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1.
Rev Col Bras Cir ; 47: e20202404, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32555963

RESUMO

PURPOSE: To compare the nutritional status follow up of patients who underwent Roux-en-Y gastric bypass (BGYR) and Sleeve gastrectomy (SG) in hospitals of the private and public health systems, in Pernambuco. METHODS: This study included patients who underwent bariatric surgery in the public and private health systems, in Pernambuco, from 2008 to 2016. Anthropometric and biochemical (hemoglobin, B12, iron and ferritin) data were evaluated in the preoperative period and at 3, 6 and 12 months after the operation. RESULTS: There were no significant difference between patients seen at the two health systems regarding the levels of hemoglobin, iron, anemia and vitamin B12. Patients who underwent the RYGB, presented with iron deficiency which was significantly lower for those in the private system, but only at the 3 month evaluation. Low levels of ferritin were observed at the 6 month evaluation, and patients in the private health system presented with the highest ferritin deficiency. The rate of surgical success was significantly higher in those patients undergoing the RYGB at the private system. CONCLUSIONS: After a 12-month bariatric surgery follow-up, there was no statistically significant difference regarding micronutrient deficiency between patients followed up at the private and public health systems.


Assuntos
Cirurgia Bariátrica/métodos , Estado Nutricional , Obesidade Mórbida/cirurgia , Adulto , Feminino , Ferritinas/sangue , Seguimentos , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Setor Privado , Setor Público , Estudos Retrospectivos , Vitamina B 12/sangue , Adulto Jovem
2.
Clín. investig. arterioscler. (Ed. impr.) ; 32(2): 79-86, mar.-abr. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-187151

RESUMO

La prevalencia de la obesidad ha aumentado de manera exponencial en las últimas décadas, convirtiéndose en un problema de salud pública de primer orden. La dislipemia de la obesidad, caracterizada por niveles bajos de colesterol de las lipoproteínas de alta densidad (HDL), hipertrigliceridemia y partículas pequeñas y densas de lipoproteínas de baja densidad (LDL), es responsable en parte del elevado riesgo cardiovascular residual de esta situación clínica. Por otro lado, la cirugía bariátrica (CB) es el tratamiento más eficaz para la obesidad; con ella se obtiene una mayor pérdida ponderal que con el tratamiento médico convencional y favorece la mejoría o remisión de las comorbilidades asociadas. Las técnicas de CB más utilizadas en la actualidad son el bypass gástrico laparoscópico en Y de Roux (BGYRL) y la gastrectomía tubular laparoscópica (GTL). Estas han obtenido resultados similares tanto en cuanto a la pérdida de peso como a la remisión de ciertas comorbilidades como la diabetes mellitus tipo 2 o la hipertensión arterial. Un rasgo diferencial entre ambas técnicas podría ser el diferente impacto sobre el perfil lipoproteico. Así, estudios previos con seguimiento a corto y a medio plazo han objetivado una superioridad del BGYRL frente a la GTL en la reducción del colesterol total y del colesterol LDL. Existen resultados discordantes en cuanto a la evolución del colesterol HDL y los triglicéridos. Por todo ello, hemos considerado de interés revisar los efectos de la CB a corto y a medio plazo en el perfil lipoproteico, así como las tasas de remisión de las diferentes alteraciones lipídicas y los posibles factores relacionados


Obesity prevalence has presented an exponential increase in the last decades, becoming a first order public health issue. Dyslipidemia of obesity, characterized by low levels of high density lipoprotein (HDL) cholesterol, hypertriglyceridemia and small and dense low-density lipoprotein (LDL) particles, is partly responsible for the high residual cardiovascular risk of this clinical situation. On the other hand, bariatric surgery (BS) is the most effective treatment for obesity, obtaining a greater weight loss than achieved with conventional medical therapy and favoring the improvement or remission of associated comorbidities. The most commonly used BS techniques nowadays are laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). Both of these procedures have obtained similar results in terms of weight loss and comorbidity remission such as type 2 diabetes mellitus or hypertension. A differential feature between both techniques could be the different impact on the lipoprotein profile. In this respect, previous studies with short and mid-term follow-up have proved LRYGB to be superior to LSG in total and LDL cholesterol reduction. Results regarding triglycerides and HDL cholesterol are contradictory. Therefore, we consider of interest to review the effects of BS at short and mid-term follow-up on lipoprotein profile, as well as the remission rates of the different lipid abnormalities and the possible related factors


Assuntos
Humanos , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Hiperlipidemias/sangue , Lipídeos/sangue , Cirurgia Bariátrica/métodos
3.
Cardiovasc Diabetol ; 19(1): 26, 2020 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-32101157

