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1.
BMC Surg ; 24(1): 178, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38849774

RESUMO

OBJECTIVE: This study aimed to examine the correlation between preoperative body mass index (BMI) and adequate percentage of total weight loss (TWL%) outcome and present evidence of tiered treatment for patients with obesity in different preoperative BMI. METHODS: We included patients with complete follow-up data who underwent metabolic and bariatric surgery (BMS). We termed optimal clinical response as TWL% >20% at one year following MBS. To investigate dose-response association between preoperative BMI and optimal clinical response, preoperative BMI was analyzed in three ways: (1) as quartiles; (2) per 2.5 kg/m2 units (3) using RCS, with 3 knots as recommended. RESULTS: A total of 291 patients with obesity were included in our study. The corresponding quartile odds ratios associated with optimal clinical response and adjusted for potential confounders were 1.00 (reference), 1.434 [95% confidence interval (95%CI)   =  0.589-3.495], 4.926 (95%CI   =  1.538-15.772), and 2.084 (95%CI   =  0.941-1.005), respectively. RCS analysis showed a non-linear inverted U-shaped association between preoperative BMI and optimal clinical response (Nonlinear P   =  0.009). In spline analysis, when preoperative BMI was no less than 42.9 kg/m2, the possibility of optimal clinical response raised as preoperative BMI increased. When preoperative BMI was greater than 42.9 kg/m2, the possibility of optimal clinical response had a tendency to decline as preoperative BMI increased. CONCLUSION: Our research indicated the non-linear inverted U-shaped correlation between preoperative BMI and adequate weight loss. Setting a preoperative BMI threshold of 42.9 is critical to predicting optimal clinical outcomes.


Assuntos
Cirurgia Bariátrica , Índice de Massa Corporal , Redução de Peso , Humanos , Cirurgia Bariátrica/métodos , Estudos Retrospectivos , Feminino , Masculino , Redução de Peso/fisiologia , Pessoa de Meia-Idade , Adulto , Resultado do Tratamento , Obesidade/complicações , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações
3.
PeerJ ; 12: e17431, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38827293

RESUMO

Purpose: To compare the impact of erector spinae plane block (ESPB) and paravertebral block (PVB) on the quality of postoperative recovery (QoR) of patients following laparoscopic sleeve gastrectomy (LSG). Methods: A total of 110 patients who underwent elective LSG under general anesthesia were randomly assigned to receive either ultrasound-guided bilateral ESPB or PVB at T8 levels. Before anesthesia induction, 40 mL of 0.33% ropivacaine was administered. The primary outcome was the QoR-15 score at 24 hours postoperatively. Results: At 24 hours postoperatively, the QoR-15 score was comparable between the ESPB and PVB groups (131 (112-140) vs. 124 (111-142.5), P = 0.525). Consistently, there was no significant difference in QoR-15 scores at 48 hours postoperatively, numerical rating scale (NRS) pain scores at any postoperative time points, time to first ambulation, time to first anal exhaust, postoperative cumulative oxycodone consumption, and incidence of postoperative nausea and vomiting (PONV) between the two groups (all P > 0.05). No nerve block-related complications were observed in either group. Conclusion: In patients undergoing LSG, preoperative bilateral ultrasound-guided ESPB yields comparable postoperative recovery to preoperative bilateral ultrasound-guided PVB.


Assuntos
Gastrectomia , Laparoscopia , Bloqueio Nervoso , Dor Pós-Operatória , Humanos , Feminino , Bloqueio Nervoso/métodos , Masculino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Laparoscopia/efeitos adversos , Adulto , Dor Pós-Operatória/prevenção & controle , Pessoa de Meia-Idade , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Ropivacaina/administração & dosagem , Ropivacaina/uso terapêutico , Ultrassonografia de Intervenção/métodos , Medição da Dor , Músculos Paraespinais/inervação , Músculos Paraespinais/diagnóstico por imagem , Resultado do Tratamento , Obesidade Mórbida/cirurgia , Náusea e Vômito Pós-Operatórios/epidemiologia , Anestesia Geral/efeitos adversos
4.
J Robot Surg ; 18(1): 247, 2024 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-38850381

