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1.
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
2.
N Engl J Med ; 380(22): 2136-2145, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31116917

RESUMO

BACKGROUND: Bariatric surgery results in weight loss and health improvements in adults and adolescents. However, whether outcomes differ according to the age of the patient at the time of surgery is unclear. METHODS: We evaluated the health effects of Roux-en-Y gastric bypass in a cohort of adolescents (161 patients enrolled from 2006 through 2012) and a cohort of adults (396 patients enrolled from 2006 through 2009). The two cohorts were participants in two related but independent studies. Linear mixed and Poisson mixed models were used to compare outcomes with regard to weight and coexisting conditions between the cohorts 5 years after surgery. The rates of death and subsequent abdominal operations and selected micronutrient levels (up to 2 years after surgery) were also compared between the cohorts. RESULTS: There was no significant difference in percent weight change between adolescents (-26%; 95% confidence interval [CI], -29 to -23) and adults (-29%; 95% CI, -31 to -27) 5 years after surgery (P = 0.08). After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes (86% vs. 53%; risk ratio, 1.27; 95% CI, 1.03 to 1.57) and of hypertension (68% vs. 41%; risk ratio, 1.51; 95% CI, 1.21 to 1.88). Three adolescents (1.9%) and seven adults (1.8%) died in the 5 years after surgery. The rate of abdominal reoperations was significantly higher among adolescents than among adults (19 vs. 10 reoperations per 500 person-years, P = 0.003). More adolescents than adults had low ferritin levels (72 of 132 patients [48%] vs. 54 of 179 patients [29%], P = 0.004). CONCLUSIONS: Adolescents and adults who underwent gastric bypass had marked weight loss that was similar in magnitude 5 years after surgery. Adolescents had remission of diabetes and hypertension more often than adults. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; ClinicalTrials.gov number, NCT00474318.).


Assuntos
Derivação Gástrica , Obesidade Mórbida/cirurgia , Perda de Peso , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Feminino , Ferritinas/sangue , Derivação Gástrica/mortalidade , Hemoglobina A Glicada/análise , Humanos , Hipertensão/complicações , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Obesidade Mórbida/mortalidade , Distribuição de Poisson , Indução de Remissão , Reoperação/estatística & dados numéricos , Vitamina D/análogos & derivados , Vitamina D/sangue , Adulto Jovem
3.
Int J Mol Sci ; 20(9)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31052333

RESUMO

Circulating extracellular vesicles are small particles enclosed by a phospholipid bilayer. Vesicles deriving directly from the cellular membrane by an active budding process retain cell origin specific proteins and RNA. These vesicles carry pathophysiological information from their parental cell and hold the potential to allow analysis of organs without the need for a biopsy. We included in our study 27 patients undergoing bariatric surgery. Hepatic extracellular vesicles were determined by flow cytometry. mRNA specific for hepatic cellular origin was determined in the extracellular vesicle fraction using qPCR. Surgery led to a massive reduction of weight and overall hepatic stress as determined by alanine transaminase (ALT), aspartate transaminase (AST) and γ-glutamyltransferase (GGT). Total extracellular vesicle numbers were reduced after bariatric surgery. Liver specific vesicles identified by HepPar1 or asialoglycoprotein receptor (ASGPR) were significantly reduced after bariatric surgery in both AnnexinV+ and AnnexinV- subgroups. When analyzing circulating liver-specific mRNAs, we found reduced levels of these mRNAs after surgery even though total circulating RNA remained unchanged. We conclude that circulating hepatic extracellular vesicles are detectable in samples from patients undergoing gastric bypass surgery. These vesicles are reduced after a reduction of hepatic stress also observed with classic liver enzyme measurements. We conclude that ASGPR or HepPar positive vesicles hold the potential to serve as liver specific vesicle markers.


Assuntos
Vesículas Extracelulares/metabolismo , Derivação Gástrica , Fígado/metabolismo , Obesidade Mórbida/metabolismo , Adulto , Biomarcadores/sangue , Ácidos Nucleicos Livres/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia
4.
Am Surg ; 85(3): 252-255, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30947769

