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1.
J Clin Sleep Med ; 16(4): 503-514, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32003737

RESUMO

STUDY OBJECTIVES: To determine whether an intensive weight-loss program (IWLP) is effective for reducing weight, the severity of obstructive sleep apnea (OSA), and metabolic variables in patients with obesity and severe OSA undergoing continuous positive airway pressure treatment. METHODS: Forty-two patients were randomized to the control (CG, n = 20) or the intervention group (IG, n = 22), who followed a 12-month IWLP. The primary outcome was a reduction in the apnea-hypopnea index (AHI) as measured at 3 and 12 months by full polysomnography. Metabolic variables, blood pressure, body fat composition by bioimpedance, carotid intima media thickness, and visceral fat by computed tomography were also assessed. RESULTS: Mean age was 49 (6.7) years, body mass index 35 (2.7) kg/m², and AHI 69 (20) events/h. Weight reduction was higher for the IG than the CG at 3 and 12 months, -10.5 versus -2.3 kg (P < .001), and -8.2 versus -0.1 kg (P < .001), respectively, as was loss of visceral fat at 12 months. AHI decreased more in the IG at 3 months (-23.72 versus -9 events/h) but the difference was not significant at 12 months, though 28% of patients from the IG had an AHI < 30 events/h compared to none in the CG (P = .046). At 12 months, the IG showed a reduction in C-reactive protein (P = .013), glycated hemoglobin (P = .031) and an increase in high density lipoprotein cholesterol (P = .027). CONCLUSIONS: An IWLP in patients with obesity and severe OSA is effective for reducing weight and OSA severity. It also results in an improvement in lipid profiles, glycemic control, and inflammatory markers. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Title: Effectiveness of an Intensive Weight Loss Program for Obstructive Sleep Apnea Syndrome (OSAS) Treatment; Identifier: NCT02832414; URL: https://clinicaltrials.gov/ct2/show/record/NCT02832414.

2.
Obes Surg ; 30(1): 180-188, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31420830

RESUMO

BACKGROUND: To compare changes in bone mineral density (BMD) in patients with morbid obesity and type 2 diabetes (T2D) a year after being randomized to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP). We also analyzed the association of gastrointestinal hormones with skeletal metabolism. METHODS: Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Before and 12 months after surgery, anthropometric, body composition, biochemical parameters, fasting plasma glucagon, ghrelin, and PYY as well as GLP-1, GLP-2, and insulin after a standard meal were determined. RESULTS: After surgery, the decrease at femoral neck (FN) was similar but at lumbar spine (LS), it was greater in the mRYGB group compared with SG and GCP - 7.29 (4.6) vs. - 0.48 (3.9) vs. - 1.2 (2.7)%, p < 0.001. Osteocalcin and alkaline phosphatase increased more after mRYGB. Bone mineral content (BMC) at the LS after surgery correlated with fasting ghrelin (r = - 0.412, p = 0.01) and AUC for GLP-1 (r = - 0.402, p = 0.017). FN BMD at 12 months correlated with post-surgical fasting glucagon (r = 0.498, p = 0.04) and insulin AUC (r = 0.384, p = 0.030) and at LS with the AUC for GLP-1 in the same time period (r = - 0.335, p = 0.049). However, in the multiple regression analysis after adjusting for age, sex, and BMI, the type of surgery (mRYGB) remained the only factor associated with BMD reduction at LS and FN. CONCLUSIONS: mRYGB induces greater deleterious effects on the bone at LS compared with SG and GCP, and gastrointestinal hormones do not play a major role in bone changes.

