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Rodrigues PS, Mendonça FM, Neves JS, Luís C, Rodrigues I, Moreno T, Festas D, Pedro J, Varela A, Fernandes A, Costa EL, Freitas P. Effects of Bariatric Surgery on Sarcopenic Obesity Outcomes: A One-Year Prospective Study in Middle-Aged Women. Obes Surg 2024; 34:1674-1683. [PMID: 38523172 DOI: 10.1007/s11695-024-07164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Sarcopenic obesity (SO) is characterised by the confluence of muscle deterioration and high adiposity. When non-surgical interventions prove insufficient, bariatric surgery (BS) becomes the primary approach. This study aimed to address BS effects on SO outcomes 1 year post-surgery among middle-aged women, also considering physical exercise's impact. METHODS Prospective single-centre study of 140 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy between November 2019 and December 2022. Participants were categorised into tertiles according to SO's diagnosis and severity (group 1-patients with the most severe SO; group 2-intermediate; group 3-the least severe or without SO), calculated considering the consensus issued by ESPEN and EASO in 2022. Evaluations of clinical and biochemical parameters were conducted before and 12 months after BS, and the variation was used for comparative purposes. Body composition was assessed using bone density scans. Linear regression analysis accounted for both surgery type and baseline body mass index (BMI). RESULTS Before BS, SO prevalence in the overall sample was 89.3%, decreasing to 2.9% after BS. Group 1 had more body fat mass (56.9 vs 54.8 vs 50.7 kg, p < 0.001), total, trunk and leg fat at baseline and a significantly lower total skeletal muscle mass (47.2 vs 49.4 vs 51.8 kg, p < 0.001). One year post-BS, group 1 presented more weight loss (- 39.8 ± 11.4 kg, p = 0.031), BMI reduction (- 15.9 ± 4.6 kg/m2, p = 0.005) and lost more fat mass (- 32.6 vs - 30.5 vs - 27.9 kg, p = 0.005), but not total skeletal muscle mass (- 5.8 vs - 5.9 vs - 6.8 kg, p = 0.130). Remission rates for comorbidities were substantial among all groups, but more marked among patients within group 1 (type 2 diabetes mellitus 75%, hypertension 47.1% and dyslipidemia 52.8%). Engagement in physical exercise of any kind has increased post-BS (33.1% vs 79.1%). CONCLUSION Despite concerns about malabsorptive mechanisms potentially worsening muscle loss, patients with the most severe SO undergoing BS lost more fat mass while experiencing the smallest reduction in total skeletal muscle mass. Remission rates for comorbidities following BS were notable among all groups.
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Affiliation(s)
- Pietra S Rodrigues
- Biochemistry Unit, Biomedicine Department, FMUP-Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal
| | - Fernando M Mendonça
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal.
- CRIO group (Centro de Responsabilidade Integrada de Obesidade), São João Hospital and University Centre, 4200-319, Porto, Portugal.
| | - João S Neves
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carla Luís
- Biochemistry Unit, Biomedicine Department, FMUP-Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal
- i3S (Instituto de Investigação e Inovação em Saúde), Universidade do Porto, 4200-135, Porto, Portugal
| | - Ilda Rodrigues
- Biochemistry Unit, Biomedicine Department, FMUP-Faculty of Medicine, University of Porto, 4200-450, Porto, Portugal
| | - Telma Moreno
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Diana Festas
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
- CRIO group (Centro de Responsabilidade Integrada de Obesidade), São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Jorge Pedro
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
- CRIO group (Centro de Responsabilidade Integrada de Obesidade), São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Ana Varela
- Endocrinology, Diabetes and Metabolism Service, São João Hospital and University Centre, 4200-319, Porto, Portugal
- CRIO group (Centro de Responsabilidade Integrada de Obesidade), São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Ana Fernandes
- Nuclear Medicine Department, São João Hospital and University Centre, 4200-319, Porto, Portugal
- CINTESIS.UFP@RISE (Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde), Universidade Fernando Pessoa, 4249-004, Porto, Portugal
| | - Eduardo L Costa
- CRIO group (Centro de Responsabilidade Integrada de Obesidade), São João Hospital and University Centre, 4200-319, Porto, Portugal
| | - Paula Freitas
- CRIO group (Centro de Responsabilidade Integrada de Obesidade), São João Hospital and University Centre, 4200-319, Porto, Portugal
- i3S (Instituto de Investigação e Inovação em Saúde), Universidade do Porto, 4200-135, Porto, Portugal