RESUMO

Polycystic ovary syndrome (PCOS) is a common disease among the bariatric population. However, there are limited data regarding the impact of laparoscopic sleeve gastrectomy (SG) on these patients. The study was conducted at University Hospital, United States. The purpose of this study was to examine per cent excess body weight loss (%EWL) and diabetes control in patients who have PCOS compared with those without PCOS. A total of 550 female patients underwent SG between December 2011 and October 2016. Retrospective analysis was completed to include follow-up data at 1, 3, 6, and 12 months and yearly after that. Outcomes measured were %EWL and hemoglobin A1c (HgbA1c). The mean and median follow-up for the entire cohort was 21 and 15 months, respectively. Seventy-eight per cent of patients completed at least 12 months of follow-up for %EWL, although only 21 per cent had similar follow-up for HgbA1c. PCOS patients had similar age (36.3 vs 36.2 years, P = 0.90), preoperative BMI (47.2 vs 47.2, P = 0.99), preoperative HgbA1c (6% vs 5.8%, P = 0.31), conversion rate to gastric bypass, and other associated comorbidities compared with non-PCOS comparisons. There was no difference in %EWL at 12-month (49.7% vs 53.1%, P = 0.53) or 24-month (43% vs 49.8%, P = 0.46) postoperative intervals. There was no difference in absolute change of HgbA1c at 12 months (-0.47% vs -0.67%, P = 0.39). SG has equivalent short-term results in %EWL and reduction in HgbA1c for patients who have PCOS and those who do not.


Assuntos
Gastrectomia , Laparoscopia , Obesidade Mórbida/cirurgia , Síndrome do Ovário Policístico/complicações , Adulto , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Síndrome do Ovário Policístico/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Perda de Peso
5.
Gene ; 705: 51-54, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31004714

RESUMO

Obesity is a major public health concern worldwide. Genetic, behavioral, and environmental factors contribute to the multifactorial etiology of obesity. Evidence suggests an association between human Brain-Derived Neurotrophic Factor (BDNF) Val66Met single nucleotide polymorphism (SNP) and obesity. Reduced plasma BDNF levels have also been reported in patients with eating disorders and obesity. We aimed to evaluate the BDNF Val66Met (rs6265) SNP and also plasma BDNF levels in morbidly obese patients compared with healthy normal controls in southern Iran. One hundred morbidly obese patients and one hundred eight healthy normal controls were enrolled. Blood-derived DNA samples were genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and confirmed by DNA sequencing. Plasma BDNF levels were evaluated using a commercially available sandwich enzyme-linked immunosorbent assay (ELISA) kit for human BDNF. Data analysis was performed by SPSS software, version 18.0. Genotype distribution was not significantly different between obese patients and controls. However, plasma BDNF levels were significantly lower in obese patients compared with controls. Interestingly, a significant association was found between BDNF Val66Met SNP and plasma BDNF levels. No relationship was observed between BDNF Val66Met SNP and all assessed demographic and clinical characteristics of obese patients. It seems that plasma BDNF levels were associated with both obesity and BDNF Val66Met SNP. However, this association was not found between BDNF Val66Met SNP and obesity. Further studies with larger sample sizes are needed for more detailed assessment of this genetic variation as a potential biomarker for obesity.


Assuntos
Substituição de Aminoácidos , Fator Neurotrófico Derivado do Encéfalo/sangue , Fator Neurotrófico Derivado do Encéfalo/genética , Metionina/genética , Obesidade Mórbida/genética , Valina/genética , Adulto , Estudos de Casos e Controles , Regulação para Baixo , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Polimorfismo de Fragmento de Restrição , Análise de Sequência de DNA
6.
J Trace Elem Med Biol ; 52: 68-73, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30732902

RESUMO

BACKGROUND & AIMS: Oral iron absorption is hampered in obese and bariatric patients, especially after Roux-en-Y gastric bypass (RYGB). As a result, iron deficiency, which is common in both patient groups, can be difficult to treat by oral supplements, often necessitating a switch to parenteral administration. The aim of this study was to find possible predictors of the extent of absorption of an effervescent iron gluconate oral supplement, which enables to pre-emptively identify those patients in which oral supplementation is likely to fail. METHODS: The pharmacokinetic properties of 695 mg effervescent iron gluconate (80 mg Fe2+) were assessed in 13 obese patients (female = 10; mean age ± SD: 45.2 ± 12.5years) pre- and six months post-RYGB by measuring serum iron concentrations during 24 hours and by calculating the adjusted for baseline AUC0-24h, Cmax and Tmax. A multivariate regression analysis was performed to investigate the effect of hepcidin concentration, iron and hematologic indices, personal and anthropometric characteristics on iron absorption. Subsequently, Receiver Operating Characteristic (ROC) curves were used to propose the cut-off value for hepcidin concentrations above which obese patients are unlikely to benefit from oral iron supplementation. Data are expressed as mean ± SD. RESULTS: Low iron status persisted after surgery as there was no significant difference observed in TSAT (17.3 ± 5.2 vs. 20.2 ± 6.6%), ferritin (91.8 ± 68.6 vs. 136.2 ± 176.9 µg/L) and hepcidin concentration (32.0 ± 30.1 vs. 28.3 ± 21.3 ng/mL) after RYGB. The absorption of effervescent iron gluconate was similar pre- and post-RYGB [AUC0-24h,pre-RYGB: 28.6 ± 10.8 µg/dL*h; AUC0-24h,post-RYGB: 27.5 ± 9.11 µg/dL*h (P = 0.84)]. Post-RYGB, iron AUC0-24h showed a strong negative correlation with both hepcidin concentrations and TSAT (R=-0.51; P = 0.08 and R=-0.81; P = 0.001), respectively. Pre-RYGB, there was a clear trend for the same negative correlations for hepcidin concentrations and TSAT (R=-0.47; P = 0.11 ;R=-0.41; P = 0.16), respectively. Taking pre-and post-RYGB data together, the negative correlations were confirmed for hepcidin concentrations and TSAT (R=-0.54; P = 0.004; R=-0.60; P = 0.001), respectively. The AUCROC = 0.87 (95%CI 0.71; 1.00) showed an optimal sensitivity/specificity cut-off at hepcidin concentrations of 26.8 ng/mL. CONCLUSIONS: The iron AUC0-24h showed a negative correlation with the hepcidin concentration and TSAT of obese patients, in particular post-RYGB. Therefore, our data support the use of hepcidin concentration and TSAT to distinguish potential responders from non-responders for iron supplementation particularly post-RYGB. Additionally, this study showed that the pharmacokinetic properties of iron gluconate from an effervescent tablet were unaffected by RYGB-surgery.