RESUMO

BACKGROUND: High soluble suppression of tumorigenicity-2 (sST2) is a marker of poor prognosis in chronic inflammatory conditions. ST2 and its ligand interleukin (IL)-33 are elevated in adipose tissue of obese individuals. We aimed to evaluate circulating sST2 and IL-33 as possible markers of metabolic benefit in morbidly overweight patients after Roux-en-Y gastric bypass (RYGB) bariatric surgery. METHODS: sST2, IL-33, high sensitive IL-6, high sensitive C-reactive protein (hsCRP), leptin, cholesterol metabolism and liver parameters were measured in 80 morbidly obese individuals before and 1 year after bariatric surgery. RESULTS: sST2 was higher (P = 0.03) in diabetics as compared to individuals without diabetes. Baseline sST2 was also higher in males than in females (P= 0.0002). One year after bariatric surgery, sST2 levels were decreased (median 120, IQR 59-176 pg/mL) as compared to sST2 before surgery (median 141, IQR 111-181, P = 0.0024), and the diabetic group showed most pronounced reduction in sST2 (P = 0.0016). An association was found between sST2 and liver function parameters before and after bariatric surgery, and between baseline sST2 and total cholesterol, triglyceride, total low density lipoprotein (LDL), small dense LDL, Apolipoprotein B as well as with small dense high density lipoproteins (HDL). In the subgroup of diabetic patients positive correlation between IL-33 and sST2 (r = 0.44, P = 0.05) was noticed. CONCLUSIONS: Circulating sST2 is associated with markers of liver functions and lipid metabolism in severely obese patients and a reduction of sST2 was shown after successful bariatric surgery, most prominently in diabetic patients.


Assuntos
Diabetes Mellitus/sangue , Derivação Gástrica , Mediadores da Inflamação/sangue , Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Obesidade Mórbida/cirurgia , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Diabetes Mellitus/diagnóstico , Regulação para Baixo , Feminino , Humanos , Interleucina-33/sangue , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/diagnóstico , Fatores de Tempo , Resultado do Tratamento
4.
Obes Facts ; 13(1): 58-65, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31991405

RESUMO

INTRODUCTION: Bariatric surgery confers a high risk for nutritional deficiencies that could affect physiologic adaptation of lipids during pregnancy. We aimed to evaluate differences in serum lipids in pregnant women after bariatric surgery compared to obese and lean mothers. METHODS: 25 women with a history of Roux-en-Y gastric bypass (RYGB), 19 obese and 19 normal-weight controls were included at the 24th-28th gestational week for determination of fasting lipids with follow-up in a subgroup after delivery. Data on neonatal biometry were additionally assessed. RESULTS: Women after RYGB showed lower total-cholesterol (TC), low-density lipoprotein C (LDL-C), non-high-density lipoprotein C (non-HDL-C) and triglycerides (TG) compared to obese mothers. Despite their higher BMI, women after RYGB showed lower TC, LDL-C and non-HDL-C than normal-weight mothers. Ultrasensitive C-reactive protein was lower in RYGB mothers than in obese ones, reaching values of lean controls. Differences remained unchanged in BMI-matched comparison. Birth weight percentiles of RYGB offspring were associated with maternal TC (r = 0.59, p = 0.021), LDL-C (r = 0.71, p = 0.003), non-HDL (r = 0.59, p = 0.021) but not HDL-C or TG. After delivery, lipids decreased in all women; however, TC and LDL-C showed more attenuated decline in mothers after RYGB than control women. CONCLUSION: Pregnancies after RYGB show alterations of physiologic patterns in lipid profile. Further studies are required to evaluate whether imbalances in maternal lipids constitute a risk for abnormal fetal growth in this special cohort.


Assuntos
Cirurgia Bariátrica , Lipídeos/sangue , Mães , Obesidade Mórbida/cirurgia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Obesidade Mórbida/sangue , Gravidez , Complicações na Gravidez/sangue , Triglicerídeos/sangue , Adulto Jovem
5.
Am Heart J ; 219: 47-57, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31707324

RESUMO

BACKGROUND: Obesity is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). Whether obesity affects outcomes among those with T2D and atherosclerotic CVD (ASCVD) remains uncertain. Our objective was to investigate the relationship between body mass index (BMI) and ASCVD outcomes among TECOS participants with T2D and ASCVD. METHODS: BMI categories were defined as underweight/normal weight (BMI <25 kg/m2), overweight (25-29.9 kg/m2), obese class I (30-34.9 kg/m2), obese class II (35-39.9 kg/m2), and obese class III (≥ 40 kg/m2). Asian-specific BMI categories were applied to Asian participants. Kaplan-Meier survival analysis and Cox proportional hazards models were used to examine associations between baseline BMI and a composite CV outcome (CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina). RESULTS: For 14,534 TECOS patients with available BMI, mean age was 65.5 years; 29.3% were female, 32.0% non-White, and 23.1% insulin-treated, with median 3 years' follow-up. At baseline, 11.6% (n = 1686) were underweight/normal weight, 38.1% (n = 5532) overweight, 32.2% (n = 4683) obese class I, 12.4% (n = 1806) obese class II, and 5.7% (n = 827) obese class III. The composite CV outcome occurred in 11.4% (n = 1663) of participants; the outcome risk was lower, compared with under/normal weight, in overweight (HR 0.83, 95% CI 0.71-0.98) and obese class I (HR 0.79, 95% CI 0.67-0.93) individuals. Obesity was not associated with worse glycemic control. CONCLUSIONS: The majority of TECOS participants with ASCVD and T2D were overweight or obese, yet overweight or obese class I individuals had lower CV risk than those who were under/normal weight. These results suggest the presence of an obesity paradox, but this paradox may reflect an epidemiological artifact rather than a true negative association between normal weight and clinical outcomes.


