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da Silva DS, da Silva TS, Leal PRF, Lopes KG, Kraemer-Aguiar LG. Early Changes in Eating Behavior Patterns and Their Relationship with Weight Outcomes in Patients Undergoing Bariatric Surgery. Nutrients 2024; 16:3868. [PMID: 39599654 PMCID: PMC11597042 DOI: 10.3390/nu16223868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 11/11/2024] [Accepted: 11/11/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND/OBJECTIVE Eating behaviors (EB) correlate with weight loss after bariatric surgery (BS). Therefore, the investigation of EB could guide interventions to prevent insufficient weight outcomes. METHOD A prospective cohort of 85 patients undergoing Roux-en-Y Gastric Bypass (RYGB; 84.7% female, mean age 44.7 ± 9.3 years) was included. Six months after undergoing RYGB, EB patterns, including cognitive restraint (CR), uncontrolled (UE), and emotional eating (EE), were assessed using the Three-Factor Eating Questionnaire R21 (TFEQ-R21). History, physical examination, and anthropometric assessments were collected pre- and 12 months postoperative. Patients were divided based on the percentage of excess weight loss (%EWL < 80% or ≥80%) and EB patterns were correlated with weight outcomes at 12 months. RESULTS The %EWL ≥ 80% group demonstrated significantly higher scores in CR and EE compared to %EWL < 80% (p < 0.001 and p = 0.01, respectively). UE scores were similar between groups (p = 0.41). At 12 months postoperative, the %EWL ≥ 80% group had negative correlations between CR and BMI and positive correlations between CR and EWL (rho = -0.33 and rho = 0.29; p = 0.04). Multiple logistic regression considering %EWL ≥ 80% as the aim outcome revealed that CR had a significant influence (OR = 1.037; p = 0.058), while age (OR = 0.962; p = 0.145), sex (OR = 2.984; p = 0.135), UE (OR = 0.995; p = 0.736), and EE (OR = 1.017; p = 0.296) did not. CONCLUSIONS EBs influence outcomes after BS, and a model using TFEQ-R21 predicted them. CR six months post-surgery was the strongest predictor of higher EWL at 12 months. Further research is needed to understand the relationship between restrictive EB and BS outcomes, possibly identifying strategies to prevent disordered EB in patients with higher scores.
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Affiliation(s)
- Daniel Sant’Anna da Silva
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
| | - Thiago Sant’Anna da Silva
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
| | - Paulo Roberto Falcão Leal
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
- General Surgery Department, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
| | - Karynne Grutter Lopes
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
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Shu J, Zhu T, Xiong S, Liu T, Zhao Y, Huang X, Liu S. Sex dimorphism in the effect and predictors of weight loss after sleeve gastrectomy. Front Endocrinol (Lausanne) 2024; 14:1333051. [PMID: 38269248 PMCID: PMC10806568 DOI: 10.3389/fendo.2023.1333051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Background No sex-specific guidelines for surgical anti-obesity strategies have been proposed, partially due to the controversy regarding sex-related differences in weight loss after bariatric metabolic surgery. Objectives To explore sex dimorphism in the effect and predictors of weight loss after sleeve gastrectomy (SG), thereby providing clinical evidence for the sex-specific surgical treatment strategy. Methods In a prospective cohort design, participants scheduled for SG at an affiliated hospital between November 2020 and January 2022 were assessed for eligibility and allocated to the Male or Female group with a 1-year follow-up after surgery. The primary outcome was the sex difference in the weight-loss effect after SG indicated by both percentage of total weight loss (TWL%) and excess weight loss (EWL%). The secondary outcome was the analysis of sex-specific preoperative predictors of weight loss after SG based on univariate and multivariate analyses. Independent predictors were obtained to construct a nomogram model. The discrimination, calibration, and clinical utility of the nomogram were based on receiver operating characteristic curve, concordance index, calibration curve, and decision curve analysis, respectively. Results Ninety-five male and 226 female patients were initially included. After propensity score matching by baseline body mass index (BMI), 85 male and 143 female patients achieved comparable TWL% and EWL% for 1 year after SG. For male patients, baseline BMI, area under the curve for insulin during oral glucose tolerance test, and progesterone were independent predictors of weight loss after SG. Baseline BMI, age, thyroid stimulating hormone, and Self-Rating Anxiety Scale score were independent predictors for female patients. Conclusion No obvious sex difference is detected in the weight-loss effect after SG. Sex dimorphism exists in the predictors of weight loss after SG. Further research with long-term and a multicenter design is needed to confirm the predictive model.
