Total plasma magnesium, zinc, copper and selenium concentrations in obese patients before and after bariatric surgery.

Obesity enhances the risk of type-2 diabetes, cardiovascular disease and inflammatory conditions and often leads to metal dyshomeostasis, which contributes to the negative health aspects associated with the disease. In severe cases, bariatric surgery can be recommended to achieve sustained weight loss and improvement in health. Here, magnesium, zinc, copper and selenium concentrations were examined in 24 obese patients (7 males; 17 females) before and 9 months after undergoing Roux-en-Y gastric bypass surgery. All patients lost weight over this period, with the mean BMI reducing from 51.2±7.1 kg/m2 to 37.2±5.5 kg/m2. Moreover, whole-blood glycated haemoglobin (HbA1c), as a marker of average glycaemia, was also measured and a correlative analysis of this parameter with metal concentrations performed. Significant alterations in the plasma concentrations of magnesium, zinc (both increased by 13.2% and 25.2% respectively) and copper (decreased by 7.9%) were observed over this period (plasma selenium concentration was unchanged), with BMI values correlating with plasma magnesium (p = 0.004) and zinc (p = 0.022) concentrations. At 9 months post-surgery, an increase in mean zinc/copper ratio was observed (0.86±0.29 compared to 0.63±0.14 pre-surgery). Comparison of whole-blood HbA1c concentrations pre- and post-surgery revealed a reduction from 6.50±1.28% pre-surgery to 5.51±0.49% post-surgery. Differences in plasma HbA1c and magnesium at either pre- and post-surgery correlated significantly, as did HbA1c and magnesium levels when pre- and post-surgery values were analysed together. Collectively, this work reveals that bariatric surgery, in conjunction with lifestyle/dietary changes, lead to improvements in the nutritional status of magnesium, zinc and copper. Furthermore, the observed improvements in magnesium and zinc were associated with weight loss and in the case of magnesium, to better glycaemic control.

Obesity-related hypertension and its remission following gastric bypass surgery - a review of the mechanisms and predictive factors.

It is well established that hypertension and obesity appear to be associated. The exact mechanism by which they are linked is unclear and remains a topic of a great deal of research. Current NICE guidelines recommend that patients with a BMI in excess of 35 kg/m(2) should be considered for bariatric surgery if they have a concomitant obesity-associated condition, of which hypertension is one. The commonest bariatric procedure in the UK is the Roux-en-Y gastric bypass, which has been shown to result in long-standing remission of hypertension in up to 93% of patients. This paper summarizes the existing literature on the main theories as to how obesity leads to hypertension as well as the literature concerning the effects of gastric bypass surgery on hypertension.

Roux-en-Y gastric bypass for morbid obesity: what are the preoperative predictors of weight loss?

Obesity has become an increasingly important health problem over the past 30 years. Presently around a quarter of the UK adult population are obese and this figure is set to increase further in the coming decades. The health consequences of obesity on multiple body systems have been well established as has the financial cost of the condition to both the individuals affected as well as to society as a whole. Bariatric surgery has been shown to be the only long term effective solution in terms of sustained weight loss and comorbidity resolution. The commonest bariatric procedure in the UK is the Roux-en-y gastric bypass which consistently results in the loss of 70%-80% of excess bodyweight. Results however are variable and in order to optimise resource allocation and avoid exposing patients unlikely to benefit from surgery to its inherent risks, much research has been done to try to identify those patients most likely to obtain a good result. The only factor which has been subjected to meta-analysis is that of preoperative weight loss which shows a positive association with postoperative weight loss following bypass surgery. Although the remaining data are not based on level 1 evidence those other preoperatively identifiable factors which are associated with an improved outcome include Caucasian or Hispanic ethnicity, higher educational status, non-shift-work working patterns, female gender and divorced or single marital status. Similarly increased levels of preoperative physical activity and an absence of binge eating behaviour are consistent with a favourable result whereas increased age, smoking and other socioeconomic factors have not been shown to have a significant impact. Conversely diabetes mellitus seems to have a slight negative correlation with postoperative weight loss; however, a history of sexual abuse or psychiatric illness has not been shown to have a lasting influence.

Predictive Value of C-Reactive Protein for Complications Post-Laparoscopic Roux-En-Y Gastric Bypass.