Assuntos
Índice de Massa Corporal , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Obesidade/mortalidade , Idoso , Angina Instável/etiologia , Aterosclerose/epidemiologia , Aterosclerose/etnologia , Peso Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/etiologia , Causas de Morte , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Hemoglobina A/análise , Hospitalização , Humanos , Hipoglicemiantes/uso terapêutico , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/etnologia , Obesidade Mórbida/sangue , Obesidade Mórbida/epidemiologia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Sobrepeso/mortalidade , Modelos de Riscos Proporcionais , Fosfato de Sitagliptina/uso terapêutico , Acidente Vascular Cerebral/etiologia , Magreza/epidemiologia
6.
Tohoku J Exp Med ; 249(3): 223-229, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31776301

RESUMO

Hypothalamic obesity is a clinical syndrome characterized by severe and refractory obesity that is caused by hypothalamic function impairment. Recently, bariatric surgery has been attempted for patients with hypothalamic obesity after craniopharyngioma, but experiences have not yet been accumulated in other hypothalamic disorders. Here, we report the case of a 39-year-old male patient with panhypopituitarism who received laparoscopic sleeve gastrectomy (LSG) after intracranial germinoma treatment. The patient was diagnosed with intracranial germinoma at age 15 and achieved complete remission after radiotherapy (total 50 Gy). He was obese during diagnosis [body mass index (BMI), 29.2 kg/m2], and his obesity gradually worsened after the intracranial germinoma treatment, and LSG was considered when his BMI was 48.6 kg/m2. After 1 month of hospitalized diet-exercise program, LSG was performed. After LSG, his BMI gradually decreased and reached 38.8 kg/m2 on the day of discharge (6 weeks after the surgery). Five months after LSG, his insulin resistance improved, but insulin hypersecretion remained. Fifteen months after the surgery, his BMI was 31.2 kg/m2, with marked decrease in visceral and subcutaneous fat areas (from 393.8 cm2 and 168.2 cm2 before the surgery to 111.5 cm2 and 56.3 cm2, respectively.). To our knowledge, this is the first case of LSG for hypothalamic obesity after intracranial germinoma treatment. Although the pathophysiology of hypothalamic obesity is different from that of primary obesity, LSG could be a successful therapeutic choice for patients with hypothalamic obesity after the intracranial germinoma treatment.


Assuntos
Neoplasias Encefálicas/radioterapia , Gastrectomia , Germinoma/radioterapia , Laparoscopia , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Glicemia/metabolismo , Índice de Massa Corporal , Neoplasias Encefálicas/sangue , Germinoma/sangue , Teste de Tolerância a Glucose , Hospitalização , Humanos , Testes de Inteligência , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/patologia , Masculino , Obesidade Mórbida/sangue , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/patologia , Tomografia Computadorizada por Raios X
7.
Obesity (Silver Spring) ; 27(11): 1865-1873, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31689012

RESUMO

OBJECTIVE: Persistent organic pollutants (POPs) are lipophilic environmental toxicants that accumulate in adipose tissue. Weight loss leads to mobilization and increased redistribution of these toxicants. Many are obesogens and endocrine disruptors. Increased exposure could pose long-term health risks. The study objective was to measure the changes in serum concentrations of lipophilic POPs during significant weight loss. METHODS: This study enrolled 27 patients at a university hospital in a longitudinal, 6-month, observational study examining changes in POP blood levels after bariatric surgery. The primary outcome was the changes in the concentrations of 24 polychlorinated biphenyls (PCBs), 9 organochlorine pesticides (OCPs), 11 polybrominated diphenyl ethers, 2,2',4,4',5,5'-hexabromobiphenyl, and 4 perfluorochemicals (PFCs). RESULTS: Older adults (those born before 1976) had baseline levels of PCBs, OCPs, and PFCs that were two- to fivefold higher than younger adults (those born after 1976). Older adults had greater increases in PCBs, OCPs, and polybrominated diphenyl ethers associated with weight loss. Conversely, younger adults had greater increases in PFCs associated with weight loss. On average, blood POP levels increased as weight loss occurred. CONCLUSIONS: Although weight loss is considered beneficial, the release and redistribution of POPs to other lipid-rich organs such as the brain, kidneys, and liver warrant further investigation. Interventions should be considered to limit organ exposure to POPs when weight loss interventions are planned.


Assuntos
Tecido Adiposo/metabolismo , Cirurgia Bariátrica , Poluentes Ambientais/sangue , Poluentes Ambientais/farmacocinética , Obesidade Mórbida/cirurgia , Tecido Adiposo/química , Adulto , Fatores Etários , Análise Química do Sangue , Exposição Ambiental/análise , Poluentes Ambientais/análise , Feminino , Seguimentos , Éteres Difenil Halogenados/análise , Éteres Difenil Halogenados/sangue , Éteres Difenil Halogenados/farmacocinética , Humanos , Hidrocarbonetos Clorados/análise , Hidrocarbonetos Clorados/sangue , Hidrocarbonetos Clorados/farmacocinética , Fígado/química , Fígado/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/metabolismo , Praguicidas/análise , Praguicidas/sangue , Praguicidas/farmacocinética , Bifenilos Policlorados/análise , Bifenilos Policlorados/sangue , Bifenilos Policlorados/farmacocinética , Período Pós-Operatório , Distribuição Tecidual , Perda de Peso/fisiologia
8.
Rev Assoc Med Bras (1992) ; 65(9): 1182-1187, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618335

