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2.
PLoS Med ; 16(11): e1002985, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31747392

RESUMO

BACKGROUND: Although bariatric surgery is an effective treatment for type 2 diabetes (T2D) in patients with morbid obesity, further studies are needed to evaluate factors influencing the chance of achieving diabetes remission. The objective of the present study was to investigate the association between T2D duration and the chance of achieving remission of T2D after bariatric surgery. METHODS AND FINDINGS: We conducted a nationwide register-based cohort study including all adult patients with T2D and BMI ≥ 35 kg/m2 who received primary bariatric surgery in Sweden between 2007 and 2015 identified through the Scandinavian Obesity Surgery Registry. The main outcome was remission of T2D, defined as being free from diabetes medication or as complete remission (HbA1c < 42 mmol/mol without medication). In all, 8,546 patients with T2D were included. Mean age was 47.8 ± 10.1 years, mean BMI was 42.2 ± 5.8 kg/m2, 5,277 (61.7%) were women, and mean HbA1c was 58.9 ± 17.4 mmol/mol. The proportion of patients free from diabetes medication 2 years after surgery was 76.6% (n = 6,499), and 69.9% at 5 years (n = 3,765). The chance of being free from T2D medication was less in patients with longer preoperative duration of diabetes both at 2 years (odds ratio [OR] 0.80/year, 95% CI 0.79-0.81, p < 0.001) and 5 years after surgery (OR 0.76/year, 95% CI 0.75-0.78, p < 0.001). Complete remission of T2D was achieved in 58.2% (n = 2,090) at 2 years, and 46.6% at 5 years (n = 681). The chance of achieving complete remission correlated negatively with the duration of diabetes (adjusted OR 0.87/year, 95% CI 0.85-0.89, p < 0.001), insulin treatment (adjusted OR 0.25, 95% CI 0.20-0.31, p < 0.001), age (adjusted OR 0.94/year, 95% CI 0.93-0.95, p < 0.001), and HbA1c at baseline (adjusted OR 0.98/mmol/mol, 95% CI 0.97-0.98, p < 0.001), but was greater among males (adjusted OR 1.57, 95% CI 1.29-1.90, p < 0.001) and patients with higher BMI at baseline (adjusted OR 1.07/kg/m2, 95% CI 1.05-1.09, p < 0.001). The main limitations of the study lie in its retrospective nature and the low availability of HbA1c values at long-term follow-up. CONCLUSIONS: In this study, we found that remission of T2D after bariatric surgery was inversely associated with duration of diabetes and was highest among patients with recent onset and those without insulin treatment.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/cirurgia , Indução de Remissão/métodos , Adulto , Cirurgia Bariátrica/tendências , Glicemia , Índice de Massa Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Progressão da Doença , Feminino , Hemoglobina A Glicada , Humanos , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Estudos Retrospectivos , Suécia/epidemiologia , Resultado do Tratamento , Perda de Peso
3.
Presse Med ; 48(12): 1502-1506, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31757736

RESUMO

Bariatric surgery is indicated for patients with BMI≥35kg/m2 and associated steatohepatitis. Bariatric surgery induces NASH disappearance for nearly 80% of patients after 1 year of follow up. Bariatric surgery is associated with low morbidity and mortality if patients are well selected. Bariatric surgery is contraindicated in patients with cirrhosis. Long-term data are needed to determine the risk of recurrence of NASH. The extension of indications for bariatric surgery to patients with BMI less than 35kg/m2 will depend on the results of randomized trials.


Assuntos
Cirurgia Bariátrica , Hepatopatia Gordurosa não Alcoólica/cirurgia , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/classificação , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/tendências , Humanos , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Cuidados Pós-Operatórios/métodos
4.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31744891