Assuntos
Suplementos Nutricionais , Compostos Ferrosos/metabolismo , Derivação Gástrica , Obesidade Mórbida/metabolismo , Obesidade Mórbida/cirurgia , Absorção Fisiológica , Administração Oral , Adulto , Feminino , Compostos Ferrosos/administração & dosagem , Compostos Ferrosos/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Comprimidos
7.
J Dermatol ; 46(4): 338-342, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30724385

RESUMO

Bariatric surgery is an effective method for severe obesity and its related comorbidities. This study was performed to explore the alterations of sex hormones and inflammatory markers following laparoscopic sleeve gastrectomy (LSG) among obese Chinese men with acanthosis nigricans (AN). Sixty-five obese men who underwent LSG were enrolled, comprising simple obesity without AN (OB group, n = 20) and obesity with AN (AN group, n = 45). There were 31 healthy male controls with normal body mass index (BMI) included. Anthropometry data, inflammatory markers, sex hormones and metabolic parameters were compared preoperatively and 12 months post-operatively. At baseline, patients in the AN group were associated with more severe metabolic abnormalities than the OB and control groups. Twelve months after surgery, AN patients obtained significant improvement in skin condition and reduction in AN score. BMI, fasting insulin (FINS), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), tumor necrosis factor-α (TNF-α) and total testosterone (TT) were significantly changed in both groups, while interleukin (IL)-6, IL-8 and C-reactive protein were changed significantly only in the AN group. Moreover, FINS, HOMA-IR, TT and IL-6 levels were changed more in the AN group than those in the OB group. Multivariate regression analysis revealed that TT increase correlated significantly with reduction in FINS and HOMA-IR in both groups, but correlated with changes in IL-6 only in the AN group. In conclusion, LSG is effective in improving the skin condition of obese men with AN. The increased TT in AN patients correlated with amelioration of inflammatory state in addition to insulin resistance after LSG.


Assuntos
Acantose Nigricans/diagnóstico , Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Inflamação/diagnóstico , Obesidade Mórbida/cirurgia , Testosterona/sangue , Acantose Nigricans/sangue , Acantose Nigricans/etiologia , Acantose Nigricans/metabolismo , Adulto , Grupo com Ancestrais do Continente Asiático , Biomarcadores/sangue , Voluntários Saudáveis , Humanos , Inflamação/sangue , Inflamação/etiologia , Inflamação/metabolismo , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Obesidade Mórbida/metabolismo , Índice de Gravidade de Doença , Pele/patologia , Resultado do Tratamento , Adulto Jovem
8.
Int J Clin Pract ; 73(6): e13315, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30681756

