Impact of dietary patterns according to NOVA food groups: 2 y after Roux-en-Y gastric bypass surgery.

INTRODUCTION: Appropriate eating habits are crucial for sustained weight loss after bariatric surgery. A qualitative analysis of food consumption in the late postoperative period of bariatric surgery is thus advisable, even more so considering the increasing consumption of obesity-impacting ultra-processed foods. OBJECTIVE: This study aimed to analyze the contribution of unprocessed, processed, and ultra-processed foods 2 y after Roux-en-Y gastric bypass (RYGB). METHODS: This was a prospective study performed with 32 patients undergoing RYGB. Anthropometric and food intake data were analyzed. A food intake evaluation was conducted with a focus on quantitative and qualitative analyses. The latter was performed by categorizing food according to the NOVA classification. RESULTS: There was a reduction in body mass, representing an excess weight loss of 83.80 ± 24.50% at 24 months postoperatively; and a reduction in calorie intake, macronutrients, fiber, and sodium after surgery. Regarding the qualitative analysis, 6 months after RYGB the calorie intake from processed and ultra-processed food decreased from 1398.47 ± 623.82 kcal to 471.80 ± 48.94 kcal (P < 0.05). However, between 6 and 24 months postoperatively there was an increase in 60.04% of the calorie consumption of these type of food (P < 0.01). The most important finding was that the consumption of processed and ultra-processed food exceeded 50% of the total calorie intake of the diet in all periods analyzed. CONCLUSIONS: RYGB promotes quick results in weight loss and a reduction of food intake, but the quality of food may affect long-term prognosis and deserves attention in the population studied. These results highlight the importance of dietary counseling aimed at guiding better food choices, in the interest of promoting sustained weight loss after bariatric surgery.

Impact of Weight Loss on Inflammation State and Endothelial Markers Among Individuals with Extreme Obesity After Gastric Bypass Surgery: a 2-Year Follow-up Study.

BACKGROUND: The medium-term impact of gastric bypass (GB) surgery on the inflammatory state and endothelial function of patients has yet to be confirmed. OBJECTIVE: This study aims to elucidate the inflammatory profile and endothelial dysfunction response of adults with obesity 6 and 24 months after undergoing GB surgery. METHODS: The anthropometric and biochemical markers of 32 adults with obesity (two men and 30 females) were collected preoperatively, and 6 and 24 months postoperatively. RESULTS: Body mass index (BMI) and excess weight had decreased by 15.79 ± 1.21 kg/m2 (p < 0.01) and 83.80 ± 24.50% respectively at 24 months. Leptin, C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1) levels, and the leptin/adiponectin ratio decreased significantly at both postoperative follow-up points compared with preoperative values (p < 0.01). IL-6 and ICAM-1 levels decreased between 6 and 24 months post-GB (p < 0.01). IL-6 and ICAM-1 levels decreased between 6- and 24-months post-GB (p < 0.01). Resistin levels were significantly decreased (p < 0.01) at 6-month follow-up. The levels of the anti-inflammatory biomarkers IL-10, adiponectin, and the adiponectin/leptin ratio significantly increased postoperatively. There was an improvement in metabolic disorders after surgery. CONCLUSION: Our results demonstrated that after GB there was an improvement in the inflammatory profile, identified by a reduction in pro-inflammatory markers (CRP, IL-6, leptin) and an increase in anti-inflammatory markers (adiponectin, IL-10). The decrease in PAI-1 and ICAM-1 levels may suggest improvement in endothelial function. These findings provide clear evidence of the medium-term impact of GB on inflammation state and a number of endothelial markers, and a consequent reduction in the risk of cardiovascular diseases.

Neuroendocrine regulation of energy balance: Implications on the development and surgical treatment of obesity.

