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Ožvald I, Božičević D, Duh L, Vinković Vrček I, Pavičić I, Domijan AM, Milić M. Effects of a 3-Week Hospital-Controlled Very-Low-Calorie Diet in Severely Obese Patients. Nutrients 2021; 13:4468. [PMID: 34960018 PMCID: PMC8703721 DOI: 10.3390/nu13124468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/28/2022] Open
Abstract
Although a very-low-calorie diet (VLCD) is considered safe and has demonstrated benefits among other types of diets, data are scarce concerning its effects on improving health and weight loss in severely obese patients. As part of the personalized weight loss program developed at the Duga Resa Special Hospital for Extended Treatment, Croatia, we evaluated anthropometric, biochemical, and permanent DNA damage parameters (assessed with the cytochalasin B-blocked micronucleus cytome assay-CBMN) in severely obese patients (BMI ≥ 35 kg m-2) after 3-weeks on a 567 kcal, hospital-controlled VLCD. This is the first study on the permanent genomic (in)stability in such VLCD patients. VLCDs caused significant decreases in weight (loss), parameters of the lipid profile, urea, insulin resistance, and reduced glutathione (GSH). Genomic instability parameters were lowered by half, reaching reference values usually found in the healthy population. A correlation was found between GSH decrease and reduced DNA damage. VLCDs revealed susceptible individuals with remaining higher DNA damage for further monitoring. In a highly heterogeneous group (class II and III in obesity, differences in weight, BMI, and other categories) consisting of 26 obese patients, the approach demonstrated its usefulness and benefits in health improvement, enabling an individual approach to further monitoring, diagnosis, treatment, and risk assessment based on changing anthropometric/biochemical VLCD parameters, and CBMN results.
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Affiliation(s)
- Ivan Ožvald
- Duga Resa Special Hospital for Extended Treatment, 47250 Duga Resa, Croatia; (I.O.); (D.B.); (L.D.)
| | - Dragan Božičević
- Duga Resa Special Hospital for Extended Treatment, 47250 Duga Resa, Croatia; (I.O.); (D.B.); (L.D.)
| | - Lidija Duh
- Duga Resa Special Hospital for Extended Treatment, 47250 Duga Resa, Croatia; (I.O.); (D.B.); (L.D.)
| | - Ivana Vinković Vrček
- Analytical Toxicology and Mineral Metabolism Unit, Institute for Medical Research and Occupational Health (IMROH), Ksaverska Cesta 2, 10001 Zagreb, Croatia;
| | - Ivan Pavičić
- Radiation Dosimetry and Radiobiology Unit, Institute for Medical Research and Occupational Health (IMROH), Ksaverska Cesta 2, 10001 Zagreb, Croatia;
| | - Ana-Marija Domijan
- Department of Pharmaceutical Botany, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia;
| | - Mirta Milić
- Mutagenesis Unit, Institute for Medical Research and Occupational Health (IMROH), Ksaverska Cesta 2, 10001 Zagreb, Croatia
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Longhi R, Santos ASEADC, López-Yerena A, Rodrigues APS, de Oliveira C, Silveira EA. The Effectiveness of Extra Virgin Olive Oil and the Traditional Brazilian Diet in Reducing the Inflammatory Profile of Individuals with Severe Obesity: A Randomized Clinical Trial. Nutrients 2021; 13:nu13114139. [PMID: 34836393 PMCID: PMC8624522 DOI: 10.3390/nu13114139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022] Open
Abstract
We analyzed the effectiveness of two nutritional interventions alone and together, EVOO and the DieTBra, on the inflammatory profile of severely obese individuals. This study was an RCT with 149 individuals aged from 18 to 65 years, with a body mass index ≥ 35 kg/m2, randomized into three intervention groups: (1) 52 mL/day of EVOO (n = 50); (2) DieTBra (n = 49); and (3) DieTBra plus 52 mL/day of EVOO (DieTBra + EVOO, n = 50). The primary outcomes we measured were the-neutrophil-to-lymphocyte ratio (NLR) and the secondary outcomes we measured were the lymphocyte-to-monocyte ratio (LMR); leukocytes; and C reactive protein (CRP). After 12 weeks of intervention, DieTBra + EVOO significantly reduced the total leucocytes (p = 0.037) and LMR (p = 0.008). No statistically significant differences were found for the NLR in neither the intra-group and inter-group analyses, although a slight reduction was found in the DieTBra group (−0.22 ± 1.87). We observed reductions in the total leukocytes and LMR in the three groups, though without statistical difference between groups. In conclusion, nutritional intervention with DietBra + EVOO promotes a significant reduction in inflammatory biomarkers, namely leukocytes and LMR. CRP was reduced in EVOO and DieTBra groups and NLR reduced in the DieTBra group. This study was registered at ClinicalTrials.gov under NCT02463435.
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Affiliation(s)
- Rafael Longhi
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil;
| | - Annelisa Silva e Alves de Carvalho Santos
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Rua 235 c/1ª s/n, Setor Universitário, Goiânia 74650-050, Brazil; (A.S.e.A.d.C.S.); (A.P.S.R.)
| | - Anallely López-Yerena
- Department of Nutrition, Food Science and Gastronomy, XIA, Faculty of Pharmacy and Food Sciences, Institute of Nutrition and Food Safety (INSA-UB), University of Barcelona, 08028 Barcelona, Spain;
| | - Ana Paula Santos Rodrigues
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Rua 235 c/1ª s/n, Setor Universitário, Goiânia 74650-050, Brazil; (A.S.e.A.d.C.S.); (A.P.S.R.)
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, London University College, London WC1E 6BT, UK;
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Rua 235 c/1ª s/n, Setor Universitário, Goiânia 74650-050, Brazil; (A.S.e.A.d.C.S.); (A.P.S.R.)
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, London University College, London WC1E 6BT, UK;
- Correspondence: ; Tel.: +55-62-3209-6151
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Tricò D, Moriconi D, Nannipieri M. Reply to Landry et al. Findings from Diet Comparison Difficult to Interpret in the Absence of Adherence Assessment. Comment on "Tricò et al. Effects of Low-Carbohydrate versus Mediterranean Diets on Weight Loss, Glucose Metabolism, Insulin Kinetics and β-Cell Function in Morbidly Obese Individuals. Nutrients 2021, 13, 1345". Nutrients 2021; 13:3695. [PMID: 34835951 PMCID: PMC8617652 DOI: 10.3390/nu13113695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/25/2021] [Indexed: 12/30/2022] Open
Abstract
We thank Dr. Landry and colleagues [...].
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Affiliation(s)
- Domenico Tricò
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Diego Moriconi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
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Kolen AM, Romeijn MM, Holthuijsen DDB, Janssen L, Greve JWM, Leclercq WKG, van Dielen FMH. Current preoperative strategies applied in the Dutch bariatric centers: A national survey. Clin Obes 2021; 11:e12461. [PMID: 34028197 PMCID: PMC8365720 DOI: 10.1111/cob.12461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/30/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
There is no consensus about the optimal management of patients undergoing bariatric surgery. This study aimed to identify current weight loss goals prior to bariatric surgery, as well as aimed to explore preoperative strategies related to diet, nutritional supplements and physical activity. An online survey was distributed among bariatric surgeons and dietitians in all 18 Dutch bariatric centers. This survey included the following four domains: weight loss, diet, nutritional supplements and physical activity. For the analyses one answer per center was used, either the most common answer or the answer given by the most expert responder. All 18 centers reported at least one response. Preoperative weight loss was requested in 28% of the centers, whereas 61% desired a stable weight or weight loss, and 11% had no requests. A preoperative diet was routinely recommended in 78% of the centers and on indication (ie, depending on baseline weight and/or comorbidity status) in 22%. The most frequently prescribed diet was a low-energy diet (800-1500 kcal/day) in 44% of the centers. Nutritional supplements were recommended in 78% of the centers. Physical activity with low intensity was recommended in 83% of the centers, while physical exercise training with mid- to high-intensity was recommended in 72%. Inconsistent responses within centers were observed in 56% of the questions. The current bariatric practice within the Netherlands shows high variability and inconsistencies in preoperative management. Consensus-building and standardization of strategies should be promoted in the future.
