Impact of Bariatric Surgery on the Saliva of Patients with Morbid Obesity.

BACKGROUND: The oral condition of obese patients may change following bariatric surgery owing to adverse effects that cause alterations in the oral cavity. The aim of this study was to evaluate the impact of bariatric surgery on the saliva of patients with morbid obesity. METHODS: Whole saliva samples were collected from 27 patients with morbid obesity (BMI >40 kg/m(2)), prior to and 6 months after bariatric surgery. Stimulated salivary flow rate, pH, buffering capacity, and microbial levels of mutans streptococci, Lactobacillus spp., and Candida albicans were analyzed from saliva. RESULTS: Values of all salivary variables before and after bariatric surgery were within the normal range, except for the level of C. albicans, which was elevated at both times. An increase in the level of mutans streptococci was observed after bariatric surgery (p < 0.05). CONCLUSIONS: The results suggest that the salivary levels of mutans streptococci increase following bariatric surgery in morbidly obese patients.

Improvement of exercise capacity and peripheral metaboreflex after bariatric surgery.

BACKGROUND: Bariatric surgery is the only predictable method to obtain weight loss in severe obesity. Poor physical performance of obese individuals may be mediated by the peripheral metaboreflex, which controls blood flow redistribution to exercising muscles. Weight reduction improves exercise capacity through several possible mechanisms that are insufficiently understood. We hypothesized that the metaboreflex is one among the causes of improvement in exercise capacity after weight loss. This study thus aimed to examine the effect of bariatric surgery on exercise performance and metaboreflex. METHODS: Severely obese patients were assessed before and 3 months after bariatric surgery. Metaboreflex was evaluated by the technique of selective induction by post-exercise circulatory occlusion (PECO+) after isometric handgrip exercise at 30% of maximum voluntary contraction. The exercise capacity was assessed by 6-min walking test. RESULTS: Seventeen patients completed the protocol. Body mass index decreased from 46.4 ± 2 to 36.6 ± 2 kg/m2 (P < 0.001). The distance walked in 6 min increased from 489 ± 14 to 536 ± 14 m (P < 0.001). The peripheral metaboreflex activity, expressed by the area under the curve of vascular resistance, was lower after than before bariatric surgery (42 ± 5 to 20 ± 4 units, P = 0.003). Heart rate, blood pressure, and vascular resistance were also significantly decreased. The correlation between change in distance walked in 6 min and change in peripheral metaboreflex activity was not significant. CONCLUSIONS: Weight loss after bariatric surgery increases exercise capacity and reduces peripheral metaboreflex, heart rate, and blood pressure. Further investigation on the role of metaboreflex regarding mechanisms of exercise capacity of individuals with obesity is warranted.

Functional vascular endothelial growth factor -634G>C SNP is associated with proliferative diabetic retinopathy: a case-control study in a Brazilian population of European ancestry.

OBJECTIVE: The purpose of this study was to evaluate the effect of the single nucleotide polymorphism (SNP) -634G>C at the 5' regulatory region of the vascular endothelial growth factor (VEGF) in the risk of proliferative diabetic retinopathy (PDR) in the Brazilian population of European ancestry with type 2 diabetes. RESEARCH DESIGN AND METHODS: A case-control study was conducted in 501 type 2 diabetic patients of European ancestry. Patients underwent a standardized clinical, ophthalmological, and laboratory evaluation. Of these, 167 patients had PDR (case patients), and 334 were considered as control subjects (patients without PDR) for PDR. A reference population (110 individuals of European ancestry) was also evaluated. RESULTS: No evidence of association between -634G>C/VEGF and the presence of diabetic retinopathy or type 2 diabetes was observed (P > 0.05). However, CC homozygous for the SNP -634G>C was significantly more frequent in patients with PDR (37 of 167; 22.2%) than in the corresponding control group (40 of 334; 12%) in accordance with a recessive model (P = 0.003). This effect was further observed when creatinine, BMI, sex, duration of type 2 diabetes, HDL cholesterol, and systolic blood pressure were taken into account (odds ratio 1.9 [95% CI 1.01-3.79], P = 0.04). CONCLUSIONS: The presence of the allele -634C/VEGF in homozygosity is an independent risk factor for the development of PDR in type 2 diabetic patients of European ancestry.