INTRODUCTION: Obesity, a serious public health problem, occurs mainly when food consumption exceeds energy expenditure. Therefore, energy balance depends on the regulation of the hunger-satiety mechanism, which involves interconnection of the central nervous system and peripheral signals from the adipose tissue, pancreas and gastrointestinal tract, generating responses in short-term food intake and long-term energy balance. Increased body fat alters the gut- and adipose-tissue-derived hormone signaling, which promotes modifications in appetite-regulating hormones, decreasing satiety and increasing hunger senses. With the failure of conventional weight loss interventions (dietary treatment, exercise, drugs and lifestyle modifications), bariatric surgeries are well-accepted tools for the treatment of severe obesity, with long-term and sustained weight loss. Bariatric surgeries may cause weight loss due to restriction/malabsorption of nutrients from the anatomical alteration of the gastrointestinal tract that decreases energy intake, but also by other physiological factors associated with better results of the surgical procedure. OBJECTIVE: This review discusses the neuroendocrine regulation of energy balance, with description of the predominant hormones and peptides involved in the control of energy balance in obesity and all currently available bariatric surgeries. CONCLUSIONS: According to the findings of our review, bariatric surgeries promote effective and sustained weight loss not only by reducing calorie intake, but also by precipitating changes in appetite control, satiation and satiety, and physiological changes in gut-, neuro- and adipose-tissue-derived hormone signaling.

Eating patterns and food choice as determinant of weight loss and improvement of metabolic profile after RYGB.

OBJECTIVE: Significant changes in the preference for different dietary components have been observed after Roux-en-Y gastric bypass (RYGB). The aim of this study was to evaluate the early post-RYGB changes in quality of eating patterns and their relationship to weight loss and metabolic parameters. METHODS: The sample was composed of 41 extremely obese individuals undergoing RYGB. Dietary data were collected using a validated food frequency questionnaire in Brazil. A food intake evaluation was conducted with a focus on the frequency of consumption (≥4 times/wk) of markers for healthy eating and markers for unhealthy eating. Furthermore, anthropometric and metabolic markers were collected before surgery and 6 mo post-RYGB. RESULTS: Compared with baseline, the postsurgery body mass index was reduced by 12.9 kg/m2, corresponding to an excess weight loss of 63.5%. Blood glucose, insulin, ferritin, cholesterol, low-density lipoprotein-cholesterol, triacylglycerol (TG), and hemoglobin were reduced 6 mo after RYGB (P < 0.05). The consumption frequency of many foods defined as unhealthy decreased after surgery (e.g., from 15.4% to 5.1% for pizza and 18% to 0% for hamburger), and some healthy food increased (e.g., from 0% to 5.1% for fish and from 0% to 25.6% for plain yogurt). There was a decrease in the frequency of individuals who reported consuming fruit and vegetables. Conversely, insulin, glucose, and TG levels were positively associated with intake of chocolates/truffles and ice cream/sundaes. CONCLUSION: Participants in the present study appeared to develop a healthier dietary pattern by 6 mo after RYGB. These results show that a healthier dietary pattern is associated with a significant improvement of metabolic profile and weight loss.

Roux-en-Y gastric bypass decreases pro-inflammatory and thrombotic biomarkers in individuals with extreme obesity.

