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Insulin Clearance After Oral and Intravenous Glucose Following Gastric Bypass and Gastric Banding Weight Loss.
Shah, A, Holter, MM, Rimawi, F, Mark, V, Dutia, R, McGinty, J, Levin, B, Laferrère, B
Diabetes care. 2019;(2):311-317
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Abstract
OBJECTIVE Hepatic insulin clearance is a significant regulator of glucose homestasis. We hypothesized that the improvement in insulin clearance rates (ICRs) under fasting conditions and in response to oral and intravenous (IV) glucose would improve similarly after Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) as a function of weight loss; the difference in ICR after oral and IV glucose stimulation will be enhanced after RYGB compared with AGB, an effect mediated by glucagon-like peptide 1 (GLP-1). RESEARCH DESIGN AND METHODS In study 1, the ICR was calculated under fasting condition (F-ICR), after oral glucose (O-ICR), and after an isoglycemic IV glucose clamp (IV-ICR) in individuals from an established cohort with type 2 diabetes mellitus (T2DM) before, after 10% matched weight loss, and 1 year after either RYGB (n = 22) or AGB (n = 12). In study 2, O-ICR was studied in a separate cohort of individuals with T2DM (n = 22), before and 3 months after RYGB, with and without exendin(9-39) infusion. RESULTS In study 1, age, BMI, T2DM duration and control, and ICR did not differ between RYGB and AGB preintervention. Weight loss at 1 year was two times greater after RYGB than after AGB (31.6 ± 5.9% vs. 16.6 ± 9.8%; P < 0.05). RYGB and AGB both significantly increased F-ICR, O-ICR, and IV-ICR at 1 year. ICR was inversely associated with insulinemia. The difference between IV-ICR and O-ICR was significantly greater after RYGB versus AGB. GLP-1 antagonism with exendin(9-39) led to an increase in O-ICR in subjects post-RYGB. CONCLUSIONS Weight loss increased ICR, an effect more pronounced after RYGB compared with AGB. Our data support a potential role for endogenous GLP-1 in the control of postprandial ICR after RYGB.
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Is There Association between Vitamin D Concentrations and Body Mass Index Variation in Women Submitted to Y-Roux Surgery?
Dos Santos, MTA, Suano-Souza, FI, Affonso Fonseca, FL, Lazaretti-Castro, M, Sarni, ROS
Journal of obesity. 2018;:3251675
Abstract
OBJECTIVE To evaluate vitamin D deficiency and body composition of women submitted to bariatric surgery and relate their body mass index variation after surgery to 25(OH)D concentrations. METHOD A cross-sectional and controlled study was performed including 49 obese adult volunteer women, submitted to Roux-en-Y gastric bypass (RYGB group). COLLECTED DATA Body mass index (BMI), self-declared ethnicity, economic condition, physical activity level, serum concentrations of 25-hydroxycholecalciferol (25(OH)D; radioimmunoassay), parathormone, and body composition by dual-energy X-ray absorptiometry (Hologic DXA-QDR-1000) were collected. RESULTS 25(OH)D deficiency was found in 27 (55.1%) and 8 (21.1%) in the RYGB and control groups (p=0.002). Secondary hyperparathyroidism was more frequent in the RYGB group compared to the control group (15 (30.6%) versus 1 (2.6%); p=0.001). There was no relation of the studied variables and body composition with 25(OH)D deficiency. 25(OH)D concentrations were correlated (r=-0.531; p < 0.001) with BMI reduction, regardless of vitamin D supplementation. CONCLUSION Women submitted to bariatric surgery (RYGB) around three years ago had higher BMI and vitamin D deficiency, along with hyperparathyroidism, compared to the control group. There was no association between variables related to body composition and 25(OH)D concentrations. On the other hand, vitamin concentrations correlated negatively to BMI variation after undergoing surgery.
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Effectiveness of a Smartphone Application for the Management of Metabolic Syndrome Components Focusing on Weight Loss: A Preliminary Study.