RESUMO

OBJECTIVES: To evaluate the longitudinal effects of metabolic and bariatric surgery (MBS) on the prevalence of musculoskeletal and lower extremity (LE) pain, physical function, and health-related quality of life. METHODS: The Teen Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected data on 242 adolescents undergoing MBS at 5 centers over a 3-year follow-up. Joint pain and physical function outcomes were assessed by using the Health Assessment Questionnaire Disability Index, Impact of Weight on Quality of Life - Kids, and the Short Form 36 Health Survey. Adolescents with Blount disease (n = 9) were excluded. RESULTS: Prevalent musculoskeletal and LE pain were reduced by 40% within 12 months and persisted over 3 years. Adjusted models revealed a 6% lower odds of having musculoskeletal pain (odds ratio = 0.94, 95% confidence interval: 0.92-0.99) and a 10% lower odds of having LE pain (odds ratio = 0.90, 95% confidence interval: 0.86-0.95) per 10% reduction of BMI. The prevalence of poor physical function (Health Assessment Questionnaire Disability Index score >0) declined from 49% to <20% at 6 months (P < .05), Physical comfort and the physical component scores, measured by the Impact of Weight on Quality of Life - Kids and the Short Form 36 Health Survey, improved at 6 months postsurgery and beyond (P < .01). Poor physical function predicted persistent joint pain after MBS. CONCLUSIONS: Joint pain, impaired physical function, and impaired health-related quality of life significantly improve after MBS. These benefits in patient-reported outcomes support the use of MBS in adolescents with severe obesity and musculoskeletal pain and suggest that MBS in adolescence may reverse and reduce multiple risk factors for future joint disease.


Assuntos
Cirurgia Bariátrica/psicologia , Cirurgia Bariátrica/tendências , Exercício Físico/psicologia , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/psicologia , Qualidade de Vida/psicologia , Adolescente , Cirurgia Bariátrica/efeitos adversos , Estudos de Coortes , Exercício Físico/fisiologia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Obesidade Mórbida/psicologia , Obesidade Mórbida/cirurgia , Estudos Prospectivos
5.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31656226

RESUMO

Severe obesity affects the health and well-being of millions of children and adolescents in the United States and is widely considered to be an "epidemic within an epidemic" that poses a major public health crisis. Currently, few effective treatments for severe obesity exist. Metabolic and bariatric surgery are existing but underuse treatment options for pediatric patients with severe obesity. Roux-en-Y gastric bypass and vertical sleeve gastrectomy are the most commonly performed metabolic and bariatric procedures in the United States and have been shown to result in sustained short-, mid-, and long-term weight loss, with associated resolution of multiple obesity-related comorbid diseases. Substantial evidence supports the safety and effectiveness of surgical weight loss for children and adolescents, and robust best practice guidelines for these procedures exist.


Assuntos
Cirurgia Bariátrica/tendências , Acesso aos Serviços de Saúde/tendências , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Adolescente , Cirurgia Bariátrica/métodos , Criança , Humanos , Obesidade Mórbida/diagnóstico , Estados Unidos/epidemiologia
7.
Nutr Hosp ; 36(4): 840-845, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31282170

RESUMO

Introduction: Introduction: the increase on prevalence of obesity has been linked to a higher number of bariatric surgeries, being sleeve gastrectomy (SG) the most frequent bariatric procedures in the world. However, there are few studies that determine the impact of SG on health's determinants such as physical fitness (PF) and physical activity (PA). Objectives: to describe the changes in PF and PA of patients after SG. Methods: twenty-three women with obesity (mean 36.1 ± 11.1 years old and body mass index [BMI] of 35.1 ± 3.4 kg/m2) were evaluated preoperatively to SG and at one and three months after surgery. An assessment of PF was conducted, including handgrip (HGS) and quadriceps muscle strength (QMS) with dynamometers and cardiorespiratory fitness (CRF) with an ergospirometer. PA was assessed with a three-axis accelerometer. Results: the absolute VO2 peak decreased after the first and third month (p < 0.001) post SG. The VO2 peak relative to body weight showed an increase from baseline after the SG (p = 0.002). After SG, there was a reduction in absolute values for HGS and QMS (p < 0.001) and an increase in relative HGS after three months post-surgery compared to preoperative (p = 0.011), without changes in relative QMS (p = 0.596). No changes in PA were observed. Conclusions: after SG, there is a short term decline on PF when it is expressed on absolute values. However, when it is expressed in relative terms to body weight, some components of PF improve, while others showed no change. There was no modification in PA levels of the participants.