RESUMO

OBJECTIVE: To compare the complete blood counts, namely the plateletcrit (PCT) and Platelet-To-Lymphocyte Ratio (PLR) of healthy subjects and those with morbid obesity in the young population. METHODS: We included 45 patients with morbid obesity (body mass index -BMI - greater than or equal to 45 kg/m2) and 45 healthy subjects (BMI less than or equal to 25 kg/m2) in our study. Blood samples were obtained from the participants following a 12-hour fasting period. Then we evaluated the levels of hemoglobin (Hb), hematocrit (HCT), red cell distribution width (RDW), mean platelet volume (MPV), white blood cell (WBC), PLR, platelet counts, and PCT in the complete blood count. RESULTS: The morbid obesity group had significantly higher platelet counts and PCT values (p<0.001), and PLR values (p=0.033). The value of WBC was also higher in the obese group (p=0.001). MPV was lower in the obesity group but not statistically significant (p=0.815). No significant difference was found between hemoglobin and hematocrit values in these groups; but RDW valuewere higher and statistically significant in the obese group (p=0.001). CONCLUSION: PLR or PCT may be more useful as a marker in determining an increased thrombotic state and inflammatory response in morbid obesity.


Assuntos
Plaquetas/citologia , Contagem de Linfócitos , Obesidade Mórbida/sangue , Contagem de Plaquetas , Adulto , Contagem de Células Sanguíneas , Estudos Transversais , Índices de Eritrócitos , Hemoglobinas , Humanos , Contagem de Leucócitos , Masculino , Volume Plaquetário Médio , Neutrófilos/citologia , Sensibilidade e Especificidade
9.
Anesth Analg ; 129(4): 1130-1136, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31584919

RESUMO

BACKGROUND: Morbidly obese patients undergoing general anesthesia are at risk of hypoxemia during anesthesia induction. High-flow nasal oxygenation use during anesthesia induction prolongs safe apnea time in nonobese surgical patients. The primary objective of our study was to compare safe apnea time, between patients given high-flow nasal oxygenation or conventional facemask oxygenation during anesthesia induction, in morbidly obese surgical patients. METHODS: Research ethics board approval was obtained. Elective surgical patients ≥18 years with body mass index ≥40 kg·m were included. Patients with severe comorbidity, gastric reflux disease, known difficult airway, or nasal obstruction were excluded. After obtaining informed consent patients were randomized. In the intervention (high-flow nasal oxygenation) group, preoxygenation was provided by 100% nasal oxygen for 3 minutes at 40 L·minute; in the control group, preoxygenation was delivered using a facemask with 100% oxygen, targeting end-tidal O2 >85%. Anesthesia was induced with propofol, remifentanil, and rocuronium. Bag-mask ventilation was not performed. At 2 minutes after rocuronium, videolaryngoscopy was performed. If the laryngoscopy grade was I or II, laryngoscope was left in place and the study was continued; if grade III or IV was observed, the patient was excluded from the study. During the apnea period, high-flow nasal oxygenation patients received nasal oxygen at 60 L·minute; control group patients received no supplemental oxygen. The primary outcome, safe apnea time, was reached when oxygen saturation measured by pulse oximetry (SpO2) fell to 95% or maximum 6 minutes of apnea. The patient was then intubated. T tests and χ analyses were used to compare groups. P < .05 was considered significant. RESULTS: Forty patients completed the study. Baseline parameters were comparable between groups. Safe apnea time was significantly longer (261.4 ± 77.7 vs 185.5 ± 52.9 seconds; mean difference [95% CI], 75.9 [33.3-118.5]; P = .001) and the minimum peri-intubation SpO2 was higher (91.0 ± 3.5 vs 88.0 ± 4.8; mean difference [95% CI], 3.1 [0.4-5.7]; P = .026) in the high-flow nasal oxygenation group compared to the control group. CONCLUSIONS: High-flow nasal oxygenation, compared to conventional oxygenation, provided a longer safe apnea time by 76 seconds (40%) and higher minimum SpO2 in morbidly obese patients during anesthesia induction. High-flow oxygenation use should be considered in morbidly obese surgical patients.


Assuntos
Anestesia Geral , Apneia/fisiopatologia , Hipóxia/prevenção & controle , Obesidade Mórbida/fisiopatologia , Oxigenoterapia , Oxigênio/sangue , Administração Intranasal , Adulto , Anestesia Geral/efeitos adversos , Apneia/sangue , Biomarcadores/sangue , Índice de Massa Corporal , Feminino , Humanos , Hipóxia/sangue , Hipóxia/etiologia , Hipóxia/fisiopatologia , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
Obesity (Silver Spring) ; 27(12): 2011-2017, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31579999

