Effect of Bariatric Surgery on High-Density Lipoprotein (HDL) Cholesterol in Non-diabetic Patients with Severe Obesity.

BACKGROUND: This study evaluated changes in serum high-density lipoprotein cholesterol (HDL-C) induced by laparoscopic bariatric surgery (BS) in non-diabetic obese subjects with low (L-HDL-C) or normal (N-HDL-C) levels of HDL-C. We assessed whether increased HDL-C is associated with weight loss, serum non-HDL cholesterol (non-HDL-C), serum triglycerides (TG), and physical activity (PA) before and 6 and 15 months after BS. METHODS: In this prospective cohort study, 71 subjects undergoing BS (42 by Roux-en-Y gastric bypass and 29 by sleeve gastrectomy) were evaluated for the % Excess Weight Loss (%EWL), waist circumference (WC), serum levels of glucose, glycosylated hemoglobin, TG, HDL-C, non-HDL-C, and LDL-C, and the degree, time, and energy expenditure related to PA. The short version of the International Physical Activity Questionnaire was used to assess PA. RESULTS: Levels of HDL-C significantly increased 15 months after BS (p < 0.001) in subjects with low (p < 0.001) or normal (p = 0.017) values at baseline. A similar %EWL, decrease in WC, glucose, non-HDL-C, and LDL-C levels and increase in energy expenditure related to PA, was observed in both groups (L-HDL-C and N-HDL-C) at 15 months after BS. However, the L-HDL-C group presented greater decrease in TG levels compared with N-HDL-C group (p = 0.004). In subjects with increased HDL-C 15 months after BS, there was an association between this increase and the %EWL (p = 0.030), but there was no association with the change in PA. CONCLUSIONS: Irrespective of PA after BS, subjects with low and normal HDL-C levels at baseline showed an increase in HDL-C after BS, and this increase was associated with %EWL induced by BS.

Polyneuropathy in Severely Obese Women Without Diabetes: Prevalence and Associated Factors.

BACKGROUND: Obesity and its complications are prevalent in women and increase with age. Polyneuropathy (PNP) is a complication of obesity and bariatric surgery (BS). In subjects with severe (grades II and III) obesity and without DM who are candidates for BS, the prevalence of PNP and associated conditions are not well characterized. The aim of this study was to evaluate the prevalence of PNP in severely obese (SO) women without DM or common nutritional deficiencies in order to determine factors associated with the presence of PNP. METHODS: A cross-sectional study was performed on 450 SO women. They were evaluated with the Michigan Neuropathy Screening Instrument, a Sleep Apnea Questionnaire, and the short form of the International Physical Activity Questionnaire. Data on blood pressure, body mass index, waist circumference, serum glucose, glycated hemoglobin, LDL and HDL cholesterol, triglycerides, vitamin B12, and postmenopausal (PM) status were also collected. Patients with DM and other common causes of PNP were excluded. To evaluate which variables were independently associated with PNP (dependent variable), Poisson regression models were used. RESULTS: The prevalence of PNP was 11.6%. In univariate analysis, PNP was associated with age, PM status, and diagnosis of systemic arterial hypertension (p < 0.001, p < 0.001, and p = 0.016, respectively), and there was a trend toward an association with sleep apnea risk (p = 0.101). In multivariate analysis, PM status (PR = 2.836, 95% CI 1.735-4.636, p = 0.001) and age (PR = 1.0511, 95% CI 1.031-1.071, p = 0.001) were independently associated with PNP diagnosis in two different models. CONCLUSION: Even prior to BS, PNP is highly prevalent and is associated with PM status and age in SO women without diabetes.

Peripheral polyneuropathy in severely obese patients with metabolic syndrome but without diabetes: Association with low HDL-cholesterol.

