A Comparative, Prospective and Randomized Evaluation of Roux-en-Y Gastric Bypass With and Without the Silastic Ring: A 2-Year Follow Up Preliminary Report on Weight Loss and Quality of Life.

BACKGROUND: Currently, Roux-en-Y gastric bypass (RYGB) is one of the most widely used bariatric surgeries. Banding the pouch forms a banded gastric bypass operation, an accepted and frequently used variant. Placing a silastic ring around the pouch to band the gastric bypass operation increases the restriction mechanism. However, the ubiquitous use of the banded gastric bypass remains controversial. One of the controversies is the effect of the silastic ring on patients' perception of their well being after surgery because of the frequency of vomiting. A prospective, blindly randomized, comparative trial was undertaken to resolve this controversy. METHOD: Four hundred subjects scheduled for gastric bypass surgery were randomized into two arms of the trial, 200 with a silastic ring (WR) and 200 without (NR). After 2-year follow-up, the variables associated with the scores of Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. RESULTS: The initial median weight (125 kg), BMI (47), and age (36 years) were the same in both the NR and WR groups. The median excess weight loss, weight regain, and incidence of vomiting were 71, 10.5, and 7.75%, respectively, in the NR group vs. 75.4 and 1.1, and 24.4% in the WR group. The mean QOL score was 79% in the NR group vs. 80% in the WR group. CONCLUSION: After 2-year follow-up, silastic ring placement in the RYGB resulted in greater weight loss and weight stability and a threefold greater incidence of vomiting. There was no difference in the scores in the quality of life analysis.

Gene polymorphisms and increased DNA damage in morbidly obese women.

Obesity is characterized by increased adipose tissue mass resulting from a chronic imbalance between energy intake and expenditure. Furthermore, there is a clearly defined relationship among fat mass expansion, chronic low-grade systemic inflammation and reactive oxygen species (ROS) generation; leading to ROS-related pathological events. In the past years, genome-wide association studies have generated convincing evidence associating genetic variation at multiple regions of the genome with traits that reflect obesity. Therefore, the present study aimed to evaluate the relationships among the gene polymorphisms ghrelin (GHRL-rs26802), ghrelin receptor (GHSR-rs572169), leptin (LEP-rs7799039), leptin receptor (LEPR-rs1137101) and fat mass and obesity-associated (FTO-rs9939609) and obesity. The relationships among these gene variants and the amount of DNA damage were also investigated. Three hundred Caucasian morbidly obese and 300 eutrophic (controls) women were recruited. In summary, the results demonstrated that the frequencies of the GHRL, GHSR, LEP and LEPR polymorphisms were not different between Brazilian white morbidly obese and eutrophic women. Exceptions were the AA-FTO genotype and allele A, which were significantly more frequent in obese women than in the controls (0.23% vs. 0.10%; 0.46 vs. 0.36, respectively), and the TT-FTO genotype and the T allele, which were less frequent in morbidly obese women (p<0.01). Furthermore, significant differences in the amount of genetic lesions associated with FTO variants were observed only in obese women. In conclusion, this study demonstrated that the analyzed SNPs were not closely associated with morbid obesity, suggesting they are not the major contributors to obesity. Therefore, our data indicated that these gene variants are not good biomarkers for predicting risk susceptibility for obesity, whereas ROS generated by the inflammatory status might be one of the causes of DNA damage in obese women, favoring genetically related diseases as obesity comorbidities.

Relationships in women between body mass index and the intravascular metabolism of chylomicron-like emulsions.

OBJECTIVE: To investigate whether increasing body mass index (BMI) produces increasingly intense disturbances in the metabolism of chylomicrons, the lipoproteins that carry the dietary lipids absorbed by the intestine in the circulation. SUBJECTS: Four groups of 10 normolipidemic nondiabetic women at the normal (BMI<25 kg/m(2)), preobese (BMI 25-30), obese (BMI 30-40) and morbid obese (BMI>40). METHODS: Chylomicron metabolism was studied using the method of triglyceride-rich emulsions that mimic chylomicrons. The chylomicron-like emulsion doubly labeled with (3)H-triolein (TO) and (14)C-cholesteryl-oleate (CO) was intravenously injected to calculate the plasma fractional clearance rates (FCR, in min(-1)) by a compartmental analysis model. FCR-TO mirrors both the lipolysis from lipoprotein lipase that the emulsion suffers while still in the circulation, and the triglycerides portion that is not broken down and is removed from the plasma together with the remnant particles. Lipolysis index is calculated subtracting CO from TO areas under the curve. RESULTS: FCR-TO did not differ among the four groups. The lipolysis index was positively correlated with BMI (r=0.310; P=0.05). On the other hand, FCR-CO progressively diminished from the normal to the morbid obese group (0.069+/-0.01; 0.064+/-0.01; 0.031+/-0.003; 0.029+/-0.005 min(-1), respectively, P=0.003) and there was a negative correlation between FCR-CO and BMI (r=-0.388; P=0.01). CONCLUSION: In obesity, the capacity to break down chylomicron triglycerides by lipoprotein lipase in vivo increases, but the ability of the organism to remove the resulting chylomicron remnants particles progressively diminishes as the BMI rises. Remnant accumulation most likely predisposes to coronary artery disease development.

Plasma kinetics of a chylomicron-like emulsion in normolipidemic obese women after a short-period weight loss by energy-restricted diet.

Chylomicrons carry dietary fats in the bloodstream for storage in body tissues, and thus play an important role in obesity. The 2-step chylomicron metabolism consists of lipolysis by lipoprotein lipase (LPL) on vessel walls and hepatic uptake of triglyceride-depleted remnants. A triglyceride-rich emulsion that mimics chylomicrons, labeled with [9,10-(3)H]glycerol-trioleate (TG) and [1-(14)C] cholesteryl-oleate (CE) was intravenously injected into 14 obese women with body mass index between 30 and 40 kg/m(2) (age, 30 to 40 years), before and after a 2-month energy-restricted diet and into non-obese controls for determination of radioactive lipid plasma kinetics. TG kinetics evaluates lipolysis, whereas CE kinetics evaluates remnant removal. The emulsion TG fractional clearance rate (FCR, in min(-1)) was similar in obese women and their controls (0.126 +/- 0.065; controls, 0.111 +/- 0.031), but the CE-FCR was pronouncedly reduced in the obese subjects (0.028 +/- 0.014; controls, 0.070 +/- 0.009 min(-1); P <.0001). After the energy-restricted diet, TG-FCR was reduced in the obese women (0.075 +/- 0.044 min(-1); P <.05), but CE-FCR was unchanged (0.032 +/- 0.025 min(-1)). Therefore, the lipolysis of the chylomicron-like emulsion is normal in obese women, but remnant removal from the plasma is diminished. After active weight loss by an energy-restricted diet, the remnant removal was unchanged but lipolysis was diminished, possibly due to adaptative changes in LPL activity.