Assuntos
Cirurgia Bariátrica/métodos , Exercício Físico , Gastrectomia/métodos , Obesidade/cirurgia , Aptidão Física , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/tendências , Peso Corporal , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/tendências , Força da Mão/fisiologia , Humanos , Força Muscular/fisiologia , Obesidade/fisiopatologia , Consumo de Oxigênio/fisiologia , Período Pós-Operatório , Músculo Quadríceps/fisiopatologia
8.
Biochem Pharmacol ; 164: 106-114, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30954487

RESUMO

Currently, the only available effective treatment option for obesity and its comorbidities is weight loss surgery (WLS). Long-term maintenance of weight loss after surgery cannot be explained by caloric restriction or malabsorption alone and has been attributed to unexplained changes in eating behavior. Whether these behavioral changes are related to altered taste or reward functions, or both, are subject to debate. In contrast to reduced food cravings and food addiction following WLS, recent clinical studies have revealed that bariatric surgery patients are prone to an increased risk for substance use disorder (SUD), especially alcohol use disorder (AUD). The substitution of drugs for previously stimulating foods, and the emergence of SUD after WLS, supported by preclinical studies, strongly suggest that manipulation of gut-brain signals may bring about changes in the reward system. This paper reviews current clinical and basic science research and discusses potential underlying mechanisms of reward-related behaviors. Specifically, it explores relevant neural and hormonal changes that present post WLS and their effects on dopaminergic reward pathway and highlights targets for potential pharmacological interventions. Special emphasis is given to recent work suggesting that different types of WLS procedures such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have differential effects on alcohol consumption in humans and rats. These differential effects may hold the key not only to understanding increased substance use following WLS but may also help elucidate the contribution of gut-brain signals to regulation of reward, in general.


Assuntos
Cirurgia Bariátrica/tendências , Comportamento Alimentar/fisiologia , Neurotransmissores/metabolismo , Obesidade/metabolismo , Obesidade/cirurgia , Recompensa , Perda de Peso/fisiologia , Animais , Cirurgia Bariátrica/psicologia , Comportamento Alimentar/psicologia , Gastrectomia/psicologia , Gastrectomia/tendências , Derivação Gástrica/psicologia , Derivação Gástrica/tendências , Humanos , Neurotransmissores/antagonistas & inibidores , Obesidade/psicologia
9.
Gastrointest Endosc ; 90(1): 35-43, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30928425

RESUMO

The American Society for Gastrointestinal Endoscopy's Gastrointestinal Endoscopy Editorial Board reviewed original endoscopy-related articles published during 2018 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of adenoma detection, bariatric endoscopy, EMR/submucosal dissection/full-thickness resection, artificial intelligence, expandable metal stents for palliation of biliary obstruction, pancreatic therapy with lumen-apposing metal stents, endoscope reprocessing, Barrett's esophagus, interventional EUS, and GI bleeding. This document summarizes these "Top 10" endoscopic advances of 2018.


Assuntos
Endoscopia Gastrointestinal/tendências , Gastroenterologia/tendências , Adenoma/diagnóstico , Inteligência Artificial/tendências , Cirurgia Bariátrica/tendências , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/terapia , Colestase/terapia , Neoplasias Colorretais/diagnóstico , Desinfecção , Ressecção Endoscópica de Mucosa/tendências , Endossonografia/tendências , Reutilização de Equipamento , Hemorragia Gastrointestinal/terapia , Humanos , Cisto Pancreático/terapia , Stents Metálicos Autoexpansíveis , Ultrassonografia de Intervenção/tendências
11.
Medicine (Baltimore) ; 98(3): e13824, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653091

RESUMO

Obesity has become one of the most significant health problems worldwide, affecting more than one-third of the global population. The elderly population is not immune to this proportional increase in obesity. To date, there is no cure for obesity, but surgery is the most effective treatment available today.We analyzed the results of bariatric surgery in elderly patients for a period of 3 years. Patients 65 years old and older were included in the study, 451 older adults were included. The mean age of the study group was 67.92 years old (min. 65, max. 84). The mean body mass index (BMI) was 40.32 Kg/m (min. 34 and max. 59). Sleeve gastrectomy (SG) was the most common procedures, and were conducted in 346 (76.72%) patients, gastric bypasses (GBPs) in 53 (11.75%) of which 33 were roux en y GBP (7.32%) and 20 mini GBPs (4.43%), gastric banding in 48 (10.64%), and duodenal switching in 4 (0.89%) cases.There were 40 (8.86%) patients with perioperative complications, 6 (1.33%) required re-operations, 12 (2.66) patients with operative complications were treated conservatively, 8 (1.77%) re-admission 5 of them with intrabdominal abscess, and 14 (3.10%) with co-morbidities complications. More than 76% of the patients had co-morbidities, 1 year after surgery the average remission of diseases was 34.74%, the improvement was49.67% and no changes in the co-morbidities was 15.59%. There were no deaths reported in this cohort.The mean excess body weight (EBW) loss among the patients was 70.76% (from 32% to 92%). No failure of weight loss (less than 25% of EBW loss) was observed after the first postoperative year.Bariatric surgery offers obese elderly patients an acceptable result, and it can be offered to improve the quality of life of these patients. A new consensus conference panel is needed to set appropriate recommendations regarding criteria that limit bariatric surgery in older adults.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Obesidade/cirurgia , Período Perioperatório/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Cirurgia Bariátrica/tendências , Índice de Massa Corporal , Comorbidade/tendências , Feminino , Gastrectomia/métodos , Derivação Gástrica/métodos , Humanos , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Período Perioperatório/estatística & dados numéricos , Período Pós-Operatório , Qualidade de Vida/psicologia , Estudos Retrospectivos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(4): e14132, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30681576