RESUMO

Long-term postoperative complications of metabolic and bariatric surgery (MBS) are more frequent than those of primary surgery. Robotic-assisted procedures offer several advantages over traditional laparoscopy, but there are limited data. A retrospective study of 29 patients who underwent a revisional robotic-assisted Roux-en-Y gastric bypass (RRYGB) in a Tertiary Level Hospital. Variables included were demographics, causes for revision, operative details, complications, and weight loss outcomes up to 54 month post-RRYGB. Causes for conversion were weight loss failure (WLF), weight regain (WR), Gastroesophageal Reflux Disease (GERD), or Joint Pain (JP). We assessed 29 patients. Causes for conversion included WLF (34%), WR (15%), WR with GERD (20%), GERD (24%), and JP (3%). Initial BMI was 53.43 kg/m2 ± 8.75. Mean length of hospital stay (LOS) was 2 days. Total operative time was 126 min. ± 43.45. Excess weight loss at 1 year post-surgery was 82.66% (p < 0.0001), with mean BMI of 30.93 kg/m2 (p < 0.001). At 3 years, mean %EWL was 71.26% and a mean BMI 33.81 kg/m2 (p < 0.0001). At 4.5 years, mean %EWL was 59.29% and mean BMI 37.27 kg/m2 (p < 0.0001). One complication (8%) was found (jejunojejunal stenosis). There was no mortality. The initial experience with RRYGB shows acceptable outcomes, including low morbidity, no mortality, excellent weight loss after the revisional surgery, and promising reduction in operative times, with important implications on reduction of the total cost of the procedure.


Assuntos
Derivação Gástrica , Reoperação , Procedimentos Cirúrgicos Robóticos , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Feminino , Masculino , México , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Derivação Gástrica/métodos , Resultado do Tratamento , Redução de Peso , Cirurgia Bariátrica/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Obesidade Mórbida/cirurgia , Tempo de Internação/estatística & dados numéricos , Laparoscopia/métodos
5.
JAMA Netw Open ; 7(6): e2414340, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38829616

RESUMO

Importance: Results from long-term follow-up after biliopancreatic diversion with duodenal switch (DS) are scarce. Objective: To compare weight loss, health outcomes, and quality of life 10 years or more after Roux-en-Y-gastric bypass (RYGB) and DS surgery in patients with severe obesity-that is, a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 50 to 60. Design, Setting, and Participants: This open-label randomized clinical trial was conducted at 2 academic bariatric centers in Sweden and Norway. Sixty patients with a BMI of 50 to 60 were included from March 1, 2006, to August 31, 2007. Data were analyzed from August 12, 2022, to January 25, 2023. Interventions: Laparoscopic RYGB or laparoscopic DS. Main Outcomes and Measures: The main outcome was change in BMI after 10 or more years. Secondary outcomes included anthropometric measures, lipid and glycemic profiles, bone mass density, adverse events, gastrointestinal tract symptoms, and health-related quality of life. Results: Forty-eight of the original 60 patients (80%) were assessed after a median of 12 (range, 9-13) years (mean [SD] age, 48.0 [6.0] years; 35 women [73%]). At follow-up, the mean BMI reductions were 11.0 (95% CI, 8.3-13.7) for RYGB and 20.3 (95% CI, 17.6-23.0) for DS, with a mean between-group difference of 9.3 (95% CI, 5.4-13.1; P < .001). Total weight loss was 20.0% (95% CI, 15.3%-24.7%) for RYGB and 33.9% (95% CI, 27.8%-40.0%) for DS (P = .001). Mean serum lipid levels, except high-density lipoprotein cholesterol and hemoglobin A1c, improved more in the DS group during follow-up. Bone mass was reduced for both groups from 5 to 10 years, with lower bone mass after DS at 10 years. Quality-of-life scores (Obesity-Related Problem Scale and the 36-Item Short Form Health Survey) were comparable across groups at 10 years. The total number of adverse events was higher after DS (135 vs 97 for RYGB; P = .02). More patients in the DS group developed vitamin deficiencies (21 vs 11 for RYGB; P = .008) including 25-hydroxyvitamin D deficiency (19 for DS vs 9 for RYGB; P = .005). Four of 29 patients in the DS group (14%) developed severe protein-caloric malnutrition, of whom 3 (10%) underwent revisional surgery. Conclusions and Relevance: In this randomized clinical trial, BMI reduction was greater after DS, but RYGB had a better risk profile over 10 years. Biliopancreatic diversion with DS may not be a better surgical strategy than RYGB for patients with a BMI of 50 to 60. Trial Registration: ClinicalTrials.gov Identifier: NCT00327912.


Assuntos
Índice de Massa Corporal , Derivação Gástrica , Obesidade Mórbida , Qualidade de Vida , Redução de Peso , Humanos , Derivação Gástrica/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Obesidade Mórbida/cirurgia , Resultado do Tratamento , Suécia , Noruega , Duodeno/cirurgia , Laparoscopia/métodos , Desvio Biliopancreático/métodos
6.
BMC Surg ; 24(1): 176, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840104