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Affiliation(s)
- Aniek M. Kolen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Marleen M. Romeijn
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Research School NUTRIM, Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Daniëlle D. B. Holthuijsen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Loes Janssen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
| | - Jan Willem M. Greve
- Research School NUTRIM, Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
- Department of SurgeryZuyderland Medical CenterHeerlenThe Netherlands
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Crujeiras AB, Izquierdo AG, Primo D, Milagro FI, Sajoux I, Jácome A, Fernandez-Quintela A, Portillo MP, Martínez JA, Martinez-Olmos MA, de Luis D, Casanueva FF. Epigenetic landscape in blood leukocytes following ketosis and weight loss induced by a very low calorie ketogenic diet (VLCKD) in patients with obesity. Clin Nutr 2021; 40:3959-3972. [PMID: 34139469 DOI: 10.1016/j.clnu.2021.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/07/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The molecular mechanisms underlying the potential health benefits of a ketogenic diet are unknown and could be mediated by epigenetic mechanisms. OBJECTIVE To identify the changes in the obesity-related methylome that are mediated by the induced weight loss or are dependent on ketosis in subjects with obesity underwent a very-low calorie ketogenic diet (VLCKD). METHODS Twenty-one patients with obesity (n = 12 women, 47.9 ± 1.02 yr, 33.0 ± 0.2 kg/m2) after 6 months on a VLCKD and 12 normal weight volunteers (n = 6 women, 50.3 ± 6.2 yrs, 22.7 ± 1.5 kg/m2) were studied. Data from the Infinium MethylationEPIC BeadChip methylomes of blood leukocytes were obtained at time points of ketotic phases (basal, maximum ketosis, and out of ketosis) during VLCKD (n = 10) and at baseline in volunteers (n = 12). Results were further validated by pyrosequencing in representative cohort of patients on a VLCKD (n = 18) and correlated with gene expression. RESULTS After weight reduction by VLCKD, differences were found at 988 CpG sites (786 unique genes). The VLCKD altered methylation levels in patients with obesity had high resemblance with those from normal weight volunteers and was concomitant with a downregulation of DNA methyltransferases (DNMT)1, 3a and 3b. Most of the encoded genes were involved in metabolic processes, protein metabolism, and muscle, organ, and skeletal system development. Novel genes representing the top scoring associated events were identified, including ZNF331, FGFRL1 (VLCKD-induced weight loss) and CBFA2T3, C3orf38, JSRP1, and LRFN4 (VLCKD-induced ketosis). Interestingly, ZNF331 and FGFRL1 were validated in an independent cohort and inversely correlated with gene expression. CONCLUSIONS The beneficial effects of VLCKD therapy on obesity involve a methylome more suggestive of normal weight that could be mainly mediated by the VLCKD-induced ketosis rather than weight loss.
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Affiliation(s)
- Ana B Crujeiras
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Spain; CIBER Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Spain.
| | - Andrea G Izquierdo
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Spain; CIBER Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Spain
| | - David Primo
- Center of Investigation of Endocrinology and Nutrition, Medicine School and Department of Endocrinology and Investigation, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Fermin I Milagro
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, University of Navarra (UNAV) and IdiSNA, Navarra Institute for Health Research, 31009, Pamplona, Spain; CIBER Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Spain
| | - Ignacio Sajoux
- Medical Department Pronokal Group, PronokalGroup, Barcelona, Spain
| | - Amalia Jácome
- Department of Mathematics, MODES Group, CITIC, Universidade da Coruña, Faculty of Science, A Coruña, Spain
| | - Alfredo Fernandez-Quintela
- Nutrition and Obesity Group, Department of Nutrition and Food Science, University of the Basque Country (UPV/EHU), Lucio Lascaray Research Institute and Health Research Institute BIOARABA, Vitoria, Spain; CIBER Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Spain
| | - María P Portillo
- Nutrition and Obesity Group, Department of Nutrition and Food Science, University of the Basque Country (UPV/EHU), Lucio Lascaray Research Institute and Health Research Institute BIOARABA, Vitoria, Spain; CIBER Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Spain
| | - J Alfredo Martínez
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, University of Navarra (UNAV) and IdiSNA, Navarra Institute for Health Research, 31009, Pamplona, Spain; CIBER Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Spain
| | - Miguel A Martinez-Olmos
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Spain; CIBER Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Spain
| | - Daniel de Luis
- Center of Investigation of Endocrinology and Nutrition, Medicine School and Department of Endocrinology and Investigation, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Felipe F Casanueva
- Molecular and Cellular Endocrinology Group. Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS) and Santiago de Compostela University (USC), Spain; CIBER Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Spain
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6
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van der Kolk BW, Muniandy M, Kaminska D, Alvarez M, Ko A, Miao Z, Valsesia A, Langin D, Vaittinen M, Pääkkönen M, Jokinen R, Kaye S, Heinonen S, Virtanen KA, Andersson DP, Männistö V, Saris WH, Astrup A, Rydén M, Blaak EE, Pajukanta P, Pihlajamäki J, Pietiläinen KH. Differential Mitochondrial Gene Expression in Adipose Tissue Following Weight Loss Induced by Diet or Bariatric Surgery. J Clin Endocrinol Metab 2021; 106:1312-1324. [PMID: 33560372 PMCID: PMC8063261 DOI: 10.1210/clinem/dgab072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Mitochondria are essential for cellular energy homeostasis, yet their role in subcutaneous adipose tissue (SAT) during different types of weight-loss interventions remains unknown. OBJECTIVE To investigate how SAT mitochondria change following diet-induced and bariatric surgery-induced weight-loss interventions in 4 independent weight-loss studies. METHODS The DiOGenes study is a European multicenter dietary intervention with an 8-week low caloric diet (LCD; 800 kcal/d; n = 261) and 6-month weight-maintenance (n = 121) period. The Kuopio Obesity Surgery study (KOBS) is a Roux-en-Y gastric bypass (RYGB) surgery study (n = 172) with a 1-year follow-up. We associated weight-loss percentage with global and 2210 mitochondria-related RNA transcripts in linear regression analysis adjusted for age and sex. We repeated these analyses in 2 studies. The Finnish CRYO study has a 6-week LCD (800-1000 kcal/d; n = 19) and a 10.5-month follow-up. The Swedish DEOSH study is a RYGB surgery study with a 2-year (n = 49) and 5-year (n = 37) follow-up. RESULTS Diet-induced weight loss led to a significant transcriptional downregulation of oxidative phosphorylation (DiOGenes; ingenuity pathway analysis [IPA] z-scores: -8.7 following LCD, -4.4 following weight maintenance; CRYO: IPA z-score: -5.6, all P < 0.001), while upregulation followed surgery-induced weight loss (KOBS: IPA z-score: 1.8, P < 0.001; in DEOSH: IPA z-scores: 4.0 following 2 years, 0.0 following 5 years). We confirmed an upregulated oxidative phosphorylation at the proteomics level following surgery (IPA z-score: 3.2, P < 0.001). CONCLUSIONS Differentially regulated SAT mitochondria-related gene expressions suggest qualitative alterations between weight-loss interventions, providing insights into the potential molecular mechanistic targets for weight-loss success.
