A genetic "obesity risk index" for patients with morbid obesity

Prognostic Value of Combination of Controlling Nutritional Status and Tumor Marker in Patients with Radical Non-Small-Cell Lung Cancer

Background

Controlling nutritional status (CONUT) and tumor markers are associated with prognosis in patients with non-small-cell lung cancer (NSCLC). This study is aimed at exploring the potential usefulness of T-CONUT, constructed by combining CONUT and tumor markers, for NSCLC patients undergoing radical surgery.

Methods

A total of 483 patients with NSCLC underwent radical surgical resection. The receiver characteristic operating curve (ROC) was used to select the tumor marker with the highest predictive performance, and CONUT was combined with this marker to construct the T-CONUT. The Kaplan–Meier method and log-rank test were used to analyze the overall survival (OS), and chi-square analysis was used to analyze the association between T-CONUT and clinicopathological characteristics. The independent risk factors were analyzed by Cox regression. A nomogram was constructed by R studio. Calibration plots, the c-index, and decision curves were evaluated for the performance of the nomogram.

Results

ROC analysis showed that the predictive performance of CYFRA21–1 was better than that of CEA, NSE, and SCC. CYFRA21–1 was selected for combining with CONUT to construct T-CONUT. Elevated T-CONUT indicates poor prognosis of patients. Histological type, pTNM, and T-CONUT are independent risk factors associated with patient prognosis. The areas under the curve of the nomogram for predicting 3- and 5-year OS were 0.760 and 0.761, respectively.

Conclusion

T-CONUT comprising CYFRA21–1 and CONUT can effectively predict the prognosis of NSCLC patients.

Prognostic importance of the preoperative New-Naples prognostic score for patients with gastric cancer

BACKGROUND

The wide applicability of the Naples prognostic score (NPS) is still worthy of further study in gastric cancer (GC). This study aimed to construct a New-NPS based on the differences in immunity and nutrition in patients with upper and lower gastrointestinal tumors to help obtain an individualized prediction of prognosis.

METHODS

This study retrospectively analyzed patients who underwent radical gastrectomy from April 2014 to September 2016. The cutoff values of the preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum albumin (Alb), and total cholesterol (TC) were calculated by ROC curve analysis. ROC and t-ROC were used to evaluate the accuracy of the prognostic markers. The Kaplan-Meier method and log-rank test were used to analyze the overall survival probability. Univariate and multivariate analyses based on Cox risk regression were used to show the independent predictors. The nomogram was made by R studio. The predictive accuracy of nomogram was assessed using a calibration plot, concordance index (C-index), and decision curve.

RESULTS

A total of 737 patients were included in training cohort, 411 patients were included in validation cohort. ROC showed that the New-NPS was more suitable for predicting the prognosis of GC patients. NPS = 2 indicated a poor prognosis. Multivariate analysis showed that CEA (P = 0.026), Borrmann type (P = 0.001), pTNM (P < 0.001), New-NPS (P < 0.001), and nerve infiltration (P = 0.035) were independent risk factors for prognosis.

CONCLUSION

The New-NPS based on the cutoff values of NLR, LMR, Alb, and TC is not only suitable for predicting prognosis but can also be combined with clinicopathological characteristics to construct a nomogram model for GC patients.

Prevalence of Psychoactive Substance Consumption in People With Obesity

OBJECTIVE

The aim of this study was to evaluate the prevalence and the kind of psychoactive substances consumed by people with obesity.

METHODS

Patients were included at their first visit for bariatric surgery. Socio-demographic characteristics, anxiety, depressive disorders and psychoactive substance consumption were assessed. The prevalence of psychoactive substance consumption was compared to that of the general population reported by the French National Institute of Prevention and Health Education.

RESULTS

One hundred (100) patients were consecutively recruited: 60 women (mean age 41 ± 14 years) and 40 men (mean age 46 ± 13 years). Sixty-seven percent of subjects consumed alcohol. Consumption rates of cannabis (21% vs. 10%), cocaine (7.0% vs. 0.8%) and amphetamine (6.0% vs. 0.3%) were significantly (p < .0001) higher in people with obesity than in the general population.

CONCLUSIONS

People with obesity have an excess risk of amphetamine, cocaine and cannabis consumption. This consumption may increase the risk of cardiovascular and psychiatric morbidity and should therefore be detected before surgery.

