DRD2 and BDNF polymorphisms are associated with binge eating disorder in patients with weight regain after bariatric surgery.

AIM: The aim of this study was to analyze the association and susceptibility of Single Nucleotide Polymorphisms (SNPs) in the DRD2 and BDNF genes with BED in patients with weight regain in the postoperative period of bariatric surgery. METHODS: One hundred and seventy-seven individuals who underwent bariatric surgery with weight regain were evaluated and divided into two groups according to the BED diagnostic. The individuals were submitted to an anthropometric evaluation, analysis of the presence of BED using a validated questionnaire, and blood collection for genotyping of the polymorphisms rs6265 (BDNF) and rs1800497 (DRD2) by real-time polymerase chain reaction (RT-PCR). RESULTS: The presence of wild-type alleles for rs1800497 (CC) and rs6265 (GG) was more frequent in patients without BED. Nevertheless, the presence of one or two variant alleles for rs1800497 (CT + TT) and rs6265 (GA + AA) was more frequent in patients with BED. The combination of the two studied SNPs prevailed in patients with BED. CONCLUSIONS: The presence of allele frequency of rs1800497 SNP in the DRD2 gene and rs6265 SNP in the BDNF gene, isolated and/or combined, indicated an additional risk for the development of BED in patients with obesity, especially in the context of weight regain. LEVEL OF EVIDENCE: III (evidence obtained from the case-control analytic study).

The Impact of Gastric Bypass on Telomere Length and Shelterin Complex Gene Expression: 6 Months Prospective Study.

BACKGROUND: Telomeres are structures located at the ends of chromosomes associated with a protein complex, known as the shelterin complex. In individuals with obesity, excess adipose tissue plays a key role in inducing a chronic and systemic inflammatory state, which can cause TL shortening. In this context, bariatric surgery is one of the most effective treatment modalities in improving metabolic control. AIM: Therefore, the present study aimed to evaluate how a short postoperative period of gastric bypass affects TL and expression of POT1, TRF1 and TRF2 genes. METHODS: Forty-eight women submitted to RYGB were evaluated before and after 6 months of the surgical procedure. Anthropometric measures of body weight and height (BMI), abdominal circumference (AC), body composition, food intake and blood collection for biochemical evaluation, TL analysis (DNA), and gene expression (RNA) were collected at each moment. RESULTS: There was a reduction of weight, BMI, AC, FM and FFM as well as of glycemia, total cholesterol, LDL-cholesterol, and triglycerides after gastric bypass. No difference in energy intake and macronutrients consumption was observed. There was no significant change in TL, but there was a significant increase of POT1 and TRF1 gene expression after surgery, while TRF2 expression did not change. CONCLUSIONS: Despite bariatric surgery is not capable of increasing telomere length in a short-term period, no reduction is observed; additionally, we found a correlation between serum triglycerides concentration and TL. The increase of POT1 and TRF1 gene expression may explain the maintenance of the TL after 6 months postoperative period.

UCP2 and PLIN1 Expression Affects the Resting Metabolic Rate and Weight Loss on Obese Patients.

BACKGROUND: Analysis of the expression of genes related to the energy metabolism can elucidate the understanding of physiological and genetic factors that contribute to obesity. This study aimed to evaluate the expression of genes and its influence on resting metabolic rate and weight loss in obese patients before and after bariatric surgery. METHODS: This study was conducted on 23 women, who were divided into two groups: bariatric surgery (preoperative and 6 months after surgery) and control. Abdominal subcutaneous adipose tissue samples were collected to analyze the gene expression, and the resting metabolic rate (RMR) was measured by indirect calorimetry. RESULTS: Significant differences were observed in weight reduction (22 %, p = 0.01), BMI (22.5 %, p = 0.01), and RMR values (10.5 %, p = 0.01) after the bariatric surgery, while the weight-adjusted RMR increased (15.8 %, p = 0.01). Increased UCP2 expression after 6 months of Roux-en-Y gastric bypass (RYGB) as compared to preoperative period (0.764 to 1.268, p = 0.01) was observed. Analysis with weight-adjusted RMR as dependent variable revealed that UCP2 (r 2 = 0.517, p = 0.01) and PLIN1 (r 2 = 0.420, p = 0.04) expression determine the RMR values in preoperative period. Moreover, UCP2 and PLIN1 expression in preoperative period influenced the percentage of weight loss, even when adjusted for age and BMI. CONCLUSIONS: We have demonstrated that after 6 months of bariatric surgery, there is significant increase in the UCP2 expression. Additionally, the expression of UCP2 and PLIN1 genes influences the resting metabolic rate in obese individuals and could predict the weight loss after bariatric surgery.