RESUMO

OBJECTIVE: Morbid obesity is associated with a higher independent risk of chronic kidney disease (CKD). Estimated glomerular filtration rate (eGFR) has been evaluated in a limited number of study participants with severe obesity. METHODS: A total of 706 measured GFR (mGFR) results from 598 participants with obesity (BMI ≥ 35 kg/m2 ) were retrospectively collected. The performance of the Modification of Diet in Renal Disease (MDRD) equation, Chronic Kidney Disease-Epidemiology (CKD-EPI) equation, and deindexed eGFR were compared with mGFR from the gold standard technique (inuline or iohexol), adjusted (mGFRr) or nonadjusted (mGFR) to body surface area. Absolute bias, precision, and accuracy were calculated. RESULTS: Mean mGFRr (58 ± 31 mL/min/1.73 m2 ) was significantly different from CKD-EPI and MDRD (P < 0.001). Mean mGFR (nonindexed) (70 ± 40 mL/min) was significantly higher than mGFRr (P < 0.001). eGFR showed important biases and low accuracies for CKD-EPI and MDRD (10.7 ± 10.7 and 12.2 ± 13.7 mL/min/1.73 m2 ; 78% vs. 75% respectively). Deindexation worsened bias and accuracy 30% (percentage of GFR estimates within 30% of mGFRr or mGFR) between eGFR and mGFR. CONCLUSIONS: eGFR overestimates mGFR and is associated with important biases and inaccuracies in patients with severe obesity, and deindexing eGFR worsens the overestimation. These findings may have important implications in examining kidney function in patients with obesity.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Obesidade Mórbida/sangue , Insuficiência Renal Crônica/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Coleta de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/patologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Can J Surg ; 62(5): 315-319, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31550092

RESUMO

Background: Bariatric surgery has been shown to induce type 2 diabetes mellitus (T2DM) remission in severely obese patients. After laparoscopic Roux-en-Y gastric bypass (LRYGB), diabetes remission occurs early and independently of weight loss. Previous research has identified preoperative factors for remission, such as duration of diabetes and HbA1c. Understanding factors that predict diabetes remission can help to select patients who will benefit most from bariatric surgery. Methods: We retrospectively reviewed all T2DM patients who underwent laparoscopic sleeve gastrectomy (LSG) or LRYGB between January 2008 and July 2014. The primary outcome was diabetes remission, defined as the absence of hypoglycemic medications, fasting blood glucose < 7.0 mmol/L and HbA1c < 6.5%. Data were analyzed using multivariable logistic regression analysis to identify predictive factors of diabetes remission. Results: We included 207 patients in this analysis; 84 (40.6%) had LSG and 123 (59.4%) had LRYGB. Half of the patients (49.8%) achieved diabetes remission at 1 year. Multivariable logistic analysis showed that LRYGB had higher odds of diabetes remission than LSG (odds ratio [OR] 6.58, 95% confidence interval [CI] 2.79­15.50, p < 0.001). Shorter duration of diabetes (OR 0.91, 95% CI 0.83­0.99, p = 0.032) and the absence of long-acting insulin (OR 0.0011, 95% CI < 0.000­0.236, p = 0.013) predicted remission. Conclusion: Type of bariatric procedure (LRYGB v. LSG), shorter duration of diabetes and the absence of long-acting insulin were independent predictors of diabetes remission after bariatric surgery.


Assuntos
Cirurgia Bariátrica/métodos , Diabetes Mellitus Tipo 2/terapia , Obesidade Mórbida/cirurgia , Indução de Remissão/métodos , Adulto , Glicemia/análise , Canadá , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Insulina de Ação Prolongada/uso terapêutico , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
12.
Lipids Health Dis ; 18(1): 169, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488158

RESUMO

BACKGROUND: Phosphatidylcholine (PC), the most abundant of the phospholipids, has several metabolic functions in organs such as the liver and the intestine, important structural- and signaling functions in biological membranes, and might have a role in the effects of Roux-en-Y gastric bypass (RYGB), an operation known to ameliorate metabolic diseases, including type 2 diabetes. We hypothesized that serum PC, as a reflection of phospholipid metabolism, changes after RYGB, and that changes are related to weight loss and possibly to changes in glucose metabolism (reflected in the HbA1c-level) as well as to changes in serum Apo A1, Apo B and Apo B/Apo A1 ratio. METHODS: In a cohort of 220 RYGB patients, we studied changes in serum PC after RYGB in relation to serum Apo A1 and Apo B, the main apolipoproteins in HDL- and LDL/VLDL-particles, respectively, up to 2 years following RYGB-surgery. RESULTS: Serum PC reached its lowest levels 3 months postoperatively to later rebound to preoperative levels 24 months after RYGB. No difference was seen between patients with or without type 2 diabetes. Serum Apo A1 showed a similar pattern whereas serum Apo B concentrations stayed low after the initial decrease after RYGB. As a result, the Apo B / Apo A1 ratio constantly decreased during follow-up. There was a strong positive correlation between PC and Apo A1, and between PC and Apo B, but none between Apo A1 and Apo B. After RYGB surgery, both PC and Apo A1, but not Apo B, correlated positively to weight loss. In relation to total cholesterol, the molar ratio between serum PC and plasma cholesterol increased steadily after RYGB. CONCLUSIONS: We conclude that changes in PC and apolipoproteins after RYGB are highly dynamic, reflecting a large plasticity and capability of accommodating lipid metabolism including PC-, cholesterol- and apolipoprotein metabolism imposed by RYGB surgery, independent of glucose tolerance. We suggest that after RYGB and major weight loss, PC and Apo A1 might have a special role in the altered metabolism of lipoproteins.