Assessment of the body composition and the loss of fat-free mass through bioelectric impedance analysis in patients who underwent open gastric bypass

Background. Bariatric surgery is considered an effective option for the management of morbid obesity. The incidence of obesity has been gradually increasing all over the world reaching epidemic proportions in some regions of the world. Obesity can cause a reduction of up to 22% in the life expectancy of morbidly obese patients. Objective. The objective of this paper is to assess the weight loss associated with the first 6 months after bariatric surgery using bioelectric impedance analysis (BIA) for the evaluation of fat mass and fat-free mass. Method. A total of 36 morbidly obese patients were subjected to open gastric bypass surgery. The patients weight was monitored before and after the procedure using the bioelectric impedance analysis. Results. Bariatric surgery resulted in an average percentage of weight loss of 28.6% (40 kg) as determined 6 months after the procedure was performed. Analysis of the different components of body weight indicated an undesirable loss of fat-free mass along with the reduction of total body weight. Conclusion. Open gastric bypass induced a significant loss of total weight and loss of fat-free mass in patients six months after the surgery. The use of bioelectric impedance analysis resulted in an appropriate estimation of the total weight components in individuals subjected to bariatric surgery allowing a more real analysis of the variation of weight after the surgery.

Fiber, protein, and lupin-enriched foods: role for improving cardiovascular health

Cardiovascular diseases (CVD) are the leading cause of death globally (World Health Organisation, 2011). Many of the risk factors for CVD are modifiable, including overweight and obesity. Numerous strategies have been proposed to fight CVD, with a special focus being placed on dietary interventions for weight management. The literature suggests that two nutrients, fiber and protein, may play significant roles in weight control and hence cardiovascular health. Increasing both protein and fiber in the diet can be difficult because popular low-carbohydrate and high-protein diets tend to have considerably low-fiber intakes (Slavin, 2005). One approach to obtain both is to develop functional foods using unique ingredients. Lupin flour is a novel food ingredient derived from the endosperm of lupin. It contains 40-45% protein, 25-30% fiber, and negligible sugar and starch (Petterson and Crosbie, 1990). Research conducted to date reveals that lupin-enriched foods, which are naturally high in protein and fiber, may have a significant effect on CVD risk factors. This review explores whether there is a role for fiber-, protein-, and lupin-enriched foods in improving cardiovascular health.

[The effects of ileal transposition, gastrojejunal bypass and vertical gastroplasty on the regulation of ingestion in an experimental obesity model associated with diabetes mellitus type 2]

AIM

The continual advances in our knowledge of the pathogenesis and hormonal disorders of morbid obesity lead to new studies in experimental animals and the development of new technical options. The aim is to asses whether ileal transposition can be a good treatment of morbid obesity associated with diabetes mellitus due to the action of intestinal peptide Glp-1 (enteroglucagon) compared to gastric bypass and vertical gastroplasty (VGB).

MATERIAL AND METHODS

Trial environment: experimental animals ZDF rats (Zucker Diabetic Fatty rats). Subjects of the study: three groups of 10 animals each one divided as: a) ileal tranposition; b) gastro-jejunal bypass; c) vertical gastroplasty. Parameters to determine: weight loss, levels of glycaemia, enteroglucagon, insulin and ghrelin in blood, one week before the operation as a baseline control, and 15 days after the surgical procedure.

RESULTS

Gastrojejunal bypass produces the most significant weight loss. There is a significant decrease in intake in all groups. Hyperinsulinaemia and hyperglycaemia tend to decrease after surgery in all groups, but in ileal transposition there is better control of ketosis. After gastrojejunal bypass and ileal transposition, we observed an increase in GLP-1 levels but were only significant in ileal transposition.

CONCLUSIONS

Ileal transposition produces a decrease in plasma glucose and better control of diabetes mellitus, which could benefit patients affected by morbid obesity and poor metabolic control. More studies are needed on other models of obesity. A model of exogenous and reversible obesity could be a good option to study the real benefits of the interventions.

