeh R, Kabir A, Pazouki A. Association of Hypercholesterolemia With Gastric Intestinal Metaplasia, Findings After Sleeve Gastrectomy Pathology Review. Surg Laparosc Endosc Percutan Tech 2022; 32:549-553. [PMID: 36130718 DOI: 10.1097/sle.0000000000001097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/31/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND We evaluated the relationship between comorbidities associated with obesity, body mass index (BMI), and development of intestinal metaplasia (IM) after vertical sleeve gastrectomy (VSG). MATERIALS AND METHODS All VSG specimens performed at an academic center between 2011 and 2018 were reviewed. All specimens underwent histopathologic assessment, while those with findings suspicious for IM underwent additional immunohistochemical work up. Baseline patient characteristics and demographic data were obtained from Iran National Obesity Surgery Database by retrospective review. RESULTS A total of 862 adult individuals underwent VSG during the study period and specimens were histopathologically examined. All patients had preoperative upper endoscopy. The most common histopathologic diagnosis was miscellaneous findings (57.8%) followed by no pathologic finding (36.7%). The minority of patients (5.5%) had IM. Although 40.5% of patients had positive Helicobacter pylori infection preoperatively, just 13.8% had still positive infection postoperatively. A significant association was found between IM and hypercholesterolemia (odds ratio: 1.95; 95% confidence interval: 1.1, 3.5). CONCLUSION This study found a correlation between histopathologic changes in patients with IM and hypercholesterolemia. Prospective research studies are recommended to further examine this correlation.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran
| | | | | | - Rohollah Valizadeh
- Minimally Invasive Surgery Research Center
- Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences
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26
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Qin Z, Chang K, Yang Q, Yu Q, Liao R, Su B. The association between weight-adjusted-waist index and increased urinary albumin excretion in adults: A population-based study. Front Nutr 2022; 9:941926. [PMID: 36034904 PMCID: PMC9412203 DOI: 10.3389/fnut.2022.941926] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/25/2022] [Indexed: 11/14/2022] Open
Abstract
Aims The negative effect of obesity on kidney health has been reported. The association between weight-adjusted-waist index (WWI, a newly developed adiposity index) and albuminuria has not been reported earlier. Methods This cross-sectional study was conducted among adults with complete data about WWI and urinary albumin-to-creatinine ratio (ACR) in 2005–2018 National Health and Nutrition Examination Survey (NHANES). WWI was calculated as waist circumference (WC) divided by the square root of weight. Weighted multivariable logistic regression and generalized additive model were employed to explore the independent relationship between WWI with albuminuria and its non-linearity. A two-piecewise linear regression model was used to calculate the threshold effect. Subgroup analysis and interaction tests were also performed. Results A total of 36,921 participants were enrolled with a prevalence of albuminuria of 9.32%. The prevalence of albuminuria increased with the higher WWI tertiles (Tertile 1: 5.31%, Tertile 2: 8.23%, Tertile 3: 15.65%). WWI was positively associated with a higher likelihood of albuminuria (OR = 1.28, 95% CI: 1.15–1.43), and this relationship remains stable in subgroups (all P for trend > 0.05). Non-linear positive relationships were detected in females with a breakpoint of 10.93. A positive association between WWI and albuminuria (OR = 1.39, 95% CI: 1.20–1.61) was observed on the right of the breakpoint, while the association on the left was of no statistical significance. WWI showed a stronger correlation with albuminuria (OR = 1.28) than other markers of obesity including body mass index (BMI, OR = 1.02) and WC (OR = 1.01). Conclusion Weight-adjusted-waist index levels were positively related to an increased likelihood of albuminuria in United States adults and showed a stronger relationship than BMI and WC. Our findings indicated that WWI may serve as a simple anthropometric index to predict albuminuria.
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Affiliation(s)
- Zheng Qin
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, China.,Med+ Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Kaixi Chang
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, China.,Med+ Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Qinbo Yang
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, China.,Med+ Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Qiao Yu
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, China.,Med+ Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Ruoxi Liao
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, China.,Med+ Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Baihai Su
- Department of Nephrology, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, China.,Med+ Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
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27
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Coblijn UK, Franken RJ. Comment on: predicting complications following bariatric surgery, the diagnostic accuracy of available tools. Surg Obes Relat Dis 2022; 18:886-887. [DOI: 10.1016/j.soard.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
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28
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Effect of Bariatric Surgery on Long-Term Cardiovascular Outcomes: A Systematic Review and Meta-analysis of Population-Based Cohort Studies. Surg Obes Relat Dis 2022; 18:1074-1086. [DOI: 10.1016/j.soard.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/13/2022] [Accepted: 05/04/2022] [Indexed: 02/07/2023]
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29
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Xue Y, Lyu C, Taylor A, Van Ee A, Kiemen A, Choi Y, Khavanian N, Henn D, Lee C, Hwang L, Wier E, Wang S, Lee S, Li A, Kirby C, Wang G, Wu PH, Wirtz D, Garza LA, Reddy SK. Mechanical tension mobilizes Lgr6 + epidermal stem cells to drive skin growth. SCIENCE ADVANCES 2022; 8:eabl8698. [PMID: 35476447 PMCID: PMC9045722 DOI: 10.1126/sciadv.abl8698] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Uniquely among mammalian organs, skin is capable of marked size change in adults, yet the mechanisms underlying this notable capacity are unclear. Here, we use a system of controlled tissue expansion in mice to uncover cellular and molecular determinants of skin growth. Through machine learning-guided three-dimensional tissue reconstruction, we capture morphometric changes in growing skin. We find that most growth is driven by the proliferation of the epidermis in response to mechanical tension, with more limited changes in dermal and subdermal compartments. Epidermal growth is achieved through preferential activation and differentiation of Lgr6+ stem cells of the epidermis, driven in part by the Hippo pathway. By single-cell RNA sequencing, we uncover further changes in mechanosensitive and metabolic pathways underlying growth control in the skin. These studies point to therapeutic strategies to enhance skin growth and establish a platform for understanding organ size dynamics in adult mammals.