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Affiliation(s)
- Jiaxin Shu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of Surgery, First Clinical College, Shandong University, Jinan, China
| | - Tao Zhu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of Surgery, First Clinical College, Shandong University, Jinan, China
| | - Sisi Xiong
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of Surgery, First Clinical College, Shandong University, Jinan, China
| | - Teng Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yian Zhao
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of Surgery, First Clinical College, Shandong University, Jinan, China
| | - Xin Huang
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Shaozhuang Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
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Bettini S, Schiff S, Carraro E, Callegari C, Gusella B, Pontesilli GM, D’Angelo M, Baldan V, Zattarin A, Romanelli G, Angeli P, Girardi P, Spinella P, Vettor R, Busetto L. Chrono-Nutritional Patterns, Medical Comorbidities, and Psychological Status in Patients with Severe Obesity. Nutrients 2023; 15:5003. [PMID: 38068861 PMCID: PMC10707777 DOI: 10.3390/nu15235003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
Chrono-nutrition studies dietary habits and their role in the onset of metabolic diseases. The aim of this study is to describe chrono-nutritional patterns based on the analysis of the eating habits of patients with severe obesity during the 24-h cycle and investigate a possible relationship between these profiles, the comorbidities, and the psychological status. From the overall evaluation of the chrono-nutritional profiles of 173 patients with severe obesity, four predominant eating patterns were obtained with a refined statistical model. A regression analysis was performed to determine the relationship between chrono-nutritional patterns, medical comorbidities, and psychological status. Profile 1 was the most frequent (46.2%) and characterised by the regular presence of the three main meals. The distribution of the chrono-nutritional profiles did not vary with BMI. Chrono-nutritional profiles affected predominantly psychological variables, with lower performances among chrono-nutritional profiles 3 (to eat during all the 24-h, with nibbling and snacking also during the night) and 4 (like the fourth but without night-eating). This finding could be useful in the assessment and treatment of patients with obesity, allowing the identification of patients with a higher probability of suffering from a psychopathological condition simply by knowing the patients' dietary profiles.
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Affiliation(s)
- Silvia Bettini
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Internal Medicine Unit 3, Padova University Hospital, 35128 Padova, Italy
| | - Sami Schiff
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Internal Medicine Unit 5, Padova University Hospital, 35128 Padova, Italy
| | - Enrico Carraro
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy;
| | - Chiara Callegari
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Internal Medicine Unit 5, Padova University Hospital, 35128 Padova, Italy
| | - Beatrice Gusella
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Internal Medicine Unit 3, Padova University Hospital, 35128 Padova, Italy
| | - Giulia Maria Pontesilli
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Department of General Medicine, Santa Maria della Misericordia Hospital, 45100 Rovigo, Italy
| | - Matteo D’Angelo
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Dietetics and Clinical Nutrition Unit, Padova University Hospital, 35128 Padova, Italy
| | - Valeria Baldan
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Dietetics and Clinical Nutrition Unit, Padova University Hospital, 35128 Padova, Italy
| | - Alessandra Zattarin
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Dietetics and Clinical Nutrition Unit, Padova University Hospital, 35128 Padova, Italy
| | - Giulia Romanelli
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Dietetics and Clinical Nutrition Unit, Padova University Hospital, 35128 Padova, Italy
| | - Paolo Angeli
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Internal Medicine Unit 5, Padova University Hospital, 35128 Padova, Italy
| | - Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca’ Foscari University of Venice, 30172 Venezia, Italy;
| | - Paolo Spinella
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Dietetics and Clinical Nutrition Unit, Padova University Hospital, 35128 Padova, Italy
| | - Roberto Vettor
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Internal Medicine Unit 3, Padova University Hospital, 35128 Padova, Italy
| | - Luca Busetto
- Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (C.C.); (B.G.); (G.M.P.); (M.D.); (V.B.); (A.Z.); (G.R.); (P.A.); (P.S.); (R.V.); (L.B.)