RESUMO

BACKGROUND: The interest in obesity has considerably increased in the scientific community in the last 2 decades. We present a bibliometric analysis to find out the future research hotspot and trends of obesity. METHODS: Data were based on the Science Citation Index Expanded (SCI-E), from the Institute of Scientific Information Web of Science database and the 5-year impact factor of a journal were issued from the Journal Citation Reports (JCR) in 2017. Articles referring to obesity during 1999 to 2017 were concentrated on the analysis by scientific output characters and the frequency of author keywords used. RESULTS: Globally, 50,246 articles meet the inclusion criteria during 1999 to 2017. The cumulative number of publication about obesity followed exponential distribution (R = 0.9974) from 2008. USA was the most productive countries in both independent and international collaborative papers, the countries/regions with the highest average Times Cited scores for independent articles was France and The United Kingdom scored the highest in average Times Cited for international collaborative papers. Collaboration among countries, playing an ever-growing role in contemporary scientific research. The 2 most prolific journals are Obesity Surgery and International Journal of Obesity, responsible for 3.95% of the publication. CONCLUSION: Obesity has been a field of intense research in the last 19 years. By reasonably analyzing the author keywords and the distribution of journals, "bariatric surgery" (especially "sleeve gastrectomy") and "obese complications" (especially "diabetes mellitus," "metabolic syndrome," "depression," and "polycystic ovary syndrome") will undoubtedly maintain the hotspots of obesity research in the next few decades.


Assuntos
Bibliometria , Pesquisa Biomédica/tendências , Saúde Global/tendências , Fator de Impacto de Revistas , Obesidade , Cirurgia Bariátrica/tendências , Humanos
13.
Clin Plast Surg ; 46(1): 1-7, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30447821

RESUMO

The United States has experienced a significant increase in obesity over the past several decades, including a substantial increase in obesity-related comorbidities, such as type 2 diabetes, hypertension, heart disease, and obstructive sleep apnea. With obesity reaching epidemic proportions, there has been an increasing need for surgical intervention as a treatment option. Bariatric procedures have not only contributed to the significant weight loss a patient may experience but they have also had a profound effect on the decrease of weight-related comorbidities.


Assuntos
Cirurgia Bariátrica/tendências , Obesidade Mórbida/epidemiologia , Humanos , Obesidade Mórbida/cirurgia , Prevalência , Estados Unidos/epidemiologia
14.
J Endocrinol Invest ; 42(1): 37-44, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29603098