BACKGROUND: Laparoscopic roux-en-Y gastric bypass (LRYGB) has gained increasing popularity as the primary procedure of choice for the management of patients with morbid obesity. Despite the advances, a few patients will still develop complications and predicting these early complications in morbidly obese patients can prove to be difficult. Radiological investigations have limited diagnostic value and have associated side effects and cost. We propose that C-reactive protein (CRP) is a useful predictor for early postoperative complications. This study aims to determine the ability of CRP taken on postoperative day 1 (POD 1) and 2 to predict occurrence of complications within 30 days of surgery. METHODS: This retrospective observational study selected 183 consecutive patients from the York bariatric database between 01 December 2010 and 23 March 2015. EXCLUSIONS: Patients undergoing dual procedures, conversion to open, and if no postoperative CRP measurement was performed. RESULTS: In total, 138 patients satisfied the inclusion criteria during the study period (median age 44 years [20-68], BMI 50.6 kg/m2 [38.3-62.5]). Fifteen (10.8 %) patients had minor complications (CD of 2) and 8 (5.6 %) had major complications (CD 3 or above). A CRP of greater than 127 mg/L on POD 2 was found to predict complications with 93 % sensitivity and 64 % specificity with diagnostic accuracy 0.82 (95 % confidence interval 0.731-0.908). CONCLUSIONS: In our patients, CRP on POD 2 has been shown to be a good predictor of both minor and major complications and can therefore be used to guide clinicians in making decision as to which patients may need further investigation or who can be safely discharged.

Roux-en-Y gastric bypass could slow progression of retinopathy in type 2 diabetes: a pilot study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a well-recognised complication of obesity. One of the microvascular complications of T2DM is diabetic retinopathy (DR). Bariatric surgery has been shown to effectively treat obesity and can induce remission of T2DM. It is not known what effect this improvement may have on pre-existing DR. We aimed to investigate this. METHOD: A dual-centre, observer-blinded, case-control study investigated the progression of DR in patients who received Roux-en-Y gastric bypass (treatment group (TG)), compared with controls who received medical therapy (control group (CG)) for their T2DM. Retinal images were taken pre-operatively and approximately 2 years post-operatively for the TG and over a 2-year interval for the CG. Data were collected for confounding variables, including glycaemic control (HbA(1c)) and BMI. RESULTS: Forty-five patients were recruited (TG = 21, CG = 24). Groups were significantly heterogeneous. DR showed significant progression for those in the CG (p = 0.03) but not in TG (p = 0.135), no significant difference was found when adjusting for confounding variables (p = 0.480). There was a significant trend in favour of surgery in improvement of glycaemic control (p = 0.017). CONCLUSION: The trends within these pilot data may represent a real difference in the progression of DR in patients who have received surgery, compared with medical treatment alone. Due to heterogeneity of group characteristics, further work needs to be done to validate these results. Should there be a true difference, there will be potential cost savings for the National Health Service (NHS) along with a reduced burden of disease for patients.

A prospective cohort study of feeding needle catheter jejunostomy in an upper gastrointestinal surgical unit.

BACKGROUND & AIM: Feeding jejunostomy is recommended to facilitate early enteral nutrition after major upper gastrointestinal surgery. We aimed to determine the benefits and risks associated with routine practice of feeding needle catheter jejunostomy (NCJ) in high-risk upper gastrointestinal surgery. METHOD: This is a prospective consecutive cohort study of 84 patients underwent feeding NCJ over a 3 years period in an Upper Gastrointestinal Surgical Unit. RESULTS: Feeding NCJ was placed after two-stage oesophago-gastrectomy in 24 patients (28.6%), after gastrectomy in 29 patients (34.5%), after liver resections in 7 patients (8.3%), pancreatic resection in 6 patients (7.1%), bile duct reconstruction in 8 patients (9.5%) and other operations in 10 patients (12%). The mean (SE) estimated nutritional requirement per 24 h was 1791 (31)kcal. Eighty-two patients (98%) started enteral feed on day 1 after surgery. Fifty-seven patients (68%) achieved the target nutritional requirements in 3 days. Four patients were discharged home on jejunal feed whilst only two patients required parenteral nutrition support. The rest tolerated full oral diet. There was no procedure related mortality. The morbidity related to feeding tube and feeding were 12.9% and 20%, respectively. CONCLUSIONS: Routine practice of feeding NCJ is safe. Their benefits outweigh the risks in a specialist centre.