Blood-borne circadian signal stimulates daily oscillations in actin dynamics and SRF activity.

In peripheral tissues circadian gene expression can be driven either by local oscillators or by cyclic systemic cues controlled by the master clock in the brain's suprachiasmatic nucleus. In the latter case, systemic signals can activate immediate early transcription factors (IETFs) and thereby control rhythmic transcription. In order to identify IETFs induced by diurnal blood-borne signals, we developed an unbiased experimental strategy, dubbed Synthetic TAndem Repeat PROMoter (STAR-PROM) screening. This technique relies on the observation that most transcription factor binding sites exist at a relatively high frequency in random DNA sequences. Using STAR-PROM we identified serum response factor (SRF) as an IETF responding to oscillating signaling proteins present in human and rodent sera. Our data suggest that in mouse liver SRF is regulated via dramatic diurnal changes of actin dynamics, leading to the rhythmic translocation of the SRF coactivator Myocardin-related transcription factor-B (MRTF-B) into the nucleus.

Identification of Milk and Cheese Intake Biomarkers in Healthy Adults Reveals High Interindividual Variability of Lewis System-Related Oligosaccharides.

BACKGROUND: The use of biomarkers of food intake (BFIs) in blood and urine has shown great promise for assessing dietary intake and complementing traditional dietary assessment tools whose use is prone to misreporting. OBJECTIVE: Untargeted LC-MS metabolomics was applied to identify candidate BFIs for assessing the intake of milk and cheese and to explore the metabolic response to the ingestion of these foods. METHODS: A randomized controlled crossover study was conducted in healthy adults [5 women, 6 men; age: 23.6 ± 5.0 y; BMI (kg/m2): 22.1 ± 1.7].  After a single isocaloric intake of milk (600 mL), cheese (100 g), or soy-based drink (600 mL), serum and urine samples were collected postprandially up to 6 h and after fasting after 24 h. Untargeted metabolomics was conducted using LC-MS. Discriminant metabolites were selected in serum by multivariate statistical analysis, and their mass distribution and postprandial kinetics were compared. RESULTS: Serum metabolites discriminant for cheese intake had a significantly lower mass distribution than metabolites characterizing milk intake (P = 4.1 × 10-4). Candidate BFIs for milk or cheese included saccharides, a hydroxy acid, amino acids, amino acid derivatives, and dipeptides. Two serum oligosaccharides, blood group H disaccharide (BGH) and Lewis A trisaccharide (LeA), specifically reflected milk intake but with high interindividual variability. The 2 oligosaccharides showed related but opposing trends: subjects showing an increase in either oligosaccharide did not show any increase in the other oligosaccharide. This result was confirmed in urine. CONCLUSIONS: New candidate BFIs for milk or cheese could be identified in healthy adults, most of which were related to protein metabolism. The increase in serum of LeA and BGH after cow-milk intake in adults calls for further investigations considering the beneficial health effects on newborns of such oligosaccharides in maternal milk. The trial is registered at clinicaltrials.gov as NCT02705560.

[Physical activity†: under-used therapeutic option in the treatment of metabolic diseases]. / Activité physique†: une thérapie trop peu utilisée dans la prise en charge des maladies métaboliques.

It is well demonstrated that physical activity can improve the control of diseases such as diabetes, or dyslipidemia. Introduction of regular and frequent physical activity is also part of the useful measures in the management of excess weight. It is therefore surprising that the prescription of physical activity for the treatment of these diseases is still not part of the curriculum of medical studies, and that reimbursement remains very scarce. This article summarizes the state of scientific knowledge in the field and outlines their clinical application.

Il est bien démontré que l'activité physique (AP) peut participer à l'amélioration du contrôle de maladies telles que le diabète ou l'hyperlipidémie. La reprise d'une AP régulière et fréquente fait également partie des mesures reconnues utiles dans la gestion de l'excès de poids. Il est dès lors étonnant que la prescription d'AP dans le cadre du traitement de ces maladies soit peu enseignée, et sa prise en charge très mal remboursée. Cet article fait le point sur les connaissances dans le domaine, et la manière de les appliquer cliniquement.

Insulin and IGF1 receptors are essential for the development and steroidogenic function of adult Leydig cells.