BACKGROUND: The low-grade inflammatory state in obesity leads to insulin resistance and endothelial dysfunction, which promote cardiovascular diseases in individuals with obesity. The purpose of this study was to evaluate the early effects of weight loss achieved through bariatric surgery on the inflammatory and prothrombotic states. This study also aimed to identify the role of hyperleptinemia on the prothrombotic state. METHODS: The sample was composed of 41 extremely obese who underwent Roux-en-Y gastric bypass (RYGB). Anthropometric and clinical data, and biochemical markers of inflammation were collected prior to surgery and 6 months post-RYGB. RESULTS: It was found that plasminogen activator inhibitor-1 (PAI-1) concentrations were higher among extremely obese individuals with hyperleptinemia than in those without hyperleptinemia (p < 0.01).In relation to the baseline, post-surgery body mass index (BMI) was reduced by 12.9 kg/m(2), corresponding to 63.50 % of excess weight loss. Additionally, waist circumference was found to decrease significantly from 126.2 to 101.4 cm. Plasma total cholesterol (p < 0.01), LDL cholesterol (p = 0.02), triglycerides (p < 0.01), and glucose (p = 0.01) were also found to decrease. Pro-inflammatory biomarkers were observed to decrease: PAI-1 by 55.9 ± 6.0 % (p < 0.01), C-reactive protein (CRP) by 18.8 ± 3.4 % (p < 0.01), intercellular adhesion molecule-1 (ICAM-1) by 89.9 ± 5.7 % (p < 0.01), leptin by 27.9 ± 3.2 % (p < 0.01), and resistin by 69.3 ± 5.8 % (p < 0.01). Additionally, significant decreases of tumor necrosis factor alpha (TNF-α) and leptin/adiponectin ratio were observed. Anti-inflammatory cytokines adiponectin and interleukin-10 (IL-10) were significantly increased (170.7 ± 82.5 %, p < 0.01; 122.7 ± 55.1 %, p = 0.02). CRP levels were predictive of ICAM-1 (p = 0.04), and changes in leptin concentrations were associated with decreased PAI-1 levels (p = 0.03). CONCLUSIONS: We observed that individuals with obesity that have hyperleptinemia have higher circulating PAI-1 levels, which could indicate increased risk for cardiovascular disease. The biomarkers of inflammation and thrombosis measured in this study decreased after RYGB, suggesting that the surgery may be effective in reducing pro-inflammatory and thrombotic risk in individuals with extreme obesity.

Gastroplastia vertical restritiva com derivaçäo gastrointestinal em Y de Roux em suínos: aspectos histopatológicos do segmento gástrico isolado / Restrictive vertical gastroplasty with Roux-en-Y gastrointestinal bypass in swines: histopathological aspects of the bypassed gastric segment

OBJETIVO: Estabelecer um modelo animal de gastroplastia restritiva com derivaçäo gastrointestinal em Y de Roux, avaliando alteraçöes na quantidade da ingesta, na perda de peso e os aspectos macroscópicos da mucosa e histopatológicos da parede do segmento gástrico isolado. MÉTODOS: Dezesseis suínos machos, foram alocados em dois grupos. O Grupo Cirurgia incluiu 8 animais submetidos a gastroplastia restritiva com derivaçäo gastrointestinal em Y de Roux. O Grupo Controle foi composto por 8 suínos intactos, submetidos ao mesmo cuidado e dieta. O Grupo Cirurgia foi observado por 90 dias, quando foi sacrificado para estudo do segmento gástrico isolado. O Grupo Controle foi observado por 84 dias, quando os animais foram sacrificados para ressecçäo gástrica. RESULTADOS: Foram avaliados a variaçäo ponderal e o volume da ingesta alimentar de ambos os grupos. Avaliou-se alteraçöes macroscópicas da mucosa, alteraçöes morfométricas das glândulas gástricas, características histopatológicas e quantidade de colágeno tipo I e III na camada mucosa no segmento gástrico isolado do Grupo Cirurgia. O peso dos animais e a ingesta alimentar foi significativamente maior no Grupo Controle que no Cirurgia. Ocorreu diminuiçäo no tamanho das glândulas gástricas, maior quantidade de colágeno tipo I na camada mucosa e deposiçäo de tecido gorduroso na camada muscular do segmento gástrico isolado. CONCLUSAO: O modelo suíno de gastroplastia restritiva com derivaçäo gastrointestinal em Y de Roux proporciona reduçäo da ingesta e perda ponderal. A gastroplastia restritiva com derivaçäo gastrointestinal em Y de Roux em suínos näo proporciona alteraçöes macroscópicas no segmento gástrico isolado e que os achados histopatológicos säo compatíveis com os de atrofia inicial do segmento gástrico isolado.