RESUMO

AIMS: The paraoxonase-1 (PON1) enzyme could play an important role in the anti-oxidant capacity of high-density lipoprotein. However, there are no studies which analyse the evolution of the three activities of PON1 (PON arylesterase, PON paraoxonase and PON lactonase) after Roux-en-Y Gastric Bypass (RYGB) in morbidly obese subjects. We analysed the association of PON concentration and activities with the evolution of morbidly obese subjects who underwent RYGB, and its relationship with biochemical variables and different atherogenic indices. METHODS: Twenty-seven non-obese and 82 morbidly obese subjects were studied before and 6 months after RYGB. RESULTS: Before RYGB, morbidly obese subjects had a lower PON1 concentration (P < 0.05) and higher PON lactonase activity (P < 0.001) than non-obese subjects, with no differences in PON arylesterase and PON paraoxonase activities. After RYGB, PON1 concentration (P < 0.05) and PON lactonase activity (P < 0.001) decreased with regard to the presurgery state. PON lactonase activity correlated with the atherogenic index of plasma before (r = 0.19, P = 0.047) and after RYGB (r = 0.27, P = 0.035). In different multiple lineal regression analysis models, presurgery PON lactonase activity was associated with total cholesterol (ß = 0.909, P < 0.001), LDL (ß = 0.632, P = 0.006) and DBP (ß = 0.230, P = 0.030) (R2  = 0.295), postsurgery PON lactonase activity was associated with esterified cholesterol (ß = 0.362, P = 0.011) (R2  = 0.131), and the change (Δ) in PON lactonase activity after RYGB was associated with Δesterified cholesterol (ß = 0.304, P = 0.030) (R2  = 0.093). CONCLUSIONS: PON lactonase activity is associated with the presence of morbid obesity and with an impaired lipid profile. All associations found could indicate the relationship between PON lactonase activity and the development of atherosclerosis.


Assuntos
Arildialquilfosfatase/sangue , Colesterol/sangue , Obesidade Mórbida/sangue , Adulto , Aterosclerose/etiologia , Estudos de Casos e Controles , Feminino , Derivação Gástrica , Humanos , Resistência à Insulina , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Resultado do Tratamento
9.
Diabetes Obes Metab ; 21(1): 178-182, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30047224

RESUMO

Chronic inflammation drives many obesity-associated conditions including atherosclerosis. GlycA, a marker of systemic inflammation with lower intra-individual variability than high sensitivity C-reactive protein, is independently associated with incident cardiovascular events and mortality. Although GlycA is elevated in obesity, correlations with anthropometric measures are modest and the effect of body weight loss on GlycA is untested. Obese (body mass index [BMI] 44.6 ± 6.6 kg/m2 ), non-diabetic women (33.7 ± 8.2 years) undergoing Roux-en-Y gastric bypass (n = 23) or sleeve gastrectomy (n = 31) were prospectively studied at baseline, 6 and 12 months postprocedure. Women with normal BMI (n = 14) served as controls. Bariatric surgery significantly reduced GlycA by 6 months (451 ± 47 µmol/L vs. 383 ± 50 µmol/L; P < 0.001) with further reduction at 12 months (348 ± 41 µmol/L; P < 0.001) and no difference between procedures. At 12 months, despite 41% of surgical subjects maintaining BMI >30 kg/m2 , GlycA levels did not differ between surgical and control subjects (P = 0.13). Increased high density lipoprotein particle size was strongly associated with reduced GlycA (r = -0.49; P < 0.001) and was found to mediate up to 43% of its body weight-loss-associated fall. This is the first study to demonstrate that surgical body weight loss markedly reduces levels of GlycA.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Biomarcadores/sangue , Inflamação/sangue , Obesidade Mórbida , Adulto , Humanos , Inflamação/complicações , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia
10.
Clin Hemorheol Microcirc ; 71(1): 95-102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30530969

RESUMO

OBJECTIVE: The aim of this study was to investigate the relationship between red blood cell (RBC) aggregation and deformability and angiogenesis parameters in obese patients. METHODS: We studied 35 obese subjects and 20 non-obese people as a control group. Angiogenesis was detected using Bio-Plex Pro Human Angiogenesis Multiplex Assays. The RBC aggregation and deformability of the red blood cell aggregation were performed by the Laser-assisted Optical Rotational Cell Analyser - LORCA. RESULTS: The aggregation index and the syllectogram's amplitude were significantly higher in the obese patients, whereas the aggregation half-time (t1/2) was lower compared with the control group. The deformability of RBC expressed as EI was significantly lower in the obese group than it was in the control group. All angiogenesis parameters were higher in obese individuals than they were in the control group. Significant differences were observed in angiopoietin 2 (p = 0.048), folistin (p = 0.0017), G-CSF (p = 0.042), HGF (p = 0.016), and PECAM-1 (p = 0.014). The VEGF tended to be higher in the obese patients than in the control group (p = 0.09); nevertheless, the concentration of PDGF-BB was similar in both groups. EI at shear stresses of 18.49 Pa and 30.2 Pa was strongly correlated with all angiogenesis parameters. No correlations were found between the studied RBC aggregation indices and angiogenesis parameters. Multivariate analyses indicated that only HGF was an independent predictor of RBC deformability at 18.49 Pa (ß-0.83, P < 0.000005) and at 30.2 Pa (ß-0.83, P < 0.00005). CONCLUSIONS: The study found that there are relationships between enhanced RBC rigidity and angiogenesis status in obese subjects. Because this correlation between angiogenesis and RBC deformability is presented for the first time, the physiological importance of the relationship requires further research.


