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1.
Reduced Th1 response is associated with lower glycolytic activity in activated peripheral blood mononuclear cells after metabolic and bariatric surgery.
Villarreal-Calderón, JR, Castillo, EC, Cuellar-Tamez, RX, García-Garza, M, Elizondo-Montemayor, L, García-Rivas, G
Journal of endocrinological investigation. 2021;(12):2819-2830
Abstract
BACKGROUND Obesity promotes cellular immunometabolism changes that trigger the activation of macrophages and lymphocytes, leading to systemic inflammation. Activated leukocytes undergo metabolic reprogramming, increasing glycolytic activity. OBJECTIVE To examine whether the reduction in the inflammatory state associated with bariatric surgery is associated with decreased glycolytic activity in leukocytes. Setting Single-center, prospective observational study. METHODS This study involved 18 patients with obesity undergoing bariatric surgery. All measurements were performed preoperatively and six months postoperatively. Peripheral blood mononuclear cells and plasma were obtained to determine the glycolytic rate and mitochondrial membrane potential as surrogates of the metabolic switching and high-sensitivity C-reactive protein, adipokines, and CD69 expression as inflammatory and activation markers. RESULTS Glycolytic activity engaged by CD3/CD28 activation was reduced six months after bariatric surgery, associated with decreased levels of T helper (Th) 1 and Th17 signature cytokines. An overall reduction in inflammatory markers was observed, which correlated with a higher adiponectin/leptin ratio. CONCLUSIONS Metabolic and bariatric surgery-induced weight loss leads to reprogramming in T cells' metabolic machinery, resulting in reduced stimulation of glycolysis after activation, which may explain the decrease in systemic inflammation mediated by cytokines such as interferon-γ and interleukin-17A.
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2.
Beta Cell Function as a Baseline Predictor of Weight Loss After Bariatric Surgery.
Borges-Canha, M, Neves, JS, Mendonça, F, Silva, MM, Costa, C, M Cabral, P, Guerreiro, V, Lourenço, R, Meira, P, Salazar, D, et al
Frontiers in endocrinology. 2021;:714173
Abstract
BACKGROUND Obesity is a multifactorial disease, which is strongly associated to other metabolic disorders. Bariatric surgery is the most effective treatment of morbid obesity. The role of beta cell function in weight loss after bariatric surgery is uncertain. AIM: To evaluate the association between beta cell function and percentage of total body weight loss (TBWL%) 1, 2, 3, and 4 years after bariatric surgery in patients with morbid obesity. METHODS Retrospective longitudinal study in patients with morbid obesity followed in our center between January 2010 and July 2018. Patients were excluded if they had diabetes at baseline or missing data on the needed parameters. We evaluated baseline Homeostatic Model Assessment of IR, Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index, and Matsuda and DeFronzo index, and TBWL% at years 1 to 4. Linear regression models were used to evaluate the association of indexes of insulin resistance with TBWL% (unadjusted and adjusted for age, sex, BMI, and type of surgery). RESULTS There were 1,561 patients included in this analysis. HOMA-beta was negatively associated with TBWL% at second, third, and fourth years post-surgery (β = -1.04 [-1.82 to -0.26], p<0.01; β = -1.16 [-2.13 to -0.19], p=0.02; β = -1.29 [-2.64 to 0.06], p=0.061, respectively). This was not observed in the first year post-surgery nor for the other indexes. Glycemia at baseline was positively associated to EWL% at second and third years post-surgery. CONCLUSION β-cell function at baseline seems to be associated to long-term weight loss, explicitly after the first year post bariatric surgery. This might be a helpful predictor of weight loss in clinical practice.
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3.
Impact of Bariatric Surgery on Bone Mineral Density: Observational Study of 110 Patients Followed up in a Specialized Center for the Treatment of Obesity in France.
Geoffroy, M, Charlot-Lambrecht, I, Chrusciel, J, Gaubil-Kaladjian, I, Diaz-Cives, A, Eschard, JP, Salmon, JH
Obesity surgery. 2019;(6):1765-1772
Abstract
INTRODUCTION Bariatric surgery is used to treat severe obesity. We aimed to investigate the incidence of clinically significant bone mineral density (BMD) loss at 6 and 12 months after bariatric surgery. METHODS Observational study performed in a specialized center for the treatment of obesity at the University Hospital of Reims, France. Surface BMD was measured by dual x-ray absorptiometry (DEXA). A reduction of > 0.03 g/cm2 was considered clinically significant. RESULTS A total of 110 patients were included. A clinically significant reduction in BMD was observed in 62.1% of patients at 6 months, and in 71.6% at 12 months after surgery. No case of osteoporosis was observed. There were four cases of osteopenia and one fracture post-surgery. BMD loss was related by univariate analysis to the reduction in body mass index (BMI) (p < 0.01), weight loss (p < 0.01), fat mass (p < 0.01), and lean mass (p < 0.01). Multivariable analysis found a significant association between the reduction in BMD and the excess weight loss percentage (odds ratio 1.11, 95% confidence interval (1.05-1.18), p < 0.001). CONCLUSION There was a clinically significant reduction in BMD at 6 months after surgery in over 60% of patients undergoing bariatric surgery. BMD loss is persistent over time and predominantly situated at the femoral level, and strongly associated with weight loss. Systematic vitamin and calcium supplementation, as well as follow-up by DEXA scan seems appropriate. Systematic DEXA scan pre- and post-surgery, and annually thereafter until weight has stabilized seems appropriate.