RESUMO

PURPOSE: Epigenetic traits are influenced by clinical variables; interaction between DNA methylation (DNAmeth) and bariatric surgery-induced weight loss has been scarcely explored. We investigated whether DNAmeth of genes encoding for molecules/hormones regulating appetite, food intake or obesity could predict successful weight outcome following Roux-en-Y gastric bypass (RYGB). METHODS: Forty-five obese individuals with no known comorbidities were stratified accordingly to weight decrease one-year after RYGB (excess weight loss, EWL ≥ 50%: good responders, GR; EWL < 50%: worse responders, WR). DNAmeth of leptin (LEP), ghrelin (GHRL), ghrelin receptor (GHSR) and insulin-growth factor-2 (IGF2) was assessed before intervention. Single nucleotide polymorphisms of genes affecting DNAmeth, DNMT3A and DNMT3B, were also determined. RESULTS: At baseline, type 2 diabetes was diagnosed by OGTT in 13 patients. Post-operatively, GR (n = 23) and WR (n = 22) achieved an EWL of 67.7 ± 9.6 vs 38.2 ± 9.0%, respectively. Baseline DNAmeth did not differ between GR and WR for any tested genes, even when the analysis was restricted to subjects with no diabetes. A relationship between GHRL and LEP methylation profiles emerged (r = 0.47, p = 0.001). Searching for correlation between DNAmeth of the studied genes with demographic characteristics and baseline biochemical parameters of the studied population, we observed a correlation between IGF2 methylation and folate (r = 0.44, p = 0.003). Rs11683424 for DNMT3A and rs2424913 for DNMT3B did not correlate with DNAmeth of the studied genes. CONCLUSIONS: In severely obese subjects, the degree of DNAmeth of some genes affecting obesity and related conditions does not work as predictor of successful response to RYGB.


Assuntos
Apetite/fisiologia , Metilação de DNA/fisiologia , Derivação Gástrica/tendências , Obesidade/genética , Obesidade/cirurgia , Perda de Peso/fisiologia , Adulto , Cirurgia Bariátrica/tendências , Estudos de Coortes , Epigênese Genética/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/metabolismo , Obesidade Mórbida/genética , Obesidade Mórbida/metabolismo , Obesidade Mórbida/cirurgia , Valor Preditivo dos Testes , Resultado do Tratamento
15.
Neuroimage Clin ; 21: 101640, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30553762

RESUMO

Obesity is associated with reduced cortical thickness and brain volume, which may be related to poor nutrition. Given that brain atrophy in anorexia nervosa recovers with nutritional improvements and weight gain, it is worth examining how brain structure changes at the other end of the weight spectrum with weight loss. Thus, this study aimed to examine change in cortical thickness and brain volume in 47 patients with severe obesity who participated in no treatment, behavioral weight loss, or bariatric surgery. T1-weighted MRI scans were conducted pre-treatment and approximately four months later. Measures of cortical thickness, gray matter volume, and white matter volume were compared between time points. Despite overall reduction in BMI, there was no significant change in cortical thickness. There was a significant increase in left hemisphere gray matter and white matter volumes across the sample. At baseline and follow-up, there was no relationship between cortical thickness or brain volumes and BMI. This study is the first to examine changes in cortical thickness and brain volume with weight loss in adults with obesity and the findings show partial support for the hypotheses that weight loss results in increased cortical gray and white matter.


Assuntos
Cirurgia Bariátrica/tendências , Terapia Comportamental/tendências , Córtex Cerebral/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Obesidade/terapia , Perda de Peso/fisiologia , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética/tendências , Masculino , Obesidade/psicologia , Tamanho do Órgão/fisiologia
16.
Dtsch Arztebl Int ; 115(42): 705-711, 2018 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-30479251

RESUMO

BACKGROUND: 3.9% of men and 5.2% of women in Germany suffer from second-degree obesity (body mass index [BMI] ≥ 35 to <40 kg/m2), and 6.5 million persons suffer from diabetes. Obesity surgery has become established as a further treatment option alongside lifestyle changes and pharmacotherapy. METHODS: The guideline was created by a multidisciplinary panel of experts on the basis of publications retrieved by a systematic literature search. It was subjected to a formal consensus process and tested in public consultation. RESULTS: The therapeutic aims of surgery for obesity and/or metabolic disease are to improve the quality of life and to prolong life by countering the life-shortening effect of obesity and its comorbidities. These interventions are superior to conservative treatments and are indicated when optimal non-surgical multimodal treatment has been tried without benefit, in patients with BMI ≥ 40 kg/m², or else in patients with BMI ≥ 35 kg/m² who also have one or more of the accompanying illnesses that are associated with obesity. A primary indication without any prior trial of conservative treatment exists if the patient has a BMI ≥ 50 kg/m², if conservative treatment is considered unlikely to help, or if especially severe comorbidities and sequelae of obesity are present that make any delay of surgical treatment inadvisable. Metabolic surgery for type 2 diabetes is indicated (with varying recommendation grades) for patients with BMI ≥ 30 kg/m², and as a primary indication for patients with BMI ≥ 40 kg/m². The currently established standard operations are gastric banding, sleeve gastrectomy, proximal Roux-en-Y gastric bypass, omega-loop gastric bypass, and biliopancreatic diversion. CONCLUSION: No single standard technique can be recommended in all cases. In the presence of an appropriate indication, the various surgical treatment options for obesity and/or metabolic disease should be discussed with the patient.