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Affiliation(s)
- Birgitta W van der Kolk
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Maheswary Muniandy
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Dorota Kaminska
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marcus Alvarez
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Arthur Ko
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zong Miao
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Bioinformatics Interdepartmental Program, UCLA, Los Angeles, CA, USA
| | - Armand Valsesia
- Nestlé Institute of Health Sciences, 1015 Lausanne, Switzerland
| | - Dominique Langin
- Institut National de la Santé et de la Recherche Médicale (Inserm), Université Paul Sabatier, Institute of Metabolic and Cardiovascular Diseases, Toulouse, France
- Department of Biochemistry, Toulouse University Hospitals, France
| | - Maija Vaittinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mirva Pääkkönen
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Finland
| | - Riikka Jokinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Sanna Kaye
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Sini Heinonen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Kirsi A Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
- Turku PET Center, Turku University Hospital, Turku, Finland
| | - Daniel P Andersson
- Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Ville Männistö
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Wim H Saris
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, MD Maastricht, The Netherlands
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Mikael Rydén
- Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Ellen E Blaak
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, MD Maastricht, The Netherlands
| | - Päivi Pajukanta
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Bioinformatics Interdepartmental Program, UCLA, Los Angeles, CA, USA
- Institute for Precision Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
- Obesity Center, Abdominal center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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7
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Fontalba-Romero MI, López-Enriquez S, Lago-Sampedro A, Garcia-Escobar E, Pastori RL, Domínguez-Bendala J, Alvarez-Cubela S, Valdés S, Rojo-Martinez G, García-Fuentes E, Labajos-Manzanares MT, García-Serrano S. Association between the Mediterranean Diet and Metabolic Syndrome with Serum Levels of miRNA in Morbid Obesity. Nutrients 2021; 13:nu13020436. [PMID: 33572759 PMCID: PMC7911421 DOI: 10.3390/nu13020436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/17/2022] Open
Abstract
Background: The Mediterranean diet (MD) could be involved in the regulation of different miRNAs related to metabolic syndrome (MS). Methods: We analyzed the serum level of mir-let7a-5p, mir-21, mir-590, mir-107 and mir-192 in patients with morbid obesity and its association with the MD and MS. Results: There is an association between the adherence to MD and higher serum levels of mir-590. Mir-590 was lower in those patients who consumed >2 commercial pastries/week. Mir-let7a was lower in those who consumed ≥1 sweetened drinks, in those who consumed ≥3 pieces of fruit/day and in those who consumed less red than white meat. A lower mir-590 and mir-let7a, and a higher mir-192 level, were found in patients who met the high-density lipoprotein cholesterol (HDL) criterion of MS. A higher mir-192 was found in those patients who met the triglyceride criterion of MS and in those with type 2 diabetes (T2DM). Conclusions: There is an association between specific serum levels of miRNAs and the amount and kind of food intake related to MD. Mir-590 was positively associated with a healthy metabolic profile and type of diet, while mir-192 was positively associated with a worse metabolic profile. These associations could be suggestive of a possible modulation of these miRNAs by food.
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Affiliation(s)
- María I. Fontalba-Romero
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario, 29010 Málaga, Spain; (M.I.F.-R.); (A.L.-S.); (E.G.-E.); (S.V.); (S.G.-S.)
| | - Soledad López-Enriquez
- Departamento de Bioquímica Médica, Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain;
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
| | - Ana Lago-Sampedro
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario, 29010 Málaga, Spain; (M.I.F.-R.); (A.L.-S.); (E.G.-E.); (S.V.); (S.G.-S.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
| | - Eva Garcia-Escobar
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario, 29010 Málaga, Spain; (M.I.F.-R.); (A.L.-S.); (E.G.-E.); (S.V.); (S.G.-S.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
- CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), 29009 Málaga, Spain
| | - Ricardo L. Pastori
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.L.P.); (J.D.-B.); (S.A.-C.)
| | - Juan Domínguez-Bendala
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.L.P.); (J.D.-B.); (S.A.-C.)
| | - Silvia Alvarez-Cubela
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.L.P.); (J.D.-B.); (S.A.-C.)
| | - Sergio Valdés
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario, 29010 Málaga, Spain; (M.I.F.-R.); (A.L.-S.); (E.G.-E.); (S.V.); (S.G.-S.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
- CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), 29009 Málaga, Spain
| | - Gemma Rojo-Martinez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario, 29010 Málaga, Spain; (M.I.F.-R.); (A.L.-S.); (E.G.-E.); (S.V.); (S.G.-S.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
- CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), 29009 Málaga, Spain
- Correspondence: (G.R.-M); (E.G.-F.)
| | - Eduardo García-Fuentes
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Correspondence: (G.R.-M); (E.G.-F.)
| | | | - Sara García-Serrano
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario, 29010 Málaga, Spain; (M.I.F.-R.); (A.L.-S.); (E.G.-E.); (S.V.); (S.G.-S.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
- CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), 29009 Málaga, Spain
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8
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Aakre KM, Omland T, Nordstrand N, Gjevestad ES, Holven KB, Lyngbakken MN, Hjelmesæth J. Gastric bypass surgery is associated with reduced subclinical myocardial injury and greater activation of the cardiac natriuretic peptide system than lifestyle intervention. Clin Biochem 2020; 86:36-44. [PMID: 32986994 DOI: 10.1016/j.clinbiochem.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/26/2020] [Revised: 09/09/2020] [Accepted: 09/19/2020] [Indexed: 12/18/2022]
Abstract
AIMS Morbid obesity is a risk factor for cardiovascular disease. The relative effects of Roux-en-Y gastric bypass surgery (GBS) and intensive lifestyle intervention (ILI) on subclinical myocardial injury, the activity of the cardiac natriuretic system, and systemic inflammation remain unclear. METHODS In a 59-week non-randomized clinical trial that included 131 patients with morbid obesity, we compared the effects ofGBS and ILI on concentrations of cardiac troponin T (cTnT) and I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP). RESULTS In the GBS and ILI group, median body mass index (BMI) was reduced by 14.4 kg/m2 versus 3.9 kg/m2, respectively (p value < 0.001). Cardiac troponins decreased after GBS, p = 0.014 (cTnT) and p = 0.065 (cTnI) and increased significantly in those treated with ILI (p values ≤ 0.021) (between-group differences for deltas: p ≤ 0.003). NT-proBNP increased in both groups, but significantly more in the GBS than in the ILI group (between-group differences for deltas: p = 0.008). CRP decreased significantly within the GBS and the ILI group, with this change significantly greater in the GBS group (between-group differences for deltas p < 0.001). The dominating mediator of the biomarker changes was weight loss. Prior coronary artery disease and diabetes were predictive of the magnitude of the changes in cTnI and NT-proBNP, respectively. CONCLUSION Compared to ILI, GBS was associated with reduced subclinical myocardial injury and systemic inflammation, and enhancement of the cardiac natriuretic peptide system. The biomarker changes were predominantly mediated by weight loss.
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Affiliation(s)
- Kristin M Aakre
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Njord Nordstrand
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Magnus N Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Cardiovascular Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jøran Hjelmesæth
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Norway
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9
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D’Abbondanza M, Ministrini S, Pucci G, Nulli Migliola E, Martorelli EE, Gandolfo V, Siepi D, Lupattelli G, Vaudo G. Very Low-Carbohydrate Ketogenic Diet for the Treatment of Severe Obesity and Associated Non-Alcoholic Fatty Liver Disease: The Role of Sex Differences. Nutrients 2020; 12:nu12092748. [PMID: 32916989 PMCID: PMC7551320 DOI: 10.3390/nu12092748] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
Very low-carbohydrate ketogenic diets (VLCKDs) are an emerging nutritional treatment for severe obesity and are associated with a significant improvement in non-alcoholic fatty liver disease (NAFLD). Little is known about the effect of sex differences on weight loss induced by following a VLCKD. The aim of this study was to investigate the effects of sex differences on weight loss and NAFLD improvement in patients with severe obesity undergoing a VLCKD. Forty-two females and 28 males with severe obesity underwent a 25-day VLCKD. Anthropometric parameters, bioimpedentiometry, degree of liver steatosis measured by ultrasonography, liver function tests, and glucose homeostasis were measured before and after the VLCKD. Males experienced a significantly larger excess body weight loss (EBWL) and a greater reduction in γ-glutamyl transferase (γGT) than females. Dividing the female group by menopausal status, a significant difference between males and pre-menopausal females was found for both EBWL and γGT. No significant difference between groups was observed for improvement in the Edmonton stage or in the degree of steatosis. We conclude that the efficacy of following a VLCKD in severe obesity is affected by sex differences and, for females, by menopausal status. Males seem to experience larger benefits than females in terms of EBWL and NAFLD improvement. These differences are attenuated after menopause, probably because of changes in hormonal profile and body composition.