Toro-Ramos, T, Lee, DH, Kim, Y, Michaelides, A, Oh, TJ, Kim, KM, Jang, HC, Lim, S
Metabolic syndrome and related disorders. 2017;(9):465-473
Abstract
BACKGROUND There are inconsistent results for the effectiveness of using smartphone applications (apps) or websites on weight loss. We investigated the efficacy of a smartphone intervention using a designated app that utilizes a lifestyle intervention-focused approach, including a human coaching element, toward weight loss in overweight or obese Korean adults. METHODS One hundred four adults aged 20-60 years with a body mass index ≥23 kg/m2, who signed up for a smartphone program for weight loss (using the Noom app), were recruited. Participants received an in-person orientation about the study and app use, and a baseline blood sample was obtained. The in-app intervention with daily behavior and nutrition education content and coaching lasted 15 weeks. The primary endpoint of the study was a change in weight. The secondary endpoints were changes in metabolic risk factors such as blood pressure, waist circumference, and glucose and lipid profiles. Body composition changes were also assessed, and body weight at 52 weeks was measured to ascertain long-term effects. RESULTS Participants showed a clinically significant weight loss effect of -7.5% at the end of the 15-week program (P < 0.001), and at a 52-week follow-up, a weight loss effect of -5.2% was maintained. At 15 weeks, percent body fat and visceral fat decreased by -6.0 ± 5.4% and -3.4 ± 2.7 kg, respectively (both P < 0.001). Fasting glucose level also decreased significantly by -5.7 ± 14.6 mg/dL at 15 weeks. Lipid parameters showed significant improvements, except for high-density lipoprotein cholesterol. The frequency of logging meals and exercise was associated with body fat loss. CONCLUSIONS This advanced smartphone app was a useful tool to maintain weight loss in overweight or obese people.
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The effects of rikkunshito on body weight loss after esophagectomy.
Nakamura, M, Nakamori, M, Ojima, T, Katsuda, M, Hayata, K, Iwahashi, M, Yamaue, H
The Journal of surgical research. 2016;(1):130-8
Abstract
BACKGROUND After esophagectomy, esophageal cancer patients suffer from malnutrition, anorexia, and dysfunction of digestion and absorption. Rikkunshito, a traditional Japanese herbal medicine, reportedly attenuates gastrointestinal symptoms and appetite loss after gastrointestinal surgery. We evaluated the clinical effect of rikkunshito and its relationship with ghrelin in esophageal cancer patients after esophagectomy. METHODS This prospective nonrandomized study included 40 patients with esophageal cancer who underwent esophagectomy at Wakayama Medical University Hospital. They were assigned to either the control group (n = 20, April 2011-January 2012) or the rikkunshito group (n = 20, January 2012-August 2012). Patients in the rikkunshito group received 2.5 g of rikkunshito before every meal for 48 wk beginning 4 wk after surgery. During the 48-week treatment, we assessed body weight loss, nutritional parameters, and quality of life (Functional Assessment of Cancer Therapy-Esophageal scale). The primary end point was the rate of body weight loss in two groups after the 48-week treatments. RESULTS The rate of body weight loss was significantly less in the rikkunshito group than in the control group (P = 0.016). The acyl ghrelin level after the 48-week treatments was significantly higher in the rikkunshito group (131.7% ± 74.5%) than in the control group (75.6% ± 47.5%, P = 0.039). For the Functional Assessment of Cancer Therapy-Esophageal symptom scale, satisfaction of food consumption in the rikkunshito group was significantly better than in the control group at 52 wk postoperatively (P = 0.031). CONCLUSIONS For esophageal cancer patients after esophagectomy, rikkunshito is useful for improving body weight loss in connection with an increase in plasma acyl ghrelin levels.
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Decreased NK cell functions in obesity can be reactivated by fat mass reduction.