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Mendonça FM, Silva MM, Borges-Canha M, Neves JS, Costa C, Cabral PM, Guerreiro V, Lourenço R, Meira P, Ferreira MJ, Salazar D, Pedro J, Varela A, Souto S, Lau E, Freitas P, Carvalho D, Group C. Statin Therapy Among Bariatric Patients: The Impact on Metabolic Outcomes and Diabetes Status. Exp Clin Endocrinol Diabetes 2022; 130:539-545. [PMID: 35320845 DOI: 10.1055/a-1743-2335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Statin therapy is associated with an increased risk of developing diabetes. Among bariatric patients, the influence of this therapy on various metabolic outcomes, such as diabetes status and its remission, is largely unknown. METHODS This was a retrospective study of 1710 patients who underwent bariatric surgery at our hospital between January/2010 and June/2017. We compared patients with and without statin therapy at baseline, 12 and 24 months after surgery regarding statin use and its impact on several clinical and analytical parameters. Multiple linear regression was performed, adjusting differences for age, sex, surgery type, antidiabetic drugs at baseline, hypertension at baseline, LDL cholesterol ˃ 130 mg/dL, weight variation one year after surgery, and age of obesity onset. RESULTS The overall prevalence of statin use was 20.2% before, 13.6% 12 months after surgery, and 15.0% 24 months after surgery. There was a larger reduction in fasting glucose and HbA1c at 12 and 24 months after surgery among statin-treated patients, with the opposite trend for weight reduction and BMI. Statin-treated patients with diabetes had lower diabetes remission rates (45.3 vs 68.5%) 12 months after surgery, with the highest reduction in HbA1c (1.3±1.3 vs -1.1±1.2%; p=0.042), fasting glucose (-40.8±48.8 vs -30.9±41.6 mg/dL; p=0.028), and insulin (-21.7±28.2 vs -13.4±14.2 mIU/L; p=0.039). The proportion of new-onset cases of diabetes was equal between statin-treated vs non-treated individuals at 12 months (1.9%) and 24 months (1.0%) after surgery. CONCLUSION Bariatric surgery seems to lead to diabetes remission more frequently in patients not treated with statins. A larger reduction was observed in fasting glucose and HbA1c among statin-treated patients. Statin did not contribute to an increased proportion of new-onset diabetes after surgery.
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Affiliation(s)
- Fernando M Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Maria M Silva
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Marta Borges-Canha
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - João S Neves
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Cláudia Costa
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João
| | - Pedro M Cabral
- Serviço de Patologia Clínica do Centro Hospitalar Universitário Cova da Beira
| | - Vanessa Guerreiro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto
| | - Patrícia Meira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto
| | - Maria J Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Daniela Salazar
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Jorge Pedro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Ana Varela
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Selma Souto
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Eva Lau
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar e Universitário de S. João.,Faculdade de Medicina da Universidade do Porto.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto
| | - Crio Group
- Centro de responsabilidade integrada em Obesidade, Centro Hospitalar e Universitário de S. João
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Mendonça FM, Neves JS, Silva MM, Borges-Canha M, Costa C, Cabral PM, Guerreiro V, Lourenço R, Meira P, Ferreira MJ, Salazar D, Pedro J, Viana S, Souto S, Varela A, Belo S, Lau E, Freitas P, Carvalho D. Secondary Hyperparathyroidism Among Bariatric Patients: Unraveling the Prevalence of an Overlooked Foe. Obes Surg 2021; 31:3768-3775. [PMID: 34120309 DOI: 10.1007/s11695-021-05495-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Bariatric surgery (BS) is the most effective therapeutic approach to obesity. It is associated with great gastrointestinal anatomic changes, predisposing the patients to altered nutrient absorption that impacts phosphocalcium metabolism. This study aimed to clarify the prevalence of secondary hyperparathyroidism (SHPT) and its predictors in patients submitted to BS. METHODS Retrospective study of 1431 patients who underwent metabolic surgery between January 2010 and June 2017 and who were followed for at least 1 year. We compared the clinical and biochemical characteristics of patients with and without secondary hyperparathyroidism (considering SHPT a PTH ˃ 69 pg/mL). Two different analyses were performed: (1) paired analysis of participants before and 1 year after surgery (N = 441); (2) Cross