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Affiliation(s)
- Marco D’Abbondanza
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Internal Medicine, “Santa Maria” University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy
| | - Stefano Ministrini
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Correspondence: ; Tel.: +39-075-578-4020
| | - Giacomo Pucci
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Internal Medicine, “Santa Maria” University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy
| | - Elisa Nulli Migliola
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
| | - Eva-Edvige Martorelli
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
| | - Vito Gandolfo
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Internal Medicine, “Santa Maria” University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy
| | - Donatella Siepi
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
| | - Graziana Lupattelli
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
| | - Gaetano Vaudo
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Internal Medicine, “Santa Maria” University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy
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10
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Abstract
Bariatric surgery (BS) is today the most effective therapy for inducing long-term weight loss and for reducing comorbidity burden and mortality in patients with severe obesity. On the other hand, BS may be associated to new clinical problems, complications and side effects, in particular in the nutritional domain. Therefore, the nutritional management of the bariatric patients requires specific nutritional skills. In this paper, a brief overview of the nutritional management of the bariatric patients will be provided from pre-operative to post-operative phase. Patients with severe obesity often display micronutrient deficiencies when compared to normal weight controls. Therefore, nutritional status should be checked in every patient and correction of deficiencies attempted before surgery. At present, evidences from randomized and retrospective studies do not support the hypothesis that pre-operative weight loss could improve weight loss after BS surgery, and the insurance-mandated policy of a preoperative weight loss as a pre-requisite for admission to surgery is not supported by medical evidence. On the contrary, some studies suggest that a modest weight loss of 5-10% in the immediate preoperative period could facilitate surgery and reduce the risk of complications. Very low calories diet (VLCD) and very low calories ketogenic diets (VLCKD) are the most frequently used methods for the induction of a pre-operative weight loss today. After surgery, nutritional counselling is recommended in order to facilitate the adaptation of the eating habits to the new gastro-intestinal physiology. Nutritional deficits may arise according to the type of bariatric procedure and they should be prevented, diagnosed and eventually treated. Finally, specific nutritional problems, like dumping syndrome and reactive hypoglycaemia, can occur and should be managed largely by nutritional manipulation. In conclusion, the nutritional management of the bariatric patients requires specific nutritional skills and the intervention of experienced nutritionists and dieticians.
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Affiliation(s)
- Silvia Bettini
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Anna Belligoli
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Roberto Fabris
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Luca Busetto
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy.
- Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, Padova, 35128, Italy.
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11
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Lingamfelter M, Orozco FR, Beck CN, Harrer MF, Post ZD, Ong AC, Ponzio DY. Nutritional Counseling Program for Morbidly Obese Patients Enables Weight Optimization for Safe Total Joint Arthroplasty. Orthopedics 2020; 43:e316-e322. [PMID: 32501522 DOI: 10.3928/01477447-20200521-08] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/06/2019] [Indexed: 02/03/2023]
Abstract
Obesity affects one-third of total joint arthroplasty (TJA) patients and is the most common modifiable risk factor for increased complications in the TJA population. The authors' institution implemented a body mass index (BMI) cutoff of 40 kg/m2 to define appropriate TJA candidates. Patients above the cutoff were referred for nutritional counseling. The study objective was to evaluate the efficacy of this protocol in optimizing patient BMI for safe and successful TJA. Between 2016 and 2018, the authors examined 133 patients (mean age, 62.6 years) with a BMI greater than 40 kg/m2 seeking TJA (94 knee, 39 hip) seen by an arthroplasty surgeon and then a dietitian. Outcomes included weight loss, change in BMI, duration of counseling, and surgical status. For postoperative patients, 90-day complications were recorded. A total of 102 (92%) patients achieved weight loss during a mean 154 days (range, 8-601 days). Patients lost a mean of 17 lb, lowering their BMI by 2.7 points (range, +6.3 to -17.7 points). Twenty-two patients discontinued nutritional counseling after 1 visit, most commonly secondary to cost when not covered by insurance. Seventy-one patients successfully underwent TJA, representing 64% of those patients who participated in nutritional counseling. Complications included delayed wound healing (n=2), periprosthetic fracture (n=2), infection (n=1), cellulitis (n=1), and peroneal nerve palsy (n=1). Surgeons must actively counsel obese patients about weight optimization as part of the preoperative standard of care. Nutritional counseling with a dietitian and follow-up with the surgeon translated to safe and successful TJA in a majority of patients. [Orthopedics. 2020;43(4):e316-e322.].
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12
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Santos ASEADC, Rodrigues APDS, Rosa LPDS, Noll M, Silveira EA. Traditional Brazilian Diet and Olive Oil Reduce Cardiometabolic Risk Factors in Severely Obese Individuals: A Randomized Trial. Nutrients 2020; 12:nu12051413. [PMID: 32422956 PMCID: PMC7284483 DOI: 10.3390/nu12051413] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/03/2020] [Accepted: 05/11/2020] [Indexed: 01/14/2023] Open
Abstract
Cardioprotective effects associated with extra virgin olive oil (EVOO) have been studied within the Mediterranean diet. However, little is known about its consumption in the traditional Brazilian diet (DieTBra) or without any dietary prescription, particularly in severely obese individuals. This study aimed to assess the effectiveness of DieTBra and EVOO in cardiometabolic risk factor (CMRF) reduction in severely obese individuals. We conducted a parallel randomized clinical trial with 149 severely obese individuals (body mass index ≥ 35.0 kg/m2) aged 18–65 years, assigned to three groups: 52 mL/day of EVOO (n = 50), DieTBra (n = 49), and DieTBra + 52 mL/day of EVOO (n = 50). Participants were followed up for 12 weeks. Low-density lipoprotein cholesterol (LDL-c) was the primary endpoint and several cardiometabolic parameters were secondary endpoints. Endpoints were compared at baseline and at the end of the study using analysis of variance, the Kruskal–Wallis test, and Student’s t-test. The TC/High-density lipoprotein (HDL) ratio (−0.33 ± 0.68, p = 0.002) and LDL/HDL ratio (−0.26 ± 0.59, p = 0.005) decreased in the EVOO group. Delta values for all variables showed no significant statistical difference between groups. However, we highlight the clinical significance of LDL-c reduction in the EVOO group by 5.11 ± 21.79 mg/dL and in the DieTBra group by 4.27 ± 23.84 mg/dL. We also found a mean reduction of around 10% for Castelli II (LDL/HDL) and homocysteine in the EVOO group and TG and the TG/HDL ratio in the DieTBra group. EVOO or DieTBra when administered alone lead to reduction in some cardiometabolic risk parameters in severely obese individuals.
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Affiliation(s)
- Annelisa Silva e Alves de Carvalho Santos
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74.650-050, GO, Brazil; (A.P.d.S.R.); (L.P.d.S.R.); (M.N.)
- Correspondence: (A.S.e.A.d.C.S.); (E.A.S.); Tel./Fax: +55-62-3209-6151 (E.A.S.)
| | - Ana Paula dos Santos Rodrigues
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74.650-050, GO, Brazil; (A.P.d.S.R.); (L.P.d.S.R.); (M.N.)
| | - Lorena Pereira de Souza Rosa
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74.650-050, GO, Brazil; (A.P.d.S.R.); (L.P.d.S.R.); (M.N.)
| | - Matias Noll
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74.650-050, GO, Brazil; (A.P.d.S.R.); (L.P.d.S.R.); (M.N.)
- Instituto Federal Goiano, Rodovia Go-154, Km 03, s/n, Ceres 76300-000, GO, Brazil
| | - Erika Aparecida Silveira
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74.650-050, GO, Brazil; (A.P.d.S.R.); (L.P.d.S.R.); (M.N.)
- Correspondence: (A.S.e.A.d.C.S.); (E.A.S.); Tel./Fax: +55-62-3209-6151 (E.A.S.)
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13
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Davenport L, Johari Y, Klejn A, Laurie C, Smith A, Ooi GJ, Burton PR, Brown WA. Improving Compliance with Very Low Energy Diets (VLEDs) Prior to Bariatric Surgery-a Randomised Controlled Trial of Two Formulations. Obes Surg 2020; 29:2750-2757. [PMID: 31111344 DOI: 10.1007/s11695-019-03916-2] [Citation(s) in RCA: 8] [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] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Preoperative very low energy diets (VLEDs) improve access during bariatric surgery. Compliance with traditional VLED is variable, mainly due to gastrointestinal side effects. Formulite™ is a new formulation of VLED, with higher protein, soluble fibre and probiotics. AIMS To compare traditional VLED (Optifast™) with the new VLED (Formulite™) and assess compliance, weight loss, satisfaction, side effects and surgical access. METHODS This was a randomised double-blinded study involving patients scheduled for bariatric surgery. The primary outcome was compliance, assessed by urinary ketone concentration and proportion of patients in ketosis at 2 weeks. Secondary outcomes were weight loss, satisfaction and patient reported outcomes, gastrointestinal side effects and operative conditions. RESULTS There were 69 participants: 35 in the Formulite™ group and 34 in the Optifast™ group. Ketosis at 2 weeks was achieved in both groups (88.5% vs 83.3%, Formulite™ vs. Optifast™, p = 0.602). Urinary ketones were higher with Formulite™ (1.5 vs 15 mmol/L, p = 0.030). Total body weight loss percentage, hunger and operative conditions were similar in both groups. Formulite™ produced less flatulence (score 3 vs 2, p = 0.010) and emotional eating (score 2 vs 1, p = 0.037); however, Optifast™ ranked higher in terms of taste (score 4 vs 3, p = 0.001) and overall satisfaction (score 5 vs 7, p = 0.011). CONCLUSIONS Compliance over 2 weeks was high in both VLEDs with most subjects achieving ketosis. Overall satisfaction was moderately high, although variable. Whilst Formulite™ is a viable alternative to Optifast™, better formulations of VLED that addresses key adverse effects, whilst achieving ketosis, would be of significant value.