The insulin family of growth factors (insulin, IGF1, and IGF2) are critical in sex determination, adrenal differentiation, and testicular function. Notably, the IGF system has been reported to mediate the proliferation of steroidogenic cells. However, the precise role and contribution of the membrane receptors mediating those effects, namely, insulin receptor (INSR) and type-I insulin-like growth factor receptor (IGF1R), have not, to our knowledge, been investigated. We show here that specific deletion of both Insr and Igf1r in steroidogenic cells in mice leads to severe alterations of adrenocortical and testicular development. Double-mutant mice display drastic size reduction of both adrenocortex and testes, with impaired corticosterone, testosterone, and sperm production. Detailed developmental analysis of the testes revealed that fetal Leydig cell (LC) function is normal, but there is a failure of adult LC maturation and steroidogenic function associated with accumulation of progenitor LCs (PLCs). Cell-lineage tracing revealed PLC enrichment is secondary to Insr and Igf1r deletion in differentiated adult LCs, suggesting a feedback mechanism between cells at different steps of differentiation. Taken together, these data reveal the cell-autonomous and nonautonomous roles of the IGF system for proper development and maintenance of steroidogenic lineages.-Neirijnck, Y., Calvel, P., Kilcoyne, K. R., Kühne, F., Stévant, I., Griffeth, R. J., Pitetti, J.-L., Andric, S. A., Hu, M.-C., Pralong, F., Smith, L. B., Nef, S. Insulin and IGF1 receptors are essential for the development and steroidogenic function of adult Leydig cells.

[Bariatric surgery†: sleeve versus gastric bypass, how to make the decision†?] / Chirurgie bariatrique†: sleeve gastrectomy ou bypass gastrique, comment choisir†?

Considering the growing epidemic of obesity worldwide, bariatric surgery is considered the most effective measure for significant weight loss and coping with comorbidities associated with obesity once it is established. Indications for bariatric surgery in Switzerland are clearly defined, but the type of intervention is often debated. As the gastric band gradually disappears, the number of sleeve gastrectomy (SG) is constantly increasing and has surpassed the traditional gastric bypass worldwide, because of the theoretically safer profile of this intervention. The purpose of this article is to summarize the most common types of bariatric surgery, their advantages and disadvantages, and their indication according to the patient's profile.

Face à l'épidémie croissante d'obésité dans le monde, la chirurgie bariatrique est considérée comme la mesure la plus efficace pour une perte de poids significative et pour faire face aux comorbidités liées à l'obésité une fois que celle-ci est installée. Les indications à une chirurgie bariatrique en Suisse sont clairement définies mais le type d'intervention reste souvent matière à débat. Alors que l'anneau gastrique disparaît peu à peu, le nombre de sleeve gastrectomy (SG) est en constante augmentation et a surpassé celui du traditionnel bypass gastrique dans le monde, en raison du profil théoriquement plus sûr de cette intervention. L'objectif de cet article a pour but de résumer les différents types de chirurgie bariatrique les plus répandus, leurs avantages et leurs inconvénients, ainsi que leur indication selon le profil du patient.

[Harmful effects of sugar consumption on health]. / Les méfaits du sucre dans l'alimentation.

Glucids are ubiquitous and yet controversial components of our nutrition. This narrative review focuses on the potential harmful effects of sugars on health, particularly as a risk factor for overweight, obesity or diabetes mellitus. Current guidelines recommend a daily limit of intake, and notably a restriction on added sugars. « Keto ¼ diets and intermittent fasting are trending in this era of sugar mistrust. However, the metabolic benefits are not yet clearly established, and the underlying risks should restrain the prescription of these diets to a population of carefully selected patients.

Les glucides sont des composants ubiquitaires et pourtant controversés de notre alimentation. Cette revue narrative s'intéresse aux éventuels méfaits des sucres sur la santé, plus particulièrement sur le risque de développer un surpoids ou une obésité, ainsi qu'un diabète sucré. Les recommandations actuelles préconisent ainsi une limitation journalière des apports, et notamment une restriction des sucres ajoutés. Les régimes dits « Keto ¼ et de jeûne intermittent se sont récemment popularisés dans ce contexte de conjuration des sucres. Leurs bénéfices métaboliques ne sont cependant pas clairement démontrés à ce jour, et les risques encourus devraient limiter les praticiens à les recommander à une population de patients sélectionnés.

Metabolic Footprinting of Fermented Milk Consumption in Serum of Healthy Men.