Estudo do padrão alimentar tardio em obesos submetidos à derivação gástrica com bandagem em Y- de- Roux: comparação entre homens e mulheres

OBJETIVO: Avaliar o padrão alimentar caracterizando preferências e intolerâncias alimentares em pacientes submetidos à derivação gástrica com bandagem em Y-de-Roux frente às modificações decorrentes da capacidade gástrica reduzida e também se há diferenças entre homens e mulheres em relação à alimentação após cirurgia. MÉTODOS: De julho de 2006 a julho de 2007 foi realizado um estudo transversal descritivo, de amostra por conveniência com 116 pacientes, após 12 meses de cirurgia de derivação gástrica com bandagem em Y-de-Roux, no ambulatório de Cirurgia Digestiva do Hospital Universitário da Universidade Estadual de Londrina. Foi aplicado um questionário abordando características demográficas, informações referentes ao hábito e padrão alimentar, presença de vômitos e sintomas de "dumping". As variáveis foram analisadas aplicando o teste exato de Fischer ou Qui-quadrado. RESULTADOS: Dos 116 pacientes 91(78,4%) eram mulheres e 25(21,5%) homens. Não houve diferença significativa entre homens e mulheres quanto ao tempo das refeições, número de refeições, líquidos nas refeições e ingestão hídrica diária. Quanto ao consumo de alimentos, relato de vômitos e sintomas de "dumping" houve pequena diferença entre homens e mulheres, no entanto sem diferença significativa a não ser quanto à ingestão de frutas e sonolência significativamente mais freqüente em mulheres. CONCLUSÃO: Com o questionário proposto foi possível avaliar o padrão tardio de aceitação alimentar dos pacientes e constatar que existe diferença entre homens e mulheres nas variáveis analisadas, apenas para o consumo de frutas.

Cardiologists' charting varied by risk factor, and was often discordant with patient report

OBJECTIVE

To assess the completeness of cardiac risk factor documentation by cardiologists, and agreement with patient report.

STUDY DESIGN AND SETTING

A total of 68 Ontario cardiologists and 789 of their ambulatory cardiology patients were randomly selected. Cardiac risk factor data were systematically extracted from medical charts, and a survey was mailed to participants to assess risk factor concordance.

RESULTS

With regard to completeness of risk factor documentation, 90.4% of charts contained a report of hypertension, 87.2% of diabetes, 80.5% of dyslipidemia, 78.6% of smoking behavior, 73.0% of other comorbidities, 48.7% of family history of heart disease, and 45.9% of body mass index or obesity. Using Cohen's k, there was a concordance of 87.7% between physician charts and patient self-report of diabetes, 69.5% for obesity, 56.8% for smoking status, 49% for hypertension, and 48.4% for family history.

CONCLUSION

Two of four major cardiac risk factors (hypertension and diabetes) were recorded in 90% of patient records; however, arguably the most important reversible risk factors for cardiac disease (dyslipidemia and smoking) were only reported 80% of the time. The results suggest that physician chart report may not be the criterion standard for quality assessment in cardiac risk factor reporting.

Weight loss outcome after silastic ring Roux-en-Y gastric bypass: five years of follow-up

BACKGROUND

An underlying major aim of bariatric surgery is weight loss and its long-term maintainance. In spite of this, most studies regarding weight loss after surgical treatment of morbid obesity, show 3-year follow-up results. We evaluated the effectiveness of Silastic ring Roux-en-Y gastric bypass (SR-RYGBP) in promoting significant weight loss after a 5-year follow-up at the Londrina State University Hospital.

METHODS

From May 1999 to December 2000, 211 morbidly obese patients were submitted to SR-RYGBP, by the same surgical team. The study's design was longitudinal, prospective and descriptive. The analysis of postoperative ponderal decrease was based on excess weight loss in percentage (%EWL) and the calculation of the BMI. Therapeutic failure was considered when patients lost <50% of excess weight at 2-years follow-up.

RESULTS

Patient loss to follow-up loss was 13%; therefore 183 patients were included in this study. The average global EWL was: 67.6% +/- 14.9 at the first postoperative year; 72.6% +/- 14.9 at the second year; and 69.7% +/- 15.1 in the fifth postoperative year. Surgical treatment failure occurred in 12 patients (6.5%) during the 5-year follow-up.

CONCLUSIONS

SR-RYGBP was effective in promoting and maintaining weight loss in the long-term, with a low failure rate.

Influence of sleeve gastrectomy on several experimental models of obesity: metabolic and hormonal implications

BACKGROUND

Ghrelin is an important factor in the regulation of intake. Most ghrelin is synthesized in the gastric fundus, but this is not the only location. The aim of this experimental study was to analyze the effect of sleeve gastrectomy (removing fundus) on the volume of intake in four experimental models and determine how this relates to changes in weight, plasmatic levels of glycemia, ghrelin, GLP-1, and insulin.

METHODS

Sleeve gastrectomy was performed on four experimental models: (1) non-obesity; (2) exogenous obesity caused by excessive calorie intake; (3) genetically determined obesity (Zucker rats); and (4) genetically determined obesity and type 2 diabetes mellitus (Zucker diabetic fatty; ZDF rats). Model 2 had a control group on which sleeve gastrectomy was not performed.