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Affiliation(s)
- Yingchao Xue
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Chenyi Lyu
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Ainsley Taylor
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Amy Van Ee
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Ashley Kiemen
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
| | - YoungGeun Choi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Nima Khavanian
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Dominic Henn
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Chaewon Lee
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Lisa Hwang
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Eric Wier
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Saifeng Wang
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Sam Lee
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Ang Li
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Charles Kirby
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Gaofeng Wang
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Pei-Hsun Wu
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Denis Wirtz
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Luis A. Garza
- Department of Dermatology, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Cell Biology, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
- Corresponding author. (S.K.R.); (L.A.G.)
| | - Sashank K. Reddy
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD 21231, USA
- Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21231, USA
- Corresponding author. (S.K.R.); (L.A.G.)
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30
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Unamuno X, Gómez-Ambrosi J, Becerril S, Álvarez-Cienfuegos FJ, Ramírez B, Rodríguez A, Ezquerro S, Valentí V, Moncada R, Mentxaka A, Llorente M, Silva C, Elizalde MDLR, Catalán V, Frühbeck G. Changes in mechanical properties of adipose tissue after bariatric surgery driven by extracellular matrix remodelling and neovascularization are associated with metabolic improvements. Acta Biomater 2022; 141:264-279. [PMID: 35007786 DOI: 10.1016/j.actbio.2022.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/08/2023]
Abstract
Biomechanical properties of adipose tissue (AT) are closely involved in the development of obesity-associated comorbidities. Bariatric surgery (BS) constitutes the most effective option for a sustained weight loss in addition to improving obesity-associated metabolic diseases including type 2 diabetes (T2D). We aimed to determine the impact of weight loss achieved by BS and caloric restriction (CR) on the biomechanical properties of AT. BS but not CR changed the biomechanical properties of epididymal white AT (EWAT) from a diet-induced obesity rat model, which were associated with metabolic improvements. We found decreased gene expression levels of collagens and Lox together with increased elastin and Mmps mRNA levels in EWAT after BS, which were also associated with the biomechanical properties. Moreover, an increased blood vessel density was observed in EWAT after surgery, confirmed by an upregulation of Acta2 and Antxr1 gene expression levels, which was also correlated with the biomechanical properties. Visceral AT from patients with obesity showed increased stiffness after tensile tests compared to the EWAT from the animal model. This study uncovers new insights into EWAT adaptation after BS with decreased collagen crosslink and synthesis as well as an increased degradation together with enhanced blood vessel density providing, simultaneously, higher stiffness and more ductility. STATEMENT OF SIGNIFICANCE: Biomechanical properties of the adipose tissue (AT) are closely involved in the development of obesity-associated comorbidities. In this study, we show for the first time that biomechanical properties of AT determined by E, UTS and strain at UTS are decreased in obesity, being increased after bariatric surgery by the promotion of ECM remodelling and neovascularization. Moreover, these changes in biomechanical properties are associated with improvements in metabolic homeostasis. Consistently, a better characterization of the plasticity and biomechanical properties of the AT after bariatric surgery opens up a new field for the development of innovative strategies for the reduction of fibrosis and inflammation in AT as well as to better understand obesity and its associated comorbidities.
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Ibacache-Saavedra P, Jerez-Mayorga D, Carretero-Ruiz A, Miranda-Fuentes C, Cano-Cappellacci M, Artero EG. Effects of bariatric surgery on cardiorespiratory fitness: A systematic review and meta-analysis. Obes Rev 2022; 23:e13408. [PMID: 34927337 DOI: 10.1111/obr.13408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
Although bariatric surgery (BS) is recognized as an effective strategy for body weight loss, its impact on cardiorespiratory fitness (CRF) is still unclear. We aimed to examine postoperative changes in CRF (VO2max/peak ) and its relationship with weight loss among adults undergoing BS. We systematically searched the WoS, PubMed, MEDLINE, and Scopus databases. Observational and intervention studies were selected reporting the presurgery and postsurgery CRF, measured by breath-by-breath VO2 or its estimation. Eleven articles (312 patients) revealed that BS leads to a reduction in absolute VO2max/peak in the short term (effect size, ES = -0.539; 95%CI = -0.708, -0.369; p < 0.001), and those patients who suffered a more significant decrease in BMI after BS also had a greater loss of absolute VO2max/peak . However, VO2max/peak relative to body weight increased after surgery (ES = 0.658; 95%CI = 0.473, 0.842; p < 0.001). An insufficient number of studies were found investigating medium and long-term changes in CRF after BS. This study provides moderate-quality evidence that the weight loss induced by BS can reduce CRF in the short term, which represents a therapeutic target to optimize BS outcomes. More high-quality studies are needed to evaluate the impact of BS on VO2max/peak in the short, medium, and long term including normalized values for fat-free mass.