Background: Fermentation is a widely used method of natural food preservation that has consequences on the nutritional value of the transformed food. Fermented dairy products are increasingly investigated in view of their ability to exert health benefits beyond their nutritional qualities. Objective: To explore the mechanisms underpinning the health benefits of fermented dairy intake, the present study followed the effects of milk fermentation, from changes in the product metabolome to consequences on the human serum metabolome after its ingestion. Methods: A randomized crossover study design was conducted in 14 healthy men [mean age: 24.6 y; mean body mass index (in kg/m2): 21.8]. At the beginning of each test phase, serum samples were taken 6 h postprandially after the ingestion of 800 g of a nonfermented milk or a probiotic yogurt. During the 2-wk test phases, subjects consumed 400 g of the assigned test product daily (200 g, 2 times/d). Serum samples were taken from fasting participants at the end of each test phase. The serum metabolome was assessed through the use of LC-MS-based untargeted metabolomics. Results: Postprandial serum metabolomes after milk or yogurt intake could be differentiated [orthogonal projections to latent structures discriminant analysis (OPLS-DA) Q2 = 0.74]. Yogurt intake was characterized by higher concentrations of 7 free amino acids (including proline, P = 0.03), reduced concentrations of 5 bile acids (including glycocholic acid, P = 0.04), and modulation of 4 indole derivative compounds (including indole lactic acid, P = 0.01). Fasting serum samples after 2 wk of daily intake of milk or yogurt could also be differentiated based on their metabolic profiles (OPLS-DA Q2 = 0.56) and were discussed in light of the postprandial results. Conclusion: Metabolic pathways related to amino acids, indole derivatives, and bile acids were modulated in healthy men by the intake of yogurt. Further investigation to explore novel health effects of fermented dairy products is warranted.This trial was registered at clinicaltrials.gov as NCT02230345.

[Centers for bariatric medicine : why and how ?] / Centres de médecine bariatrique : pourquoi, comment ?

Obesity is a chronic, complex and relapsing disease. Because of this complexity, work up and follow up of affected patients implicate different specialists, working in synergy to diagnose and treat obesity and its complications. This follow up is specialized, and should be available in integrated centers of bariatric medicine offering all modalities of treatments with proven efficacy, whether medical, surgical or psychotherapeutical.

L'obésité est une maladie chronique, complexe et récidivante. Du fait de cette complexité, la prise en charge clinique des patients affectés doit impliquer différents spécialistes, travaillant en synergie pour diagnostiquer et traiter les différentes facettes de l'obésité et de ses complications. L'organisation de cette prise en charge spécialisée devrait s'articuler autour de centres intégrés de médecine bariatrique offrant tous les traitements reconnus efficaces, qu'ils soient médicaux, chirurgicaux ou psychothérapeutiques.

[Can surgery treat type 2 diabetes ? Yes, according to international companies]. / La chirurgie peut-elle traiter le diabète de type 2 ? Oui, selon les sociétés internationales.

Type 2 diabetes (DM2) and obesity are chronic diseases that often coexist with considerable morbidity and mortality. Approximately 85 % of all DM2 patients have a body mass index (BMI) ranking them as overweight (BMI 25­29,9 kg/m2) or obese (BMI > 30 kg/m2). Metabolic surgery is the only treatment for diabetes that results in long-term remission in 23 to 60 % of patients in the office depending on the preoperative duration of diabetes and the severity of the disease. This review presents evidence for the use of metabolic surgery (CM) as a primary treatment for DM2, potential mechanisms of its effects, and recommendations for its use in expanded patient populations.

Le diabète de type 2 (D2) et l'obésité sont des maladies chroniques qui coexistent souvent avec une morbidité et une mortalité considérables. Environ 85 % de tous les patients atteints de D2 ont un indice de masse corporelle (IMC) les classant en surpoids (IMC 25­29,9 kg/m2) ou obèses (IMC > 30 kg/m2). La chirurgie métabolique est le seul traitement du diabète qui entraîne une rémission à long terme chez 23 à 60 % des patients en fonction de la durée préopératoire du diabète et de la gravité de la maladie. Cette revue présente des évidences en faveur de l'utilisation de la chirurgie métabolique (CM) comme traitement principal du D2, des mécanismes potentiels de ses effets, et des recommandations pour son utilisation dans des populations de patients élargies.

Identification of Urinary Food Intake Biomarkers for Milk, Cheese, and Soy-Based Drink by Untargeted GC-MS and NMR in Healthy Humans.