INTRODUCTION:: The purpose of this study was to evaluate the prevalence of peripheral polyneuropathy (PPN) in subjects with grade II and III obesity (Ob-II,III) and metabolic syndrome (MetS) but without diabetes and to investigate possible associated factors. METHOD:: A cross-sectional study was performed in non-diabetic Ob-II,III,MetS patients using the Michigan Neuropathy Screening Instrument (MNSI) to assess the presence of PPN. RESULTS:: A total of 24 of 218 non-diabetic Ob-II,III,MetS patients had PPN. Based on univariate analysis, serum levels of LDL-cholesterol (p=0.046) were significantly associated with PPN, while serum triglycerides (p=0.118) and low HDL-cholesterol (p=0.057) showed a tendency toward this association. On a Poisson regression analysis, when the three possible associations were included, low HDL-cholesterol (p=0.047) remained independently associated. CONCLUSION:: In non-diabetic Ob-II,III,MetS patients, PPN defined by the MNSI showed a high prevalence and was associated with low levels of HDL-cholesterol. In order to diagnose that complication, neurological evaluation should be performed in these patients.

Peripheral polyneuropathy in severely obese patients with metabolic syndrome but without diabetes: Association with low HDL-cholesterol / Polineuropatia periférica em pacientes obesos graves com síndrome metabólica sem diabetes: associação com baixo HDL-colesterol

Summary Introduction: The purpose of this study was to evaluate the prevalence of peripheral polyneuropathy (PPN) in subjects with grade II and III obesity (Ob-II,III) and metabolic syndrome (MetS) but without diabetes and to investigate possible associated factors. Method: A cross-sectional study was performed in non-diabetic Ob-II,III,MetS patients using the Michigan Neuropathy Screening Instrument (MNSI) to assess the presence of PPN. Results: A total of 24 of 218 non-diabetic Ob-II,III,MetS patients had PPN. Based on univariate analysis, serum levels of LDL-cholesterol (p=0.046) were significantly associated with PPN, while serum triglycerides (p=0.118) and low HDL-cholesterol (p=0.057) showed a tendency toward this association. On a Poisson regression analysis, when the three possible associations were included, low HDL-cholesterol (p=0.047) remained independently associated. Conclusion: In non-diabetic Ob-II,III,MetS patients, PPN defined by the MNSI showed a high prevalence and was associated with low levels of HDL-cholesterol. In order to diagnose that complication, neurological evaluation should be performed in these patients.

Resumo Objetivo: Avaliar a prevalência da polineuropatia periférica (PNP) em indivíduos obesos graus II e III com síndrome metabólica (Ob-II,III,SM) sem diabetes e buscar possíveis fatores associados. Método: Em um estudo transversal, realizado em indivíduos Ob-II,III,SM e sem diagnóstico de diabetes, o Instrumento de Screening de Michigan (MNSI) foi utilizado para avaliar a presença de PNP. Resultados: Um total de 24 de 218 pacientes Ob-II,III,SM e sem diabetes tinham PNP. Quando observamos as associações com PNP em uma análise univariada, níveis séricos de LDL-colesterol (p=0.046) estiveram significativamente associados e houve também uma tendência à associação com níveis séricos de triglicerídeos (p=0.118) e baixo HDL-colesterol (p=0.057). Em uma análise de regressão de Poisson, quando as três possíveis associações foram incluídas, baixo HDL-colesterol (p=0.047) manteve-se independentemente associado. Conclusão: Em pacientes Ob-II,III,SM, mas sem diabetes, a PNP definida pelo MNSI tem uma prevalência elevada e está associada a baixos níveis de HDL-colesterol. Para diagnóstico dessa complicação, recomenda-se realizar o exame neurológico desses pacientes.

Metabolic syndrome resolution by Roux-en-Y gastric bypass in a real world: a case control study.