Assuntos
Fenômenos Fisiológicos Cardiovasculares/imunologia , Eritrócitos/metabolismo , Obesidade Mórbida/sangue , Reologia/métodos , Feminino , Humanos , Masculino
11.
Cell Syst ; 7(6): 601-612.e3, 2018 12 26.
Artigo em Inglês | MEDLINE | ID: mdl-30528273

RESUMO

Obesity-related diseases affect half of the global population, and bariatric surgery is one of the few interventions with long-lasting weight loss and cardio-metabolic effects. Here, we investigated the effect of Roux-en-Y gastric bypass surgery on the plasma proteome, hypothesizing that specific proteins or protein patterns may serve as key mediators and markers of the metabolic response. We performed mass spectrometry (MS)-based proteomics on two longitudinal studies encompassing 47 morbidly obese patients, generating quantitative information on more than 1,700 proteins. A global correlation matrix incorporating about 200,000 relationships revealed functional connections between proteins and assigned them to physiological processes. The main classes of significantly altered proteins were markers of systemic inflammation and those involved in lipid metabolism. Our data highlight robust correlative and anti-correlative behaviors of circulating proteins to each other and to clinical parameters. A group of inflammation-related proteins showed distinct inverse relationships to proteins consistently associated with insulin sensitivity.


Assuntos
Proteínas Sanguíneas/metabolismo , Derivação Gástrica , Metabolismo dos Lipídeos , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Mapas de Interação de Proteínas , Adulto , Biomarcadores/sangue , Biomarcadores/metabolismo , Feminino , Derivação Gástrica/métodos , Humanos , Inflamação/sangue , Inflamação/metabolismo , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Proteoma/metabolismo , Proteômica
12.
Arq Gastroenterol ; 55(3): 247-251, 2018 Jul-Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30540086

RESUMO

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the commonest hepatopathy worldwide. OBJECTIVE: To investigate the correlations between NAFLD histopathological features and the levels of adipokines (adiponectin, leptin, and resistin) and circulating inflammatory markers (interleukin-6 [IL-6], interleukin-8 [IL-8], tumor necrosis factor alpha [TNF-α], and C-reactive protein [CRP]). METHODS: This is an exploratory cross-sectional study, which enrolled 19 women with obesity who underwent bariatric surgery. Biochemical characteristics evaluated included the levels of adiponectin, leptin, resistin, IL-6, IL-8, TNF-α, and CRP. NAFLD was assessed through histological examination of liver biopsies carried out during the surgical procedures. RESULTS: The mean age of the study group was 37.3±8.2 years old; mean BMI was 36.2±2.5 kg/m2. Among individuals with liver fibrosis, the levels of IL-8 were significantly higher (24.4 ± 9.7 versus 12.7 ± 6.6; P=0.016726). The intensity of fibrosis presented a significant negative correlation with the levels of adiponectin (R= -0.49379; P=0.03166); i.e. the higher the levels of adiponectin, the lower the intensity of fibrosis. The intensity of steatohepatitis presented a significant negative correlation with the levels of adiponectin (R= -0.562321; P=0.01221); this means that the higher the levels of adiponectin, the lower the intensity of steatohepatitis. CONCLUSION: Adiponectin levels were inversely correlated with the severity of fibrosis and steatohepatitis, whereas IL-8 levels were higher in individuals with liver fibrosis among individuals with obesity and NAFLD undergoing bariatric surgery. The use of these markers to assess NAFLD may bring significant information within similar populations.


Assuntos
Adipocinas/sangue , Citocinas/sangue , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade Mórbida/sangue , Adulto , Cirurgia Bariátrica , Biópsia , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/patologia , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Valores de Referência , Índice de Gravidade de Doença , Estatísticas não Paramétricas
13.
Knee ; 25(5): 923-931, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30029995

RESUMO

BACKGROUND: Severe and morbid obesity (Class II -III) represents a challenge for successful knee surgery. There isn't consensus on what influence body mass index has on blood loss and on red blood cell (RBC) transfusion during total knee arthroplasty (TKA). The objective was to determine blood loss and transfusion needs in severe and morbid obese patients undertaking TKA. METHODS: We recorded retrospectively all patients undergoing TKA. Obesity was assessed according to WHO guidelines. Perioperative haemoglobin and treatments for its optimisation were recorded. Blood losses were estimated from specific formulae for lost red-cell mass and percentage of lost blood volume. RESULTS: 922 patients were included: 35.90% were obese Class I and 18.76% obese Class II - III. Estimated blood volume was 4390  ±â€¯â€¯470 ml, 4736  ±â€¯â€¯423 ml and 5030 ±â€¯464 ml among non-obese, obese Class I and obese Class II-III, respectively (P < 0.001). The global estimated blood volume (EBV) lost was 1502  ±â€¯â€¯680 ml without differences between the three groups. However, the percentage of lost blood volume was lower in obese Class II -III (29.65%) than in non-obese (33.55%) and obese Class I (30.97%) (P < 0.005). Transfusion rates were 12.7%, 12.1% and 6.4% for non-obese, obese Class I and Class II -III, respectively (P = 0.062). A negative transfusion risk was predicted for Class II -III patients. CONCLUSIONS: Severely and morbidly obese patients did not show greater blood loss nor higher RBC transfusion needs after primary TKA than non-obese and obese Class I patients. This could be because obese Class II -III patients had higher EBV but similar RBC losses.