Familial history of type 2 diabetes in patients from Southern Brazil and its influence on the clinical characteristics of this disease.

OBJECTIVE: To investigate the presence of maternal and paternal history of type 2 diabetes mellitus (DM) in relatives of 644 type 2 diabetic patients from Southern Brazil, and also to evaluate its influence on the clinical characteristics of this disease. PATIENTS AND METHODS: Familial history of type 2 DM was investigated by a questionnaire. The maternal and paternal history was investigated over two generations. Complete data sets on familial history were obtained from 396 patients. RESULTS: In general, 76.6% of the patients reported at least one first-degree affected relative. Besides, 31.6% of the patients reported a maternal history of type 2 DM and 12.6% reported a paternal history. Patients with maternal and/or paternal history presented a lower age at type 2 DM diagnosis when compared to patients without familial history. In addition, patients with only paternal history presented a higher frequency of hypertension than patients with no familial history. CONCLUSIONS: This study suggests that there is a significant maternal effect in the transmission of type 2 DM in Southern Brazil, and that most of the clinical characteristics of this disease do not differ between patients with or without familial history of type 2 DM.

Familial history of type 2 diabetes in patients from Southern Brazil and its influence on the clinical characteristics of this disease / História familiar de diabetes tipo 2 em pacientes do sul do Brasil e sua influência nas características dessa doença

OBJECTIVE: To investigate the presence of maternal and paternal history of type 2 diabetes mellitus (DM) in relatives of 644 type 2 diabetic patients from Southern Brazil, and also to evaluate its influence on the clinical characteristics of this disease. PATIENTS AND METHODS: Familial history of type 2 DM was investigated by a questionnaire. The maternal and paternal history was investigated over two generations. Complete data sets on familial history were obtained from 396 patients. RESULTS: In general, 76.6 percent of the patients reported at least one first-degree affected relative. Besides, 31.6 percent of the patients reported a maternal history of type 2 DM and 12.6 percent reported a paternal history. Patients with maternal and/or paternal history presented a lower age at type 2 DM diagnosis when compared to patients without familial history. In addition, patients with only paternal history presented a higher frequency of hypertension than patients with no familial history. CONCLUSIONS: This study suggests that there is a significant maternal effect in the transmission of type 2 DM in Southern Brazil, and that most of the clinical characteristics of this disease do not differ between patients with or without familial history of type 2 DM.

OBJETIVOS: Investigar a presença de história materna e paterna de diabetes mellitus tipo 2 (DM) entre familiares de 644 pacientes diabéticos tipo 2 provenientes do sul do Brasil, bem como avaliar sua influência nas características clínicas dessa doença. MATERIAIS E MÉTODOS: A história familiar de DM tipo 2 foi investigada através de um questionário, sendo que a presença de história materna e paterna foi investigada em duas gerações. Dados completos sobre história familiar foram obtidos para 396 pacientes. RESULTADOS: Em geral, 76,6 por cento dos pacientes reportaram ao menos um familiar em primeiro grau afetado por DM tipo 2. Além disso, 31,6 por cento dos pacientes relataram uma história materna de DM tipo 2 e 12,6 por cento relataram uma história paterna. Pacientes com história materna e/ou paterna apresentaram uma idade de diagnóstico de DM tipo 2 mais baixa quando comparado a pacientes sem história familiar. Adicionalmente, pacientes que relataram apenas história paterna de DM tipo 2 apresentaram uma maior freqüência de hipertensão do que pacientes sem história familiar. CONCLUSÕES: Nosso estudo sugere que há um efeito materno significativo na transmissão do DM tipo 2 no Sul do Brasil, e que a maioria das características clínicas dessa doença não difere entre pacientes com e sem história familiar de DM tipo 2.