RESUMO

BACKGROUND: Laparoscopic sleeve gastrectomy combined with fundoplication (LSGFD) can significantly control body weight and achieve effective anti-reflux effects. The aim of this study is to investigate the correlation between the alteration in Ghrelin levels and weight loss following SGFD, and to compare Ghrelin levels, weight loss and metabolic improvements between SG and SGFD, with the objective of contributing to the existing body of knowledge on SGFD technique in the management of patients with obesity and gastroesophageal reflux disease (GERD). METHODS: A retrospective analysis was conducted on the clinical data of 115 obese patients who underwent bariatric surgery between March 2023 and June 2023 at the Department of Minimally Invasivew Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region. The subjects were divided into two groups based on surgical methods: sleeve gastrectomy group (SG group, 93 cases) and sleeve gastrectomy combined with fundoplication group (SGFD group, 22 cases). Clinical data, such as ghrelin levels before and after the operation, were compared between the two groups, and the correlation between changes in ghrelin levels and weight loss effectiveness after the operation was analyzed. RESULTS: Three months after the operation, there was no significant difference in body mass, BMI, EWL%, fasting blood glucose, triglyceride, cholesterol, and uric acid levels between the SG and SGFD groups (P > 0.05). However, the SGFD group exhibited a significant decrease in body weight, BMI, and uric acid levels compared to preoperative levels (P < 0.05), while the decrease in ghrelin levels was not statistically significant (P > 0.05). Logistic regression analysis indicated that ghrelin levels three months after the operation were influential in postoperative weight loss. CONCLUSION: The reduction of plasma Ghrelin level in patients after SGFD is not as obvious as that in patients after SG, but it can make obese patients get the same good weight loss and metabolic improvement as patients after SG. Ghrelin level at the third month after operation is the influencing factor of postoperative weight loss.


Assuntos
Fundoplicatura , Gastrectomia , Refluxo Gastroesofágico , Grelina , Redução de Peso , Humanos , Grelina/sangue , Redução de Peso/fisiologia , Masculino , Feminino , Gastrectomia/métodos , Estudos Retrospectivos , Adulto , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Refluxo Gastroesofágico/sangue , Refluxo Gastroesofágico/etiologia , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Obesidade Mórbida/sangue , Laparoscopia/métodos , Cirurgia Bariátrica/métodos , Resultado do Tratamento
7.
PLoS One ; 19(6): e0298402, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38843138

RESUMO

BACKGROUND: Bariatric surgery leads to sustained weight loss in a majority of recipients, and also reduces fasting insulin levels and markers of inflammation. We described the long-term associations between bariatric surgery and clinical outcomes including 30 morbidities. METHODS: We did a retrospective population-based cohort study of 304,157 adults with severe obesity, living in Alberta, Canada; 6,212 of whom had bariatric surgery. We modelled adjusted time to mortality, hospitalization, surgery and the adjusted incidence/prevalence of 30 new or ongoing morbidities after 5 years of follow-up. RESULTS: Over a median follow-up of 4.4 years (range 1 day-22.0 years), bariatric surgery was associated with increased risk of hospitalization (HR 1.46, 95% CI 1.41,1.51) and additional surgery (HR 1.42, 95% CI 1.32,1.52) but with a decreased risk of mortality (HR 0.76, 95% CI 0.64,0.91). After 5 years (median of 9.9 years), bariatric surgery was associated with a lower risk of severe chronic kidney disease (HR 0.45, 95% CI 0.27,0.75), coronary disease (HR 0.49, 95% CI 0.33,0.72), diabetes (HR 0.51, 95% CI 0.47,0.56), inflammatory bowel disease (HR 0.55, 95% CI 0.37,0.83), hypertension (HR 0.70, 95% CI 0.66,0.75), chronic pulmonary disease (HR 0.75, 95% CI 0.66,0.86), asthma (HR 0.79, 95% 0.65,0.96), cancer (HR 0.79, 95% CI 0.65,0.96), and chronic heart failure (HR 0.79, 95% CI 0.64,0.96). In contrast, after 5 years, bariatric surgery was associated with an increased risk of peptic ulcer (HR 1.99, 95% CI 1.32,3.01), alcohol misuse (HR 1.55, 95% CI 1.25,1.94), frailty (HR 1.28, 95% 1.11,1.46), severe constipation (HR 1.26, 95% CI 1.07,1.49), sleep disturbance (HR 1.21, 95% CI 1.08,1.35), depression (HR 1.18, 95% CI 1.10,1.27), and chronic pain (HR 1.12, 95% CI 1.04,1.20). INTERPRETATION: Bariatric surgery was associated with lower risks of death and certain morbidities. However, bariatric surgery was also associated with increased risk of hospitalization and additional surgery, as well as certain other morbidities. Since values and preferences for these various benefits and harms may differ between individuals, this suggests that comprehensive counselling should be offered to patients considering bariatric surgery.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Humanos , Cirurgia Bariátrica/efeitos adversos , Masculino , Feminino , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Obesidade Mórbida/mortalidade , Hospitalização , Resultado do Tratamento , Seguimentos , Alberta/epidemiologia
9.
Am Heart J ; 274: 130-133, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38866442

RESUMO

BACKGROUND: Patients with obesity and advanced heart failure requiring left ventricular assist device (LVAD) support are more likely to experience LVAD complications and may be disproportionately Black and/or female when compared to patients without obesity. Among these patients, obesity may represent a barrier to transplant eligibility and a marker of inequity in heart transplantation and health outcomes in advanced heart failure. METHODS: To better understand this issue at our institution, we examined our active LVAD cohort and found that almost one-third of all patients had severe obesity with BMI ≥ 35 kg/m2. RESULTS: Patients with LVADs and severe obesity were significantly younger and more likely to self-identify as Black, and numerically more likely to be female. CONCLUSION: Weight management in this group represents a vital area for improved equity in health outcomes and barriers to heart transplantation. TRIAL REGISTRATION: NA.