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4.
Changes in Thyroid Replacement Therapy after Bariatric Surgery: Differences between Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy.
Julià, H, Benaiges, D, Mollà, P, Pedro-Botet, J, Villatoro, M, Fontané, L, Ramon, JM, Climent, E, Flores Le Roux, JA, Goday, A
Obesity surgery. 2019;(8):2593-2599
Abstract
INTRODUCTION Levothyroxine (LT4) requirements can presumably be modified differently after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). The present study compared changes in LT4 dose in hypothyroid subjects undergoing LRYGB or LSG 2 years after the procedure. MATERIAL AND METHODS A 2-year follow-up observational study was conducted in a prospective cohort of obese patients who had undergone bariatric surgery and were receiving LT4. Indication for the type of surgical procedure was based on clinical criteria. Repeated measures ANOVA models were used to examine differences within and between groups. RESULTS Thirty-five consecutive patients were included for analysis: 22 LRYGB and 13 LSG. Total daily LT4 dosage decreased in the LSG group (133.7 ± 50.3 mcg/day at baseline to 104.3 ± 43.3 mcg/day at 2 years; p = 0.047) whereas it remained stable in the LRYGB group (129.5 ± 46.1 mcg/day at baseline to 125.2 ± 55.7 mcg/day at 2 years; p = 1.000). Differences between groups became significant at 24 months. Daily weight-based LT4 dose increased in the LRYGB group (1.11 ± 0.38 mcg/kg day at baseline to 1.57 ± 0.74 mcg/kg day at 2 years; p = 0.005) with no significant changes in the LSG group (1.15 ± 0.35 mcg/kg day at baseline vs 1.11 ± 0.49 mcg/kg day at 2 years; p = 1.000). CONCLUSION LRYGB and LSG showed different changes in LT4 requirements 2 years after surgery. There was an early decrease in daily total LT4 dose requirements after LSG, which suggests an early preventive reduction to be validated in future studies.
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5.
Multicentre cohort study of antihypertensive and lipid-lowering therapy cessation after bariatric surgery.
Thereaux, J, Lesuffleur, T, Czernichow, S, Basdevant, A, Msika, S, Nocca, D, Millat, B, Fagot-Campagna, A
The British journal of surgery. 2019;(3):286-295
Abstract
BACKGROUND Few studies have assessed changes in antihypertensive and lipid-lowering therapy after bariatric surgery. The aim of this study was to assess the 6-year rates of continuation, discontinuation or initiation of antihypertensive and lipid-lowering therapy after bariatric surgery compared with those in a matched control group of obese patients. METHODS This nationwide observational population-based cohort study used data extracted from the French national health insurance database. All patients undergoing gastric bypass or sleeve gastrectomy in France in 2009 were matched with control patients. Mixed-effect logistic regression models were used to analyse factors that influenced discontinuation or initiation of treatment over a 6-year interval. RESULTS In 2009, 8199 patients underwent primary gastric bypass (55·2 per cent) or sleeve gastrectomy (44·8 per cent). After 6 years, the proportion of patients receiving antihypertensive and lipid-lowering therapy had decreased more in the bariatric group than in the control group (antihypertensives: -40·7 versus -11·7 per cent respectively; lipid-lowering therapy: -53·6 versus -20·2 per cent; both P < 0·001). Gastric bypass was the main predictive factor for discontinuation of therapy for hypertension (odds ratio (OR) 9·07, 95 per cent c.i. 7·72 to 10·65) and hyperlipidaemia (OR 11·91, 9·65 to 14·71). The proportion of patients not receiving treatment at baseline who were subsequently started on medication was lower after bariatric surgery than in controls for hypertension (5·6 versus 15·8 per cent respectively; P < 0·001) and hyperlipidaemia (2·2 versus 9·1 per cent; P < 0·001). Gastric bypass was the main protective factor for antihypertensives (OR 0·22, 0·18 to 0·26) and lipid-lowering medication (OR 0·12, 0·09 to 0·15). CONCLUSION Bariatric surgery is associated with a good discontinuation of antihypertensive and lipid-lowering therapy, with gastric bypass being more effective than sleeve gastrectomy.