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Affiliation(s)
- Lucy Davenport
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia
| | - Yazmin Johari
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia
- Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Alexandria Klejn
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia
| | - Cheryl Laurie
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia
| | - Andrew Smith
- Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Geraldine J Ooi
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia
- Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Paul R Burton
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia
- Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Wendy A Brown
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia.
- Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
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14
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Santos ASAC, Rodrigues APS, Rosa LPS, Sarrafzadegan N, Silveira EA. Cardiometabolic risk factors and Framingham Risk Score in severely obese patients: Baseline data from DieTBra trial. Nutr Metab Cardiovasc Dis 2020; 30:474-482. [PMID: 31791637 DOI: 10.1016/j.numecd.2019.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/01/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Little is known about differences of cardiometabolic risk factors (CMRF) and the function of Framingham Risk Score (FRS) within severe obesity, thus we aimed to study not only CMRF and FRS, but to determine significant differences between BMI ranges within severe obesity. METHODS AND RESULTS In this baseline analysis of the Traditional Brazilian Diet (DieTBra) Trial, several CMRF were assessed in 150 adult patients in two BMI ranges: 35.0-44.9 kg/m2 (n = 76) and ≥45 kg/m2 (n = 74). Body composition was evaluated by multifrequency bioelectrical impedance analysis to measure the percent of body fat, visceral fat area and waist circumference. Pearson's Chi-squared, Fisher's Exact, Student's t-test, and Mann-Whitney's test were used in the statistical analysis with a 5% significance level. Hypertension, C-reactive protein, systolic and diastolic blood pressure and positive family history for heart diseases were more prevalent in BMI ≥45.0 kg/m2 (p < 0.05). Mean values of waist circumference, body fat %, visceral fat area, and systolic blood pressure were significantly higher in patients with BMI ≥45.0 kg/m2. Regarding the function of FRS, 40.0% of the patients were at high risk. No differences were found for diabetes, lifestyle, lipid parameters, and FRS within different BMI ranges, except for dyslipidemia, significantly higher among participants with BMI 35.0-44.9 kg/m2. CONCLUSION BMI >45 kg/m2 was associated with higher prevalence of hypertension, systolic and diastolic blood pressure, C-reactive protein, waist circumference, body fat % and family history of heart diseases, enhancing the risk for the occurrence of cardiovascular diseases.
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Affiliation(s)
- Annelisa S A C Santos
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Brazil.
| | - Ana Paula S Rodrigues
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Brazil
| | - Lorena P S Rosa
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Brazil
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Erika A Silveira
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás, Brazil
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15
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Cardoso CKDS, Santos ASEADC, Rosa LPDS, Mendonça CR, Vitorino PVDO, Peixoto MDRG, Silveira ÉA. Effect of Extra Virgin Olive Oil and Traditional Brazilian Diet on the Bone Health Parameters of Severely Obese Adults: A Randomized Controlled Trial. Nutrients 2020; 12:E403. [PMID: 32032997 PMCID: PMC7071276 DOI: 10.3390/nu12020403] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 12/11/2022] Open
Abstract
Dietary interventions can stabilize and/or reverse bone mass loss. However, there are no reports on its effects on bone mineral density (BMD) in severely obese people, despite the vulnerability of this group to bone loss. We examine the effect of extra virgin olive oil supplementation and the traditional Brazilian diet (DieTBra) on BMD and levels of calcium, vitamin D, and parathyroid hormone (PTH) in severely obese adults. A randomized controlled trial followed-up with severely obese adults (n = 111, with mean body mass index 43.6 kg/m2 ± 4.5 kg/m2) for 12 weeks. Study participants received either olive oil (52 mL/day), DieTBra, or olive oil + DieTBra (52 mL/day + DieTBra). BMD was assessed by total spine and hip dual-energy X-ray absorptiometry. After interventions, BMD means for total spine (p = 0.016) and total hip (p = 0.029) were higher in the DieTBra group than in the olive oil + DieTBra group. Final mean calcium levels were higher in the olive oil group compared to the olive oil + DieTBra group (p = 0.026). Findings suggest that DieTBra and extra virgin olive oil have positive effects on bone health in severely obese adults. The major study was registered at ClinicalTrials.gov (NCT02463435).
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Affiliation(s)
- Camila Kellen de Souza Cardoso
- The Postgraduate Program in Health Sciences, School of Social Sciences and Health, Nutrition Course, Pontifical Catholic University of Goiás, Goiânia, 74605-020 Goiás, Brazil;
| | - Annelisa Silva e Alves de Carvalho Santos
- The Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, 74605-220 Goiás, Brazil; (A.S.e.A.d.C.S.); (L.P.d.S.R.); (C.R.M.)
| | - Lorena Pereira de Souza Rosa
- The Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, 74605-220 Goiás, Brazil; (A.S.e.A.d.C.S.); (L.P.d.S.R.); (C.R.M.)
| | - Carolina Rodrigues Mendonça
- The Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, 74605-220 Goiás, Brazil; (A.S.e.A.d.C.S.); (L.P.d.S.R.); (C.R.M.)
| | - Priscila Valverde de Oliveira Vitorino
- The Postgraduate Program in Health Sciences, Professor of the School of Social Sciences and Health, Pontifical Catholic University of Goiás, Goiânia, 74605-020 Goiás, Brazil;
| | - Maria do Rosário Gondim Peixoto
- The Postgraduate Program Nutrition and Health, Faculty of Nutrition, Federal University of Goiás, Goiânia, 74605-220 Goiás, Brazil;
| | - Érika Aparecida Silveira
- The Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, 74605-220 Goiás, Brazil; (A.S.e.A.d.C.S.); (L.P.d.S.R.); (C.R.M.)
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16
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Abstract
As metabolic and bariatric surgery (MBS) increasingly becomes a treatment of choice for adolescents with severe obesity, there is a need to understand how to deliver pre- and postoperative care in ways that maximize long-term safety and efficacy. This article describes major pre- and postoperative goals, lifestyle modification targets, and, when necessary, pharmacologic management strategies for adolescents undergoing MBS. Three categories of evidence were used-studies of pre- and postoperative interventions and factors influencing MBS outcomes in adolescents, studies of pre- and postoperative associations and interventions in adults, and studies of non-surgical weight management applicable to adolescents pursuing MBS. Finally, priority areas for future research within this topic are identified.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Matthew A Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, University of Minnesota Medical School, Minneapolis, MN 55455, United States
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17
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Abstract
Objective Intragastric balloon (IGB) therapy is a low-invasion treatment for obesity. Recently, a low-carbohydrate diet has shown effectiveness for encouraging weight loss, but whether or not a low-carbohydrate diet improves the efficacy of IGB therapy remains unclear. Therefore, we examined the effectiveness of a low-carbohydrate diet compared with a calorie-restricted diet in combination with IGB therapy. Methods A prospective study was conducted on 51 patients who had undergone IGB therapy from October 2012 to December 2017. Overall, 31 of the 51 patients were included in this study (12-month assessment after IGB placement). These 31 cases consisted of 18 IGB plus low-carbohydrate diet and 13 IGB plus calorie-restricted diet. We compared the two groups with respect to body weight loss as outcomes. Results At 12 months after IGB placement, the body weight was significantly lower than that observed at baseline in both the IGB plus low-carbohydrate diet group (baseline 101.9±25.8 kg, 12 months 88.2±21.9 kg) (p<0.0001) and the IGB plus calorie-restricted diet group (baseline 103.5±17.0 kg, 12 months 89.1±6.2 kg) (p<0.005). The percentage of excess weight loss in the IGB plus low-carbohydrate diet group was slightly higher than that in the IGB plus calorie-restricted diet group, but there was no significant difference between the 2 groups at 12 months after IGB placement (IGB plus low-carbohydrate 49.9±60.0%, IGB plus calorie-restricted diet 33.1±27.0%). Conclusion Our study demonstrated that both a low-carbohydrate diet and a calorie-restricted diet were effective interventions for weight reduction in combination with IGB therapy.