Jahn, J, Spielau, M, Brandsch, C, Stangl, GI, Delank, KS, Bähr, I, Berreis, T, Wrann, CD, Kielstein, H
Obesity (Silver Spring, Md.). 2015;(11):2233-41
Abstract
OBJECTIVE Natural killer (NK) cells are the first defense against malignant cells, and their functions are severely impaired in individuals with obesity. However, it is not known whether functions can be re-activated after weight loss. The alterations of NK cell functions after fat mass reduction were investigated. METHODS Thirty-two healthy adults with obesity were divided into control and experimental groups. Participants of the experimental group performed a 3-month program of exercise training and nutrition. Anthropometric, physiological, and metabolic parameters and plasma adipocytokines were determined. Peripheral blood mononuclear cells were analyzed by means of flow cytometry and Western blot assay for various NK cell-specific functional parameters and leptin signaling components. NK cell-mediated cytotoxicity assay with leptin stimulation was performed. RESULTS Male participants significantly decreased their body fat mass (P < 0.05) and increased physical fitness (P < 0.05). Plasma leptin levels were significantly reduced (P < 0.05) and intracellular interferon gamma (IFN-γ) expression in CD56(dim) NK cells was significantly increased (P < 0.001) 3 months after study end. Stimulation of NK-92 cells with different leptin dosages revealed a significant dose-dependent decrease of specific tumor cell lysis. CONCLUSIONS The present study demonstrates a reactivation of NK cell functionality after body fat mass reduction in persons with obesity.
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Enhanced fatty acid uptake in visceral adipose tissue is not reversed by weight loss in obese individuals with the metabolic syndrome.
Bucci, M, Karmi, AC, Iozzo, P, Fielding, BA, Viljanen, A, Badeau, RM, Borra, R, Saunavaara, V, Pham, T, Hannukainen, JC, et al
Diabetologia. 2015;(1):158-64
Abstract
AIMS/HYPOTHESIS Obesity causes an imbalance in fat mass distribution between visceral and subcutaneous adipose tissue (AT) depots. We tested the hypothesis that this relates to increased NEFA uptake between these depots in obese compared with healthy participants. Second, we hypothesised that a diet very low in energy (very low calorie diet [VLCD]) decreases fat mass in obese participants and that this is associated with the decline in NEFA uptake. METHODS NEFA uptake in AT depots was measured with [(18)F]-fluoro-6-thia-heptadecanoic acid ((18)F-FTHA) and positron emission tomography (PET) in 18 obese participants with the metabolic syndrome before and after a 6 week VLCD. Whole body fat oxidation was measured using indirect calorimetry and [U-(13)C]palmitate. Sixteen non-obese participants were controls. RESULTS Obese participants had >100% higher (p < 0.0001) NEFA uptake in the visceral and subcutaneous abdominal AT depots than controls. VLCD decreased AT mass in all regions (12% to 21%), but NEFA uptake was decreased significantly (18%; p < 0.006) only in the femoral AT. Whole body carbohydrate oxidation decreased, while fat oxidation increased. CONCLUSIONS/INTERPRETATION The data demonstrate that weight loss caused by VLCD does not affect abdominal fasting NEFA uptake rates. We found that visceral fat takes up more NEFAs than subcutaneous AT depots, even after weight loss.
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Roux-en-Y gastric bypass surgery, but not calorie restriction, reduces plasma branched-chain amino acids in obese women independent of weight loss or the presence of type 2 diabetes.