sectional analysis of participants submitted to bariatric surgery before (N = 441), 1 year after (N = 1431) and 4 years after surgery (N = 333). Multiple logistic regression models were used to evaluate possible predictors of SHPT after BS. RESULTS The overall prevalence of SHPT was 24.9% before surgery, 11.2% 1 year after surgery and 21.3% 4 years after surgery. Patients submitted to LAGB had the highest prevalence of SHPT 1 year after surgery (19.4%; vs RYGB, 12.8%, vs SG, 5.3%). Four years after surgery, RYGB had the highest prevalence of SHPT (27.0%), followed by LAGB (13.2%) and SG (6.9%). Higher body mass index and age, decreased levels of vitamin D and RYGB seem to be independent predictors of SHPT 1 year after surgery. The only independent predictor of SHPT 4 years after surgery was RYGB. CONCLUSION The prevalence of SHPT is higher before and 4 years after BS than 1 year after surgery. This fact raises some questions about the efficacy of the implemented follow-up plans of vitamin D supplementation on the long term, mainly among patients submitted to RYGB.
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Affiliation(s)
- Fernando M Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal.
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - João S Neves
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria M Silva
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Marta Borges-Canha
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Cláudia Costa
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro M Cabral
- Serviço de Patologia Clínica, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - Vanessa Guerreiro
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Patrícia Meira
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Maria J Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Jorge Pedro
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Sara Viana
- Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Selma Souto
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Varela
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Sandra Belo
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Eva Lau
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Ferrándiz L, Silla-Prósper M, García-de-la-Oliva A, Mendonça FM, Ojeda-Vila T, Moreno-Ramírez D. Yield of Computed Tomography at Baseline Staging of Melanoma. Actas Dermosifiliogr 2015; 107:55-61. [PMID: 26548299 DOI: 10.1016/j.ad.2015.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/05/2015] [Accepted: 09/12/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Current guidelines call for baseline imaging only for very high-risk (T4b) primary cutaneous melanomas. OBJECTIVES To estimate the frequency of computed tomography (CT) at baseline staging of primary cutaneous melanoma and the diagnostic yield of CT; and to describe the types and frequencies of incidentaloma findings. MATERIAL AND METHODS Cross-sectional study of cutaneous melanoma cases (tumor classifications Tis to T4bN0M0) attended between 2008 and 2014 in a specialized melanoma unit. Reports of CT scans performed during baseline staging were reviewed to determine the frequency of positive scan results, incidentaloma findings, unit cost for detection of metastasis, and factors associated with the decision to order CT. RESULTS CT results were available for 310 of the 419 patients included (73.99%). The tumor classifications were as follows: Tis, 17; T1, 137; T2, 71; T3, 48; and T4, 37. The CT results were negative in 81.61%, and incidentalomas were found in 18.06%. Additional primary tumors were found in 2 patients (0.64%), and metastasis was identified in one patient (0.32%). The cost of finding the case of metastasis was €71,234.90. A T2 tumor classification (odds ratio [OR], 8.73) and age under 70 years (OR, 3.53) were associated with greater likelihood of CT being ordered. Excision of the primary tumor in the melanoma unit (OR, 0.08) was associated with less likelihood of ordering CT. CONCLUSIONS The results for this patient series support current recommendations restricting CT at baseline to cases where there is high risk of metastasis (stagesiiC-iii).
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Affiliation(s)
- L Ferrándiz
- Unidad de Melanoma, Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - M Silla-Prósper
- Unidad de Melanoma, Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A García-de-la-Oliva
- Unidad de Gestión Clínica de Diagnóstico por la Imagen, Hospital Universitario Virgen Macarena, Sevilla, España
| | - F M Mendonça
- Unidad de Melanoma, Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - T Ojeda-Vila
- Unidad de Melanoma, Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - D Moreno-Ramírez
- Unidad de Melanoma, Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España
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