OBJECTIVES: the aim of this study was to evaluate the efficacy of Roux-en-Y Gastric Bypass (RYGB), compared with nonsurgical treatment (NS group), as an instrument for inducing remission of co-morbidities related to Metabolic Syndrome (MetS) in patients with Obesity, grades 2 and 3 (Ob2,3). METHODS: two hundred and fifty eight Ob2,3 patients were selected in a retrospective analysis and included in a case control study. MetS was defined as described by the International Diabetes Federation. One hundred and twenty-nine of these patients underwent RYGB (S group), and 129 were assessed as an NS group. RESULTS: at baseline, S and NS groups did not differ in BMI, age, female sex and prevalence of MetS (p>0.05). For the S group the outcomes were a reduction in BMI of 38.1% (p<0.001), waist circumference of 28.6% (p<0.001), fasting plasma glucose of 10.5% (p<0.001), serum LDL-cholesterol of 21.9% (p<0.001) and of 85% in the number of patients with MetS (p<0.001). For the NS group, only a decrease of 4.12%(p=0.047) in triglyceride levels and of 5.9%(p=0.031) in Diastolic Blood Pressure was observed. In the NS group, 98.6% of the patients continued to have MetS. The number needed to treat (NNT) with surgery to resolve one case of MetS was 1.2 (CI 95%: 1.1 - 1.4). CONCLUSION: in the real world, in the South of Brazil, compared with NS treatment and after 1 year of observation, RYGB is highly effective for decreasing the prevalence of MetS.

Metabolic syndrome resolution by Roux-en-Y gastric bypass in a real world: a case control study / Resolução da síndrome metabólica pela gastroplastia Roux-em-Y em um mundo real: estudo caso-controle

Summary Objectives: the aim of this study was to evaluate the efficacy of Roux-en-Y Gastric Bypass (RYGB), compared with nonsurgical treatment (NS group), as an instrument for inducing remission of co-morbidities related to Metabolic Syndrome (MetS) in patients with Obesity, grades 2 and 3 (Ob2,3). Methods: two hundred and fifty eight Ob2,3 patients were selected in a retrospective analysis and included in a case control study. MetS was defined as described by the International Diabetes Federation. One hundred and twenty-nine of these patients underwent RYGB (S group), and 129 were assessed as an NS group. Results: at baseline, S and NS groups did not differ in BMI, age, female sex and prevalence of MetS (p>0.05). For the S group the outcomes were a reduction in BMI of 38.1% (p<0.001), waist circumference of 28.6% (p<0.001), fasting plasma glucose of 10.5% (p<0.001), serum LDL-cholesterol of 21.9% (p<0.001) and of 85% in the number of patients with MetS (p<0.001). For the NS group, only a decrease of 4.12%(p=0.047) in triglyceride levels and of 5.9%(p=0.031) in Diastolic Blood Pressure was observed. In the NS group, 98.6% of the patients continued to have MetS. The number needed to treat (NNT) with surgery to resolve one case of MetS was 1.2 (CI 95%: 1.1 - 1.4). Conclusion: in the real world, in the South of Brazil, compared with NS treatment and after 1 year of observation, RYGB is highly effective for decreasing the prevalence of MetS. .

Resumo Objetivo: o objetivo deste estudo foi avaliar a eficácia do bypass gástrico em Y de Roux (BGYR), em comparação a um tratamento não cirúrgico (grupo NC), como instrumento para induzir remissão da síndrome metabólica (SMet) em pacientes com obesidade graus 2 e 3 (Ob2, 3). Métodos: duzentos e cinquenta e oito pacientes com Ob2,3 foram selecionados para análise retrospectiva em estudos de caso e controle. SMet foi definida como descrita pela Federação Internacional de Diabetes. Dos pacientes, 129 foram submetidos ao BGYR (grupo C), e 129 formaram o grupo NC. Resultados: antes dos tratamentos, os grupos C e NC não diferiram em IMC, idade, sexo feminino e prevalência de SMet (p>0,05). No grupo C, houve uma redução no IMC de 38,1% (p<0,001), circunferência da cintura de 28,6% (p<0,001), glicemia de jejum de 10,5% (p<0,001), LDL colesterol sérico de 21,9% (p<0,001) e em 85% dos casos de SMet (p<0,001). As diferenças observadas no grupo NC foram uma diminuição nos níveis de triglicérides, de 4,12% (p=0,047), e na pressão arterial diastólica, de 5,9% (p=0,031). No grupo NC, 98,6% dos pacientes persistiram com SMet. O número necessário para tratar (NNT) com a cirurgia, para resolver um caso de SMet, foi de 1,2 (IC 95%: 1,1 - 1,4). Conclusão: em um mundo real, no Sul do Brasil, em comparação ao tratamento NS e após 1 ano de observação, BGYR foi altamente eficaz para diminuir a prevalência de SMet. .