Assuntos
Insuficiência Cardíaca , Transplante de Coração , Coração Auxiliar , Obesidade Mórbida , Humanos , Feminino , Masculino , Insuficiência Cardíaca/terapia , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Índice de Massa Corporal , Adulto , Idoso , Estudos Retrospectivos
10.
Cardiovasc Diabetol ; 23(1): 205, 2024 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-38879559

RESUMO

BACKGROUND: There has been a substantial increase in the use of laparoscopic sleeve gastrectomy (SG) to treat morbid obesity despite observational evidence demonstrating the superiority of Roux-en-Y gastric bypass (RYGB) for reducing low-density lipoprotein (LDL) cholesterol. The main aim was to ascertain whether high LDL cholesterol levels should be considered when selecting the most appropriate surgical procedure for each patient (RYGB or SG). METHODS: In this single-center, randomized clinical trial using intention-to-treat analysis, 38 patients with severe obesity and elevated levels of LDL cholesterol were randomly assigned to undergo RYGB or SG. The primary outcome was LDL cholesterol remission at 12 months, defined as LDL cholesterol < 3.36 nmol/l without lipid-lowering medications. Secondary outcomes included changes in weight, other comorbidities, qualitative lipoprotein traits, cholesterol esters, glycoproteins, cholesterol absorption and synthesis metabolites and complications. RESULTS: Intention-to-treat analysis revealed that LDL cholesterol remission occurred in 66.6% of RYGB patients compared to 27.8% of SG patients (p = 0.019). Among patients completing follow-up, RYGB demonstrated superior remission (80.0% vs. 29.4%, p = 0.005). Exclusive benefits of RYGB included a reduction in large, medium, and small LDL particles. Cholesterol absorption markers showed differential behavior after both techniques: campesterol (Δ -15.2 µg/mg, 95% CI -30.2 to -0.1) decreased after RYGB, and sitosterol (Δ 21.1 µg/mg, 95% CI 0.9 to 41.2), cholestanol (Δ 30.6 µg/mg, 95% CI 14.8 to 57.9) and campesterol (Δ 18.4 µg/mg, 95% CI 4.4 to 32.3) increased after SG. No differences in weight loss, cholesterol esters, glycoproteins, cholesterol synthesis metabolites or postoperative complications were observed between techniques. CONCLUSION: In conclusion, RYGB is superior to SG in terms of short-term of high LDL cholesterol remission. Furthermore, RYGB also led to a greater improvement in lipoprotein parameters that confer an atherogenic profile. Therefore, the presence of elevated levels of LDL cholesterol should be considered when determining the optimal bariatric surgery procedure for each patient. TRIAL REGISTRATION: Clinicaltrials.gov number, NCT03975478).


Assuntos
Biomarcadores , LDL-Colesterol , Gastrectomia , Derivação Gástrica , Obesidade Mórbida , Humanos , Masculino , Feminino , Derivação Gástrica/efeitos adversos , Gastrectomia/efeitos adversos , Adulto , Pessoa de Meia-Idade , LDL-Colesterol/sangue , Resultado do Tratamento , Obesidade Mórbida/cirurgia , Obesidade Mórbida/sangue , Obesidade Mórbida/diagnóstico , Fatores de Tempo , Biomarcadores/sangue , Redução de Peso , Indução de Remissão , Laparoscopia/efeitos adversos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/tratamento farmacológico , Sitosteroides/sangue
11.
Sao Paulo Med J ; 142(5): e2023161, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38836818

RESUMO

BACKGROUND: Evidence on the effect of one-anastomosis gastric bypass (OAGB) on renal function is limited. OBJECTIVE: To compare the evolution of estimated renal function observed 1 year after OAGB and Roux-en-Y gastric bypass (RYGB) in individuals with obesity. DESIGN AND SETTING: Observational, analytical, and retrospective cohort study. Tertiary-level university hospital. METHODS: This study used a prospectively collected database of individuals who consecutively underwent bariatric surgery. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR), according to the Chronic Kidney Disease Epidemiology Collaboration. The one-year variation in the eGFR was compared between the procedures. RESULTS: No significant differences in age, sex, obesity-associated conditions, or body mass index were observed among individuals who underwent either OAGB or RYGB. OAGB led to a significantly higher percentage of total (P = 0.007) and excess weight loss (P = 0.026). Both OAGB and RYGB led to significantly higher values of eGFR (103.9 ± 22 versus 116.1 ± 13.3; P = 0.007, and 102.4 ± 19 versus 113.2 ± 13.3; P < 0.001, respectively). The one-year variation in eGFR was 11 ± 16.2% after OAGB and 16.7 ± 26.3% after RYGB (P = 0.3). Younger age and lower baseline eGFR were independently associated with greater postoperative improvement in renal function (P < 0.001). CONCLUSION: Compared with RYGB, OAGB led to an equivalent improvement in renal function 1 year after the procedure, along with greater weight loss.