Lips, MA, Van Klinken, JB, van Harmelen, V, Dharuri, HK, 't Hoen, PA, Laros, JF, van Ommen, GJ, Janssen, IM, Van Ramshorst, B, Van Wagensveld, BA, et al
Diabetes care. 2014;(12):3150-6
Abstract
OBJECTIVE Obesity and type 2 diabetes mellitus (T2DM) have been associated with increased levels of circulating branched-chain amino acids (BCAAs) that may be involved in the pathogenesis of insulin resistance. However, weight loss has not been consistently associated with the reduction of BCAA levels. RESEARCH DESIGN AND METHODS We included 30 obese normal glucose-tolerant (NGT) subjects, 32 obese subjects with T2DM, and 12 lean female subjects. Obese subjects underwent either a restrictive procedure (gastric banding [GB], a very low-calorie diet [VLCD]), or a restrictive/bypass procedure (Roux-en-Y gastric bypass [RYGB] surgery). Fasting blood samples were taken for the determination of amine group containing metabolites 4 weeks before, as well as 3 weeks and 3 months after the intervention. RESULTS BCAA levels were higher in T2DM subjects, but not in NGT subjects, compared with lean subjects. Principal component (PC) analysis revealed a concise PC consisting of all BCAAs, which showed a correlation with measures of insulin sensitivity and glucose tolerance. Only after the RYGB procedure, and at both 3 weeks and 3 months, were circulating BCAA levels reduced. CONCLUSIONS Our data confirm an association between deregulation of BCAA metabolism in plasma and insulin resistance and glucose intolerance. Three weeks after undergoing RYGB surgery, a significant decrease in BCAAs in both NGT as well as T2DM subjects was observed. After 3 months, despite inducing significant weight loss, neither GB nor VLCD induced a reduction in BCAA levels. Our results indicate that the bypass procedure of RYGB surgery, independent of weight loss or the presence of T2DM, reduces BCAA levels in obese subjects.
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Decrease of circulating SAA is correlated with reduction of abdominal SAA secretion during weight loss.
Yang, RZ, Blumenthal, JB, Glynn, NM, Lee, MJ, Goldberg, AP, Gong, DW, Ryan, AS
Obesity (Silver Spring, Md.). 2014;(4):1085-90
Abstract
OBJECTIVE The study goal was to determine the effect of weight loss (WL) alone and with aerobic exercise (WL + AEX) on serum amyloid A (SAA) levels and adipose SAA secretion from gluteal and abdominal depots. METHODS Ninety-six overweight or obese postmenopausal women undertook a 6-month WL alone (n = 47) or with AEX training (n = 49) (6 months WL and WL + AEX are considered WL when groups were combined). Their serum SAA levels, body weight, and adipose SAA secretion ex vivo from gluteal and abdominal depot were measured before and after WL interventions. RESULTS The participants lost an average of 8% body weight with a 10% decrease of serum SAA. Serum SAA levels remained significantly correlated with body weight before and after WL. However, the changes of serum SAA level did not correlate with changes of body weight. The gluteal adipose tissue secreted ∼50% more SAA than the abdominal tissue, but the changes of abdominal, but not gluteal, SAA secretion correlated (R(2) = 0.19, p < 0.01) with those of serum SAA levels during WL. CONCLUSIONS No linear correlation between the decrease in systemic SAA and WL was found. There is a depot-dependent difference in adipose SAA secretion and abdominal SAA secretion, which may partially account for the systemic SAA reduction during WL.
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Aerobic exercise and weight loss reduce vascular markers of inflammation and improve insulin sensitivity in obese women.