The measurement of food intake biomarkers (FIBs) in biofluids represents an objective tool for dietary assessment. FIBs of milk and cheese still need more investigation due to the absence of candidate markers. Thus, an acute intervention study has been performed to sensitively and specifically identify candidate FIBs. Eleven healthy male and female volunteers participated in the randomized, controlled crossover study that tested a single intake of milk and cheese as test products, and soy-based drink as a control. Urine samples were collected at baseline and up to 24 h at distinct time intervals (0-1, 1-2, 2-4, 4-6, 6-12, and 12-24 h) and were analyzed using an untargeted multiplatform approach (GC-MS and 1H NMR). Lactose, galactose, and galactonate were identified exclusively after milk intake while for other metabolites (allantoin, hippurate, galactitol, and galactono-1,5-lactone) a significant increase has been observed. Urinary 3-phenyllactic acid was the only compound specifically reflecting cheese intake although alanine, proline, and pyroglutamic acid were found at significantly higher levels after cheese consumption. In addition, several novel candidate markers for soy drink were identified, such as pinitol and trigonelline. Together, these candidate FIBs of dairy intake could serve as a basis for future validation studies under free-living conditions.

Blood lactose after dairy product intake in healthy men.

The absence of a dedicated transport for disaccharides in the intestine implicates that the metabolic use of dietary lactose relies on its prior hydrolysis at the intestinal brush border. Consequently, lactose in blood or urine has mostly been associated with specific cases in which the gastrointestinal barrier is damaged. On the other hand, lactose appears in the blood of lactating women and has been detected in the blood and urine of healthy men, indicating that the presence of lactose in the circulation of healthy subjects is not incompatible with normal physiology. In this cross-over study we have characterised the postprandial kinetics of lactose, and its major constituent, galactose, in the serum of fourteen healthy men who consumed a unique dose of 800 g milk or yogurt. Genetic testing for lactase persistence and microbiota profiling of the subjects were also performed. Data revealed that lactose does appear in serum after dairy intake, although with delayed kinetics compared with galactose. Median serum concentrations of approximately 0·02 mmol/l lactose and approximately 0·2 mmol/l galactose were observed after the ingestion of milk and yogurt respectively. The serum concentrations of lactose were inversely correlated with the concentrations of galactose, and the variability observed between the subjects' responses could not be explained by the presence of the lactase persistence allele. Finally, lactose levels have been associated with the abundance of the Veillonella genus in faecal microbiota. The measurement of systemic lactose following dietary intake could provide information about lactose metabolism and nutrient transport processes under normal or pathological conditions.

Probiotic yogurt and acidified milk similarly reduce postprandial inflammation and both alter the gut microbiota of healthy, young men.

Probiotic yogurt and milk supplemented with probiotics have been investigated for their role in 'low-grade' inflammation but evidence for their efficacy is inconclusive. This study explores the impact of probiotic yogurt on metabolic and inflammatory biomarkers, with a parallel study of gut microbiota dynamics. The randomised cross-over study was conducted in fourteen healthy, young men to test probiotic yogurt compared with milk acidified with 2 % d-(+)-glucono-δ-lactone during a 2-week intervention (400 g/d). Fasting assessments, a high-fat meal test (HFM) and microbiota analyses were used to assess the intervention effects. Baseline assessments for the HFM were carried out after a run-in during which normal milk was provided. No significant differences in the inflammatory response to the HFM were observed after probiotic yogurt compared with acidified milk intake; however, both products were associated with significant reductions in the inflammatory response to the HFM compared with the baseline tests (assessed by IL6, TNFα and chemokine ligand 5) (P<0·001). These observations were accompanied by significant changes in microbiota taxa, including decreased abundance of Bilophila wadsworthia after acidified milk (log 2-fold-change (FC)=-1·5, P adj=0·05) and probiotic yogurt intake (FC=-1·3, P adj=0·03), increased abundance of Bifidobacterium species after acidified milk intake (FC=1·4, P adj=0·04) and detection of Lactobacillus delbrueckii spp. bulgaricus (FC=7·0, P adj<0·01) and Streptococcus salivarius spp. thermophilus (FC=6·0, P adj<0·01) after probiotic yogurt intake. Probiotic yogurt and acidified milk similarly reduce postprandial inflammation that is associated with a HFM while inducing distinct changes in the gut microbiota of healthy men. These observations could be relevant for dietary treatments that target 'low-grade' inflammation.

[Multidisciplinary management of dumping syndromes after bariatric surgery]. / Prise en charge pluridisciplinaire des syndromes de dumping après chirurgie bariatrique.