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Affiliation(s)
- Paulina Ibacache-Saavedra
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Daniel Jerez-Mayorga
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Alejandro Carretero-Ruiz
- Department of Education and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almeria, Spain
| | - Claudia Miranda-Fuentes
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | | | - Enrique G Artero
- Department of Education and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almeria, Spain
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Srinivasan M, Thangaraj SR, Arzoun H, Thomas SS, Mohammed L. The Impact of Bariatric Surgery on Cardiovascular Risk Factors and Outcomes: A Systematic Review. Cureus 2022; 14:e23340. [PMID: 35371868 PMCID: PMC8938230 DOI: 10.7759/cureus.23340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/20/2022] [Indexed: 12/04/2022] Open
Abstract
Obesity and its complications are increasing in today's era, with cardiovascular health being one of the most significant obesity-related comorbidities. Hypertension in obesity is considered one of the major causes of death and disability due to their negative repercussions on cardiovascular health. Bariatric surgery is an approved therapeutic modality for obese people in classes II and III who have a body mass index (BMI) of more than 35 kg/m2 and 40 kg/m2, respectively. These weight loss surgeries are procedures that alter metabolism by causing weight reduction and altering gastrointestinal physiology, thereby considerably decreasing cardiometabolic risk factors that have been poorly understood to date. The purpose of this review is to explore the impact of bariatric surgery on reducing cardiac risk factors, in turn protecting the heart from succumbing to premature death. A literature search was done in the following databases: PubMed, Google Scholar, and PubMed Central (PMC). The studies taken into account for this review were observational studies published between 2016 and 2021 in the English language, where the quality was assessed using relevant quality appraisal methodologies. Finally, 10 reports were selected as definitive studies. Upon extensive evaluation of the final studies, it can be concluded that bariatric surgery results in significant weight loss, which lowers metabolic syndrome prevalence, cardiovascular risk factors, and major adverse cardiovascular events, particularly acute coronary events, and a favorable improvement in cardiac structure and function, altogether steering to reduced mortality due to cardiovascular diseases in obese patients. It is also worth noting that, while metabolic surgery can help patients with various metabolic comorbidities, the impact on individuals with hypertension is still debatable. Although the studies show significant effects on the cardiovascular system, these were only observational studies in geographically dispersed locations where each patient's lifestyle patterns and motivational levels could vary. Since real-world data are not fully explored due to the limited randomized controlled trials, it is suggested that further human trials on a larger scale be conducted to provide an even more factual conclusion.
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Affiliation(s)
- Mirra Srinivasan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Santhosh Raja Thangaraj
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Hadia Arzoun
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Siji S Thomas
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Widjaja J, Chu Y, Yang J, Wang J, Gu Y. Can we abandon foregut exclusion for an ideal and safe metabolic surgery? Front Endocrinol (Lausanne) 2022; 13:1014901. [PMID: 36440199 PMCID: PMC9687376 DOI: 10.3389/fendo.2022.1014901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Foregut (foregut exclusions) and hindgut (rapid transit of nutrients to the distal intestine) theories are the most commonly used explanations for the metabolic improvements observed after metabolic surgeries. However, several procedures that do not comprise duodenal exclusions, such as sleeve with jejunojejunal bypass, ileal interposition, and transit bipartition and sleeve gastrectomy were found to have similar diabetes remission rates when compared with duodenal exclusion procedures, such as gastric bypass, biliopancreatic diversion with duodenal switch, and diverted sleeve with ileal interposition. Moreover, the complete exclusion of the proximal intestine could result in the malabsorption of several important micronutrients. This article reviews commonly performed procedures, with and without foregut exclusion, to better comprehend whether there is a critical need to include foregut exclusion in metabolic surgery.
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Affiliation(s)
- Jason Widjaja
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, China
| | - Yuxiao Chu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jianjun Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, China
| | - Jian Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yan Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, China
- *Correspondence: Yan Gu,
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Bae S, Oh J, Song I, Yu KS, Lee S. Considerations for clinical evaluation of the effects of bariatric surgery on the pharmacokinetics of orally administered drugs. Transl Clin Pharmacol 2022; 30:145-154. [PMID: 36247747 PMCID: PMC9532855 DOI: 10.12793/tcp.2022.30.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022] Open
Abstract
Obesity has been a growing worldwide concern, and surgical intervention including bariatric surgery is considered as one of the options for treatment. However, there still is controversy over the change in pharmacokinetics (PKs) of drugs after the surgery. To investigate the potential covariates that can influence the area under the curve (AUC) and maximum plasma concentration (Cmax), the design of previous studies was reviewed based on pre-determined eligibility criteria. Each study calculated the ratios of the AUC and Cmax before and after bariatric surgery. These studies investigated whether the PK parameters were affected by the time after the surgery or by the type of control group. The ratio of the AUC calculated in the early and late follow-up period was similar across Roux-en Y gastric bypass patients. No significant difference in the PK parameters was found between the pre-surgical patients and matched healthy subjects. However, certain control groups could be preferable depending on the purpose of the clinical trial. Although Cmax was inconsistent compared to the AUC, insufficient sampling of the time points may have caused such an inconsistency. This is the first article exploring the appropriate methodology in designing clinical studies for changes in the PK characteristics of orally administered drugs in patients with bariatric surgery.
