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Torrego-Ellacuría M, Barabash A, Larrad-Sainz A, Hernández-Nuñez GM, Matía-Martín P, Pérez-Ferre N, Marcuello C, Sánchez-Pernaute A, Torres AJ, Calle-Pascual AL, Rubio MA. Weight Regain Outcomes After Bariatric Surgery in the Long-term Follow-up: Role of Preoperative Factors. Obes Surg 2021; 31:3947-3955. [PMID: 34146246 DOI: 10.1007/s11695-021-05497-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Weight regain (WR) compromises the effectiveness of bariatric surgery. The objective of this study was to determine differences in long-term WR prevalence using different definitions and analyze possible preoperative predictors involved. METHODS Single-center retrospective cohort study including 445 adults who underwent 3 modalities of bariatric surgery between 2009 and 2014. EXPOSURE age, gender, ethnicity, body mass index (BMI), type 2 diabetes (T2D), hypertension (HTN), and type of surgery. MAIN OUTCOMES WR at year 6 assessed by 4 definitions and 6 multivariate models based on common thresholds. RESULTS Our cohort (71.1% female) had a mean age of 44.78 ± 11.94 years, and mean presurgery BMI of 44.94 ± 6.88 kg/m2, with a median follow-up of 6 years (IQR=5-8). The prevalences of T2D and HTN were 36.0% and 46.7% respectively. WR rates over thresholds ranged from 25.4 to 68.1%, with significant differences between groups in the WR measured as the percentage of maximum weight loss (MWL) and the increase in excess weight loss (EWL). Presurgery BMI was a significant predictor in 3 models; restrictive techniques were associated with WR in all the models except for those considering WR over 10 kg and WR over 15% from nadir as dependent variables. CONCLUSIONS In this long-term study, WR defined as percentage of MWL and increase in EWL from nadir had the greatest significance in logistic regression models with preoperative BMI and type of surgery as independent variables. These findings could serve to establish a standardized outcome reporting WR in other longitudinal studies. KEY POINTS • Lack of standardized outcome to measure weight regain after bariatric surgery. • Lowest rates of weight regain in malabsorptive techniques in all definitions applied. • Weight regain measured as percentage of maximum weight lost.
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Affiliation(s)
- Macarena Torrego-Ellacuría
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Ana Barabash
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, Profesor Martín Lagos s/n, 28040, Madrid, Spain.,Faculty of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Angélica Larrad-Sainz
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Gemma Maria Hernández-Nuñez
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Pilar Matía-Martín
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, Profesor Martín Lagos s/n, 28040, Madrid, Spain.,Faculty of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Natalia Pérez-Ferre
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Clara Marcuello
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Andrés Sánchez-Pernaute
- Faculty of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain.,Department of Surgery, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Antonio José Torres
- Faculty of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain.,Department of Surgery, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Alfonso Luis Calle-Pascual
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, Profesor Martín Lagos s/n, 28040, Madrid, Spain.,Faculty of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Miguel Angel Rubio
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, Profesor Martín Lagos s/n, 28040, Madrid, Spain. .,Faculty of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain.
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Reduced intestinal FADS1 gene expression and plasma omega-3 fatty acids following Roux-en-Y gastric bypass. Clin Nutr 2019; 38:1280-1288. [DOI: 10.1016/j.clnu.2018.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/10/2018] [Accepted: 05/21/2018] [Indexed: 12/29/2022]
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Lecube A, de Hollanda A, Calañas A, Vilarrasa N, Rubio MA, Breton I, Goday A, Vidal J, Iglesias P, Fernández-Soto ML, Pellitero S, de Cos AI, Morales MJ, Campos C, Masmiquel L, Tinahones F, Pujante P, García-Luna PP, Bueno M, Cámara R, Bandrés O, Caixàs A. Trends in Bariatric Surgery in Spain in the Twenty-First Century: Baseline Results and 1-Month Follow Up of the RICIBA, a National Registry. Obes Surg 2018; 26:1836-42. [PMID: 26661106 DOI: 10.1007/s11695-015-2001-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Specific data is needed to safely expand bariatric surgery and to preserve good surgical outcomes in response to the non-stop increase in obesity prevalence worldwide. OBJECTIVE The aims of this study are to provide an overview of the baseline characteristics, type of surgery, and 30-day postoperative morbidity and mortality in patients undergoing bariatric surgery in Spanish public hospitals, and evaluate changes throughout the 2000-2014 period. MATERIAL AND METHODS This is a descriptive study using data from the RICIBA, a computerized multicenter and multidisciplinary registry created by the Obesity Group of the Endocrinology and Nutrition Spanish Society. Three periods according to the date of surgery were created: January 2000 to December 2004 (G1), January 2005 to December 2009 (G2), and January 2010 to December 2014 (G3). RESULTS Data from 3843 patients were available (44.8 ± 10.5 years, a 3:1 female-to-male ratio, 46.9 ± 8.2 kg/m(2)). Throughout the 15-year period assessed, candidate patients for bariatric surgery were progressively older and less obese, with an increase in associated comorbidities and in the prevalence of men. The global trend also showed a progressive decrease in Roux-en-Y gastric bypass, the most performed bariatric procedure (75.1 % in G1, 69.3 % in G2, and 42.6 % in G3; p < 0.001), associated with a parallel increase in sleeve gastrectomy (0.8 % in G1, 18.1 % in G2, and 39.6 % in G3; p < 0.001). An overall mortality rate of 0.3 % was reported. CONCLUSIONS Data from Spain is similar to data observed worldwide. Information recorded in the National Registries like RICIBA is necessary in order to safely expand bariatric surgery in response to increasing demand.