Assuntos
Derivação Gástrica , Taxa de Filtração Glomerular , Humanos , Masculino , Feminino , Estudos Retrospectivos , Taxa de Filtração Glomerular/fisiologia , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Redução de Peso/fisiologia , Obesidade Mórbida/cirurgia , Obesidade Mórbida/fisiopatologia , Rim/fisiopatologia , Rim/fisiologia , Índice de Massa Corporal , Fatores de Tempo
12.
BMC Res Notes ; 17(1): 164, 2024 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-38879520

RESUMO

OBJECTIVE: Bariatric surgery induces a significant loss of both fat mass (FM) and fat-free mass (FFM). The proteoglycan receptor syndecan-4 (SDC4) plays a crucial role in adipose tissue and skeletal muscle functions. Thus, this study was performed (i) to assess plasma SDC4 levels after both Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) surgeries, and (ii) to explore potential associations with changes in body composition variables. RESULTS: Twenty-six patients (17 females) with severe obesity underwent SG (n = 13) or RYGB (n = 13) and were followed up to 1 year (1Y). Body weight, FM, FFM, and SCD4 were measured at baseline (BL), and at week 11 (W11) and 1Y after surgery. Independently of procedure, there was a significant body weight loss at W11, with an average FM and FFM reduction of 13.7 ± 0.6 kg and 5.3 ± 0.5 kg, respectively. Participants continued to lose weight afterwards, with a total weigth loss of 38.2 ± 1.5 kg at 1Y. No associations were found at BL between SDC4 levels and any anthropometric variable; however, SDC4 levels were lower than BL at both W11 and 1Y, independently of type of surgery. Additionally, changes in SDC4 between BL and 1Y were positively correlated with weight and FFM loss during the same period. TRIAL REGISTRATION: ClinicalTrials.gov NCT04051190 on 09/08/2019.


Assuntos
Cirurgia Bariátrica , Sindecana-4 , Redução de Peso , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tecido Adiposo/metabolismo , Cirurgia Bariátrica/métodos , Composição Corporal/fisiologia , Gastrectomia/métodos , Derivação Gástrica , Obesidade Mórbida/cirurgia , Obesidade Mórbida/sangue , Sindecana-4/sangue , Redução de Peso/fisiologia
13.
Turk Psikiyatri Derg ; 35(2): 116-126, 2024.
Artigo em Inglês, Turco | MEDLINE | ID: mdl-38842153

RESUMO

OBJECTIVE: Psychiatric evaluation of candidate patients before bariatric surgery (BS) has an important place in the success of the treatment. In this study, it was aimed to examine the relationship between childhood trauma (CT) and body image, self-esteem and eating attitudes of individuals who applied for BS. METHOD: A total of 87 BS candidate patients with morbid obesity, 57 women and 30 men, were included in the study. Sociodemographic Information Form, Childhood Trauma Questionnaire (CTQ), Body Perception Scale (BPS), Rosenberg Self-Esteem Scale (RSES), and Eating Attitude Test (EAT-40) were used as data collection tools in the study. RESULTS: CT was detected in 47.1% of the cases. RSES (t=3.296; p<0.01) and BPS (t=3.267; p<0.01) scores were found to be significantly higher in those with a history of CT. A positive and significant relationship was found between EAT-40 and CTQ -sexual abuse (SA) sub-dimension (r=0.570; p<0.01). A significant relationship was found between all subdimensions of CTQ and RSES. A significant relationship was found between CTQ physical neglect (PN), emotional neglect (EN), and emotional abuse (EA) sub-dimensions and BPS. In addition, CTQ total score was found to significantly and negatively predict self-esteem (ß=- 4.432; p<0.001) and body image (ß=-3.700; p<0.001). CONCLUSION: In our study, it was found that those with CT were dissatisfied with their bodies and had lower self-esteem. Questioning CT in the psychological evaluation of pre-BS cases may contribute to the understanding of the etiology of obesity and may play an important role in planning the follow-up after BS.