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Affiliation(s)
- Sungyeun Bae
- Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, and Seoul National University College of Medicine, Seoul 03080, Korea
| | - JungJin Oh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, and Seoul National University College of Medicine, Seoul 03080, Korea
| | - Ildae Song
- Department of Pharmaceutical Science and Technology, Kyungsung University, Busan 48434, Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, and Seoul National University College of Medicine, Seoul 03080, Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, and Seoul National University College of Medicine, Seoul 03080, Korea
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Lupoli R, Lembo E, Rainone C, Schiavo L, Iannelli A, Di Minno MND, Capaldo B. Rate of post-bariatric hypoglycemia using continuous glucose monitoring: A meta-analysis of literature studies. Nutr Metab Cardiovasc Dis 2022; 32:32-39. [PMID: 34802853 DOI: 10.1016/j.numecd.2021.08.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/28/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022]
Abstract
AIMS Hypoglycemia is a serious complication of bariatric surgery. The aim of the present meta-analysis was to evaluate the rate and the timing of post-bariatric hypoglycemia (PBH) with different bariatric procedures using reliable data from continuous glucose monitoring (CGM). DATA SYNTHESIS Studies were systematically searched in the Web of Science, Scopus and PubMed databases according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of PBH was expressed as weighted mean prevalence (WMP) with pertinent 95% confidence intervals (95%CI). A total of 8 studies (16 datasets) enrolling 280 bariatric subjects were identified. The total WMP of PBH was 54.3% (95%CI: 44.5%-63.8%) while the WMP of nocturnal PBH was 16.4% (95%CI: 7.0%-34%). We found a comparable rate of PBH after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) (OR 1.62, 95%CI: 0.71-3.7; P = 0.248); likewise, the percent time spent in hypoglycemia was similar with the two procedures (mean difference 5.3%, 95%CI: -1.4%-12.0%; P = 0.122); however, RYGB was characterized by a higher glycemic variability than SG. Regression models showed that the time elapsed from surgical intervention was positively associated with a higher rate of both total PBH (Z-value: 3.32, P < 0.001) and nocturnal PBH (Z-value: 2.15, P = 0.013). CONCLUSIONS PBH, both post-prandial and nocturnal, is more prevalent than currently believed. The rate of PBH increases at increasing time from surgery and is comparable after RYGB and SG with a higher glucose variability after RYGB.
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Affiliation(s)
- Roberta Lupoli
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy.
| | - Erminia Lembo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Carmen Rainone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luigi Schiavo
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy; General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, Nice, France; Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France
| | - Matteo N D Di Minno
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Luesma MJ, Fernando J, Cantarero I, Lucea P, Santander S. Surgical Treatment of Obesity. Special Mention to Roux-en-Y Gastric Bypass and Vertical Gastrectomy. Front Endocrinol (Lausanne) 2022; 13:867838. [PMID: 35432187 PMCID: PMC9010401 DOI: 10.3389/fendo.2022.867838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The prevalence of obesity has increased exponentially in recent decades, being one of the diseases that most affects global health. It is a chronic disease associated with multiple comorbidities, which lead to a decrease in life expectancy and quality of life. It requires a multidisciplinary approach by a specialized medical team. Obesity can be treated with conservative or with surgical treatments that will depend on the characteristics of the patient. OBJECTIVE/METHODOLOGY The referenced surgery can be performed using different surgical techniques that are analyzed in the present work through an exhaustive narrative bibliographic review in the PubMed and Cochrane databases, as well as in UpToDate. RESULTS Currently, those most used are restrictive techniques, specifically vertical gastrectomy and mixed techniques, with gastric bypass being the "gold standard". CONCLUSIONS In order to choose one technique or another, the characteristics of each patient and the experience of the surgical team must be taken into account.
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Affiliation(s)
- María José Luesma
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza, Spain
- *Correspondence: Sonia Santander, ; María José Luesma,
| | - José Fernando
- General Surgery and Digestive System Service, Royo Villanova Hospital, Zaragoza, Spain
| | - Irene Cantarero
- Department of Morphological and Social Health Sciences, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Pilar Lucea
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Sonia Santander
- Department of Pharmacology and Physiology, School of Medicine, University of Zaragoza, Zaragoza, Spain
- *Correspondence: Sonia Santander, ; María José Luesma,
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OUP accepted manuscript. J Appl Lab Med 2022; 7:1062-1075. [DOI: 10.1093/jalm/jfac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022]
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Kiasat A, Granström AL, Stenberg E, Gustafsson UO, Marsk R. The risk of inflammatory bowel disease after bariatric surgery. Surg Obes Relat Dis 2021; 18:343-350. [PMID: 35012883 DOI: 10.1016/j.soard.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/18/2021] [Accepted: 12/11/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The association between bariatric surgery and new onset of inflammatory bowel disease has so far only been sparsely studied and with conflicting results. OBJECTIVES To investigate the association between bariatric surgery and inflammatory bowel disease in a large population-based cohort. SETTING Nationwide in Sweden. METHODS This population-based retrospective cohort study included Swedish individuals registered in the Scandinavian Obesity Surgery Registry who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy during 2007-2018. Ten control individuals from the general population were matched according to age, sex, and region of residence at time of exposure. The study population was followed until 2019 with regard to the development of inflammatory bowel disease. Cox proportional hazards models were used to compare disease-free survival time between subgroups and control individuals for each outcome. RESULTS The final cohort consisted of 64,188 exposed individuals with a total follow-up of 346,860 person-years and 634,530 controls with total follow-up of 3,444,186 person-years. Individuals who underwent Roux-en-Y-gastric bypass had an increased risk of later development of Crohn's disease (hazard ratio [HR] 1.8, 95% CI 1.5-2.2) and unclassified inflammatory bowel disease (HR 2.7, 95% CI 2.0-3.7) but not ulcerative colitis (HR .9, 95% CI .8-1.1) compared with control individuals, whereas individuals who underwent sleeve gastrectomy had an increased risk of ulcerative colitis (HR 1.8, 95% CI 1.1-3.1) but not Crohn's disease (HR .8, 95% CI .3-2.1) and unclassified inflammatory bowel disease (HR 2.5, 95% CI .8-7.8). CONCLUSIONS Roux-en-Y gastric bypass was associated with increased risk of Crohn's disease and unclassified inflammatory bowel disease, whereas sleeve gastrectomy was associated with increased risk of ulcerative colitis only.