4.
J Clin Med ; 8(10)2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31569607

RESUMO

Altered activity in decision-making neural circuitry may underlie the maladaptive food choices found in obesity. Here, we aimed to identify the brain regions purportedly underpinning risk-taking behavior in individuals with obesity. Twenty-three adult women with obesity and twenty-three healthy weight controls completed the Risky Gains Task during functional magnetic resonance imaging (fMRI). This task allows participants to choose between a safe option for a small, guaranteed monetary reward and risky options with larger rewards. fMRI analyses comparing losing trials to winning trials found that participants with obesity presented decreased activity in the left anterior insula in comparison to controls (p < 0.05, AlphaSim corrected). Moreover, left insula activation during losses vs. wins was negatively correlated with UPPS-P questionnaire sensation seeking scores. During safe vs. risky trials following a loss, the control group exhibited increased activation in the ventromedial prefrontal cortex (vmPFC) (p < 0.05, AlphaSim corrected) in comparison to the OB group. Moreover, vmPFC response in the obesity group during post-loss trials was negatively correlated with risky choices on the task overall. As a whole, our findings support that diminished tuning of the insula towards interoceptive signals may lead to a lack of input to the vmPFC when weighing the costs and benefits of risky choices.

5.
Diabetes Care ; 42(10): 1956-1965, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31375523

RESUMO

OBJECTIVE: To determine the potential use of baseline circulating succinate to predict type 2 diabetes remission after bariatric surgery. RESEARCH DESIGN AND METHODS: Forty-five obese patients with diabetes were randomly assigned to Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or laparoscopic greater curvature plication. Anthropometric parameters were evaluated, and a complete biochemical analysis including circulating serum succinate concentrations was performed at baseline and 1 year after surgery. The results were externally validated in a second cohort including 88 obese patients with diabetes assigned to RYGB or SG based on clinical criteria. RESULTS: Succinate baseline concentrations were an independent predictor of diabetes remission after bariatric surgery. Patients achieving remission after 1 year had lower levels of baseline succinate (47.8 [37.6-64.6] µmol/L vs. 64.1 [52.5-82.9] µmol/L; P = 0.018). Moreover, succinate concentrations were significantly decreased 1 year after surgery (58.9 [46.4-82.4] µmol/L vs. 46.0 [35.8-65.3] µmol/L, P = 0.005). In multivariate analysis, the best logistic regression model showed that baseline succinate (odds ratio [OR] 11.3, P = 0.031) and the type of surgery (OR 26.4, P = 0.010) were independently associated with remission. The C-statistic for this model was 0.899 (95% CI 0.809-0.989) in the derivation cohort, which significantly improved the prediction of remission compared with current available scores, and 0.729 (95% CI 0.612-0.846) in the validation cohort. Interestingly, patients had a different response to the type of surgery according to baseline succinate, with significant differences in remission rates. CONCLUSIONS: Circulating succinate is reduced after bariatric surgery. Baseline succinate levels have predictive value for diabetes remission independently of previously described presurgical factors and improve upon the current available scores to predict remission.

6.
Transl Psychiatry ; 9(1): 194, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31431608

RESUMO

Maladaptive emotion regulation contributes to overeating and impedes weight loss. Our study aimed to compare the voluntary downregulation of negative emotions by means of cognitive reappraisal in adult women with obesity (OB) and female healthy controls (HC) using a data-driven, multimodal magnetic resonance imaging (MRI) approach. Women with OB (n = 24) and HC (n = 25) carried out an emotion regulation task during functional MRI scanning. Seed-to-voxel resting-state connectivity patterns derived from activation peaks identified by this task were compared between groups. Diffusion tensor imaging (DTI) was used to examine white matter microstructure integrity between regions exhibiting group differences in resting-state functional connectivity. Participants in the OB group presented reduced activation in the ventromedial prefrontal (vmPFC) cortex in comparison to the HC group when downregulating negative emotions, along with heightened activation in the extrastriate visual cortex (p < 0.05, AlphaSim-corrected). Moreover, vmPFC peak activity levels during cognitive reappraisal were negatively correlated with self-reported difficulties in emotion regulation. OB patients exhibited decreased functional connectivity between the vmPFC and the temporal pole during rest (peak-pFWE = 0.039). Decreased fractional white-matter track volume in the uncinate fasciculus, which links these two regions, was also found in participants with OB. Taken together, our findings are indicative of emotion regulation deficits in OB being underpinned by dysfunctional hypoactivity in the vmPFC and hyperactivity in the extrastriate visual cortex. Our results provide a potential target circuit for neuromodulatory interventions to improve emotion regulation skills and weight-loss intervention outcomes.