Assuntos
Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Índice de Massa Corporal , Obesidade Mórbida/complicações , Osteoartrite do Joelho/cirurgia , Assistência Perioperatória/métodos , Idoso , Feminino , Hemoglobinas/análise , Humanos , Masculino , Obesidade Mórbida/sangue , Osteoartrite do Joelho/complicações , Estudos Retrospectivos , Medição de Risco
14.
Lipids Health Dis ; 17(1): 145, 2018 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-29925393

RESUMO

BACKGROUND: The beneficial effects in lipid profiles after obesity surgery might be associated with the decrease in cardiovascular risk. However, direct comparison between different surgical techniques has not been extensively performed. METHODS: In the present study we compare 20 obese women submitted to laparoscopic Roux en Y gastric bypass (RYGB) with 20 women submitted to sleeve gastrectomy (SG). Twenty control women matched for age and baseline cardiovascular risk were also included. Both patients and controls were followed up for 1 year after surgery or conventional treatment with diet and exercise, respectively. Lipid profiles were measured at baseline, 6 and 12 months later. Carotid intima-media thickness was measured by ultrasonography at baseline and at the end of the study. RESULTS: Women submitted to bariatric surgery showed a decrease in total cholesterol, triglycerides, oxidized-LDL and ApoB, and an increase in HDL and ApoA concentrations that occurred regardless of the surgical procedure. LDL concentrations, however, decreased only after RYGB whereas Lp(a) showed no changes. We did not observe any correlation between the changes in serum lipid concentrations and those in carotid intima-media thickness. CONCLUSIONS: Sleeve gastrectomy and gastric bypass induce a similar beneficial effect on serum lipids in women with high cardiovascular risk 1 year after surgery.


Assuntos
Gastrectomia/métodos , Derivação Gástrica , Gastroplastia/métodos , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Adulto , Apolipoproteínas A/sangue , Apolipoproteínas B/sangue , Restrição Calórica , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/prevenção & controle , Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Exercício , Feminino , Seguimentos , Humanos , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Pessoa de Meia-Idade , Obesidade Mórbida/dietoterapia , Obesidade Mórbida/patologia , Risco , Triglicerídeos/sangue , Ultrassonografia
15.
Ther Adv Cardiovasc Dis ; 12(8): 207-216, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29914293

RESUMO

BACKGROUND: Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. The objective of this study is to evaluate warfarin requirements in hospitalized patients, stratified by BMI. METHODS: This retrospective review included two cohorts of patients: cohort A (patients admitted with a therapeutic international normalized ratio (INR)) and cohort B (newly initiated on warfarin during hospitalization). Exclusion criteria included: age under 18 years, pregnancy, INR (goal 2.5-3.5), and warfarin thromboprophylaxis post orthopedic surgery. The primary outcome was mean total weekly dose (TWD) of warfarin based on weight classification: underweight (BMI <18 kg/m2), normal/overweight (BMI 18-29.9 kg/m2), obese (BMI 30-39.9 kg/m2), and morbidly obese (BMI ⩾ 40 kg/m2). Data were extracted from two community hospitals in reverse chronologic order during July 2015-June 2013 until both study institutions evaluated 100 patients per cohort in each BMI classification or until all patients had been evaluated within the prespecified timeframe. RESULTS: A total of 585 patients were included in cohort A (26 underweight, 200 normal/overweight, 200 obese, 159 morbidly obese). There was a statistically significant difference in TWD as determined by one-way analysis of variance ( p < 0.05). A Tukey post hoc test revealed a statistically significantly higher TWD in morbidly obese (41.5 mg) compared with underweight (25.6 mg, p < 0.05), normal/overweight (28.8 mg, p < 0.05) and obese patients (32.4 mg, p < 0.05). In cohort B, 379 patients were evaluated (9 underweight, 166 normal/overweight, 152 obese, 52 morbidly obese). Overall, 191 patients had a therapeutic INR on discharge (88.9% underweight, 52.4% normal/overweight, 44.1% obese, 55.8% morbidly obese, p = 0.035). Of those, there was a statistically significant difference in TWD ( p = 0.021) with a higher TWD in the morbidly obese (41 mg) compared with underweight patients (24.4 mg, p = 0.017). CONCLUSIONS: Based on the results of this study, morbidly obese patients may require higher TWD to obtain and maintain a therapeutic INR.