Dumping syndromes are a frequent complication of gastric or bariatric surgery and include early and late dumping. Early dumping is a consequence of rapid delivery of hyperosmolar nutrients into the bowel. Late dumping is the result of a reactive hypoglycemia induced by a hyperinsulinemic response. These syndromes are becoming increasingly prevalent with the rising incidence of bariatric surgery. Effective management of these complications requires multidisciplinary collaboration. First line management of early and late dumping syndrome involves specific dietary and behavioral modifications which generally improve the quality of life of patients.

Les syndromes de dumping sont une complication fréquente de la chirurgie gastrique ou bariatrique. Le dumping précoce est la conséquence d'un passage rapide d'aliments peu digérés à haut pouvoir osmotique dans l'intestin grêle. Le dumping tardif est causé par une hypoglycémie réactive à une réponse insulinique excessive. La prévalence de ces syndromes augmente en raison du nombre croissant de chirurgies bariatriques. Leur prise en charge requiert une collaboration multidisciplinaire. Le traitement de ces dumpings consiste en première ligne en des modifications diététiques et comportementales, propres à chaque type de dumping, qui permettent généralement d'améliorer significativement la qualité de vie des patients.

[Towards bariatric surgery : taking your time preserves you from loosing your time]. / Préparation à la chirurgie bariatrique : lorsque prendre du temps n'est pas en perdre.

Obesity has become a worldwide public health concern. Bariatric surgery is nowadays the most effective treatment to lose weight and control somatic comorbidities of this disease. However, a careful preparation of the patients undergoing bariatric surgery seems mandatory, despite the existence of a feeling of emergency that is often shared by the therapeutic team, and thus difficult to handle. In this context, the importance to address psychological issues such as patients' representation of their body while they will be confronted to a major physical transformation cannot be over-emphasized. Taking time is crucial to create a therapeutic context that raises the patients' awareness of their underlying psychological functioning.

Le traitement de l'obésité est devenu une problématique de santé publique mondiale. La chirurgie bariatrique est actuellement le moyen le plus efficace pour perdre du poids et contrôler les comorbidités somatiques de cette maladie. Toutefois, une préparation approfondie des patients semble incontournable malgré une impulsion d'urgence souvent partagée par les soignants qui peinent à refréner cette dynamique. L'importance d'anticiper le vécu psychique du patient, face à un corps qui va rapidement se trouver confronté à une modification de son schéma et de son image corporels, nous semble indispensable. Prendre du temps est essentiel afin d'aménager un espace permettant au patient de conscientiser les changements à venir et de pouvoir les affronter sereinement pour le reste de sa vie.

[Overweight and obesity in the canton of Vaud : projections for 2040]. / Surpoids et obésité morbide dans le canton de Vaud : projections pour 2040.

The worldwide prevalence of obesity has more than doubled since 1980. This global figure needs to be addressed tackled at the local level to face our future challenges at the local level. We attempted to project the prevalence of obesity in the canton of Vaud in the next 25 years. Data from the Enquête suisse sur la santé, a survey conducted every five years since 1992 by the Swiss Federal Office of Public Health, were used. Using different mathematical assumptions, the rate of increase in the prevalence of obesity in Switzerland between 1992 and 2012 was calculated allowing a projection of future prevalences. Between 1992 and 2016, the prevalence of obesity was 9.64%. Effective growth rate of obesity from 2016 to 2040 should be between 16'500 cases and 69'500 cases depending on the uncertainty of the effective prevalence increase over this period.

La prévalence mondiale a plus que doublé depuis 1980. Nous avons projeté la prévalence de l'obésité dans le canton de Vaud au cours des 25 prochaines années. Des données de l'Enquête suisse sur la santé, menée tous les cinq ans depuis 1992 par l'Office fédéral de la santé publique, ont été employées. En utilisant différentes hypothèses mathématiques, le taux d'augmentation de la prévalence de l'obésité en Suisse entre 1992 et 2012 a été calculé permettant une projection des prévalences futures. La prévalence de l'obésité était de 9,64 % en 2012. Le taux de croissance effectif entre 2016 et 2040 devrait être compris entre 16 500 cas et 69 500 cas en fonction de l'incertitude liée à l'augmentation effective de la prévalence au cours de cette période. La prévalence de l'obésité est en constante augmentation dans notre région et les projections ne sont pas rassurantes.

[Increased risk of alcohol use disorders after bariatric surgery]. / Chirurgie bariatrique et risque accru de dépendance à l'alcool.

After bariatric surgery the risk of alcohol use disorders is increased. This risk is greater after Roux-en-Y gastric bypass than after sleeve gastrectomy or gastric banding. These differences can be explained by modification in alcohol metabolism after gastric bypass, which increases peak alcohol levels. Other mechanisms that might be responsible for increased alcohol use disorders after bariatric surgery are neuro-biological contributors and addiction transfer from binge eating to alcohol consumption. Collaboration with a team specialized in alcoholism treatment is needed for the management of such patients.