Assuntos
Encéfalo/diagnóstico por imagem , Obesidade/psicologia , Substância Branca/diagnóstico por imagem , Adolescente , Adulto , Imagem de Tensor de Difusão , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Imagem Multimodal , Rede Nervosa/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Adulto Jovem
7.
Obes Surg ; 29(10): 3348-3356, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31209830

RESUMO

INTRODUCTION/PURPOSE: The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre-contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change. MATERIALS/METHODS: A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study. RESULTS: A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/m2 in maintenance versus 1.4 ± 1.4 kg/m2 in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change. CONCLUSION: Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge.

8.
Sci Rep ; 9(1): 6274, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-31000783

RESUMO

We aimed to explore the relationship between GLP-1 receptor (GLP-1R) expression in adipose tissue (AT) and incretin secretion, glucose homeostasis and weight loss, in patients with morbid obesity and type 2 diabetes undergoing bariatric surgery. RNA was extracted from subcutaneous (SAT) and visceral (VAT) AT biopsies from 40 patients randomized to metabolic gastric bypass, sleeve gastrectomy or greater curvature plication. Biochemical parameters, fasting plasma insulin, glucagon and area under the curve (AUC) of GLP-1 following a standard meal test were determined before and 1 year after bariatric surgery. GLP-1R expression was higher in VAT than in SAT. GLP-1R expression in VAT correlated with weight (r = -0.453, p = 0.008), waist circumference (r = -0.494, p = 0.004), plasma insulin (r = -0.466, p = 0.007), and systolic blood pressure (BP) (r = -0.410, p = 0.018). At 1 year, GLP-1R expression in VAT was negatively associated with diastolic BP (r = -0.361, p = 0.039) and, following metabolic gastric bypass, with the increase of GLP-1 AUC, (R2 = 0.46, p = 0.038). Finally, GLP-1R in AT was similar independently of diabetes outcomes and was not associated with weight loss after surgery. Thus, GLP-1R expression in AT is of limited value to predict incretin response and does not play a role in metabolic outcomes after bariatric surgery.

9.
J Sleep Res ; 28(5): e12830, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30740836

RESUMO

Central obesity is the main risk factor for obstructive sleep apnea (OSA). Whether there exists a central-obesity anthropometric that better explains apnea-hypopnea index (AHI) variability in the general population and in sleep cohorts is unknown, and this is even less explored among increasing grades of obesity. The objective of the study is to investigate whether there is an anthropometric that better explains AHI variability in a sample of morbidly obese women awaiting bariatric surgery (BS). A prospective multicentre cross-sectional study was conducted in consecutive women before BS. Demographic and anthropometric characteristics included age, body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR). OSA was diagnosed by polysomnography. The capacity of anthropometrics to explain AHI variance was investigated using regression linear models. A total of 115 women were evaluated: age, 44 ± 10 years; BMI, 46 ± 5 kg/m2 ; AHI, 35 ± 26 events/hr. AHI was associated with all anthropometrics except weight, height and HC. The best univariate predictor was WHR, which accounted for 15% of AHI variance. The simplest model (age + BMI) accounted for 9%, which increased to 20% when applying more complex measurements (age + BMI + NC + WC + HC). The explanatory capacity did not change significantly when applying a simpler model (age + WHR + NC, 19%). In this female morbidly obese cohort, anthropometrics explained one-fifth of AHI variability. WHR is the best univariate parameter and models including waist and neck data provide more information than BMI when explaining AHI variability. Thus, even in young women with extreme obesity, OSA seems to be linked to a specific central-obesity phenotype rather than to a whole-obesity pattern.