Assuntos
Anticoagulantes/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Índice de Massa Corporal , Cálculos da Dosagem de Medicamento , Hospitalização , Pacientes Internados , Obesidade Mórbida/sangue , Varfarina/administração & dosagem , Idoso , Anticoagulantes/efeitos adversos , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/fisiopatologia , Estudos Retrospectivos , Varfarina/efeitos adversos
16.
J Trace Elem Med Biol ; 48: 8-15, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29773198

RESUMO

The metabolic alterations associated with obesity include mineral dysregulation. Essential trace elements are nutrients with a relevant function in a large number of cellular processes and multiple roles in the correct functioning of metabolic enzymes. Paraoxonase-1 (PON1) is an antioxidant and anti-inflammatory enzyme that is compromised in obesity. In the present study, the potential alterations in trace elements in morbidly obese women were assessed in relation to serum PON1 activity and concentration, as well as to other obesity-related comorbidities such as diabetes mellitus and fatty liver. We recruited 41 morbidly obese women and 51 control individuals. The serum concentrations of 30 elements, PON1 paraoxonase and lactonase activities, and PON1 concentration were measured. We observed significant alterations in the levels of As, Ba, Cu, Ca, Fe, Mg, Na, Se, Sr, and Zn in obese women; some of them (As, Ca, Cr, Cu, Mg, and Se) being significantly correlated with serum PON1 values. The most relevant changes were observed in the concentrations of As, Sr and Mg, the last of which was also significantly associated with diabetes mellitus. The current results raise the possibility that increased ingestion and/or storage of a number of trace elements may be factors predisposing to obesity-related comorbidities and metabolic alterations.


Assuntos
Arildialquilfosfatase/sangue , Obesidade Mórbida/sangue , Oligoelementos/sangue , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
17.
Arch Endocrinol Metab ; 62(3): 346-351, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29791656

RESUMO

OBJECTIVE: Roux-en-Y gastric bypass (RYGB) reduces body weight and the comorbidities associated with obesity. The aim of this study was to evaluate whether glucose and lipid profiles were maintained during a 5-year follow-up period after RYGB. SUBJECTS AND METHODS: Anthropometric and laboratory data from 323 patients who had undergone this operation were analyzed. Differences in laboratory variables between the baseline and 12, 24, 36, 48 and 60 months postoperatively (PO) were assessed using a one-way ANOVA test to compare the three groups. Delta significance using one-way ANOVA was performed to assess anthropometric variable in the postoperative period (p < 0.05). RESULTS: 77 patients (24%) were included in Group 1 (G1), 101 (32%) in Group 2 (G2), and 141 (44%) in Group 3 (G3). The majority of patients, 71.7% in G1, 82.8% in G2, and 70% in G3, showed high triglycerides (TG) before surgery. A decrease in weight loss was observed in all groups followed by an increase in body weight in G2 and G3 at 36, 48 and 60 months. Laboratory results for G1, G2 and G3 showed no significant differences between groups at baseline and during the post-operative period. CONCLUSION: Our results suggest that weight regain after RYGB has no significant impact on the long-term evolution of the lipid profile and glycemia.


Assuntos
Glucose/análise , Lipídeos/sangue , Obesidade Mórbida/cirurgia , Adulto , Feminino , Seguimentos , Derivação Gástrica , Humanos , Masculino , Obesidade Mórbida/sangue , Estudos Retrospectivos
18.
Nutrients ; 10(4)2018 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-29690638

RESUMO

Neurotensin (NT) is a 13-amino acid peptide localized in the neuroendocrine cells of the small intestine, which promotes fat absorption and fatty acids translocation in response to lipid ingestion. NT-knock-out mice fed with a high-fat diet are protected from obesity, fatty liver, and the development of insulin-resistance. In humans, higher plasma levels of pro-NT, which is the stable circulating precursor of NT, predict obesity, type 2 diabetes (T2D), and cardiovascular disease. In obesity, the presence of visceral adipose tissue (VAT) inflammation leads to unfavorable metabolic outcomes and is associated with the development of T2D and non-alcoholic fatty liver disease (NAFLD). In this study, we investigated the relationship between plasma pro-NT levels and the presence of VAT inflammation in biopsies from 40 morbidly obese subjects undergoing bariatric surgery. We demonstrated that higher proNT levels are significantly associated with greater macrophages infiltration, HIF-1α, WISP-1, and UNC5B expression in VAT (all p < 0.01) due to the diagnosis of T2D and NAFLD. The overall results show that, in obesity, pro-NT is a biomarker of VAT inflammation and insulin-resistance. Additionally, NT may be involved in the development of dysmetabolic conditions likely mediated by increased gut fat absorption and the presence of a proinflammatory milieu in the adipose tissue.