Assuntos
Apolipoproteína A-I/sangue , Apolipoproteína B-100/sangue , Diabetes Mellitus Tipo 2/cirurgia , Derivação Gástrica , Obesidade Mórbida/cirurgia , Fosfatidilcolinas/sangue , Adulto , LDL-Colesterol/sangue , VLDL-Colesterol/sangue , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Teste de Tolerância a Glucose , Hemoglobina A Glicada/metabolismo , Humanos , Metabolismo dos Lipídeos/fisiologia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico , Perda de Peso
13.
Nutr Metab Cardiovasc Dis ; 29(12): 1368-1381, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31383503

RESUMO

BACKGROUND AND AIMS: Resistant training (RT) improves health markers in obesity, but its effects in morbid obesity are unknown. We aimed to determine the effects of a RT-program in preventing/attenuating the metabolic syndrome (MetS) in patients with morbid obesity. A second aim was to report the interindividual variability in terms of improvements in MetS markers and other related co-variables. METHODS AND RESULTS: Twenty-one adults with obesity or morbid obesity were divided into two groups based on body mass index (BMI): a control obesity (CO, n = 7, BMI ≥35 < 40.0 kg/m2) and a morbid obese group (MO, n = 14, BMI ≥40 kg/m2). Participants completed a 20-week RT-program (3 sessions/week, 4-8 exercise) using free weights. Participants were assessed for MetS markers (waist circumference, systolic and diastolic blood pressure [BP], fasting glucose, high-density lipoproteins, and triglycerides) and other co-variables (total cholesterol, low-density lipoprotein, one-maximum repetition of biceps curl, and handgrip strength, 6 min walking test). Significant reductions in MetS markers were observed in both CO and MO groups (P < 0.05 to P < 0.0001), but significant reductions in diastolic BP and increases in HDL-C were noted only in the MO group (P < 0.0001). Changes in waist circumference, and systolic and diastolic BP were significantly greater only in the MO group (P < 0.001), but the CO group presented a greater fasting glucose decreases (P < 0.0001). The prevalence of non-responders between CO and MO groups was similar in the MetS outcomes. CONCLUSIONS: RT promotes greater improvements in overall MetS outcomes waist circumference, BP, and plasma triglycerides in patients with morbid obesity than in obese peers, with no overall differences in the prevalence of non-responders. CLINICAL TRIAL NUMBER: NCT03921853 at www.clinicaltrials.gov.


Assuntos
Variação Biológica Individual , Síndrome Metabólica/prevenção & controle , Obesidade Mórbida/terapia , Treinamento de Resistência , Perda de Peso , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Pressão Sanguínea , Índice de Massa Corporal , Aptidão Cardiorrespiratória , Chile , Tolerância ao Exercício , Feminino , Força da Mão , Humanos , Lipídeos/sangue , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/etiologia , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Obesidade Mórbida/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Circunferência da Cintura
14.
Indian J Med Res ; 149(4): 544-547, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31411179

RESUMO

Background & objectives: Ghrelin is an orexigenic gut hormone expressed by the gastric fundus. Laparoscopic sleeve gastrectomy (LSG) procedure involves resection of the gastric fundus leading to a decreased appetite and weight loss. This study was undertaken to determine the levels of plasma ghrelin after sleeve gastrectomy in obese patients. Methods: The study was conducted on 90 morbidly obese patients [body mass index (BMI) >40 kg/m[2]] and severely obese patients (BMI >35/kg/m[2]) who underwent sleeve gastrectomy. The patients were followed up for six months. Weight loss parameters and plasma ghrelin levels were assessed pre- and postoperatively. Results: A significant weight loss and decrease in BMI were observed at three and six months postoperatively. A significant decrease in plasma ghrelin levels over six months of follow up postoperatively was also seen. Interpretation & conclusions: These preliminary findings indicated inhibition of ghrelin production after LSG leading to a decrease in the plasma ghrelin levels within a few days of surgery and sustainable weight loss in obese patients.


Assuntos
Biomarcadores/sangue , Grelina/sangue , Obesidade Mórbida/sangue , Perda de Peso , Adulto , Idoso , Índice de Massa Corporal , Feminino , Gastrectomia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Período Pós-Operatório
15.
Obes Surg ; 29(10): 3239-3245, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31256356

RESUMO

BACKGROUND: Gut microbiota likely impact obesity and metabolic diseases. We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity. METHODS: We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10% weight loss in adults with diabetes who were randomized to medical weight loss (MWL, n = 4), adjustable gastric banding (AGB, n = 4), or Roux-en-Y gastric bypass (RYGB, n = 4). RESULTS: All participants were female, 75% reported black race with mean age of 51 years. At similar weight loss amount and glycemic improvement, the RYGB group had the most number of bacterial species (10 increased, 1 decreased) that significantly changed (p < 0.05) in relative abundance. Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB (observed species for AGB vs. MWL, p = 0.0093; AGB vs. RYGB, p = 0.0093). The relative abundance of Faecalibacterium prausnitzii increased in 3 participants after RYGB, 1 after AGB, and 1 after MWL. CONCLUSIONS: At similar weight loss and glycemic improvement, the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium, F. prausnitzii. Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL. Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes. CLINICAL TRIAL REGISTRATION: NCTDK089557- ClinicalTrials.gov.