10.
Obes Surg ; 29(2): 585-592, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30397876

RESUMO

CONTEXT: Information concerning the risk-benefit profile of bariatric surgery in subjects with liver cirrhosis is scarce. Our aim was to describe the long-term outcomes of bariatric surgery in a cohort of patients with liver cirrhosis submitted to bariatric surgery. METHODS: This was a multicenter, retrospective observational study performed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), with a review of patients with cirrhosis who had undergone bariatric surgery during the period from April 2004 to March 2017 in ten public reference hospitals in Spain. RESULTS: Data on 41 patients with cirrhosis submitted to obesity surgery were collected (mean age 53.8 ± 7.9 years, 46.3% women, presurgical BMI 45 ± 8.3 kg/m2). All but one patient belonged to Child-Pugh class A, and sleeve gastrectomy was conducted in 68.3% of cases. Percentage of total weight loss (%TWL) was 26.33 ± 8.3% and 21.16 ± 15.32% at 1 and 5 years after surgery, respectively. This was accompanied by a significant reduction of type 2 diabetes, high blood pressure, and dyslipidemia and by an improvement of liver enzymes over time. Model for End-Stage Liver Disease (MELD) index increased from 7.2 ± 1.9 to 9.8 ± 4.6 after 5 years. Seven patients (17%) developed early postsurgical complications. No postsurgical mortality was observed. During follow-up, only five patients developed liver decompensation. CONCLUSIONS: Bariatric surgery in selected patients with liver cirrhosis has metabolic benefits that could have a positive impact on liver prognosis. TRIAL REGISTRATION: Controlledtrials.com Identifier: 10.1186/ISRCTN15009106.


Assuntos
Cirurgia Bariátrica , Cirrose Hepática/complicações , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Perda de Peso
11.
Eur Eat Disord Rev ; 26(6): 645-656, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30353597

RESUMO

INTRODUCTION: Evidence suggests that food addiction (FA) is prevalent among individuals with obesity seeking bariatric surgery (BS), but there is no evidence about whether FA is a predictor of weight loss (WL). We aimed to analyse the prevalence of FA in patients with obesity seeking BS and to examine whether FA could predict WL following dietary intervention before surgery. METHOD: The study included 110 patients with obesity who underwent a dietetic intervention. Assessment included endocrinological variables, a semistructured interview to rule out mental disorders, and Yale Food Addiction Scale version 2.0 (YFAS 2.0). RESULTS: In our sample, the prevalence of FA was 26.4%. Those who met YFAS 2.0 criteria showed less WL after dietetic intervention and regain weight during dietary intervention. CONCLUSIONS: FA appears to be prevalent in obesity. Our findings confirmed a lower WL throughout dietary intervention before surgery in patients who fulfilled baseline criteria for FA. Future interventions should include multidisciplinary intervention to maximize WL before and after BS.


Assuntos
Cirurgia Bariátrica/psicologia , Dependência de Alimentos/epidemiologia , Obesidade/dietoterapia , Perda de Peso , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
12.
Eur Eat Disord Rev ; 26(6): 574-584, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30159982

RESUMO

BACKGROUND: Individuals with obesity (OB) often report suffering from addiction-like symptoms. As in addictions, deficits in executive function domains, such as decision-making and sustained attention, are found in OB. No study to date has examined the associations between food addiction, OB, and neuropsychological performance. METHOD: Thirty-three adult women with OB and 36 healthy weight controls completed the Yale Food Addiction Scale Version 2.0, a validated instrument used to assess food-related addictive behaviours. Additionally, participants completed computerized versions of the Iowa Gambling Task (IGT) and Conners' Continuous Performance Test, second edition (CPT-II) to examine decision-making and attentional control, respectively. RESULTS: Food addiction criteria were met in 24.2% of the participants with OB and in 2.8% of the control group. In the OB group, food addiction severity levels were negatively correlated with overall scores on the IGT. Participants with OB meeting criteria for food addiction committed more omissions and perseveration errors on the CPT-II compared with those without food addiction. CONCLUSIONS: Our results point to an association between food addiction severity levels and impairments in decision-making and attentional capacity in individuals with OB. Given the heterogeneity found in OB, it stands to reason that this subset of patients with food addiction could potentially benefit from interventions targeting neuropsychological deficits.