- Internal Medicine Unit 3, Padova University Hospital, 35128 Padova, Italy
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SCL-90 empirical factors predict post-surgery weight loss in bariatric patients over longer time periods. Eat Weight Disord 2022; 27:2845-2855. [PMID: 35829901 PMCID: PMC9556354 DOI: 10.1007/s40519-022-01424-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/16/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE This longitudinal study examined how pre-intervention psychological health helps predict bariatric surgery (BS) success as percentage of expected body mass index loss (%EBMIL) over shorter to longer periods. METHODS Adult candidates for BS (N = 334, 67.4% females) completed the Symptoms Checklist 90 (SCL-90) questionnaire; on average, 11 months occurred between the pre-surgery psychological evaluations and the bariatric intervention. We explored the factor structure of the SCL-90 items and inspected how SCL-90 empirical factors compared with SCL-90 scales and general indices predicted %EBMIL at 3-6-month, 1-year, and 2-year follow-up occasions, adjusting for gender, pre-intervention use of antidepressants and actual and ideal BMIs. RESULTS Factor analysis combined the 90 items into 8 factors, which partially replicated the expected item structure. The SCL-90 empirical factors (but not the SCL-90 scales and indices) contributed to predict BS success. In fact, the Relational Distress factor directly protected from weight regain at 1-year follow-up, indirectly via 1-year %EBMIL at the 2-year follow-up, when it further strengthened the impact of the empirical factor of Generalized Anxiety on the 2-year BS outcome. The results also evidenced a cascade effect of the pre-surgery actual BMI across time as well as unique and direct effects of pre-surgery use of antidepressants and perceived ideal BMI on the 2-year outcome. CONCLUSIONS SCL-90 empirical factor scores for obese patients are more efficient in anticipating BS success compared with original scale scores. They reveal that relational distress and anxiety are risk factors for postoperative weight loss, in addition to pre-intervention actual BMI, antidepressant therapy, and perceived ideal BMI. LEVEL OF EVIDENCE III, well-designed cohort.
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El Ansari W, Elhag W. Preoperative Prediction of Body Mass Index of Patients with Type 2 Diabetes at 1 Year After Laparoscopic Sleeve Gastrectomy: Cross-Sectional Study. Metab Syndr Relat Disord 2022; 20:360-366. [PMID: 35506900 DOI: 10.1089/met.2021.0153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Very few models predict weight loss among type 2 diabetes mellitus (T2D) patients after laparoscopic sleeve gastrectomy (LSG). This retrospective study undertook such a task. Materials and Methods: We identified all patients >18 years old with T2D who underwent primary LSG at our institution and had complete data. The training set comprised 107 patients operated upon during the period April 2011 to June 2014; the validation set comprised 134 patients operated upon during the successive chronological period, July 2014 to December 2015. Sex, age, presurgery BMI, T2D duration, number of T2D medications, insulin use, hypertension, and dyslipidemia were utilized as independent predictors of 1-year BMI. We employed regression analysis, and assessed the goodness of fit and "Residuals versus Fits" plot. Paired sample t-tests compared the observed and predicted BMI at 1 year. Results: The model comprised preoperative BMI (β = 0.757, P = 0.026) + age (β = 0.142, P < 0.0001) with adjusted R2 of 0.581 (P < 0.0001), and goodness of fit showed an unbiased model with accurate prediction. The equation was: BMI value 1 year after LSG = 1.777 + 0.614 × presurgery BMI (kg/m2) +0.106 × age (years). For validation, the equation exhibited an adjusted R2 0.550 (P < 0.0001), and the goodness of fit indicated an unbiased model. The BMI predicted by the model fell within -3.78 BMI points to +2.42 points of the observed 1-year BMI. Pairwise difference between the mean 1-year observed and predicted BMI was not significant (-0.41 kg/m2, P = 0.225). Conclusions: This predictive model estimates the BMI 1 year after LSG. The model comprises preoperative BMI and age. It allows the forecast of patients' BMI after surgery, hence setting realistic expectations which are critical for patient satisfaction after bariatric surgery. An attainable target motivates the patient to achieve it.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Schools of Health and Education, University of Skovde, Skövde, Sweden
| | - Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
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Can We Benefit from the Preoperative Psychometric Test with Symptom Checklist-90-Revised (SCL-90-R) to Predict Weight Loss After Sleeve Gastrectomy? Obes Surg 2022; 32:1531-1538. [PMID: 35146601 DOI: 10.1007/s11695-022-05951-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The psychological assessment is crucial before bariatric surgery. Derogatis' Symptom Checklist-90-Revised (SCL-90-R) is one of the most widely used measures of psychological symptoms and distress in both clinical and research settings. We aimed to investigate the predictive value of SCL-90-R subscale scores on postoperative excess weight loss percentage (EWLP) after laparoscopic sleeve gastrectomy (LSG). METHODS Patients who underwent primary LSG for morbid obesity and fully completed preoperative SCL-90-R between January 2016 and July 2019 were retrospectively examined. A multiple linear regression analysis was performed to investigate the relationship between descriptive and psychological variables associated with EWLP percentage at the 12th-month. RESULTS One hundred six patients who met the inclusion criteria were analyzed. The adequate weight loss (EWLP ˃ 50%) was achieved in 90% of patients after 12 months. The multiple linear regression analysis indicated that younger patients (β = - 0.695; 95% CI - 1.056, - 0.333; p < 0.001), and patients with preoperative lower BMI (β = - 1.524; 95% CI - 1.974, - 1.075; p < 0.001) achieved higher EWLP at 12th-month. High somatization score (β = 11.975; 95% CI 3.653, 20.296; p = 0.005) and a low Global Severity Index (GSI) score (β = - 24.276; 95% CI - 41.457, - 7.095; p = 0.006) had a positive effect on EWLP at 12th-month. CONCLUSIONS Preoperative psychological testing can help predict surgical outcomes in the bariatric population. More intense lifestyle and behavioral support can be applied by targeting patients who are expected to lose less weight after surgery, and patients' weight loss potential can be increased.
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Batra A, Chen LM, Wang Z, Parent C, Pokhvisneva I, Patel S, Levitan RD, Meaney MJ, Silveira PP. Early Life Adversity and Polygenic Risk for High Fasting Insulin Are Associated With Childhood Impulsivity. Front Neurosci 2021; 15:704785. [PMID: 34539334 PMCID: PMC8441000 DOI: 10.3389/fnins.2021.704785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/03/2021] [Indexed: 01/11/2023] Open
Abstract
While the co-morbidity between metabolic and psychiatric behaviors is well-established, the mechanisms are poorly understood, and exposure to early life adversity (ELA) is a common developmental risk factor. ELA is associated with altered insulin sensitivity and poor behavioral inhibition throughout life, which seems to contribute to the development of metabolic and psychiatric disturbances in the long term. We hypothesize that a genetic background associated with higher fasting insulin interacts with ELA to influence the development of executive functions (e.g., impulsivity in young children). We calculated the polygenic risk scores (PRSs) from the genome-wide association study (GWAS) of fasting insulin at different thresholds and identified the subset of single nucleotide polymorphisms (SNPs) that best predicted peripheral insulin levels in children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort [N = 467; pt– initial = 0.24 (10,296 SNPs), pt– refined = 0.05 (57 SNPs)]. We then calculated the refined PRS (rPRS) for fasting insulin at this specific threshold in the children from the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) cohort and investigated its interaction effect with adversity on an impulsivity task applied at 36 months. We found a significant effect of interaction between fasting insulin rPRS and adversity exposure predicting impulsivity measured by the Snack Delay Task at 36 months [β = −0.329, p = 0.024], such that higher PRS [β = −0.551, p = 0.009] was linked to more impulsivity in individuals exposed to more adversity. Enrichment analysis (MetaCoreTM) of the SNPs that compose the fasting insulin rPRS at this threshold was significant for certain nervous system development processes including dopamine D2 receptor signaling. Additional enrichment analysis (FUMA) of the genes mapped from the SNPs in the fasting insulin rPRS showed enrichment with the accelerated cognitive decline GWAS. Therefore, the genetic background associated with risk for adult higher fasting insulin moderates the impact of early adversity on childhood impulsivity.