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Affiliation(s)
- Ali Kiasat
- Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Löf Granström
- Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulf O Gustafsson
- Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Richard Marsk
- Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Jin ZL, Liu W. Progress in treatment of type 2 diabetes by bariatric surgery. World J Diabetes 2021; 12:1187-1199. [PMID: 34512886 PMCID: PMC8394224 DOI: 10.4239/wjd.v12.i8.1187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/29/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of type 2 diabetes (T2D) is increasing at an alarming rate worldwide. Bariatric surgical procedures, such as the vertical sleeve gastrectomy and Roux-en-Y gastric bypass, are the most efficient approaches to obtain substantial and durable remission of T2D. The benefits of bariatric surgery are realized through the consequent increased satiety and alterations in gastrointestinal hormones, bile acids, and the intestinal microbiota. A comprehensive understanding of the mechanisms by which various bariatric surgical procedures exert their benefits on T2D could contribute to the design of better non-surgical treatments for T2D. In this review, we describe the classification and evolution of bariatric surgery and explore the multiple mechanisms underlying the effect of bariatric surgery on insulin resistance. Based upon our summarization of the current knowledge on the underlying mechanisms, we speculate that the gut might act as a new target for improving T2D. Our ultimate goal with this review is to provide a better understanding of T2D pathophysiology in order to support development of T2D treatments that are less invasive and more scalable.
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Affiliation(s)
- Zhang-Liu Jin
- Department of General Surgery & Department of Biliopancreatic and Metabolic Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Wei Liu
- Department of General Surgery & Department of Biliopancreatic and Metabolic Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Valentí V, Cienfuegos JA, Becerril Mañas S, Frühbeck G. Mechanism of bariatric and metabolic surgery: beyond surgeons, gastroenterologists and endocrinologists. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:229-233. [PMID: 32081018 DOI: 10.17235/reed.2020.6925/2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bariatric-metabolic surgery is the safest, most effective and long-lasting treatment for obesity and its associated co-morbidities, whether they be metabolic (type 2 diabetes, hyperlipidemia non-alcoholic fatty liver disease) or cardiovascular (myocardial infarction, stroke). Due to the obesity pandemic, bariatric-metabolic surgery is the second most frequent intra-abdominal procedure and the gastroenterologist and the surgeon must be aware of the physiologic changes caused by the anatomic reconfiguration following surgery. Among the mechanisms of action, independent of the loss of weight and fat tissue, surgery leads to the release of gut hormones related to carbohydrate metabolism (the rapid and continuous release of insulin), appetite and degree of satiety (glucagon-like peptide 1, peptide Y-Y, grhelin). As a result, indications for surgery have been extended to earlier disease stages. Apart from the neurohormonal effects, changes in the metabolism of biliary acids and the microbiota have also been reported. The aim of this review is to describe the physiologic changes caused by bariatric-metabolic surgery.
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Affiliation(s)
| | | | | | - Gema Frühbeck
- Endocrinología, Clínica Universidad de Navarra, España
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Guo L, Yang K, Zhou P, Yong W. Gut microbiota in obesity and nonalcoholic fatty liver disease. SURGERY IN PRACTICE AND SCIENCE 2021. [DOI: 10.1016/j.sipas.2021.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
IMPORTANCE AND OBJECTIVE Obesity is a chronic disease of epidemic proportions that continues to affect millions of Americans each year. Postmenopausal women are particularly affected by obesity and have higher rates of severe obesity when compared with their male counterparts. The prevalence of obesity in this population is linked to increased morbidity and mortality and promotes the development and progression of numerous obesity-related health conditions. This review examines the epidemiology, pathophysiology, clinical assessment, and treatment of postmenopausal women with obesity. METHODS We have reviewed relevant and up-to-date literature in the MEDLINE database to represent the current understanding of obesity and its effects in this patient population. Articles published between the years 2000 and 2020 were selected for review to represent the most up-to-date evidence on the topic. Search terms used in the PubMed search included women, obesity, menopause, aging, mid-age women, metabolism, weight gain, treatment of obesity, weight loss, bariatric surgery, weight loss medications, diet, physical activity, and behavior modification. DISCUSSION AND CONCLUSION Obesity is a complex, chronic, relapsing disease that requires comprehensive assessment and treatment. Obesity is linked to hormonal, lifestyle, and environmental changes that occur during the menopausal transition, and it increases the risk for cardiometabolic disease. The utilization of appropriate clinical evaluation methods to identify obesity in postmenopausal women, and the implementation of effective lifestyle, pharmacotherapeutic, and surgical interventions, have the propensity to reduce the deleterious effects of obesity in this population.