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Affiliation(s)
| | | | - Masaru Harada
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
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18
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Abstract
BACKGROUND Although widely applied, there is no consensus about the characteristics of the diets prescribed in the immediate preoperative period of bariatric surgery (BS). The objective of this study was to perform a survey on preoperative dietary management in BS centers. METHODS This was a cross-sectional study with BS Brazilian centers. Only BS centers with certificate of excellence by Surgical Review Corporation were included. An electronic questionnaire was applied to assess details about the dietary management in the immediate preoperative period of BS. RESULTS Of the 15 centers invited, 80% (n = 12) answered the questionnaire. Preoperative weight loss was required to patients in all 12 centers. For 8.3% (n = 1), this request was applied to all patients; 91.7% (n = 11) of the centers requested weight loss in specific cases. Ten (83.3%) centers prescribed restrictive diets; none of these adopted a standard dietary protocol. The caloric value of the diets ranged from 800 to 2000 kcal/day. The duration of the diet ranged from 10 to 20 days in 40% (n = 4) of the centers and from 20 to 90 days in 60% (n = 6) of the centers. Dietary prescription was based on team consensus in 100% (n = 12) of the centers. In 33.3% (n = 4) of the centers, scientific evidence supporting dietary prescription was cited. CONCLUSION This study identified the frequent practice of requesting preoperative weight loss and the diversity of diets used in the immediate preoperative period by Brazilian BS centers. Future guideline proposal is needed on preoperative BS diets.
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Affiliation(s)
- Mariana Steffen Holderbaum
- Graduate Program in Medicine: Hepatology, Porto Alegre, Brazil
- Center of Obesity and Metabolic Syndrome - São Lucas Hospital (C.O.M. PUCRS), Porto Alegre, Brazil
| | - Caroline Buss
- Graduate Program in Medicine: Hepatology, Porto Alegre, Brazil.
- Graduate Program in Health Sciences, Porto Alegre, Brazil.
- Nutrition Department - UFCSPA, Porto Alegre, Brazil.
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19
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Eneli I, Xu J, Tindall A, Watowicz R, Worthington J, Tanner K, Pratt K, Walston M. Using a Revised Protein-Sparing Modified Fast (rPSMF) for Children and Adolescents with Severe Obesity: A Pilot Study. Int J Environ Res Public Health 2019; 16:E3061. [PMID: 31443606 PMCID: PMC6747308 DOI: 10.3390/ijerph16173061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022]
Abstract
Treatment options are limited for children and adolescents with severe obesity. One alternative treatment is the protein-sparing modified fast (PSMF), a low-carbohydrate, high-protein diet that can result in substantial weight loss. The aim of the study is to evaluate the adherence and efficacy of a revised PSMF (rPSMF) for severe obesity in a pediatric tertiary care weight-management program. The rPSMF with 1200-1800 calories, 40-60 g of carbohydrate/day and 1.2-1.5 g protein/kg of ideal bodyweight was implemented over 12 months. Twenty-one participants enrolled in the study. Mean age 16.2 ± 1.4 years, females (76.2%) and mean weight at baseline was 119 ± 19.9 kg. Regardless of adherence to the rPSMF, the mean weight change at 1 month was -3.7 ± 3.5 kg, (range -13.5 kg to 0.9 kg); at 3 months was -5.5 ± 5.1 kg, (range -19.3 kg to 1.8 kg) and at 6 months was -4.7 ± 6.6 kg, (range -18.3 kg to 8.6 kg). At 12 months, the mean weight change was -1.3 ± 10.6 kg (range -17.7 kg to 14.8 kg). Parent and child-reported physical and psychosocial quality of life (HRQOL) improved. Despite limited adherence, the rPSMF diet resulted in clinically significant weight loss and improved HRQOL for children and adolescents with severe obesity.
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Affiliation(s)
- Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH 43205, USA.
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA.
| | - Jinyu Xu
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Alexis Tindall
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Rosanna Watowicz
- Department of Nutrition, Case Western University, Cleveland, OH 44106, USA
| | - Jennifer Worthington
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Kelly Tanner
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Keeley Pratt
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Marnie Walston
- Department of Pediatrics, Akron Children's Hospital, Akron, OH 44308, USA
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20
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Burguera B, Schauer P, Kahan S. What to Offer the 99% of Patients With Severe Obesity Who Do Not Undergo Bariatric Surgery? Mayo Clin Proc 2019; 94:957-960. [PMID: 31171134 DOI: 10.1016/j.mayocp.2018.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/27/2018] [Indexed: 11/21/2022]
Affiliation(s)
- Bartolome Burguera
- Department of Endocrinology, Endocrinology and Metabolism Institute, Cleveland Clinic, OH; National Diabetes and Obesity Research Institute, Tradition, MS.
| | - Philip Schauer
- Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Scott Kahan
- George Washington University School of Medicine, Washington, DC; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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21
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Serafim MP, Santo MA, Gadducci AV, Scabim VM, Cecconello I, de Cleva R. Very low-calorie diet in candidates for bariatric surgery: change in body composition during rapid weight loss. Clinics (Sao Paulo) 2019; 74:e560. [PMID: 30892414 PMCID: PMC6399661 DOI: 10.6061/clinics/2019/e560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To analyze the changes in the body composition of morbidly obese patients induced by a very low-calorie diet. METHODS We evaluated 120 patients selected from a university hospital. Body composition was assessed before and after the diet provided during hospitalization, and changes in weight, body mass index, and neck, waist and hip circumferences were analyzed. Bioimpedance was used to obtain body fat and fat-free mass values. The data were categorized by gender, age, body mass index and diabetes diagnosis. RESULTS The patients consumed the diet for 8 days. They presented a 5% weight loss (without significant difference among groups), which represented an 85% reduction in body fat. All changes in body circumference were statistically significant. There was greater weight loss and a greater reduction of body fat in men, but the elderly showed a significantly higher percentage of weight loss and greater reductions in body fat and fat-free mass. Greater reductions in body fat and fat-free mass were also observed in superobese patients. The changes in the diabetic participants did not differ significantly from those of the non-diabetic participants. CONCLUSIONS The use of a VLCD before bariatric surgery led to a loss of weight at the expense of body fat over a short period, with no significant differences in the alteration of body composition according to gender, age, body mass index and diabetes status.
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Affiliation(s)
- Marcela Pires Serafim
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexandre Vieira Gadducci
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Veruska Magalhães Scabim
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ivan Cecconello
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Roberto de Cleva
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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22
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Relling I, Akcay G, Fangmann D, Knappe C, Schulte DM, Hartmann K, Müller N, Türk K, Dempfle A, Franke A, Schreiber S, Laudes M. Role of wnt5a in Metabolic Inflammation in Humans. J Clin Endocrinol Metab 2018; 103:4253-4264. [PMID: 30137542 DOI: 10.1210/jc.2018-01007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/15/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Common nutrition-associated diseases like obesity and type 2 diabetes are linked to chronic low-grade inflammation. The secreted glycopeptide wingless-type mouse mammary tumor virus integration site family member 5a (wnt5a) has been implicated in metabolic inflammation in rodent models, suggesting a potential treatment target. Data on the role of wnt5a in human physiology have yielded conflicting results. OBJECTIVE Serum concentrations of wnt5a were measured in a cross-sectional cohort of 896 people to gain deeper insights into wnt5a physiology. DESIGN Serum concentrations of wnt5a were measured by ELISA and related to several phenotyping and genotyping data. In vitro experiments were performed in THP-1 macrophages to examine potential molecular mechanisms. RESULTS Wnt5a levels were significantly positively correlated to IL-6 and triglyceride levels. In subjects with diabetes, wnt5a levels were elevated and significantly correlated with fasting plasma glucose concentrations. Although wnt5a levels were not influenced by common single-nucleotide polymorphisms in the human wnt5a gene, environmental factors significantly altered wnt5a concentrations, as follows: (1) wnt5a levels were reduced in subjects with high nutritional load of the long-chain eicosatetraenoic acid independent of the total caloric intake and overall composition of the macronutrients, and (2) wnt5a levels were lower in humans with a high gut microbiome α diversity. In vitro experiments revealed that stimulation of the IL-6 receptor or the long-chain fatty acid receptor GPR40 directly affected wnt5a expression in human macrophages. CONCLUSION Our data suggest that wnt5a is important in linking inflammation to metabolism. The nutrition and the microbiome might be interesting targets to prevent and/or treat wnt5a-mediated metabolic inflammation.