Assuntos
Cirurgia Bariátrica , Imagem Corporal , Obesidade Mórbida , Autoimagem , Humanos , Feminino , Masculino , Imagem Corporal/psicologia , Cirurgia Bariátrica/psicologia , Adulto , Obesidade Mórbida/psicologia , Obesidade Mórbida/cirurgia , Inquéritos e Questionários , Pessoa de Meia-Idade , Turquia , Adulto Jovem
14.
Sci Rep ; 14(1): 13495, 2024 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-38866860

RESUMO

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women that is associated with an increased risk of anxiety and depression and with a lower health-related quality of life (HRQoL). PCOS is closely associated with obesity, which per se can lead to symptoms of anxiety and depression and lower HRQoL. The first-line treatment for PCOS is weight loss through lifestyle intervention, which has been shown to improve all symptoms of the syndrome. The aim of this study was to investigate symptoms of anxiety and depression and HRQoL in women with severe obesity (BMI ≥ 35) with and without PCOS, and to evaluate the effect of a one-year structured weight loss intervention. A total of 246 women with severe obesity (PCOS n = 63, non-PCOS n = 183) were included. The comprehensive psychopathological rating scale self-rating scale for affective symptoms (CPRS-S-A) and the short form-36 (SF-36) were used to assess symptoms of anxiety and depression and HRQoL. In total 72 women of the 246 women with severe obesity completed a one-year weight loss programme and were followed up and compared with baseline data. In women with severe obesity, there were no differences in symptoms of anxiety and depression and HRQoL between women with and without PCOS at baseline. Clinically relevant anxiety symptoms were present in 71.3% (PCOS) and 65.6% (non-PCOS), and depression symptoms were present in 56.4% (PCOS) and 52.2% (non-PCOS). Significant weight loss improved physical HRQoL in all women, but reduced symptoms of anxiety and depression only in women without PCOS. There were no differences when comparing the changes between the groups. Women with severe obesity are severely affected by symptoms of anxiety and depression, independent of PCOS. Weight loss improved symptoms of anxiety and depression in women without PCOS, but there were no differences between groups in change from baseline to follow-up.Trial registration number: Clinical trial.gov: NCT01319162, March 18, 2011. Date of registration and enrolment of the first subject September 2011.


Assuntos
Ansiedade , Depressão , Síndrome do Ovário Policístico , Qualidade de Vida , Redução de Peso , Humanos , Feminino , Síndrome do Ovário Policístico/psicologia , Síndrome do Ovário Policístico/terapia , Síndrome do Ovário Policístico/complicações , Adulto , Ansiedade/terapia , Depressão/terapia , Obesidade Mórbida/psicologia , Obesidade Mórbida/terapia , Programas de Redução de Peso/métodos
15.
Br J Gen Pract ; 74(suppl 1)2024 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-38902076

RESUMO

BACKGROUND: Obesity is a driver of multimorbidity. Knowledge regarding individual and population based solutions is evolving in primary care. Stigma/self-stigma are important in developing clinical solutions. Inquiry based stress reduction (IBSR) is emerging as a solution for self-stigma in a range of conditions. This study explores IBSR (also known as The Work of Byron Katie) in obesity self-stigma in the GP setting, with severe obesity, utilising a multidisciplinary approach. AIM: Is it feasible/acceptable to utilise Inquiry Based Stress Reduction in the GP setting for obesity? METHOD: Mixed-method pilot study including a convenience sample of people with severe spectrum obesity from a three-doctor general practice, including use of IBSR provided in both group, partner and individual settings, predominantly online, utilising certified and accredited IBSR facilitators, a clinical psychologist, and participating GPs. Outcomes include pre- and post-intervention surveys (Becks Depression Scale, HRQoL, Weight Bias Internalisation Scale, Weight Self-stigma Questionnaire) and qualitative data from participants. RESULTS: Of 22 initially invited to participate, 14 commenced and 10 completed the intervention. Mean BMI was 42.8, mean age 49 years, female:male = 7:3. Many believed obesity was their own fault, related very difficult interactions with healthcare professionals, and valued opportunity to engage with the intervention. While participants had alarming levels of comorbidity, they were far more concerned regarding stigma and self-stigma. CONCLUSION: Results and experience in practice indicate this approach is feasible and acceptable. Results are valuable in planning a larger study in multiple practices.


Assuntos
Medicina Geral , Estigma Social , Estresse Psicológico , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Adulto , Obesidade Mórbida/psicologia , Autoimagem , Inquéritos e Questionários
16.
Langenbecks Arch Surg ; 409(1): 195, 2024 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-38904793