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Affiliation(s)
- Albert Lecube
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitari Arnau de Vilanova, CIBERDEM (CIBER de diabetes y enfermedades metabólicas asociadas), ISCIII, Institut de Recerca Biomèdica de Lleida (IRB-Lleida), Universitat de Lleida, Av Rovira Roure 80, 25198, Lleida, Spain. .,Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitari Vall d'Hebrón, Barcelona, Spain.
| | - Ana de Hollanda
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitari Arnau de Vilanova, CIBERDEM (CIBER de diabetes y enfermedades metabólicas asociadas), ISCIII, Institut de Recerca Biomèdica de Lleida (IRB-Lleida), Universitat de Lleida, Av Rovira Roure 80, 25198, Lleida, Spain
| | - Alfonso Calañas
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Núria Vilarrasa
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitari de Bellvitge, CIBERDEM (CIBER de diabetes y enfermedades metabólicas asociadas, ISCIII), L'Hospitalet de Llobregat, Spain
| | - Miguel Angel Rubio
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Clínico San Carlos IDISSC, Madrid, Spain
| | - Irene Breton
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Albert Goday
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), CIBEROBN (CIBER de obesidad y nutrición, ISCIII), Departament de Medicina Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Vidal
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Clínic de Barcelona, CIBERDEM (CIBER de diabetes y enfermedades metabólicas asociadas, ISCIII), Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paloma Iglesias
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - María Luisa Fernández-Soto
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitario San Cecilio, Granada, Spain
| | - Silvia Pellitero
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitario Germans Trias i Pujol, CIBERDEM (CIBER de diabetes y enfermedades metabólicas asociadas), ISCIII, Badalona, Spain
| | - Ana Isabel de Cos
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitario La Paz, Madrid, Spain
| | - María José Morales
- Obesity Unit and Endocrinology and Nutrition Departments, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Cristina Campos
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Lluís Masmiquel
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital de Son Llàtzer, Palma de Mallorca, Spain
| | - Francisco Tinahones
- Obesity Unit and Endocrinology and Nutrition Departments, Complejo Hospitalario de Málaga (Virgen de la Victoria), Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, CIBEROBN (CIBER de obesidad y nutrición, ISCIII), Málaga, Spain
| | - Pedro Pujante
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pedro P García-Luna
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Marta Bueno
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitari Arnau de Vilanova, CIBERDEM (CIBER de diabetes y enfermedades metabólicas asociadas), ISCIII, Institut de Recerca Biomèdica de Lleida (IRB-Lleida), Universitat de Lleida, Av Rovira Roure 80, 25198, Lleida, Spain
| | - Rosa Cámara
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Orosia Bandrés
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Royo Villanova, Zaragoza, Spain
| | - Assumpta Caixàs
- Obesity Unit and Endocrinology and Nutrition Departments, Hospital Universitari Parc Taulí, Sabadell, Spain
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Sánchez E, Baena-Fustegueras JA, de la Fuente MC, Gutiérrez L, Bueno M, Ros S, Lecube A. Advanced glycation end-products in morbid obesity and after bariatric surgery: When glycemic memory starts to fail. ACTA ACUST UNITED AC 2017; 64:4-10. [PMID: 28440769 DOI: 10.1016/j.endinu.2016.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Advanced glycation end-products (AGEs) are a marker of metabolic memory. Their levels increases when oxidative stress, inflammation, or chronic hyperglycemia exists. The role of morbid obesity in AGE levels, and the impact of bariatric surgery on them are unknown. PATIENTS AND METHOD An observational study with three sex- and age-matched cohorts: 52 patients with obesity, 46 patients undergoing bariatric surgery in the last 5 years, and 46 control subjects. AGE were measured using skin autofluorescence (SAF) in the forearm with an AGE Reader™ (DiagnOptics Technologies, Groningen, The Netherlands). Presence of metabolic syndrome was assessed. RESULTS Patients with morbid obesity had higher SAF levels (2.14±0.65AU) than non-obese subjects (1.81±0.22AU; P<.001), which was mainly attributed to obese subjects with metabolic syndrome (2.44±0.67 vs. 1.86±0.51AU; P<.001). After bariatric surgery, SAF continued to be high (2.18±0.40AU), and greater as compared to the non-obese population (P<.001). A multivariate analysis showed that age and presence of metabolic syndrome (but not sex or body mass index) were independently associated to SAF (R2=0.320). CONCLUSION SAF is increased in patients with morbid obesity and metabolic syndrome, mainly because of the existence of type 2 diabetes mellitus. In the first 5 years following bariatric surgery, weight loss and metabolic improvement are not associated with a parallel decrease in subcutaneous AGE levels.