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Affiliation(s)
- Aashita Batra
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Lawrence M Chen
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Zihan Wang
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Carine Parent
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Irina Pokhvisneva
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Sachin Patel
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Robert D Levitan
- Mood and Anxiety Disorders Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Michael J Meaney
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada.,Translational Neuroscience Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Patricia Pelufo Silveira
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
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Muraca E, Oltolini A, Binda A, Pizzi M, Ciardullo S, Manzoni G, Zerbini F, Bianconi E, Cannistraci R, Perra S, Pizzi P, Lattuada G, Perseghin G, Villa M. Metabolic and Psychological Features are Associated with Weight Loss 12 Months After Sleeve Gastrectomy. J Clin Endocrinol Metab 2021; 106:e3087-e3097. [PMID: 33705552 DOI: 10.1210/clinem/dgab161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Laparoscopic sleeve gastrectomy (LSG) is a recognized effective procedure of bariatric surgery, but a poor response in weight loss may still represent a clinical problem. To date there are no validated predictors useful to better perform patient selection. OBJECTIVE To establish the association of baseline anthropometric, metabolic, and psychologic features with the percent total weight loss (%TWL) and percent excess weight loss (%EWL) 12 months after surgery. DESIGN Retrospective longitudinal analysis of a set of data about obese patients attending the outpatient service of a single obesity center from June 2016 to June 2019. PATIENTS A total of 106 obese patients underwent LSG with presurgery evaluation and follow-up at 12 months after surgery. MAIN OUTCOME Weight loss 12 months after LSG. RESULTS Patients who achieved a %TWL higher than the observed median (≥34%) were younger, with a lower fasting plasma glucose and glycated hemoglobin, with a lower prevalence of hypertension and with a lower score in the impulsiveness scale, compared with patients with a %TWL < 34%. Similar findings were found when %EWL was considered. Multivariable stepwise regression analysis showed that younger age, lower impulsiveness, higher-than-normal urinary free cortisol, and lower HbA1c were associated with higher %TWL, explaining about 31.5% of the weight loss. CONCLUSION Metabolic and psychologic features at baseline were independently associated with weight loss and explained a non-negligible effect on the response to LSG. These data suggest that careful metabolic and psychologic profiling could help in sharper indications and personalized pre- and postsurgical follow-up protocols in candidates for LSG.
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Affiliation(s)
- Emanuele Muraca
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Alberto Binda
- Clinical Psychology; Policlinico di Monza, 20900 Monza, Italy
| | - Mattia Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, 20900 Monza, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Eleonora Bianconi
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Pietro Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, 20900 Monza, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
| | - Matteo Villa
- Clinical Psychology; Policlinico di Monza, 20900 Monza, Italy
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9
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Klemenčič S, Bujišić A, Hribernik NŠ, Battelino T, Homan M, Orel R, Kotnik P. Psychological Outcomes and Predictors of Weight Loss in Adolescents With Severe Obesity Following a Reversible Endoscopic Bariatric Procedure. Front Pediatr 2021; 9:688287. [PMID: 34178903 PMCID: PMC8223602 DOI: 10.3389/fped.2021.688287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction: Adolescent and children obesity is a growing concern worldwide. Bariatric surgery is used as an effective treatment for adolescents with obesity and provides physical and mental health benefits. Application of alternative, minimally invasive, safe, and reversible endoscopic procedures, such as the Duodenojejunal bypass liner (DJBL), has been recently suggested as an effective treatment for adolescents with obesity. We explored specific psychological outcomes of adolescents with obesity during a year of follow-up after undergoing a reversible endoscopic bariatric procedure, and a year after removal. We were also interested in identifying psychological factors that could predict successful weight loss after the procedure. Methods: Nineteen adolescent with severe obesity undergoing DJBL procedure were psychologically assessed in an open-label, prospective clinical trial (NTC0218393), at the implantation of device and at the removal of device after 12 months. Control group of 26 adolescents with severe obesity were recruited from the same outpatient clinic undergoing only conservative treatment. In addition, adolescents from the intervention group were followed for 12 months after the removal of the device. The Youth Self Report (YSR) was used to assess adolescents' emotional and behavioural problems; The Multidimensional Body-Self Relations Questionnaire (MBSRQ) to assess body image and The Eating Disorder Examination Questionnaire (EDE-Q) to assess attitudes and behaviours related to eating disorder. Results: Significant improvements in somatic complain (F = 12.478, p = 0.001), emotional and behavioural problems (F = 7.169, p = 0.011) and food restraining (F = 9.605, p = 0.004) were found in the intervention group at device removal compared to the control group. Moreover, at the time of device removal compared to baseline, improvements in several psychological outcomes were found (F = 32.178 p = 0.000 for emotional and behavioural problems). Adolescents also became more satisfied with their appearance (F = 6.789, p = 0.019). Majority of observed changes remained stable at the next follow up a year after the device removal. Significant predictors of successful weight loss at device removal were fewer overeating episodes (B = 0.147, p = 0.022) and lower body satisfaction (B = 0.932, p = 0.013). Discussion: Following a reversible bariatric procedure, improvements of psychological (emotional and behavioural) factors were found in adolescents with severe obesity. Psychological predictors of successful weight loss were identified, showing the greatest importance of eating behaviour and body satisfaction in successful weight loss.