RESULTS

In the non-obese group, there were few changes after intervention, but in model 2, sleeve gastrectomy led to normalization of weight and endocrine-metabolic parameters that were the same as those for non-obese rats. The exception was for GLP-1, which has an anorexigenic effect: GLP-1 remained higher. In Zucker rats, sleeve gastrectomy had a slight effect on all parameters. In ZDF rats, sleeve gastrectomy led to a reduction in intake and a stabilization of weight.

CONCLUSIONS

Sleeve gastrectomy is a very good option for exogenous obesity. Normalization of hormonal levels led us to find an extragastric ghrelin production.

BDNF Val66Met polymorphism is associated with body mass index in healthy adults

Although recent studies suggest a possible relationship between the brain-derived neurotrophic factor Val66Met polymorphism and eating disorders, no study has examined the possibility that the Met-Met genotype is associated with a lower body mass index (BMI) in healthy individuals. We examined this possibility in 481 adults (age range 18-82 years) without significant medical or psychiatric history. After adjusting for gender, analysis of covariance showed that persons with the Met-Met genotype had a lower BMI than those with the Val-Met/Val-Val genotypes (22.28 +/-3.77 vs. 24.72+/-4.81). A similar, though nonsignificant, trend emerged when comparing all three genotypes separately. These findings suggest a possible relationship between Val66Met polymorphism and BMI in healthy adults. Further work is needed to clarify possible mechanisms for this relationship.

A comparison of weight histories in women with class III vs. class I-II obesity

OBJECTIVE

To describe the weight histories of women with extreme or class III obesity (BMI >or= 40 kg/m(2)) in comparison with a sample of women with class I-II obesity (BMI < 40 kg/m(2)) and to provide reliability data for a clinical instrument that assesses weight history.

RESEARCH METHODS AND PROCEDURES

Female patients (N = 149) with extreme obesity seeking bariatric surgery and 90 class I-II obese women seeking behavioral treatment completed the Weight and Lifestyle Inventory (WALI), a self-report instrument that assesses age of onset of obesity, maximum weight at different ages, family weight history, and weight changes related to pregnancy. Test-retest reliability data were obtained by administering the WALI to a subsample (n = 58) of class I-II obese participants at their initial visit and at another pretreatment visit 1 to 2 weeks later.

RESULTS

Patients with extreme obesity had a significantly younger age of onset of obesity, were significantly heavier at all age ranges, reported significantly more weight gain with their first pregnancy, and had significantly heavier parents and siblings as compared with less obese patients. There were no significant differences between groups with respect to weight gain during second pregnancies or postpartum weight retention. Robust test-retest correlations were obtained for the weight history items on the WALI.

DISCUSSION

Patients with extreme obesity report more indicators of a genetic predisposition to obesity as compared with less obese patients. The WALI appears to be a reliable instrument for the assessment of weight history in obese patients.

Effect of Roux-en-Y gastric bypass on satiety and food likes: the role of genetics

Among factors influencing the outcome of bariatric surgery may be genetics and familial risk. The purpose of this study was to assess the etiology of obesity and its impact on hunger, satiety, and food likes in obese patients undergoing Roux-en-Y gastric bypass (RYGB). This study was based on 76 patients undergoing RYGB procedures performed by a single surgeon. A previously described 100-point obesity risk index (ORI) was used to assess familial obesity risk. Hunger and satiety were assessed using a standardized Visual Analog Scale "Snickers" test, and food preferences for regular vs. low-fat potato chips were measured preoperatively and postoperatively. Patients were stratified preoperatively into high ORI (n = 34) and low ORI (n = 42) groups. Before operation, high-ORI patients preferred high-fat (regular) potato chips to low-fat (baked) potato chips, whereas the low-ORI patients liked both food types equivalently (P < 0.05). After operation (n = 43), both groups showed lower preferences for high-fat potato chips (P < 0.05 for high-ORI group). As anticipated, hunger was dramatically suppressed after RYGB. However, there was more satiety in the high-ORI group (P < 0.05, ANOVA). Most patients undergoing bariatric surgery had a strong familial or genetic component to their disease. RYGB in high-ORI patients was associated with a significant decline in preference of fatty food and a significantly prolonged drop in hunger ratings after a fast and after a standard 282 kcal meal. The success of bariatric surgery may be influenced by the etiology of obesity.