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Affiliation(s)
- Enric Sánchez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica (IRB) de Lleida, Universitat de Lleida, Lleida, España
| | - Juan Antonio Baena-Fustegueras
- Departamento de Cirugía General, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica (IRB) de Lleida, Universitat de Lleida, Lleida, España
| | - María Cruz de la Fuente
- Departamento de Cirugía General, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica (IRB) de Lleida, Universitat de Lleida, Lleida, España
| | - Liliana Gutiérrez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica (IRB) de Lleida, Universitat de Lleida, Lleida, España
| | - Marta Bueno
- Servicio de Endocrinología y Nutrición, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica (IRB) de Lleida, Universitat de Lleida, Lleida, España
| | - Susana Ros
- Departamento de Cirugía General, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica (IRB) de Lleida, Universitat de Lleida, Lleida, España
| | - Albert Lecube
- Servicio de Endocrinología y Nutrición, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica (IRB) de Lleida, Universitat de Lleida, Lleida, España; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España.
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Sánchez E, Baena-Fustegueras JA, de la Fuente MC, Gutiérrez L, Bueno M, Ros S, Lecube A. Advanced glycation end-products in morbid obesity and after bariatric surgery: When glycemic memory starts to fail. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2017. [DOI: 10.1016/j.endien.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bojanowska E, Ciosek J. Can We Selectively Reduce Appetite for Energy-Dense Foods? An Overview of Pharmacological Strategies for Modification of Food Preference Behavior. Curr Neuropharmacol 2016; 14:118-42. [PMID: 26549651 PMCID: PMC4825944 DOI: 10.2174/1570159x14666151109103147] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/19/2015] [Accepted: 10/31/2015] [Indexed: 12/11/2022] Open
Abstract
Excessive intake of food, especially palatable and energy-dense carbohydrates and fats, is
largely responsible for the growing incidence of obesity worldwide. Although there are a number of
candidate antiobesity drugs, only a few of them have been proven able to inhibit appetite for palatable
foods without the concurrent reduction in regular food consumption. In this review, we discuss the
interrelationships between homeostatic and hedonic food intake control mechanisms in promoting
overeating with palatable foods and assess the potential usefulness of systemically administered pharmaceuticals that
impinge on the endogenous cannabinoid, opioid, aminergic, cholinergic, and peptidergic systems in the modification of
food preference behavior. Also, certain dietary supplements with the potency to reduce specifically palatable food intake
are presented. Based on human and animal studies, we indicate the most promising therapies and agents that influence the
effectiveness of appetite-modifying drugs. It should be stressed, however, that most of the data included in our review
come from preclinical studies; therefore, further investigations aimed at confirming the effectiveness and safety of the
aforementioned medications in the treatment of obese humans are necessary.
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Affiliation(s)
- Ewa Bojanowska
- Department of Behavioral Pathophysiology, Institute of General and Experimental Pathology, Medical University of Lodz, 60 Narutowicza Street, 90-136 Lodz, Poland.