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Affiliation(s)
- Simona Klemenčič
- Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ana Bujišić
- Community Health Centre Kranj, Kranj, Slovenia
| | | | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matjaž Homan
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Rok Orel
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Primož Kotnik
- Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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10
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Yeo D, Toh A, Yeo C, Low G, Yeo JZ, Aung MO, Rao J, Kaushal S. The impact of impulsivity on weight loss after bariatric surgery: a systematic review. Eat Weight Disord 2021; 26:425-438. [PMID: 32232777 DOI: 10.1007/s40519-020-00890-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Impulsivity has been shown to be associated with obesity through links to pathological eating behavior such as binge eating. The recent literature suggests that impulsivity is linked to poorer outcomes post-bariatric surgery. Impulsivity can be measured in various ways and comprises of three broad domains: impulsive choice, impulsive action, and impulsive personality traits. The aim of this systematic review is to synthesize the current evidence on the impact of impulsivity on post-bariatric surgery weight loss. METHODS A literature review was performed in February 2020. Original studies investigating the relationship between impulsivity and weight loss post-bariatric surgery were evaluated. RESULTS Ten studies with a total of 1246 patients were analyzed. There were four case-control, four prospective observational and two retrospective observational studies. The postoperative follow-up ranged from 0.5 to 12 years. Eight studies measuring trait impulsivity did not show any association with weight loss post-bariatric surgery, although two studies reported an indirect effect of impulsivity on weight loss mediated via pathological eating behavior. Assessment of impulsive action by two studies showed that post-bariatric surgery weight loss is affected by impulsive action. CONCLUSION Impulsivity may adversely affect postoperative outcomes after bariatric surgery. However, this may be specific to state impulsivity or impulsive action rather than trait impulsivity. Patients with a higher state impulsivity may benefit from closer follow-up post-bariatric surgery, as well as cognitive behavioral therapies targeting cognitive control over food. LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- D Yeo
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - A Toh
- Department of Psychology, Tan Tock Seng Hospital, Singapore, Singapore
| | - C Yeo
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - G Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J Z Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - M O Aung
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - J Rao
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - S Kaushal
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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11
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Associations between binge eating, depressive symptoms and anxiety and weight regain after Roux-en-Y gastric bypass surgery. Eat Weight Disord 2021; 26:191-199. [PMID: 31898239 DOI: 10.1007/s40519-019-00839-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Weight regain (WR) after bariatric surgery (BS) is frequent. OBJECTIVE The aim of this study was to evaluate whether the occurrence of psychiatric disorders would be associated with short- and long-term WR after BS. METHODS Ninety-six patients (77.6% female, age 40.2 ± 10.1 years, BMI of 50 ± 8.2 kg/m2) from the Obesity and Bariatric Surgery Outpatient Clinic of the Universidade Federal São Paulo completed the Questionnaire on Eating and Weight Patterns-Revised, the Beck Depression Inventory and an anxiety inventory to assess the occurrence of binge eating, depressive symptoms (DS) and anxious symptoms (AS) before and after short-term and long-term BS. RESULTS Twenty-four months after BS, the prevalence of binge eating, depression and anxiety decreased from 100 to 13%, 100 to 15% and 43 to 4%, respectively. The mean WR of 35.2 ± 17.3% of weight loss occurred in nine patients after 24 months and was associated with binge eating (p = 0.002) but not with DS or AS. At long-term follow-up (12 ± 1.5 years), 67% had a mean WR of 50.3 ± 24.9%. The prevalence of binge eating, DS and AS were 48%, 46% and 63%, respectively, in this group, and significant associations were observed between WR and binge eating (p = 0.001), DS (p = 0.029) and AS (p = 0.001). Furthermore, the number of psychiatric disorders was inversely associated with the percentage of weight loss (p < 0.05) and positively associated with WR (p < 0.05). CONCLUSION Weight regain was associated with the occurrence of binge eating in the short and long term after BS, whereas the occurrence of depressive and anxious symptoms was associated with WR only in the long term. LEVEL III Evidence obtained from well-designed cohort or case-control analytic studies.