Effect of weight loss on bone mineral density determined by ultrasound of phalanges in obese women after Roux-en-y gastric bypass: conflicting results with dual-energy X-ray absorptiometry.

The rapid weight loss that occurs in obese patients submitted to Roux-en-y gastric bypass (RYGB) as well as the changes in dietary pattern and the intestinal malabsorption result in changes in bone mineral density (BMD). The objective of the present study was to assess the changes in BMD after the weight loss induced by RYGB using ultrasound of the phalanges and compare the results with those obtained by dual-energy X-ray absorptiometry (DXA). We conducted a 1-yr prospective longitudinal study on women with grade III obesity submitted to RYGB. Anthropometric (weight, height, body mass index, and abdominal circumference) and body composition measurements by electrical bioimpedance, assessment of food consumption by 24-h recall, biochemical evaluation, and assessment of BMD by ultrasonography of the phalanges and DXA (BMD values are from the 33% radius site) were performed during the preoperative period and 3, 6, and 12 mo after surgery. The mixed-effects linear regression model was used to analyze the effect of postoperative time on the variable of interest, and the kappa coefficient (p < 0.05) was used to compare the concordance of the methods used for BMD evaluation. Twenty-nine patients were included in the study. During the 1-yr follow-up, a reduction of 39 ± 8 kg (71 ± 15% of excess weight) and 29 ± 7 kg of fat mass was observed. Calcium and zinc concentrations were reduced after 12 mo. No difference in caffeine, calcium, or sodium consumption was observed between the preoperative and postoperative periods. Analysis of BMD by ultrasonography of the phalanges 1 yr after surgery showed increased values of amplitude-dependent speed of sound (2064.6 ± 59.4 vs 2154.7 ± 63 m/s; p < 0.001) and ultrasound bone profile index (0.73 ± 0.13 vs 0.76 ± 0.14; p < 0.001). Analysis of BMD by DXA showed a reduction of BMD values (0.6 ± 0.04 vs 0.57 ± 0.05 g/cm³; p < 0.001) in the sixth month and maintenance of the values from the sixth to the 12th month. At the end of the study, there was no concordance between the methods for BMD analysis. This study showed improvement in bone quality and quantity assessed by ultrasonography. However, the DXA results showed a reduction in BMD after 12 mo of RYGB. Thus, the BMD measurement methods were discordant.

Clinical predictors of different grades of nonalcoholic fatty liver disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the comorbidities related to obesity. Liver biopsy has been used as the "gold standard" for the diagnosis, grading, and prognosis of obese patients. The objective of the present study was to evaluate clinical predictors of more advanced stages of NAFLD. METHODS: In this retrospective study we assessed several physical and laboratorial factors, including some cytokines, in morbidly obese patients submitted to Roux-en-Y gastric bypass that could be related to the diagnosis and staging of NAFLD. Fragments of the livers were obtained from wedge biopsies during operation. RESULTS: The medical records of 259 patients were studied. The patients were divided into four groups: normal hepatic biopsy, steatosis, mild nonalcoholic steatohepatitis (NASH), and moderate and severe NASH. There were no differences in cytokine levels among groups. The triglyceride levels were the only variable that could stratify the grades of NAFLD and also differentiate from normal livers in the female patients. Also in this group, the aminotransferases and GGT levels and fasting glucose were predictors of the more advanced stages of NASH, while BMI and weight were predictors of the more advanced stages of NASH in male patients. CONCLUSIONS: There are no available markers in clinical practice to detect the initial stages of NAFLD. It is very important to perform a liver biopsy in all patients submitted to bariatric surgery and in obese patients with no indication to be operated in the presence of elevated blood levels of aminotransferases, GGT, and fasting glucose.

Reporting results after bariatric surgery: reproducibility of predicted body mass index.