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6.
Is Early Reimplantation of the Duodenal-Jejunal Bypass Liner Viable?
Leventi, E, Günthert, SJ, Stier, C, Staikov, P, Stein, J, Farrag, K
Obesity surgery. 2019;(5):1690-1693
Abstract
The endoscopically implanted duodenal-jejunal bypass liner (DJBL) is an impermeable fluoropolymer device which prevents food making contact with the proximal intestine, thus inducing weight loss and improvement of type 2 diabetes mellitus (T2DM). However, weight and HbA1c levels generally increase post explantation. This study investigated the safety and feasibility of early DJBL reimplantation in five patients with obesity whose glucose levels had relapsed post explantation, examining the effect of reimplantation on weight loss, BMI and T2DM management. All DJBL implantation and explantation procedures were performed without complications. Despite reduction of T2DM medications, reduction in body weight and HbA1c levels resumed after reimplantation. In conclusion, early reimplantation of DJBL appears feasible, safe and effective.
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7.
Adaptation of controlled attenuation parameter (CAP) measurement depth in morbidly obese patients addressed for bariatric surgery.
Somda, S, Lebrun, A, Tranchart, H, Lamouri, K, Prevot, S, Njike-Nakseu, M, Gaillard, M, Lainas, P, Balian, A, Dagher, I, et al
PloS one. 2019;(5):e0217093
Abstract
BACKGROUND AND AIM The controlled attenuation parameter (CAP) using FibroScan (Echosens, Paris, France) M or XL probe has been developed for liver steatosis assessment. However, CAP performs poorly in patients with high body mass index. The aim of our study was to assess whether CAP is overestimated using the standard XL probe in patients with morbid obesity, and in the case of an overestimation, to reprocess the data at a greater depth to obtain the appropriate CAP (CAPa). PATIENTS AND METHODS We conducted an observational prospective cohort study on a total of 249 severely obese patients admitted to our institution to undergo sleeve gastrectomy. Patients had a liver biopsy performed during the surgery and a CAP measurement during the 15 days preceding biopsy. Patient files were reprocessed retrospectively by an algorithm, blinded to the patients' clinical data. The algorithm automatically assessed the probe-to-capsula distance (PCD) by analysing the echogenicity of ultrasound signals on the time-motion mode. In the case of a distance >35 mm, the algorithm automatically selected a deeper measurement for CAP (CAPa). When PCD was less than 35 mm, the measured CAP was considered as appropriated (CAPa) and no further reprocessing was performed. RESULTS CAP recording was not performed at a sufficient depth in 130 patients. In these patients, the CAPa obtained at the adapted depth was significantly lower than CAP (298±3.9 versus 340±4.2 dB/m; p< 0.0001) measured at the standard depth (35 to 75 mm). Multiple linear regression analysis revealed that both body mass index and hepatic steatosis were independently correlated with CAP values. After reprocessing the CAP in patients with PCD > 35 mm, steatosis stage was the only parameter independently correlated with CAP values. For the diagnosis of steatosis (S≥1), moderate to severe steatosis (S≥2) and severe steatosis (S = 3), the AUROC curves of CAPa (measured CAP in patients with PCD<35 mm and reprocessed CAP in those with PCD>35 mm) were 0.86, 0.83 and 0.79, respectively. The Obuchowski measure for the diagnosis of steatosis was 0.90±0.013. CONCLUSION CAP was overestimated in a half of morbidly obese patients using an XL probe, but CAP can be performed correctly in these patients after adapting the measurement depth.
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8.
Psychological well-being and marital satisfaction in response to weight loss after bariatric surgery.
Karagülle, OO, Yavuz, E, Gülçiçek, OB, Solmaz, A, Şentürk, S, Erdoğan, A, Çelik, A, Çelebi, F
Surgery today. 2019;(5):435-442
Abstract
PURPOSE To compare the marital satisfaction (MS) and psychological well-being (PWB) of men and women before and after bariatric surgery for obesity. METHODS The subjects of this prospective observational study were obese patients who underwent bariatric surgery. MS and PWB were assessed before, and 6 months after the surgery, using specific scales for MS and PWB. RESULTS The correlation matrix showed that age was not correlated with any of the scores from the PWB scales, and only with the total MS scores of men (P < 0.05). The pre-surgical BMI-post-surgical BMI (ΔBMI) was correlated negatively and significantly with the post-surgical total MS, especially for women, but it was not correlated with the sexual satisfaction of either gender. The score of positive interpersonal relationships was negatively correlated with the ΔBMI, especially for women (P < 0.05), whereas personal improvement was positively correlated for men (P < 0.05). There was also a significant correlation between ΔBMI and purpose in life for both genders. Post-surgical ΔBMIs were not associated with the other two indicators of PWB, namely, autonomy and environmental mastery for both genders. CONCLUSIONS For women, weight loss after bariatric surgery seemed to improve PWB and MS when assessed 6 months post-operatively; however, the psychiatric assessment of patients before and after the surgery is crucial.