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Affiliation(s)
- Isabelle Relling
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Gül Akcay
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Daniela Fangmann
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Carina Knappe
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | | | | | - Nike Müller
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Kathrin Türk
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, University of Kiel, 24105 Kiel, Germany
| | - Andre Franke
- Institute for Clinical Molecular Biology, University of Kiel, 24105 Kiel, Germany
| | - Stefan Schreiber
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
- Institute for Clinical Molecular Biology, University of Kiel, 24105 Kiel, Germany
| | - Matthias Laudes
- Department of Medicine 1, University of Kiel, 24105 Kiel, Germany
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23
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Marzullo P, Minocci A, Mele C, Fessehatsion R, Tagliaferri M, Pagano L, Scacchi M, Aimaretti G, Sartorio A. The relationship between resting energy expenditure and thyroid hormones in response to short-term weight loss in severe obesity. PLoS One 2018; 13:e0205293. [PMID: 30339686 PMCID: PMC6195261 DOI: 10.1371/journal.pone.0205293] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background Regulating thermogenesis is a major task of thyroid hormones (THs), and involves TH-responsive energetic processes at the central and peripheral level. In severe obesity, little is known on the relationship between THs and resting energy expenditure (REE) before and after weight loss. Methods We enrolled 100 euthyroid subjects with severe obesity who were equally distributed between genders. Each was examined before and after completion of a 4-wk inpatient multidisciplinary dieting program and subjected to measurement of thyroid function, REE, fat-free mass (FFM, kg) and percent fat mass (FM). Results Baseline REE was lower than predicted in 70 obese patients, and overall associated with BMI, FFM and FM but not thyroid-related parameters. By the study end, both BMI and REE decreased (5.5% and 4.1%, p<0.001 vs. baseline) and their percent changes were significantly associated (p<0.05), while no association related percent changes of REE and FFM or FM. Individually, REE decreased in 66 and increased in 34 patients irrespective of gender, BMI and body composition. Weight loss significantly impacted TSH (-6.3%), FT3 (-3.3%) and FT4 levels (3.9%; p<0.001 for all). By the study end, a significant correlation became evident between REE and FT4 (r = 0.42, p<0.001) as well as FT3 (r = 0.24, p<0.05). In stepwise multivariable regression analysis, however, neither THs nor body composition entered the regression equation for REE response to weight loss. Conclusions In severe obesity, short-term weight loss discloses a positive relationship between REE and THs.
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Affiliation(s)
- Paolo Marzullo
- IRCCS Istituto Auxologico Italiano, Division of General Medicine, Piancavallo, Verbania, Italy
- Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy
- * E-mail:
| | - Alessandro Minocci
- IRCCS Istituto Auxologico Italiano, Division of Metabolic Diseases, Piancavallo, Verbania, Italy
| | - Chiara Mele
- IRCCS Istituto Auxologico Italiano, Division of General Medicine, Piancavallo, Verbania, Italy
- Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy
| | - Rezene Fessehatsion
- IRCCS Istituto Auxologico Italiano, Division of Metabolic Diseases, Piancavallo, Verbania, Italy
| | | | - Loredana Pagano
- University of Turin, Department of Medical Sciences, Turin, Italy
| | - Massimo Scacchi
- IRCCS Istituto Auxologico Italiano, Division of General Medicine, Piancavallo, Verbania, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Gianluca Aimaretti
- Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy
| | - Alessandro Sartorio
- IRCCS Istituto Auxologico Italiano, Division of Metabolic Diseases, Piancavallo, Verbania, Italy
- IRCCS Istituto Auxologico Italiano, Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo, Verbania, Italy
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24
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Lamminpää R, Vehviläinen-Julkunen K, Schwab U. A systematic review of dietary interventions for gestational weight gain and gestational diabetes in overweight and obese pregnant women. Eur J Nutr 2018; 57:1721-1736. [PMID: 29128995 PMCID: PMC6060815 DOI: 10.1007/s00394-017-1567-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/13/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE The number of overweight and obese women is increasing in the obstetric population. The aim of this study was to review studies that reported results related to the efficacy of dietary interventions on gestational weight gain (GWG) or the prevention of gestational diabetes (GDM) in overweight and obese women. METHODS The search was performed using the CINAHL, PubMed, Scopus and Medic electronic databases and limited to the years between 2000 and March 2016. This systematic review includes 15 research articles of which 12 were randomized controlled trials, and three were controlled trials. Three main categories emerged as follows: (1) the types of interventions, (2) the contents of the interventions and (3) the efficacy of the intervention on GWG and the prevention of GDM. The quality of the selected studies was evaluated using the AHRQ Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews. RESULTS Of the selected 15 studies, eight included a specified diet with limited amounts of nutrients or energy, and the others included a dietary component along with other components. Ten studies reported significant differences in the measured outcomes regarding GWG or the prevention of GDM between the intervention and the control groups. CONCLUSIONS This review confirms the variability in the strategies used to deliver dietary interventions in studies aiming to limit GWG and prevent GDM in overweight and obese women. Inconsistency in the provider as well as the content of the dietary interventions leaves the difficulty of summarizing the components of effective dietary interventions.
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Affiliation(s)
- Reeta Lamminpää
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, P.O. BOX 1627, 70211, Kuopio, Finland.
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland and Kuopio University Hospital, 70029, Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, 70211, Kuopio, Finland
- Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, 70029, Kuopio, Finland
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25
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Abstract
PURPOSE OF REVIEW This paper will review the intestinal and gastric origins for diabetes resolution after bariatric surgery. RECENT FINDINGS In addition to the known metabolic effects of changes in the gut hormonal milieu, more recent studies investigating the role of the microbiome and bile acids and changes in nutrient sensing mechanisms have been shown to have glycemic effects in human and animal models. Independent of weight loss, there are multiple mechanisms that may lead to amelioration or resolution of diabetes following bariatric surgery. There is abundant evidence pointing to changes in gut hormones, bile acids, gut microbiome, and intestinal nutrient sensing; more research is needed to clearly delineate their role in regulating energy and glucose homeostasis after bariatric surgery.
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MESH Headings
- Animals
- Bariatric Surgery
- Bile Acids and Salts/metabolism
- Biomarkers/blood
- Biomarkers/metabolism
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/physiopathology
- Diabetes Mellitus, Type 2/therapy
- Diet, Reducing
- Dysbiosis/complications
- Dysbiosis/etiology
- Dysbiosis/microbiology
- Dysbiosis/prevention & control
- Gastrointestinal Microbiome
- Humans
- Insulin Resistance
- Intestinal Mucosa/innervation
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/microbiology
- Intestinal Mucosa/physiopathology
- Intestines/innervation
- Intestines/microbiology
- Intestines/physiopathology
- Neurons, Afferent/metabolism
- Neurons, Efferent/metabolism
- Obesity, Morbid/complications
- Obesity, Morbid/diet therapy
- Obesity, Morbid/physiopathology
- Obesity, Morbid/surgery
- Weight Loss
- Weight Reduction Programs
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Affiliation(s)
- Caroline A Andrew
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, 1165 York Avenue, New York, NY, 10065, USA
| | - Devika Umashanker
- Comprehensive Medical Weight Management, Department of Bariatric Surgery, Hartford HealthCare Medical Group, Hartford, CT, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, 1165 York Avenue, New York, NY, 10065, USA
| | - Alpana P Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, 1165 York Avenue, New York, NY, 10065, USA.