Assuntos
Função Executiva/fisiologia , Dependência de Alimentos/fisiopatologia , Obesidade/psicologia , Adolescente , Adulto , Atenção/fisiologia , Tomada de Decisões/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Adulto Jovem
13.
Eur J Clin Nutr ; 72(10): 1447-1450, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29352218

RESUMO

Endobarrier® is a minimally invasive, reversible endoscopic treatment for obesity. It provokes malabsorption along 60 cm of the small intestine, which can contribute to the development of vitamin deficiencies and to changes in bone mineral density (BMD). To determine the prevalence of nutrient deficiencies, changes in body composition and BMD during the first year after Endobarrier® placement. Twenty-one patients with type 2 diabetes met inclusion criteria. Levels of vitamins, micro and macronutrients were assessed prior and at 1, 3 and 12 months post-operatively. DEXA was performed before and 12 months after implant. Nineteen patients completed the 12 months follow-up. Vitamin D deficiency was the most prevalent finding before Endobarrier® implant. The percentage of patients with severe deficiency decreased from 19 to 5% at 12 months after supplementation. Microcytic anaemia was initially present in 9.5% of patients and increased to 26.3% at 12 months. Low ferritin and vitamin B12 levels were observed in 14.2 and 4.8% of patients before the implant and worsened to 42 and 10.5%. Low concentrations of magnesium and phosphorus were also common but improved along the study. A significant but not clinically relevant decrease in BMD of 4.14 ± 4.0% at the femoral neck was observed at 12 months without changes in osteocalcin levels. Vitamin deficiencies are common after Endobarrier® implant. It is therefore important to screen patients prior to and at regular intervals after the implant, and to encourage adherence to diet counselling and supplementation.


Assuntos
Densidade Óssea , Deficiências Nutricionais/etiologia , Diabetes Mellitus Tipo 2/complicações , Absorção Intestinal , Intestino Delgado , Obesidade/terapia , Próteses e Implantes/efeitos adversos , Anemia/etiologia , Deficiência de Vitaminas/etiologia , Deficiências Nutricionais/sangue , Feminino , Colo do Fêmur , Ferritinas/sangue , Humanos , Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Fósforo/sangue , Vitamina B 12/sangue , Deficiência de Vitamina B 12/etiologia , Deficiência de Vitamina D/etiologia
14.
Nutrients ; 9(12)2017 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-29207490

RESUMO

INTRODUCTION: The effects of bariatric surgery on skeletal health raise many concerns. Trabecular bone score (TBS) is obtained through the analysis of lumbar spine dual X-ray absorptiometry (DXA) images and allows an indirect assessment of skeletal microarchitecture (MA). The aim of our study was to evaluate the changes in bone mineral density (BMD) and alterations in bone microarchitecture assessed by TBS in morbidly obese women undergoing Roux-en-Y gastric bypass (RYGB), over a three-year follow-up. MATERIAL/METHODS: A prospective study of 38 morbidly obese white women, aged 46.3 ± 8.2 years, undergoing RYGB was conducted. Biochemical analyses and DXA scans with TBS evaluation were performed before and at one year and three years after surgery. RESULTS: Patients showed normal calcium and phosphorus plasma concentrations throughout the study. However, 25-hydroxyvitamin D (25(OH)D3) decreased, and 71% of patients had a vitamin D deficiency at three years. BMD at femoral neck and lumbar spine (LSBMD) significantly decreased 13.53 ± 5.42% and 6.03 ± 6.79%, respectively, during the three-year follow-up; however Z-score values remained above those for women of the same age. TBS was within normal ranges at one and three years (1.431 ± 106 and 1.413 ± 85, respectively), and at the end of the study, 73.7% of patients had normal bone MA. TBS at three years correlated inversely with age (r = -0.41, p = 0.010), body fat (r = -0.465, p = 0.004) and greater body fat deposited in trunk (r = -0.48, p = 0.004), and positively with LSBMD (r = 0.433, p = 0.007), fat mass loss (r = 0.438, p = 0.007) and lean mass loss (r = 0.432, p = 0.008). In the regression analysis, TBS remained associated with body fat (ß = -0.625, p = 0.031; R² = 0.47). The fracture risk, calculated by FRAX® (University of Sheffield, Sheffield, UK), with and without adjustment by TBS, was low. CONCLUSION: Women undergoing RYGB in the mid-term have a preserved bone MA, assessed by TBS.