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Martini F, Paolino L, Marzano E, D'Agostino J, Lazzati A, Schneck AS, Sánchez-Pernaute A, Torres A, Iannelli A. Single-Anastomosis Pylorus-Preserving Bariatric Procedures: Review of the Literature. Obes Surg 2016; 26:2503-2515. [PMID: 27473361 DOI: 10.1007/s11695-016-2310-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Single-anastomosis pylorus-preserving procedures (SAPPP) were recently introduced into bariatric surgery in order to combine the physiologic advantages of a post-pyloric reconstruction with the technical advantages of an omega loop. Surgery consists of a sleeve gastrectomy that is performed first, followed by a duodeno-enterostomy. Two main variants exist: proximal and distal SAPPP, with duodeno-jejunostomy and duodeno-ileostomy, respectively. This review describes the SAPPP reported in the literature and analyzes their outcomes in comparison with the most frequently performed bariatric techniques. Preliminary results appear as promising in terms of both safety and effectiveness on weight loss and comorbidities improvement.
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Affiliation(s)
- Francesco Martini
- Digestive and Bariatric Unit, Joseph Ducuing Hospital, Toulouse, France
| | - Luca Paolino
- Digestive and Bariatric Unit, Joseph Ducuing Hospital, Toulouse, France
| | - Ettore Marzano
- Pole Obésité Etang de Berre, Clinique de Martigues, Martigues, France
| | - Jacopo D'Agostino
- Pole Obésité Etang de Berre, Clinique de Martigues, Martigues, France
| | - Andrea Lazzati
- Digestive Unit, Centre Hospitalier Intercommunal de Creteil, Créteil, France
| | - Anne-Sophie Schneck
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, F-06202, Nice, France
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity", F-06204, Nice, France
- University of Nice Sophia-Antipolis, F-06107, Nice, France
| | | | - Antonio Torres
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, F-06202, Nice, France.
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity", F-06204, Nice, France.
- University of Nice Sophia-Antipolis, F-06107, Nice, France.
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Singh AK, Kota SK. Bariatric surgery and diabetes remission: how far have we progressed? Expert Rev Endocrinol Metab 2015; 10:545-559. [PMID: 30298760 DOI: 10.1586/17446651.2015.1073586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Obesity and type 2 diabetes mellitus have been associated with higher morbidity and mortality. Bariatric surgery results in substantial and sustained weight loss in morbidly obese patients and improves obstructive sleep apnea. Furthermore, bariatric surgery improves diabetes control, hypertension, quality of life, stroke, myocardial infarction and reduces mortality. Interestingly, bariatric surgery induces high rates of short and long-term diabetes remission. While the exact mechanisms behind this are not completely understood, improved insulin action, β-cell function and a complex interplay of hormones in the entero-insular axis appear to play major roles. Insulin action improves proportionally to weight loss and it gets completely normalized especially after bilio-pancreatic diversion. β-Cell function also seems to improve after a variety of bariatric surgeries. Seemingly, baseline β-cell function is able to predict future diabetes remission. This article will review the effectiveness of bariatric procedures on the remission and improvement of diabetes and its implicated mechanisms.
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Sánchez-Pernaute A, Rubio MÁ, Cabrerizo L, Ramos-Levi A, Pérez-Aguirre E, Torres A. Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients. Surg Obes Relat Dis 2015; 11:1092-8. [PMID: 26048517 DOI: 10.1016/j.soard.2015.01.024] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/22/2015] [Accepted: 01/29/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric operations achieve a high remission rate of type 2 diabetes in patients with morbid obesity. Malabsorptive operations usually are followed by a higher rate of metabolic improvement, though complications and secondary effects of these operations are usually higher. OBJECTIVES Analyze the results of a simplified duodenal switch, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) on patients with obesity and type 2 diabetes mellitus (T2 DM). SETTING University Hospital, Madrid, Spain. METHODS Ninety-seven T2 DM patients with a mean body mass index (BMI) of 44.3 kg/m(2) were included. Mean preoperative glycated hemoglobin was 7.6%, and mean duration of the disease was 8.5 years. Forty patients were under insulin treatment. SADI-S was completed with a sleeve gastrectomy performed over a 54 French bougie and a 200 cm common limb in 28 cases and 250 cm in 69. RESULTS Follow up was possible for 86 patients (95.5%) in the first postoperative year, 74 (92.5%) in the second, 66 (91.6%) in the third, 46 (86.7%) in the fourth and 25 out of 32 (78%) in the fifht postoperative year. Mean glycemia and glycated hemoglobin decreased immediately. Control of the disease, with HbA1c below 6%, was obtained in 70 to 84% in the long term, depending on the initial antidiabetic therapy. Most patients abandoned antidiabetic therapy after the operation. Absolute remission rate was higher for patients under oral therapy than for those under initial insulin therapy, 92.5% versus 47% in the first postoperative year, 96.4% versus 56% in the third and 75% versus 38.4% in the fifth. A short diabetes history and no need for insulin were related to a higher remission rate. Three patients had to be reoperated for recurrent hypoproteinemia. CONCLUSION SADI-S is an effective therapeutic option for obese patients with diabetes mellitus.