Assuntos
Hormônios Gastrointestinais/sangue , Intestino Delgado/metabolismo , Gordura Intra-Abdominal/metabolismo , Metabolismo dos Lipídeos , Neurotensina/sangue , Obesidade Mórbida/sangue , Adulto , Idoso , Proteínas de Sinalização Intercelular CCN/metabolismo , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Intestino Delgado/fisiopatologia , Gordura Intra-Abdominal/fisiopatologia , Macrófagos/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/fisiopatologia , Proteínas Proto-Oncogênicas/metabolismo , Receptores de Superfície Celular/metabolismo , Regulação para Cima
19.
Endokrynol Pol ; 69(3): 252-258, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29645064

RESUMO

INTRODUCTION: Visceral adiposity is associated with decreased serum adiponectin levels, peripheral resistance to insulin and an increased risk of cardio-metabolic complications. However, the link between adiponectin expression in visceral adipose tissue (VAT), its serum levels and metabolic protection is controversial. The aim of this study was to investigate the relationship between the adiponectin gene expression in VAT and clinical and metabolic parameters in patients with severe obesity. MATERIAL AND METHODS: This is a cross-sectional study that included 51 severely obese patients (age 43.24±11.29 years, BMI 45.13±8.67 kg/m2), extensively evaluated clinically and biologically (metabolic tests, serum adiponectin measurements, HOMA-IR) before bariatric surgery. Omental adipose tissue was sampled during the intervention and the relative quantification of adiponectin gene expression was performed by real-time PCR, using beta-actin as reference gene. RESULTS: Adiponectin mRNA in VAT was significantly higher in obese insulin-sensitive patients than in the rest of obese patients (p < 0.05) and negatively correlated with HOMA-IR (r =-0.354, p=0.016) and uric acid (r =-0.304, p=0.045). After adjustment for gender, TG/HDL ratio and uric acid, adiponectin expresion (ß= -0.439, p=0.001), waist circumference (ß=0.467, p=0.001) and serum adiponectin (ß =-0.339, p=0.011) remained significantly associated with HOMA-IR, together explaining more than 50% of its variation. CONCLUSIONS: In severely obese patients, adiponectin gene expression in VAT is negatively correlated with serum levels of uric acid and is an independent determinant, together with anthropometric parameters of visceral obesity and serum adiponectin levels, of insulin resistance.


Assuntos
Adiponectina/genética , Resistência à Insulina , Gordura Intra-Abdominal/metabolismo , Obesidade Mórbida/metabolismo , Adiponectina/sangue , Adulto , Estudos Transversais , Feminino , Regulação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/fisiopatologia , RNA Mensageiro , Ácido Úrico/sangue
20.
Artigo em Inglês | MEDLINE | ID: mdl-29589549

RESUMO

INTRODUCTION: In obese patients, the incidences of several thyroid disorders have increased in comparison to the general population. This study is aimed to investigate the effect of laparoscopic sleeve gastrectomy (LSG) on thyroid function tests in obese patients. METHODS: The patient files of 186 individuals who underwent laparoscopic sleeve gastrectomy surgery were examined retrospectively. Forty-nine females and 29 males comprising a total of 78 patients were included in the study. The routine physical examination findings and laboratory parameters recorded preoperatively were compared with their counterparts obtained in the postoperative sixth month. RESULTS: The mean preoperative body mass index (BMI) levels of the patients in the study was calculated as 46.91 kg/m2, whereas the mean BMI in the postoperative sixth month was 30.35 kg/m2 (p<0.001). Prior to the sleeve gastrectomy, the mean thyroid stimulating hormone (TSH) level of the patients was 2.53 ±2.06 µIU/mL; however, a significant reduction was observed in the mean TSH level during the postoperative sixth month, which was calculated as 1.77 ±1.12 µIU/mL (p=0.015). The mean free T4 level was 1.18±0.1 ng/dL in the preoperative period, but this increased to 1.22 ±0.24 ng/dL postoperatively, an insignificant change. The decrease in the TSH levels after the LSG was determined not to be correlated with the decrease in body weight. CONCLUSION: The results of our study demonstrate that the levels of TSH decreased significantly in patients who underwent LSG and that the decrease was independent of the changes in BMI.


Assuntos
Gastrectomia/métodos , Laparoscopia , Obesidade Mórbida/cirurgia , Tireotropina/sangue , Biomarcadores/sangue , Índice de Massa Corporal , Regulação para Baixo , Feminino , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Obesidade Mórbida/sangue , Obesidade Mórbida/diagnóstico , Estudos Retrospectivos , Testes de Função Tireóidea , Tiroxina/sangue , Fatores de Tempo , Resultado do Tratamento , Perda de Peso
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