Ryan, AS, Ge, S, Blumenthal, JB, Serra, MC, Prior, SJ, Goldberg, AP
Journal of the American Geriatrics Society. 2014;(4):607-14
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Abstract
OBJECTIVES To examine the relationships between plasma and tissue markers of systemic and vascular inflammation and obesity and insulin resistance and determine the effects of aerobic exercise training plus weight loss (AEX+WL) and weight loss (WL) alone on these biomarkers. DESIGN Prospective controlled study. SETTING Veterans Affairs Medical Center and University research setting. PARTICIPANTS Overweight and obese sedentary postmenopausal women (N = 77). INTERVENTIONS Six months, 3 d/wk AEX+WL (n = 37) or WL (n = 40). MEASUREMENTS Total-body dual-energy X-ray absorptiometry, abdominal computed tomography, hyperinsulinemic-euglycemic clamps (a criterion standard method of assessing insulin sensitivity), adipose tissue biopsies (n = 28), and blood for homeostasis model assessment-insulin resistance, and soluble forms of intracellular adhesion molecule 1 (sICAM-1) and vascular cell adhesion molecule 1 (sVCAM-1), C-reactive protein (CRP), and serum amyloid A (SAA). RESULTS Body weight (P < .001), percentage of fat (P < .001), visceral fat (P < .005), triglyceride levels (P < .001), and systolic blood pressure decreased comparably after WL and AEX+WL (P = .04). Maximal oxygen consumption increased 16% after AEX+WL (P < .001). Insulin resistance decreased in both groups (P = .005). Glucose utilization according to the clamp increased 10% (P = .04) with AEX+WL and 8% with WL (P = .07). AEX+WL decreased CRP by 29% (P < .001) and WL by 21% (P = .02). SAA levels decreased twice as much after AEX+WL (-19%, P = .02) as after WL (-9%, P = .08). Plasma sICAM-1 and sVCAM-1 levels did not change, but women with the greatest reduction in plasma sICAM-1 levels had the greatest reductions in fasting glucose (P = .02), insulin (P = .02), and insulin resistance (P = .004). Gluteal ICAM messenger ribonucleic acid levels decreased 27% after AEX+WL (P = .02) and did not change after WL. CONCLUSION Obesity and insulin resistance worsen markers of systemic and vascular inflammation. A reduction in plasma sICAM-1 is important to improve insulin sensitivity. CRP, SAA, and tissue ICAM decrease with exercise and weight loss, suggesting that exercise training is a necessary component of lifestyle modification in obese postmenopausal women.
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Effect of weight loss on sympatho-vagal balance in subjects with grade-3 obesity: restrictive surgery versus hypocaloric diet.
Pontiroli, AE, Merlotti, C, Veronelli, A, Lombardi, F
Acta diabetologica. 2013;(6):843-50
Abstract
Few and mostly uncontrolled studies indicate that weight loss improves heart rate variability (HRV) in grade-3 obesity. The aim of this study was to compare in grade-3 obesity surgery and hypocaloric diet on clinical and metabolic variables and on autonomic indices of HRV. Twenty-four subjects (body mass index, BMI 45.5 ± 9.13 kg/m(2)) underwent surgery (n = 12, gastric banding, LAGB) or received hypocaloric diet (n = 12, 1,000-1,200 kg/day). Clinical [BMI, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate] and metabolic variables [glucose, cholesterol, HDL- and LDL-cholesterol, triglycerides, AST and ALT transaminases] and 24-h Holter electrocardiographic-derived HRV parameters [R-R interval, standard deviation of R-R intervals (SDNN); low/high-frequency (LF/HF) ratio, and QT interval] were measured at baseline and after 6 months. The two groups were identical at baseline. BMI (-7.5 ± 3.57 kg/m(2), mean ± SD), glucose (-24.1 ± 26.77 mg/dL), SBP (-16.7 ± 22.19 mmHg) and DBP (-6.2 ± 8.56 mmHg) decreased in LAGB subjects (p < 0.05) and remained unchanged in controls. At 6 months, SDNN increased in LAGB subjects (+25.0 ± 37.19 ms, p < 0.05) and LF/HF ratio diminished (2.9 ± 1.84 vs. 4.9 ± 2.78; p = 0.01), with no change in controls; LF (daytime) and HF (24 h and daytime) increased in LAGB subjects, with no change in controls. Decrease in BMI correlated with SBP and DBP decrease (p < 0.05), and DBP decrease correlated with HR decrease (p < 0.05) and QT shortening (p < 0.05). Weight loss is associated with improvement of glucose metabolism, of blood pressure, and with changes in time and frequency domain parameters of HRV; all these changes indicate recovery of a more physiological autonomic control, with increase in parasympathetic and reduction in sympathetic indices of HRV.