BACKGROUND: There is a controversy about the best way to report results after bariatric surgery. Several indices have been proposed over the years such as percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of excess body mass index loss (%EBMIL). More recently, it has been suggested to individualize the body mass index (BMI) goal to be achieved by the patients (predicted BMI-PBMI). The objective was to assess the reproducibility of this PBMI in our service. METHODS: In this retrospective study, we assessed the %TWL, %EWL, %EBMIL (with expected BMI of 25 kg/m2), and %EBMIL (with PBMI) over 4 years of observation in two groups of patients: BMI <50 kg/m2 and BMI ≥50 kg/m2. RESULTS: The medical records of 403 patients were studied. From 18 to 42 months after surgery, %TWL was higher in the superobese group, whereas %EWL was similar for the two groups. %EBMIL was higher in less obese patients up to 24 months and similar thereafter. In contrast, %EBMIL with PBMI was greater in the superobese group, although it never reached the 100% goal. CONCLUSIONS: We conclude that %EBMIL results according to PBMI were not reproducible in our institution. There is a need to elaborate a new easy-to-obtain and reproducible index.

Factors related to weight loss up to 4 years after bariatric surgery.

BACKGROUND: Gastric bypass is the bariatric surgery most frequently performed in the world. It is responsible for sustainable weight loss, resolution of comorbidities, and improvement of quality of life. However, weight loss is not homogeneous, at times being insufficient in some patients. Our objective was to assess which factors were important in influencing this differentiated weight loss over a period of 4 years after surgery. METHODS: In this retrospective study, we assessed several physical, socioeconomic, behavioral, surgical, and demographic factors in morbidly obese patients submitted to Roux-en-Y gastric bypass that might influence excess weight loss over a period of 4 years after surgery. The same factors were assessed in order to characterize insufficient excess weight loss (<50% EWL). RESULTS: Review of the medical records of 149 patients showed that type-2 diabetes mellitus and dyslipidemia were the most important factors related to a lower EWL up to the third year. Preoperative weight loss, lower schooling, and lack of adherence to nutritional guidelines were important after 2 and 3 years. The presence of depression and lack of adherence to nutritional guidelines were the factors related to EWL of less than 50%. CONCLUSIONS: Special attention and clarification should be provided to patients with diabetes mellitus type 2 and dyslipidemia and to patients with depression and lower schooling, since these patients tend to lose less excess weight after surgery. Multiprofessional care should also be provided so that the patients will follow nutritional guidelines more rigorously after surgery.

Treatment of gastrogastric fistula after Roux-en-Y gastric bypass: surgery combined with gastroscopy.

A 53-year-old male who had previously undergone an open gastric bypass (Capella-Fobi) developed a gastrogastric fistula during the late postoperative course. Because he regained weight and had a stomal ulcer difficult to control, it was decided to submit him to revisional surgery. At laparotomy, a retrogastric approach plus gastroscopy permitted easy identification and closure of the fistula. The patient is doing well and losing weight after this reoperation.

Effect of preoperative endoscopic decompression on malignant biliary obstruction and postoperative infection.

BACKGROUND/AIMS: The role of preoperative biliary drainage as an adjunct in patients undergoing surgical resection for malignant biliary obstruction is controversial. The objective of the present study was to evaluate the effects of preoperative endoscopic biliary drainage and its possible association with postoperative infection in patients presenting neoplastic obstructive jaundice. METHODOLOGY: The medical records of 53 patients presenting periampullary neoplasia were reviewed. In all of these patients, bile was obtained intraoperatively by puncture. Among the 53 patients, 14 had been submitted to preoperative endoscopic drainage (Group I) and 39 had undergone surgery without decompression (Group II). For statistical analysis, the level of significance was set at 5%. RESULTS: Bile culture was positive in 13 (92.8%) of the patients in Group I, a significantly higher incidence than that observed in group II, in which 16 (41%) of the patients presented positive cultures (p=0.001). There was no significant difference in general postoperative morbidity between groups (64.2% for group I vs. 46% for group II) or mortality (0% vs. 7.6%, respectively). When infective complications (cholangitis, pneumonia, wall infection) were analyzed separately, a higher incidence, although without significance, was found in Group I than in Group II (50% vs. 28.2%, respectively; p=0.1913). CONCLUSIONS: The presence of an endoscopic biliary drain provokes bacterial colonization, possibly due to the combination of residual cholestasis and duodenal reflux to the bile duct, raising concerns about the possible appearance of infective complications during the postoperative period.