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12
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Derderian SC, Patten L, Kaizer AM, Moore JM, Ogle S, Jenkins TM, Michalsky MP, Mitchell JE, Bjornstad P, Dixon JB, Inge T. Influence of Weight Loss on Obesity-Associated Complications After Metabolic and Bariatric Surgery in Adolescents. Obesity (Silver Spring) 2020; 28:2397-2404. [PMID: 33230961 PMCID: PMC8882436 DOI: 10.1002/oby.23038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/21/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Following metabolic and bariatric surgery (MBS), most adolescents experience weight loss and improvement of many obesity-associated complications (OACs). The relationship between weight loss and remission of OACs after MBS in adolescents has not been well described. METHODS The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a multi-institutional prospective observational study of adolescents who underwent MBS between 2007 and 2012. Lower-weight-loss responders (LWLRs) were defined as having <20% total body weight loss (TBWL) and higher-weight-loss responders (HWLRs) were defined as having ≥20% TBWL at 5 years after MBS. The prevalence of OACs was compared at baseline and 5 years after MBS. RESULTS Both LWLRs (n = 114) and HWLRs (n = 78) lost significant weight within the first year following MBS; however, the TBWL at 5 years for the LWLRs was 8.6% ± 9.5% compared with 33.8% ± 9.2% for the HWLRs. Those in the HWLR group were more likely to experience durable remission of composite dyslipidemia at 5 years, whereas there were no differences between groups in remission rates of all other OACs. CONCLUSIONS Greater weight loss after MBS in adolescents was associated with greater remission of composite dyslipidemia; however, remission of other OACs was not dependent on major sustained weight loss.
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Affiliation(s)
| | - Luke Patten
- Children’s Hospital Colorado, University of Colorado, Aurora, Colorado
| | | | - Jaime M Moore
- Children’s Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Sarah Ogle
- Children’s Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Todd M Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Marc P Michalsky
- Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio
| | | | - Petter Bjornstad
- Children’s Hospital Colorado, University of Colorado, Aurora, Colorado
| | - John B Dixon
- Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Australia
| | - Thomas Inge
- Children’s Hospital Colorado, University of Colorado, Aurora, Colorado
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13
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Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery. Surg Endosc 2020; 35:5774-5786. [DOI: 10.1007/s00464-020-08066-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
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14
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Abstract
PURPOSE OF REVIEW Bariatric surgery is today the most effective therapy for weight loss and reduction of comorbidity burden in patients with severe obesity. However, bariatric surgery does not benefit equally all the patients. A consistent variability in outcomes has been observed. Predicting responses to bariatric surgery could be an important tool in clinical practice, by improving patients' selection or by identifying patients in which more aggressive follow-up and post-operative intervention should be applied. Predictive factors for weight loss, weight regain, diabetes remission and recurrence are briefly reviewed in this paper. RECENT FINDINGS Many pre-operative factors have been proposed as negative or positive predictors of body weight reduction after surgery. However, none of these factors has been consistently demonstrated to have a sufficiently strong predictive power to influence eligibility to bariatric surgery itself. Weight regain can occur after bariatric surgery and its probability seems to be more influenced by post-operative behavioral factors than by pre-operative predictors. Several effective scores have been developed to predict diabetes remission after surgery, however long-term maintenance and diabetes recurrence after surgery seem again more influenced by post-operative behaviors and weight loss maintenance. In general, more attention and active interventions to pre-operative and post-operative eating behaviors and lifestyle modifications are probably more important at the clinical level than the search of pre-operative predictors of long-term outcomes.
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Affiliation(s)
- Anna Belligoli
- Center for the Study and the Integrated Treatment of Obesity, Padova University Hospital, Padova, Italy
| | - Silvia Bettini
- Center for the Study and the Integrated Treatment of Obesity, Padova University Hospital, Padova, Italy
| | - Gianni Segato
- Department of Surgery, "San Bortolo" Hospital, Vicenza, Italy
| | - Luca Busetto
- Center for the Study and the Integrated Treatment of Obesity, Padova University Hospital, Padova, Italy.
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