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Affiliation(s)
- Michael G Knight
- Division of General Internal Medicine, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Chika Anekwe
- Department of Internal Medicine, Endocrine Division, Harvard Medical School, Boston, MA
| | | | - Eftitan Y Akam
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Emily Wang
- Emory College, Emory University, Atlanta, GA
| | - Fatima Cody Stanford
- Department of Internal Medicine, Neuroendocrine Unit and Department of Pediatrics- Pediatric Endocrinology, MGH Weight Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Liu DF, Ma ZY, Zhang CS, Lin Q, Li MW, Su KZ, Li YR, Wang HD, Zang Q, Dong J. The effects of bariatric surgery on dyslipidemia and insulin resistance in overweight patients with or without type 2 diabetes: a systematic review and network meta-analysis. Surg Obes Relat Dis 2021; 17:1655-1672. [PMID: 34229937 DOI: 10.1016/j.soard.2021.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 12/29/2022]
Abstract
Obesity has become an epidemic in several regions globally; it may lead to cardiovascular diseases, diabetes, and dyslipidemia. Despite many therapies, all bariatric procedures fail in some patients. There is a lack of literature comparing treatment effects on specific metabolic indexes. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for relevant articles. GeMTC and R software were used to perform a network meta-analysis, draw forest plots, investigate the possibility of statistical heterogeneity, generate I2 statistics, rank probabilities, and evaluate relative effects of surgical procedures. All analyses were based on a Bayesian consistency model. We included 35 randomized controlled trials, comprising 2198 individuals and 13 interventions. For patients with high insulin resistance, single-anastomosis (mini-) gastric bypass (SAGB) and sleeve gastrectomy (SG) may be effective options, with mean differences (95% confidence intervals [CIs]) of -4.45 (-9.04 to -.34) and -4.23 (-6.74 to -2.22), respectively, compared with control groups. For patients with severe dyslipidemia, in addition to SAGB and SG, duodenal switch (DS) may be an effective surgery, with mean differences (95% CIs) of -.97 (-1.39 to -.55), -1.98 (-3.76 to -.19), .53 (.04 to 1.04), and -.94 (-1.66 to -.16) compared with control groups in terms of triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) concentrations, respectively. In adult overweight patients with or without diabetes, SAGB and SG are most effective at ameliorating insulin resistance. SAGB, Roux-en-Y gastric bypass + omentectomy, and DS are useful for reducing triglycerides, total cholesterol, and LDL-C. SG + omentectomy elevates HDL-C concentrations best. Adjustable gastric band and biliopancreatic diversion may not control insulin resistance or dyslipidemia well.
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Affiliation(s)
- De-Feng Liu
- Clinical Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Zheng-Ye Ma
- Clinical Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Cai-Shun Zhang
- Special Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Qian Lin
- Special Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Man-Wen Li
- Special Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Kai-Zhen Su
- Clinical Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Yan-Run Li
- Clinical Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Hai-Dan Wang
- Special Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Qing Zang
- Special Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Jing Dong
- Special Medicine Department, Medical College, Qingdao University, Qingdao, China; Physiology Department, Medical College, Qingdao University, Qingdao, China.
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Jabbour G, Salman A. Bariatric Surgery in Adults with Obesity: the Impact on Performance, Metabolism, and Health Indices. Obes Surg 2021; 31:1767-1789. [PMID: 33454846 PMCID: PMC8012340 DOI: 10.1007/s11695-020-05182-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
This systematic review summarizes current evidence on the impact of bariatric surgery (BS) on physical performance, metabolic, and health indices in adults with obesity. This systematic review suggests that BS induced significant reductions in body weight, fat mass, and fat-free mass in individuals with obesity. Additionally, BS may improve many physical fitness and health indicators. Observed improvements manifest during a distinct period of time. To date, studies on BS and performance have been small in number, nonrandomized in design, and not controlled regarding gender distribution and/or post-surgery follow-up. Future studies should further investigate concerns associated with understanding of BS outcomes to improve these outcomes with potential benefits for quality of life, disability, mortality, morbidity, and overall BS success.
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Affiliation(s)
- Georges Jabbour
- Sport Science Program, College of Arts and Sciences, Qatar University, P.O. Box 2713, Doha, Qatar.
| | - Ahmad Salman
- Sport Science Program, College of Arts and Sciences, Qatar University, P.O. Box 2713, Doha, Qatar
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van Loon SLM, Deneer R, Nienhuijs SW, Wilbik A, Kaymak U, van Riel N, Scharnhorst V, Boer AK. Metabolic Health Index (MHI): Assessment of Comorbidity in Bariatric Patients Based on Biomarkers. Obes Surg 2021; 30:714-724. [PMID: 31724117 DOI: 10.1007/s11695-019-04244-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The focus of bariatric surgery is reduction of weight, reflected in body mass index (BMI). However, the resolution of comorbidity is a second important outcome indicator. The degree of comorbidity is hard to quantify objectively as comorbidities develop gradually and are interdependent. Multiple scoring systems quantifying comorbidity exist but they lack continuity and objectivity. In analogy with BMI as index for weight, the Metabolic Health Index (MHI) is developed as objective quantification of metabolic health status. Laboratory data were used as comorbidities affect biomarkers. Conversely, laboratory data can be used as objectively obtained variables to describe comorbidity. METHODS Laboratory data were collected and crosschecked by national quality registry entries. Machine learning was applied to develop an ordinal logistic regression model, using 4 clinical and 32 laboratory input variables. The output was mathematically transformed into a continuous score for intuitive interpretation, ranging from 1 to 6 (MHI). RESULTS In total, 4778 data records of 1595 patients were used. The degree of comorbidity is best described by age at phlebotomy, estimated Glomerular Filtration Rate (eGFR), and concentrations of glycated hemoglobin (HbA1c), triglycerides, and potassium. The model is independent of day of sampling and type of surgery. Mean MHI was significantly different between patient subgroups with increasing number of comorbidities. CONCLUSION The MHI reflects severity of comorbidity, enabling objective assessment of a bariatric patient's metabolic health state, regardless day of sampling and surgery type. Next to weight-focused outcome measures like %TWL, the MHI can serve as outcome measure for metabolic health.