Assuntos
Densidade Óssea/fisiologia , Osso e Ossos/ultraestrutura , Derivação Gástrica/efeitos adversos , Obesidade Mórbida , Adulto , Feminino , Fraturas do Quadril , Humanos , Obesidade Mórbida/cirurgia , Osteoporose , Fatores de Risco , Adulto Jovem
16.
Eur Eat Disord Rev ; 25(6): 586-594, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28971543

RESUMO

This study aimed to explore the empirical trajectories of body mass index (BMI) 1 year following bariatric surgery (BS) and to identify the risk factors for each trajectory. The study included 115 patients with severe obesity who underwent BS. Assessment included metabolic variables, psychopathological and personality measures. Growth mixture modelling identified four separated trajectories for the percentage of total weight loss course shape (namely, T1 'good-fast', T2 'good', T3 'low' and T4 'low-slow'). After adjusting for BS subtype and metabolic baseline state, T1 and T2 registered less eating and general psychopathology. T1 was characterized by the lowest scores in novelty seeking and self-transcendence, whereas T4 was defined by the highest scores in novelty seeking and the lowest scores in persistence. Our findings suggest that psychological state prior to BS is predictive of BMI trajectories during the 12 months following BS. These results could be useful in developing more efficient interventions for these patients. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.


Assuntos
Cirurgia Bariátrica/psicologia , Obesidade Mórbida/psicologia , Obesidade Mórbida/cirurgia , Perda de Peso , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicopatologia , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
18.
Obes Surg ; 27(9): 2235-2245, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28451931

RESUMO

BACKGROUND: Our aim was to determine the predictive value of gut hormone changes for the improvement of type 2 diabetes (T2D) following metabolic Roux-en-Y gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP) in a randomized controlled trial. Contradictory results have been obtained regarding the role of gastrointestinal hormones (in particular GLP-1) in beneficial metabolic bariatric surgery outcomes. METHODS: Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and area under the curve (AUC) of GLP-1 after a standard meal test were determined prior to and at months 1 and 12 after surgery. RESULTS: Twelve months after surgery, total weight loss percentage was higher and HbA1c lower in the mRYGB group than in the SG and GCP groups (-35.2 ± 8.1 and 5.1 ± 0.6% vs. -27.8 ± 5.4 and 6.2 ± 0.8% vs. -20.5 ± 6.8 and 6.6 ± 1.3%; p = 0.007 and p < 0.001, respectively). Moreover, GLP-1 AUC at months 1 and 12 was greater and T2D remission was higher in mRYGB (80 vs. 53.3 vs. 20%, p < 0.001). Insulin treatment (odds ratio (OR) 0.025, p = 0.018) and the increase in GLP-1 AUC from baseline to month 1 (OR 1.021, p = 0.013) were associated with T2D remission. CONCLUSIONS: mRYGB achieves a superior rate of weight loss and T2D remission at month 12. Enhanced GLP-1 secretion 1 month after surgery was a determinant of glucose metabolism improvement. Registration number ( http://www.clinicaltrials.gov ): NCT14104758.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia/métodos , Derivação Gástrica/métodos , Gastroplastia/métodos , Adulto , Diabetes Mellitus Tipo 2/complicações , Feminino , Hormônios Gastrointestinais/metabolismo , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Indução de Remissão , Estômago/cirurgia , Perda de Peso
19.
Transl Res ; 184: 35-44.e4, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28347650