Assuntos
Cirurgia Bariátrica/métodos , Microbioma Gastrointestinal/fisiologia , Obesidade/cirurgia , Perda de Peso/fisiologia , Adulto , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Técnicas de Tipagem Bacteriana , Biodiversidade , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/microbiologia , Diabetes Mellitus Tipo 2/cirurgia , Fezes/microbiologia , Feminino , Derivação Gástrica , Gastroplastia , Humanos , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/microbiologia , Obesidade Mórbida/sangue , Obesidade Mórbida/microbiologia , Obesidade Mórbida/cirurgia , Projetos Piloto , Período Pós-Operatório , RNA Ribossômico 16S/genética
16.
Surgery ; 166(5): 861-866, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31253418

RESUMO

BACKGROUND: Fasting lactate is elevated in metabolic diseases and could possibly be predictive of the risk of developing the metabolic syndrome. METHODS: Plasma samples were analyzed for fasting lactate to compare lean subjects, nondiabetic subjects with severe obesity, and metabolically impaired subjects. Subjects with severe obesity were studied 1 week before and 1 week to 9 months after gastric bypass surgery. Subjects with components of the metabolic syndrome were studied before and after 6 months of an exercise intervention. RESULTS: Metabolically impaired subjects had higher fasting lactate concentrations (P < .0001) and respond to a glucose or insulin challenge with higher lactates than non-obese subjects (P < .004). Lactate was significantly reduced a week after gastric bypass surgery (P < .05) and further reduced 1 to 9 months after surgery (0.95 ± 0.04 mM in non-obese, 1.26 ± 0.12 mM in subjects with severe obesity, and 0.68 ± 0.03 mM 1-3 months after gastric bypass). Six months of chronic exercise resulted in a 16% reduction (P = .028) in fasting lactate. CONCLUSION: Fasting plasma lactate was elevated in obese subjects with the metabolic syndrome compared with healthy lean individuals. Lactate was reduced by exercise and bariatric surgery, interventions that improve metabolic health and risk for subsequent disease. The results of this study and those previously published by our research group suggest that elevated lactate may be caused by an impairment in aerobic metabolism and may offer a metric assessing the severity of the metabolic syndrome.


Assuntos
Ácido Láctico/sangue , Síndrome Metabólica/diagnóstico , Obesidade Mórbida/metabolismo , Adulto , Jejum/sangue , Jejum/metabolismo , Feminino , Seguimentos , Derivação Gástrica , Humanos , Ácido Láctico/metabolismo , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento
17.
Obes Facts ; 12(4): 397-406, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31234171

RESUMO

OBJECTIVES: The frequency of postprandial hypoglycaemia after different operative procedures of bariatric surgery (BS) is unknown, although this complication is potentially dangerous. Predictors and severity of hypoglycaemia after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, and gastric banding were investigated in a large prospective study. METHODS: This study was performed at an excellence centre for BS at a tertiary care institution. Data of 333 patients (mean BMI: 44.9 ± 9.6 kg/m2; mean age: 40 ± 10 years; 80.7% women) were analysed in a prospective study with a 2-year observation period after BS. All patients underwent a 2-hour oral glucose tolerance test (OGTT) with measurements of blood glucose (BG) and insulin. For the purpose of this study, hypoglycaemia was defined as a post-challenge BG <2.8 mmol/L during the OGTT. RESULTS: 72 (25.6%) of 281 patients showed post-challenge hypoglycaemia after surgery. Hypoglycaemia was different after various procedures: 32.6% of patients after RYGB, 22.6% after sleeve gastrectomy, but only 2.3% after gastric banding had hypoglycaemia. In the whole group, patients with hypoglycaemia had lost more weight (p = 0.013), had a slightly greater decrease in BMI (p = 0.037), a greater change in 2-hour post-challenge BG (p = 0.001), and a smaller change in 1-hour post-challenge insulin (p = 0.004) compared to patients without hypoglycaemia. CONCLUSION: This prospective study shows a higher prevalence of severe hypoglycaemia (25.6%) after BS than anticipated from retrospective registers. A systematic evaluation of glucose and insulin levels by OGTT 2 years post-surgery may help to identify patients at increased risk for symptomatic and asymptomatic hypoglycaemia.


Assuntos
Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Hipoglicemia/epidemiologia , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica/efeitos adversos , Glicemia/metabolismo , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/estatística & dados numéricos , Teste de Tolerância a Glucose , Humanos , Hipoglicemia/etiologia , Insulina/sangue , Resistência à Insulina , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Prevalência , Estudos Prospectivos
18.
Nutrients ; 11(5)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31137484