Assuntos
Cirurgia Bariátrica/tendências , Doenças Metabólicas/cirurgia , Obesidade/cirurgia , Adulto , Cirurgia Bariátrica/métodos , Índice de Massa Corporal , Prova Pericial/métodos , Feminino , Alemanha/epidemiologia , Guias como Assunto , Humanos , Masculino , Doenças Metabólicas/complicações , Doenças Metabólicas/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etiologia , Prevalência , Qualidade de Vida/psicologia
17.
BMC Endocr Disord ; 18(1): 90, 2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30486823

RESUMO

BACKGROUND: Bariatric surgery is effective in remission of obesity comorbidities. This study was aimed at comparing CVD risk between morbidly obese patients with type 2 diabetes and pre-diabetes before and after bariatric surgery as well as assessing comorbidities. METHODS: This is a retrospective observational study with 105 patients with type 2 diabetes (DMbaseline) and prediabetes (preDMbaseline) who underwent Roux-en-Y gastric bypass. Data were collected preoperative and then at 3,6,12,18,24,36,48, and 60 months after surgery. Anthropometric, cardiovascular and glycemic parameters were assessed. CVD risk was calculated using the Framingham Risk Score. RESULTS: Prior to surgery, 48 patients had type 2 diabetes, while 57 had pre-diabetes. Mean age was 48 (9.2) and mean BMI was 52 (7.4). 26.1% of patients had a high CVD risk. CVD risk decreased in patients with type 2 diabetes and prediabetes at month 12 after surgery compared to the baseline risk (p < 0.001). BMI, body fat percentage, fasting plasma glucose, HbA1c, c-peptide, HOMA-IR, LDL-c, systolic blood pressure, and diastolic blood pressure decreased during the first year after surgery. From the 12th month until the 60th, they showed a flat trend, or a very mild increase in some cases. 3.2% of patients maintained high CVD risk at 60 months. Type 2 diabetes remission was 92%. No patient of the preDMbaseline group developed type 2 diabetes. CONCLUSION: Bariatric surgery reduces CVD risk in type 2 diabetes and pre-diabetes. Given that patients with type 2 diabetes benefit the most, more studies are necessary to consider pre-diabetes as a criterion for metabolic surgery in patients with BMI ≥ 35 kg/m2.


Assuntos
Cirurgia Bariátrica/tendências , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/cirurgia , Obesidade Mórbida/cirurgia , Estado Pré-Diabético/cirurgia , Comportamento de Redução do Risco , Adulto , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Análise de Dados , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/diagnóstico , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
20.
J Neurosurg ; 131(2): 578-581, 2018 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-30168735

RESUMO

Intracranial pressure (ICP) measurements are imperative for the proper diagnosis and treatment of several neurological disorders. Telemetric sensors have shown their utility for ICP estimation in short-term monitoring in humans. However, their long-term reliability is uncertain. The authors present the case of a 37-year-old woman diagnosed with benign intracranial hypertension and obesity. The patient underwent gastric bypass surgery for ICP control. In order to monitor ICP before and after bariatric surgery, a Neurovent-P-tel sensor was implanted in the left frontal lobe. After gastric bypass, normal ICP values were recorded, and the patient's visual fields improved. However, the patient experienced incapacitating daily headaches. The authors decided to implant a Codman Microsensor ICP transducer in the right frontal lobe to assess the long-term reliability of the Neurovent-P-tel measurements. A comparison of the recordings at 24 and 48 hours showed good correlation and reliability during long-term monitoring with the Neurovent-P-tel, with minimal zero drift after 11 months of implantation.


Assuntos
Cirurgia Bariátrica/métodos , Lobo Frontal/diagnóstico por imagem , Hipertensão Intracraniana/diagnóstico por imagem , Telemetria/métodos , Adulto , Cirurgia Bariátrica/tendências , Feminino , Humanos , Hipertensão Intracraniana/cirurgia , Reprodutibilidade dos Testes , Telemetria/tendências , Fatores de Tempo , Transdutores de Pressão/tendências
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