[The Lausanne Obesity Cohort: why and how?]. / La Cohorte obésité de Lausanne (COOL): pourquoi, comment?

Bariatric surgery has become the treatment of choice for severe obesity. The significant weight loss induced by these procedures is accompanied by spectacular improvements in the metabolic comorbidities that participate in morbidity and mortality of obesity. However, several questions remain open regarding the identification of patients that will benefit the most from the intervention or the long-term outcomes in terms of weight and co-morbidities. The Cohort obesity of Lausanne was initiated in order to try and answer some of these questions, and more specifically to identify predictive factors of long-term response to gastric by-pass.

[Pregnancy after bariatric surgery]. / Grossesse après chirurgie bariatrique.

Bariatric surgery interventions are rapidly growing and most are performed on female patients. Thus, pregnancies after bariatric surgery are increasingly common. Awareness of the consequences and risks of bariatric surgery on subsequent pregnancies is important. Literature data report a reduction of the usual pregnancy risks of pregnancies in obese patients, but also an increased risk of small-for-gestational-age infants, possibly related to nutritional deficiencies. A careful screening for micronutrient deficiencies is therefore already advised before conception. Nutritional follow-up and serious evaluation of any abdominal complaints are recommended as well during pregnancy.

Inflammatory and metabolic responses to high-fat meals with and without dairy products in men.

Postprandial inflammation is an important factor for human health since chronic low-grade inflammation is associated with chronic diseases. Dairy products have a weak but significant anti-inflammatory effect on postprandial inflammation. The objective of the present study was to compare the effect of a high-fat dairy meal (HFD meal), a high-fat non-dairy meal supplemented with milk (HFM meal) and a high-fat non-dairy control meal (HFC meal) on postprandial inflammatory and metabolic responses in healthy men. A cross-over study was conducted in nineteen male subjects. Blood samples were collected before and 1, 2, 4 and 6 h after consumption of the test meals. Plasma concentrations of insulin, glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, TAG and C-reactive protein (CRP) were measured at each time point. IL-6, TNF-α and endotoxin concentrations were assessed at baseline and endpoint (6 h). Time-dependent curves of these metabolic parameters were plotted, and the net incremental AUC were found to be significantly higher for TAG and lower for CRP after consumption of the HFM meal compared with the HFD meal; however, the HFM and HFD meals were not different from the HFC meal. Alterations in IL-6, TNF-α and endotoxin concentrations were not significantly different between the test meals. The results suggest that full-fat milk and dairy products (cheese and butter) have no significant impact on the inflammatory response to a high-fat meal.

A Novel Approach to Major Surgery: Tracking Its Pathophysiologic Footprints.

BACKGROUND: To study the 'metabolic profile' of different surgical procedures and correlate it with pertinent surgical details and postoperative complications. METHODS: We conducted a prospective pilot study of 70 patients, ten for each of the seven following groups: (1) laparoscopic cholecystectomy, (2) incisional hernia repair, (3) laparoscopic and (4) open colon surgery, (5) upper gastrointestinal, (6) hepatic, and (7) pancreatic resections. Biochemical assessment included white blood cell count (WBC), C-reactive protein (CRP), glucose, triglycerides (TG), albumin (Alb), and pre-albumin (Pre-Alb), from the day before surgery until 5 days thereafter. Biological markers were compared for major versus minor surgery groups, which were defined on a clinical basis. Univariable analysis was used to identify risk factors for postoperative complications and p < 0.05 was the significance threshold. RESULTS: Common findings in all surgery groups were the acute inflammatory response (↑: WBC, CRP, ↓: TG, Alb, pre-Alb). Using cut-off values of 240 min operative (OR) time and 300 ml estimated blood loss (EBL), laparoscopic cholecystectomy, incisional hernia repair, and laparoscopic colectomy could be distinguished from open colectomy, upper gastrointestinal, liver, and pancreas resections. In a biochemical level, increased CRP and reduced postoperative Alb levels were highly discriminative of all types of 'major surgery.' Significant risk factors for postoperative complications were age, male gender, malignancy, longer OR time, higher blood loss, high CRP, and low Alb levels. CONCLUSIONS: Biochemically, CRP and Alb levels can help quantify the magnitude of the surgical trauma, which is correlated with adverse outcomes.