RESUMO

PURPOSE: SASI (single anastomosis sleeve ileal) bypass can lead to nutritional deficiencies, including disorders of iron metabolism and anemia. This study aims to evaluate the effect of SASI bypass on weight loss, anemia, and iron deficiency in patients with obesity during the follow-up period. METHODS: This study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass at our hospital between January 2020 and February 2022. RESULTS: The mean age of the patients was 42 years (range 22-58). The average duration of the follow-up period was 26 months. The mean percentage of excess weight loss (%EWL) was 90.1%, and total weight loss (%TWL) was 30.5%. During the postoperative observation period, anemia was identified in ten patients (25%), comprising 70% with normocytic anemia, 10% with microcytic anemia, and two macrocytic anemia cases (20%). Iron deficiency was observed in two patients (5%). CONCLUSION: SASI bypass is an effective bariatric procedure in weight loss outcomes. However, there may be an increased risk of anemia and iron metabolism disruptions associated with this procedure. The common limb length (250 vs. 300 cm) did not significantly impact hemoglobin, iron, TIBC, ferritin levels, or anemia incidence among patients undergoing SASI bypass. The decrease in postoperative ferritin levels signifies a depletion in tissue iron reserves, thereby emphasizing the necessity for surveillance of iron homeostasis parameters following SASI bypass.


Assuntos
Íleo , Redução de Peso , Humanos , Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Íleo/cirurgia , Complicações Pós-Operatórias/etiologia , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Anemia , Anastomose Cirúrgica , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/efeitos adversos , Adulto Jovem , Anemia Ferropriva , Ferro/metabolismo , Ferro/sangue
17.
Dan Med J ; 71(7)2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38903023

RESUMO

INTRODUCTION: Obesity adversely affects the health of the individual and impacts society through increased healthcare costs and lost workdays. Individuals in lower socioeconomic groups are more severely affected. Here, we examined people living with severe obesity and comorbidities across educational levels. METHODS: Individuals with a BMI ≥ 35 kg/m2 and aged ≥ 16 years from the Danish National Health Survey 2021 were categorised into five educational levels and according to their number of obesity-related comorbidities (0, 1, 2 and ≥ 3). RESULTS: A total of 5.8% had a BMI ≥ 35 kg/m2, ranging from 2.2% to 10.7% in the 98 municipalities, and from 2.6% to 8.8% according to education level. Among individuals with a BMI ≥ 35 kg/m2 and the shortest education, 13.4% had no comorbidities, and 45.6% had ≥ 3 comorbidities. In contrast, among individuals with a BMI ≥ 35 kg/m2 and the longest education, 47.4% had no comorbidities, and 14.6% had ≥ 3 comorbidities. Among those with a BMI ≥ 35 kg/m2 and ≥ 3 comorbidities, 73.6% had elementary or vocational school as their highest education level, and 3.4% had a long higher education. CONCLUSIONS: The prevalence of individuals living with a BMI ≥ 35 kg/m2 differs by 3-5-fold depending on municipality and between the lowest and highest educational level. Additionally, the less educated group living with a BMI ≥ 35 kg/m2 was three times more likely to have ≥ 3 comorbidities than the most educated group. Hence, more research is warranted to understand the underlying causes and reduce social inequity in health. FUNDING: Novo Nordisk Fonden. TRIAL REGISTRATION: Not relevant.


Assuntos
Índice de Massa Corporal , Escolaridade , Multimorbidade , Obesidade Mórbida , Humanos , Masculino , Feminino , Dinamarca/epidemiologia , Pessoa de Meia-Idade , Adulto , Obesidade Mórbida/epidemiologia , Prevalência , Idoso , Inquéritos Epidemiológicos , Adolescente , Fatores Socioeconômicos , Adulto Jovem , Disparidades nos Níveis de Saúde
18.
Clin Nutr ESPEN ; 62: 241-246, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38850528

RESUMO

BACKGROUND: Obesity is a chronic disease that increases the risk of cardiovascular diseases (CVD), including systemic arterial hypertension (SAH), underestimated in this population. The high mortality related to CVD reveals the need for early screening. One of the training tools is the waist-to-hip ratio (WHR). However, few studies evaluate its relationship with metabolic changes in severe obesity, making necessary a new cut-off point. METHOD: Cross-sectional study with 75 Brazilian women with severe obesity (mean age: 37,6 years; weight of 122 kg and body mass index (BMI) of 47,8 kg/m2). Height, weight, neck circumference (NC), hip (HC), waist (WC) and waist-to-hip ratio (WHR) were obtained. Blood samples were collected for lipid/glucose profile. The Receiver Operating Characteristic (ROC) was explored to define cut-off points for WHR based on SAH. Women were compared using the t-Student/Mann Whitney test. Pearson/Spearman correlations were performed, and the significance level was set at 5%. RESULTS: The ROC curve indicated that WHR ≥0.92 best predicted SAH. The group with WHR ≥0.92 had higher Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (p = 0.037), insulin (p = 0.037), NC (p = 0.004), and Atherogenic Index of Plasma (AIP) (p = 0.038). WHR correlated with NC (p = 0.002; r = 0.358), glucose (p = 0.026; r = 0.270); insulin (p = 0.05; r = 0.238); HOMA-IR (p = 0.01; r = 0.3238), triglycerides (p = 0.006; r = 329) and AIP (p = 0.02; r = 0.370). CONCLUSIONS: A new cut-off point for WHR related to SAH in severe obesity is suggested.