RESUMO

Obesity is associated with several endocrine abnormalities, including thyroid dysfunction. The objective of this study was to investigate the effect of weight loss after bariatric surgery on thyroid-stimulating hormone (TSH) levels in euthyroid patients with morbid obesity. We performed an observational study, evaluating patients with morbid obesity submitted to bariatric surgery. We included 129 patients (92 women) and 31 controls (21 women). Clinical, anthropometric, biochemical, and hormonal parameters were evaluated. The primary endpoint was circulating TSH (µU/mL). Fasting TSH levels were higher in the obese group (3.3 ± 0.2) than in the control group (2.1 ± 0.2). The mean excessive body mass index (BMI) loss (EBMIL) 12 months after bariatric surgery was 72.7 ± 2.1%. TSH levels significantly decreased in the obese patients after surgery; 3.3 ± 0.2 vs. 2.1 ± 0.2 before and 12 months after surgery, respectively. Free thyroxine (T4) (ng/dL) levels significantly decreased in the obese patients after surgery; 1.47 ± 0.02 vs. 1.12 ± 0.02 before and 12 months after surgery, respectively. TSH decreased significantly over time, and the decrement was associated with the EBMIL. In euthyroid patients with morbid obesity, weight loss induced by bariatric surgery promotes a significant decline of the increased TSH levels. This decrement of TSH is progressive over time after surgery and significantly associated with excess BMI loss.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Glândula Tireoide/metabolismo , Tireotropina/sangue , Perda de Peso , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/fisiopatologia , Estudos Retrospectivos , Glândula Tireoide/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
19.
J Trace Elem Med Biol ; 54: 150-155, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31109605

RESUMO

PURPOSE: Previous studies have suggested a role for the toxic elements lead (Pb), mercury (Hg) and cadmium (Cd) in the development of insulin resistance and hypertension. Increased blood Pb levels have been reported after bariatric surgery and weight loss. As about 80% of patients undergoing bariatric surgery are women, most of them of childbearing age, there are concerns regarding fetal exposure to toxic trace elements. We measured whole blood Hg, Pb and Cd concentrations in morbidly obese patients before and 12 months after Roux-en-Y gastric bypass (RYGB). PATIENTS AND METHODS: Forty-six patients eligible for bariatric surgery were recruited at Innlandet Hospital Trust, Norway (2012-2014). The majority were women and 54% were of reproductive age. Whole blood samples were collected prior to and 12 months after surgery. Trace element concentrations were measured using mass spectrometry (HR-ICP-MS). RESULTS: Median whole blood Pb concentrations increased by 73% during the 12 months study period while Hg and Cd decreased by 31% and 27%, respectively. We found a negative correlation between Pb levels before surgery and BMI (p = 0.02). Before surgery patients with hypertension had significantly higher median whole blood Hg levels compared to patients with normal blood pressure (p < 0.001). CONCLUSION: One year after bariatric surgery, the median whole blood Pb concentration was increased, while Hg and Cd concentrations were decreased. The majority of bariatric surgery patients are women of reproductive age and weight loss is associated with improved fertility. As even low dose Pb exposure during fetal life is associated with negative effects on the central nervous system, the observed increase in whole blood Pb after weight loss causes concern. Further studies are needed to elucidate these observations.


Assuntos
Cirurgia Bariátrica , Cádmio/sangue , Chumbo/sangue , Mercúrio/sangue , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Adulto , Feminino , Humanos , Masculino , Oligoelementos
20.
Obes Surg ; 29(8): 2517-2526, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31069691

RESUMO

BACKGROUND AND AIMS: The rising prevalence of morbid obesity is increasing the demand for bariatric surgery. The benefits observed after bariatric surgery seems to be not fully explained by surgery-induced weight loss or traditional cardiovascular risk factors regression or improvement. Some evidences suggest that bile acid (BA) levels change after bariatric surgery, thus suggesting that BA concentrations could influence some of the metabolic improvement induced by bariatric surgery. In this report, we have characterized circulating BA patterns and compared them to metabolic and vascular parameters before and after sleeve gastrectomy (SG). PATIENTS AND METHODS: Seventy-nine subjects (27 males, 52 females, aged 45 ± 12 years, mean BMI 45 ± 7 kg/m2) SG candidates were included in the study. Before and about 12 months after SG, all subjects underwent a clinical examination, blood tests (including lipid profile, plasma glucose and insulin, both used for calculating HOMA-IR, and glycated hemoglobin), ultrasound visceral fat area estimation, ultrasound flow-mediated dilation evaluation, and determination of plasma BA concentrations. RESULTS: Before SG, both primary and secondary BA levels were higher in insulin-resistant obese subjects than in non-insulin resistant obese, and BA were positively associated with the markers of insulin-resistance. After SG, total (conjugated and unconjugated) cholic acids significantly decreased (p 0.007), and total lithocholic acids significantly increased (p 0.017). SG-induced total cholic and chenodeoxycholic acid changes were directly associated with surgery-induced glycemia (p 0.011 and 0.033 respectively) and HOMA-IR (p 0.016 and 0.012 respectively) changes. CONCLUSIONS: Serum BA are associated with glucose metabolism and particularly with markers of insulin-resistance. SG modifies circulating BA pool size and composition. SG-induced BA changes are associated with insulin-resistance amelioration. In conclusion, an interplay between glucose metabolism and circulating BA exists but further studies are needed.


Assuntos
Ácidos e Sais Biliares/sangue , Gastrectomia , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica/métodos , Glicemia/metabolismo , Comorbidade , Feminino , Gastrectomia/métodos , Hemoglobina A Glicada/análise , Humanos , Insulina/sangue , Resistência à Insulina/fisiologia , Gordura Intra-Abdominal/metabolismo , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Estudos Retrospectivos
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