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Affiliation(s)
- Saskia L M van Loon
- Department of Clinical Chemistry, Catharina Hospital, P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands. .,Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands. .,Expert Center Clinical Chemistry, Eindhoven, The Netherlands.
| | - Ruben Deneer
- Department of Clinical Chemistry, Catharina Hospital, P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands.,Expert Center Clinical Chemistry, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Anna Wilbik
- Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Uzay Kaymak
- Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Natal van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Volkher Scharnhorst
- Department of Clinical Chemistry, Catharina Hospital, P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands.,Expert Center Clinical Chemistry, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Arjen-Kars Boer
- Department of Clinical Chemistry, Catharina Hospital, P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands.,Expert Center Clinical Chemistry, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Xie C, Huang W, Young RL, Jones KL, Horowitz M, Rayner CK, Wu T. Role of Bile Acids in the Regulation of Food Intake, and Their Dysregulation in Metabolic Disease. Nutrients 2021; 13:1104. [PMID: 33800566 PMCID: PMC8066182 DOI: 10.3390/nu13041104] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 02/07/2023] Open
Abstract
Bile acids are cholesterol-derived metabolites with a well-established role in the digestion and absorption of dietary fat. More recently, the discovery of bile acids as natural ligands for the nuclear farnesoid X receptor (FXR) and membrane Takeda G-protein-coupled receptor 5 (TGR5), and the recognition of the effects of FXR and TGR5 signaling have led to a paradigm shift in knowledge regarding bile acid physiology and metabolic health. Bile acids are now recognized as signaling molecules that orchestrate blood glucose, lipid and energy metabolism. Changes in FXR and/or TGR5 signaling modulates the secretion of gastrointestinal hormones including glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), hepatic gluconeogenesis, glycogen synthesis, energy expenditure, and the composition of the gut microbiome. These effects may contribute to the metabolic benefits of bile acid sequestrants, metformin, and bariatric surgery. This review focuses on the role of bile acids in energy intake and body weight, particularly their effects on gastrointestinal hormone secretion, the changes in obesity and T2D, and their potential relevance to the management of metabolic disorders.
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Affiliation(s)
- Cong Xie
- Adelaide Medical School, Center of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5005, Australia; (C.X.); (W.H.); (R.L.Y.); (K.L.J.); (M.H.); (C.K.R.)
| | - Weikun Huang
- Adelaide Medical School, Center of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5005, Australia; (C.X.); (W.H.); (R.L.Y.); (K.L.J.); (M.H.); (C.K.R.)
- The ARC Center of Excellence for Nanoscale BioPhotonics, Institute for Photonics and Advanced Sensing, School of Physical Sciences, The University of Adelaide, Adelaide 5005, Australia
| | - Richard L. Young
- Adelaide Medical School, Center of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5005, Australia; (C.X.); (W.H.); (R.L.Y.); (K.L.J.); (M.H.); (C.K.R.)
- Nutrition, Diabetes & Gut Health, Lifelong Health Theme South Australian Health & Medical Research Institute, Adelaide 5005, Australia
| | - Karen L. Jones
- Adelaide Medical School, Center of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5005, Australia; (C.X.); (W.H.); (R.L.Y.); (K.L.J.); (M.H.); (C.K.R.)
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5005, Australia
| | - Michael Horowitz
- Adelaide Medical School, Center of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5005, Australia; (C.X.); (W.H.); (R.L.Y.); (K.L.J.); (M.H.); (C.K.R.)
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5005, Australia
| | - Christopher K. Rayner
- Adelaide Medical School, Center of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5005, Australia; (C.X.); (W.H.); (R.L.Y.); (K.L.J.); (M.H.); (C.K.R.)
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5005, Australia
| | - Tongzhi Wu
- Adelaide Medical School, Center of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5005, Australia; (C.X.); (W.H.); (R.L.Y.); (K.L.J.); (M.H.); (C.K.R.)
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5005, Australia
- Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
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Sustainable weight loss over three years in children with obesity: a pragmatic family-centered lifestyle intervention. Eat Weight Disord 2021; 26:537-545. [PMID: 32170662 DOI: 10.1007/s40519-020-00887-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Childhood obesity has psychological consequences and increases the risk of continuous obesity into adulthood, associated with development of non-communicable disease (e.g. type 2 diabetes). Short-term weight loss intervention studies show good results but long-term studies are limited. METHODS One hundred ninety-nine obese children (4-18 years of age), with a BMI-SDS (standard deviation score) above + 2 SDS were enrolled into a multifactorial family-centered lifestyle intervention study. The children had yearly visits in the outpatient clinic for anthropometrics, blood samples and DXA-scans, and 6-8 meeting with community health workers between these visits. The children followed the intervention up to 3 years. RESULTS After a follow-up of 26.7 ± 17.5 months a reduction in BMI-SDS of - 0.25 SDS (p < 0.001) was observed. The 57 children who were adherent to the intervention for ≥ 2 years had significantly reduced BMI-SDS compared to the 142 children with shorter intervention (BMI-SDS: - 0.38 ± 0.67 vs. - 0.20 ± 0.50, p = 0.036). All weight loss was accompanied by decrease in fat mass and increase in muscle mass (p < 0.001). CONCLUSION The intervention was found to induce long-term reduction in BMI-SDS in obese children, with beneficial change in body composition. Children who followed the intervention the longest had the greatest reduction in BMI-SDS. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
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Yoshida N, Kitahama S, Yamashita T, Hirono Y, Tabata T, Saito Y, Shinohara R, Nakashima H, Emoto T, Hirota Y, Takahashi T, Ogawa W, Hirata K. Metabolic alterations in plasma after laparoscopic sleeve gastrectomy. J Diabetes Investig 2021; 12:123-129. [PMID: 32563200 PMCID: PMC7779268 DOI: 10.1111/jdi.13328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/30/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) is an important therapeutic option for morbidly obese patients. Although LSG promotes sufficient weight loss, how LSG changes plasma metabolites remains unclear. We assessed changes in plasma metabolite levels after LSG. We collected plasma samples from 15 morbidly obese Japanese patients before and 3 months after LSG. A total of 48 metabolites were quantified using capillary electrophoresis time-of-flight mass spectrometry-based metabolomic profiling. Branched chain amino acids, several essential amino acids, choline, 2-hydroxybutyric acid, 2-oxoisovaleric acid and hypoxanthine were significantly decreased after LSG. Tricarboxylic acid cycle metabolites, including citric acid, succinic acid and malic acid, were significantly elevated after LSG. This is the first report to show dynamic alterations in plasma metabolite concentrations, as assessed using capillary electrophoresis time-of-flight mass spectrometry, in morbidly obese patients after LSG. Our results might show how LSG helps improve obesity, in part through metabolic status changes, and propose novel therapeutic targets to ameliorate obesity.