Assuntos
Índice de Massa Corporal , Obesidade Mórbida , Relação Cintura-Quadril , Humanos , Feminino , Estudos Transversais , Adulto , Obesidade Mórbida/sangue , Brasil , Pessoa de Meia-Idade , Curva ROC , Resistência à Insulina , Glicemia/metabolismo , Circunferência da Cintura , Hipertensão , Doenças Cardiovasculares , Fatores de Risco
19.
Langenbecks Arch Surg ; 409(1): 162, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38771517

RESUMO

PURPOSE: The laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the standard procedures in metabolic surgery. Different limb lengths have been proposed in the past to maximize weight loss (WL) and reduce metabolic complications. Distal gastric bypass surgery with a very short common channel (CC) (up to 100 cm) has been often criticized due to frequent side effects such as malnutrition, bone weakening and short-bowel syndrome. We introduced a modified version of a distal LRYGB with a 50-70 cm long biliopancreatic limb (BPL) and an intermediate short CC (120-150 cm). Our primary goal was to compare the long-term WL between distal and proximal LRYGB in two cohorts of patients. Secondary outcomes were weight regain (WR), insufficient weight loss (IWL), postoperative complications and metabolic changes 5 years after surgery. METHODS: In this retrospective study we collected data from 160 patients operated between 2014 and 2015, with a BMI of 37-44 Kg/m2. 101 patients underwent a distal and 59 patients a proximal LRYGB in two bariatric centers. WL was calculated as percent of excess of BMI loss (%EBMIL), loss of body mass index (Delta-BMI), percent of excess weight loss (%EWL) and percent of total weight loss (%TWL). Data were collected 3, 6, 9, 12, 24, 48 and 60 months after surgery. RESULTS: The distal LRYGB resulted in significantly better 5-year-WL compared to the proximal bypass in terms of %EBMIL (median at 5 years: 83% vs. 65%, p = 0.001), %TWL (median at 5 years: 32% vs. 26%, p = 0.017) and %EWL (median at 5 years: 65% vs. 51%, p = 0.029), with equal major complications and metabolic alterations. In addition, WR was significantly lower in patients with distal bypass (18% vs. 35%, p = 0.032). CONCLUSIONS: Distal LYRGB with a 120-150 long CC results in better WL and WL-maintenance compared to proximal LRYGB without major side effects after five years.


Assuntos
Índice de Massa Corporal , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Redução de Peso , Humanos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Resultado do Tratamento , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia
20.
PLoS One ; 19(5): e0302099, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38748634

RESUMO

Recent national trends in the United States indicate a significant increase in childhood obesity, a major public health concern with documented physical and mental comorbidities and sociodemographic disparities. We aimed to estimate the prevalence of obesity and severe obesity among youth in New York City (NYC) before the COVID-19 pandemic and examine time trends overall and by key characteristics. We included all valid height and weight measurements of kindergarten through 8th grade public school students aged 5 to 15 from school years 2011-12 through 2019-20 (N = 1,370,890 unique students; 5,254,058 observations). Obesity and severe obesity were determined using age- and sex-specific body mass index percentiles based on the Centers for Disease Control and Prevention growth charts. Analyses were performed using multivariate logistic regression models with repeated cross-sectional observations weighted to represent the student population for each year and clustered by student and school. Among youth attending public elementary and middle schools in NYC, we estimate that 20.9% and 6.4% had obesity and severe obesity, respectively, in 2019-20. While consistent declines in prevalence were observed overall from 2011-12 to 2019-20 (2.8% relative decrease in obesity and 0.2% in severe obesity, p<0.001), increasing trends were observed among Black, Hispanic, and foreign-born students, suggesting widening disparities. Extending previous work reporting prevalence estimates in this population, nearly all groups experienced significant increases in obesity and severe obesity from 2016-17 to 2019-20 (relative change = 3.5% and 6.7%, respectively, overall; p<0.001). Yet, some of the largest increases in obesity were observed among those already bearing the greatest burden, such as Black and Hispanic students and youth living in poverty. These findings highlight the need for greater implementation of equity-centered obesity prevention efforts. Future research should consider the influence of the COVID-19 pandemic and changes in clinical guidance on childhood obesity and severe obesity in NYC.


Assuntos
COVID-19 , Obesidade Infantil , Instituições Acadêmicas , Humanos , Cidade de Nova Iorque/epidemiologia , Masculino , Criança , Feminino , Adolescente , Prevalência , Obesidade Infantil/epidemiologia , COVID-19/epidemiologia , Pré-Escolar , Obesidade Mórbida/epidemiologia , Estudantes/estatística & dados numéricos , Estudos Transversais , Índice de Massa Corporal , Disparidades nos Níveis de Saúde
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