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Affiliation(s)
| | | | - Lucio Cabrerizo
- Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
| | - Ana Ramos-Levi
- Department of Endocrinology, Hospital "La Princesa," Madrid, Spain
| | | | - Antonio Torres
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain
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Colsa Gutiérrez P, Kharazmi Taghavi M, Sosa Medina R, Gutiérrez Cabezas JM, Ovejero Gómez VJ, Ruiz JL, Ingelmo Setién A. Predictive factors of insulin resistance resolution with adjustable gastric band surgery. Cir Esp 2014; 93:159-65. [PMID: 25458549 DOI: 10.1016/j.ciresp.2014.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/03/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate preoperative factors associated with remission of diabetes and weight loss after laparoscopic gastric band surgery. MATERIAL AND METHODS A retrospective cohort of 95 patients who had an adjustable gastric band placed were included. A preliminary descriptive study of prognostic factors was performed using the logistic regression model with SPSS 17.0. The independent variables were age, sex, body mass index (BMI), diabetes status and degree of obesity; dependent variables were the proportion of weight loss, change in diabetes status score and percent changes in fasting sugar and glycosylated hemoglobin. RESULTS The variables that were significantly associated with the percentage of changes in fasting blood sugar and glycated hemoglobin were: the degree of obesity in the first year; preoperative and diabetes status respectively. The analysis of the need for antidiabetic treatment using the modified diabetes status score showed preoperative BMI, age and gender as significant predictors. CONCLUSIONS In patients undergoing gastric band surgery, weight loss is the fundamental mechanism by which insulin sensitivity increases. This improvement in glucose metabolism is influenced by factors such as sex, age, insulin treatment, duration of diabetes and degree of preoperative obesity.
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Affiliation(s)
- Pablo Colsa Gutiérrez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana, Torrelavega, Cantabria, España.
| | - Mahgol Kharazmi Taghavi
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - Rocío Sosa Medina
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana, Torrelavega, Cantabria, España
| | | | | | - José Luis Ruiz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - Alfredo Ingelmo Setién
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana, Torrelavega, Cantabria, España
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Ramos-Levi AM, Matia P, Cabrerizo L, Barabash A, Sanchez-Pernaute A, Calle-Pascual AL, Torres AJ, Rubio MA. Statistical models to predict type 2 diabetes remission after bariatric surgery. J Diabetes 2014; 6:472-7. [PMID: 24433454 DOI: 10.1111/1753-0407.12127] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/28/2013] [Accepted: 01/09/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) remission may be achieved after bariatric surgery (BS), but rates vary according to patients' baseline characteristics. The present study evaluates the relevance of several preoperative factors and develops statistical models to predict T2D remission 1 year after BS. METHODS We retrospectively studied 141 patients (57.4% women), with a preoperative diagnosis of T2D, who underwent BS in a single center (2006-2011). Anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up were recorded. Remission of T2D was defined according to consensus criteria: HbA1c <6%, fasting glucose (FG) <100 mg/dL, absence of pharmacologic treatment. The influence of several preoperative factors was explored and different statistical models to predict T2D remission were elaborated using logistic regression analysis. RESULTS Three preoperative characteristics considered individually were identified as the most powerful predictors of T2D remission: C-peptide (R2 = 0.249; odds ratio [OR] 1.652, 95% confidence interval [CI] 1.181-2.309; P = 0.003), T2D duration (R2 = 0.197; OR 0.869, 95% CI 0.808-0.935; P < 0.001), and previous insulin therapy (R2 = 0.165; OR 4.670, 95% CI 2.257-9.665; P < 0.001). High C-peptide levels, a shorter duration of T2D, and the absence of insulin therapy favored remission. Different multivariate logistic regression models were designed. When considering sex, T2D duration, and insulin treatment, remission was correctly predicted in 72.4% of cases. The model that included age, FG and C-peptide levels resulted in 83.7% correct classifications. When sex, FG, C-peptide, insulin treatment, and percentage weight loss were considered, correct classification of T2D remission was achieved in 95.9% of cases. CONCLUSION Preoperative characteristics determine T2D remission rates after BS to different extents. The use of statistical models may help clinicians reliably predict T2D remission rates after BS.
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Affiliation(s)
- Ana M Ramos-Levi
- Department of Endocrinology and Nutrition, La Princesa University Hospital, La Princesa Investigation Institute, Madrid, Spain
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