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Affiliation(s)
- Naofumi Yoshida
- Division of Cardiovascular MedicineDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Seiichi Kitahama
- Department of Bariatric and Metabolic SurgeryCenter for Obesity, Diabetes and EndocrinologyChibune General HospitalOsakaJapan
| | - Tomoya Yamashita
- Division of Cardiovascular MedicineDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yasuko Hirono
- Department of Bariatric and Metabolic SurgeryCenter for Obesity, Diabetes and EndocrinologyChibune General HospitalOsakaJapan
| | - Tokiko Tabata
- Division of Cardiovascular MedicineDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yoshihiro Saito
- Division of Cardiovascular MedicineDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | | | | | - Takuo Emoto
- Division of Cardiovascular MedicineDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yushi Hirota
- Division of Diabetes and EndocrinologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Tetsuya Takahashi
- Division of Diabetes and EndocrinologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
- Department of Diabetes and EndocrinologyCenter for Obesity, Diabetes and EndocrinologyChibune General HospitalOsakaJapan
| | - Wataru Ogawa
- Division of Diabetes and EndocrinologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Hirata
- Division of Cardiovascular MedicineDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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Qi XY, Gong Y, Jiao YW, Zhao J, Zhou Y, Cui XH, Li S, Yang HJ, Qian J, Tang LM. Influence of Helicobacter pylori Infection on Outcomes After Bariatric Surgery: A Systematic Review and Meta-Analysis. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiao-yang Qi
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yu Gong
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yu-wen Jiao
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jie Zhao
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yan Zhou
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Xiao-han Cui
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Song Li
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Hao-jun Yang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jun Qian
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Li-ming Tang
- Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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50
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Kruschitz R, Wakolbinger M, Schindler K, Prager G, Hoppichler F, Marculescu R, Ludvik B. Effect of one-anastomosis gastric bypass on cardiovascular risk factors in patients with vitamin D deficiency and morbid obesity: A secondary analysis. Nutr Metab Cardiovasc Dis 2020; 30:2379-2388. [PMID: 32981799 DOI: 10.1016/j.numecd.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Bariatric patients often suffer from vitamin D (VD) deficiency, and both, morbid obesity and VD deficiency, are related to an adverse effect on cardiovascular disease (CVD) risk. Therefore, we assessed the change of known CVD risk factors and its associations during the first 12 months following one-anastomosis gastric bypass (OAGB). METHODS AND RESULTS In this secondary analysis, CVD risk factors, medical history and anthropometric data were assessed in fifty VD deficient (25-hydroxy-vitamin D (25(OH)D) <75 nmol/l) patients, recruited for a randomized controlled trial of VD supplementation. Based on previous results regarding bone-mass loss and the association between VD and CVD risk, the study population was divided into patients with 25(OH)D ≥50 nmol/l (adequate VD group; AVD) and into those <50 nmol/l (inadequate VD group; IVD) at 6 and 12 months (T6/12) postoperatively. In the whole cohort, substantial remission rates for hypertension (38%), diabetes (30%), and dyslipidaemia (41%) and a significant reduction in CVD risk factors were observed at T12. Changes of insulin resistance markers were associated with changes of total body fat mass (TBF%), 25(OH)D, and ferritin. Moreover, significant differences in insulin resistance markers between AVD and IVD became evident at T12. CONCLUSION These findings show that OAGB leads to a significant reduction in CVD risk factors and amelioration of insulin resistance markers, which might be connected to reduced TBF%, change in 25(OH)D and ferritin levels, as an indicator for subclinical inflammation, and an adequate VD status. REGISTERED AT CLINICALTRIALS.GOV: (Identifier: NCT02092376) and EudraCT (Identifier: 2013-003546-16).
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Affiliation(s)
- Renate Kruschitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Division of Internal Medicine, General Public Hospital of the Order of Saint Elisabeth, Klagenfurt, Austria
| | - Maria Wakolbinger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Austria.
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - Friedrich Hoppichler
- Special Institute for Preventive Cardiology and Nutrition - SIPCAN, Salzburg, Austria; Division of Internal Medicine, General Public Hospital of the Brothers of Saint John of God Salzburg, Austria
| | - Rodrig Marculescu
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Department of Medicine 1, Karl Landsteiner Institute for Obesity and Metabolic Disorders, Rudolfstiftung Hospital, Vienna, Austria
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