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9.
Body image dissatisfaction in individuals with obesity seeking bariatric surgery: exploring the burden of new mediating factors.
Bianciardi, E, Di Lorenzo, G, Niolu, C, Betrò, S, Zerbin, F, Gentileschi, P, Siracusano, A
Rivista di psichiatria. 2019;(1):8-17
Abstract
INTRODUCTION For bariatric surgery candidates body image dissatisfaction (BID) may influence both psychological well-being and motivation to obtain surgery. This study aims to examine possible psychiatric predictors of BID. In particular, we explored the burden of new associated factors such as early trauma and attachment style (AS), which have not been assessed in previous literature. METHODS In this study, 536 patients with extreme obesity (mean Body Mass Index, BMI=43 kg/m2, SD=6.62) undergoing presurgical psychiatric evaluations as part of a mandatory workup before surgery were chosen as participants. A semi-structured clinical interview was performed to assess psychiatric diagnosis and patients' history of early trauma. BID was assessed using the Body Shape Questionnaire (BSQ). Depression, binge eating, and AS were assessed using self-report instruments. RESULTS Binge eating behavior (p<0.0001), depression severity (p<0.0001), female gender (p<0.0001), and the "need for approval" dimension of insecure AS (p<0.0001) were found to be independent and significant predictors of BSQ score. However, early trauma and BMI were not included in the significant regression model (F4,442=90.784, p<0.0001, adjR2=0.446). DISCUSSION Our results increased the understanding of BID among individuals with extreme obesity. Similar to previous studies, we reported that binge-eating, depressive symptoms, and gender influenced BID. Neither early trauma nor BMI were associated with BID. Our novel finding was the significance of insecure AS. Implications for multidisciplinary approaches to obesity treatment are discussed. Identifying critical features of BID to be targeted in pre- and post-operative behavioral interventions may open new possibilities for providing effective support for individuals over the course of their therapy. CONCLUSIONS For some individuals living with obesity, developmental and relational processes such as insecure AS may play a substantial role in the development of BID.
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10.
Pregnancy after bariatric surgery: Maternal and fetal outcomes of 39 pregnancies and a literature review.
Costa, MM, Belo, S, Souteiro, P, Neves, JS, Magalhães, D, Silva, RB, Oliveira, SC, Freitas, P, Varela, A, Queirós, J, et al
The journal of obstetrics and gynaecology research. 2018;(4):681-690
Abstract
AIM: We aimed to evaluate the impact of bariatric surgery (BS) on maternal and fetal outcomes. METHODS A retrospective, descriptive, observational study of 39 pregnant women who underwent BS in our institution between 2010 and 2014 was carried out. A sample of women who became pregnant after BS was evaluated, based on data concerning pregnancy, childbirth, and newborns. RESULTS Of the 1182 patients who underwent BS at our institution during the study period, 1016 (85.9%) were women. Thirty-nine of these women (with an average age of 31 ± 4.8 years) became pregnant (one twin pregnancy) and 29 of the 39 had undergone a gastric bypass. The mean time interval between BS and pregnancy was 16.6 ± 4.8 months; however, 16 (41%) women became pregnant less than a year after BS. The pre-BS body mass index (BMI) of the 39 women was 44.5 ± 6.2 kg/m2 . The women had a mean BMI of 30.2 ± 3.8 kg/m2 when they got pregnant and they gained 13.2 ± 7.3 kg during pregnancy. Iron deficiency was observed in 18 (46.1%) women, 16 (45.7%) had vitamin B12 deficiency, 12 (66.8%) had zinc deficiency, and 20 (60.6%) had vitamin D deficiency. Three women developed gestational diabetes mellitus. Premature rupture of membranes occurred in two pregnancies, preterm delivery in five, and there was one spontaneous abortion. Cesarean section was performed in seven cases. The average newborn weight was 3002 ± 587 g, five were small for gestational age, and one had macrosomia. Three infants had to be admitted to an intensive care unit. CONCLUSION Although pregnancy after BS is safe and well tolerated, close monitoring by a multidisciplinary team is required to evaluate complications resulting from BS, especially a deficit of micronutrients.