RESUMO

This work aimed to explore the link between angiopoietin-like protein 8 (ANGPTL8) and weight loss after metabolic surgery. In the cross-sectional study (n = 100), circulating ANGPTL8 concentrations were significantly lower in morbidly obese than in lean subjects, and strikingly lower in morbidly obese patients with type 2 diabetes mellitus (T2DM). Conversely, ANGPTL8 expression in subcutaneous adipose tissue (SAT) was higher in morbidly obese patients, particularly in those with T2DM, whereas its expression in visceral adipose tissue was unchanged. The main predictors for circulating levels of ANGPTL8 were BMI and T2DM, whereas ANGPTL8 expression in SAT was determined by the presence of T2DM. The prospective cohort studies before and 1 year after bariatric surgery in morbidly obese patients with (n = 45) and without (n = 30) T2DM, revealed a significant increase of circulating ANGPTL8 levels 1 year after the bariatric surgery. Intriguingly, this increment, which was predicted by basal ANGPTL8 concentrations, appeared as a determinant of T2DM remission. In conclusion, circulating ANGPTL8 levels have an inverse relationship with SAT expression. Low basal levels of ANGPTL8 rebound after bariatric surgery. The increment in ANGPTL8 concentrations at 1 month of follow-up after weight loss emerged as a significant predictor of the T2DM remission at 1 year of follow-up.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus Tipo 2/sangue , Obesidade Mórbida/cirurgia , Hormônios Peptídicos/sangue , Adulto , Proteínas Semelhantes a Angiopoietina , Cirurgia Bariátrica , Biomarcadores/metabolismo , Estudos Transversais , Diabetes Mellitus Tipo 2/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/metabolismo , Hormônios Peptídicos/genética , Estudos Prospectivos , Gordura Subcutânea/metabolismo , Resultado do Tratamento
20.
Obes Surg ; 27(3): 569-577, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27468906

RESUMO

BACKGROUND: The purpose of this study was to evaluate the efficacy and safety of Endobarrier® in grade 1 obese T2DM patients with poor metabolic control and the role of gastro-intestinal hormone changes on the metabolic outcomes. METHODS: Twenty-one patients aged 54.1 ± 9.5 years, diabetes duration 14.8 ± 8.5 years, BMI 33.4 ± 1.9 kg/m2, and HbA1c 9.1 ± 1.3 %, under insulin therapy, were implanted with Endobarrier®. Fasting concentrations of PYY, ghrelin and glucagon, and AUC for GLP-1 after a standard meal test were determined prior to and at months 1 and 12 after implantation. RESULTS: Patients lost 14.9 ± 5.7 % of their total body weight. HbA1c decreased 1.3 % in the first month, but at the end of the study, the reduction was 0.6 %. HbA1c ≤ 7 % was achieved in 26.3 % of patients. No differences in GLP-1 AUC values were found before and after implant. Fasting plasma ghrelin and PYY concentrations increased from month 1 to 12. Conversely, fasting plasma glucagon concentrations decreased at month 1 and increased thereafter. Weight (ß 0.152) and HbA1c decrease at month 1 (ß 0.176) were the only variables predictive of HbA1c values at 12 months (adjusted R 2 for the model 0.693, p = 0.001). Minor adverse events occurred in 14 % of patients and major events in 9.5 %. CONCLUSIONS: Endobarrier® in T2DM patients with grade I obesity and poor metabolic control is associated with significant weight decrease and moderate reduction in HbA1c at month 12. Our data do not support a role for GLP-1 in the metabolic improvement in this subset of patients.


Assuntos
Cirurgia Bariátrica/instrumentação , Cirurgia Bariátrica/métodos , Diabetes Mellitus Tipo 2/cirurgia , Hormônios Gastrointestinais/fisiologia , Glucose/metabolismo , Obesidade Mórbida/cirurgia , Adulto , Glicemia/metabolismo , Remoção de Dispositivo , Diabetes Mellitus Tipo 2/complicações , Endoscopia Gastrointestinal , Feminino , Hormônios Gastrointestinais/metabolismo , Grelina/sangue , Glucagon/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/metabolismo , Obesidade Mórbida/patologia , Implantação de Prótese
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