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26
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Dorenbos E, Drummen M, Rijks J, Adam T, Stouthart P, Alfredo Martínez J, Navas-Carretero S, Stratton G, Swindell N, Fogelholm M, Raben A, Westerterp-Plantenga M, Vreugdenhil A. PREVIEW (Prevention of Diabetes Through Lifestyle Intervention and Population Studies in Europe and Around the World) study in children aged 10 to 17 years: Design, methods and baseline results. Diabetes Obes Metab 2018; 20:1096-1101. [PMID: 29322617 DOI: 10.1111/dom.13216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/22/2017] [Accepted: 01/05/2018] [Indexed: 01/19/2023]
Abstract
Insulin resistance (IR) in adolescence is associated with type 2 diabetes mellitus [T2DM]. The PREVIEW (Prevention of Diabetes Through Lifestyle Intervention and Population Studies in Europe and Around the World) study assessed the effectiveness of a high-protein, low-glycaemic-index diet and a moderate-protein, moderate-glycaemic-index diet to decrease IR in insulin-resistant children who were overweight or obese. Inclusion criteria were age 10 to 17 years, homeostatic model assessment of IR (HOMA-IR) ≥2.0 and overweight/obesity. In 126 children (mean ± SD age 13.6 ± 2.2 years, body mass index [BMI] z-score 3.04 ± 0.66, HOMA-IR 3.48 ± 2.28) anthropometrics, fat mass percentage (FM%), metabolic characteristics, physical activity, food intake and sleep were measured. Baseline characteristics did not differ between the groups. IR was higher in pubertal children with morbid obesity than in prepubertal children with morbid obesity (5.41 ± 1.86 vs 3.23 ± 1.86; P = .007) and prepubertal and pubertal children with overweight/obesity (vs 3.61 ± 1.60, P = .004, and vs 3.40 ± 1.50, P < .001, respectively). IR was associated with sex, Tanner stage, BMI z-score and FM%. Fasting glucose concentrations were negatively associated with Baecke sport score (r = -0.223, P = .025) and positively with daytime sleepiness (r = 0.280, P = .016) independent of sex, Tanner stage, BMI z-score and FM%. In conclusion, IR was most severe in pubertal children with morbid obesity. The associations between fasting glucose concentration and Baecke sport score and sleepiness suggest these might be possible targets for diabetes prevention.
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Affiliation(s)
- Elke Dorenbos
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mathijs Drummen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Jesse Rijks
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tanja Adam
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Pauline Stouthart
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Alfredo Martínez
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research (CIN), Universidad de Navarra, Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Navas-Carretero
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research (CIN), Universidad de Navarra, Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, Madrid, Spain
| | - Gareth Stratton
- Research Centre in Applied Sports, Technology, Exercise and Medicine (A-STEM), Swansea University, Swansea, UK
| | - Nils Swindell
- Research Centre in Applied Sports, Technology, Exercise and Medicine (A-STEM), Swansea University, Swansea, UK
| | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Margriet Westerterp-Plantenga
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Anita Vreugdenhil
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Maastricht University Medical Centre, Maastricht, The Netherlands
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27
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Abstract
PURPOSE OF REVIEW The growing obesity epidemic is associated with an increased demand for bariatric surgery with Roux-en-Y Gastric Bypass and Sleeve Gastrectomy as the most widely performed procedures. Despite beneficial consequences, nutritional complications may arise because of anatomical and physiological changes of the gastrointestinal tract. The purpose of this review is to provide an update of the recent additions to our understanding of the impact of bariatric surgery on the intake, digestion and absorption of dietary protein. RECENT FINDINGS After bariatric surgery, protein intake is compromised because of reduced gastric capacity and aversion for certain foods. A minority of patients reaches the recommended protein intake of minimal 60 g per day, which results in the loss of fat-free mass rather than the desired loss of fat mass. Despite inadequate protein intake, protein digestion and absorption do not seem to be impaired suggesting that other mechanisms could counteract the reduced secretion of digestive enzymes and their delayed inlet. SUMMARY After bariatric surgery, protein supplementation or diet enrichment could attribute to achieve the minimal recommended protein intake and benefit the amount and composition of postoperative weight loss.
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Boyer M, Piché ME, Auclair A, Grenier-Larouche T, Biertho L, Marceau S, Hould FS, Biron S, Lebel S, Lescelleur O, Julien F, Martin J, Tchernof A, Carpentier AC, Poirier P, Arsenault BJ. Acute and Chronic Impact of Bariatric Surgery on Plasma LDL Cholesterol and PCSK9 Levels in Patients With Severe Obesity. J Clin Endocrinol Metab 2017; 102:4023-4030. [PMID: 28938493 DOI: 10.1210/jc.2017-00699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/07/2017] [Indexed: 02/09/2023]
Abstract
CONTEXT Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulator of low-density lipoprotein cholesterol (LDL-C) concentrations. In patients with severe obesity, biliopancreatic diversion with duodenal switch (BPD-DS) surgery induces substantial weight loss and influences lipoprotein metabolism. The effect of BPD-DS on PCSK9 levels is unknown. OBJECTIVES To determine the acute and chronic impact of BPD-DS on PCSK9 levels and whether the acute impact of BPD-DS could be explained by BPD-DS-associated caloric restriction (CR). DESIGN, SETTINGS, AND PARTICIPANTS PCSK9 levels were measured in 20 men and 49 women (age, 41.5 ± 11.1 years) with severe obesity before, 24 hours, 5 days, and 6 and 12 months after BPD-DS and in a comparable control group (n = 31) at baseline and at 6 and 12 months. PCSK9 levels were also measured during 3-day CR in patients (n = 7) with severe obesity and type 2 diabetes. RESULTS PCSK9 levels increased 13.4% after 24 hours (248.7 ± 64.8 to 269.7 ± 63.8 ng/mL; P = 0,02) and decreased 9.5% at 12 months compared with baseline (217.6 ± 43.0 ng/mL; P < 0,0001). LDL-C levels decreased 36.2% after 24 hours (2.6 ± 0.7 to 1.7 ± 0.6 mmol/L; P < 0.0001) and 30% at 12 months compared with baseline (1.7 ± 0.5 mmol/L; P < 0.0001). Compared with baseline levels, PCSK9 levels were lower at day 2 but not at day 1 or 3 after CR. CONCLUSION BPD-DS is associated with acute increases in PCSK9 levels that do not appear to be explained by CR but may be due to an acute response following surgery. BPD-DS induces chronic reductions in both PCSK9 and LDL-C levels.
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Affiliation(s)
- Marjorie Boyer
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec G1V 0A6, Canada
| | - Marie-Eve Piché
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec G1V 0A6, Canada
| | - Audrey Auclair
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - Thomas Grenier-Larouche
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - Laurent Biertho
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - Simon Marceau
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - Frédéric-Simon Hould
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - Simon Biron
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - Stéfane Lebel
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - Odette Lescelleur
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - François Julien
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - Julie Martin
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
| | - André Tchernof
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
- School of Nutrition, Université Laval, Quebec City, Quebec G1V 0A6, Canada
| | - André C Carpentier
- Department of Medicine, Division of Endocrinology, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Paul Poirier
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec G1V 0A6, Canada
| | - Benoit J Arsenault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec G1V 4G5, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec G1V 0A6, Canada
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Gummesson A, Nyman E, Knutsson M, Karpefors M. Effect of weight reduction on glycated haemoglobin in weight loss trials in patients with type 2 diabetes. Diabetes Obes Metab 2017; 19:1295-1305. [PMID: 28417575 DOI: 10.1111/dom.12971] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 01/06/2023]
Abstract
AIM To quantify the effect of weight loss on glycated haemoglobin (HbA1c) at group level, based on data from published weight loss trials in overweight and obese patients with type 2 diabetes (T2D). METHODS A systematic literature search in MEDLINE, EMBASE and Cochrane CENTRAL (January 1990 through December 2012) was conducted to identify prospective trials of energy-reduced diets, obesity drugs or bariatric surgery in adult, overweight and obese patients with T2D. Based on clinical data with follow-up from 3 to 24 months, a linear model was developed to describe the effect of weight reduction on HbA1c. RESULTS The literature search identified 58 eligible articles consisting of 124 treatment groups and 17 204 subjects, yielding a total of 250 data points with concurrent mean changes from baseline in weight and HbA1c. The model-based analyses indicated a linear relationship between weight loss and HbA1c reduction, with an estimated mean HbA1c reduction of 0.1 percentage points for each 1 kg of reduced body weight for the overall population. Baseline HbA1c was a significant covariate for the relationship between weight loss and HbA1c: high HbA1c at baseline was associated with a greater reduction in HbA1c for the same degree of weight loss. The collected trial data also indicated weight-loss-dependent reductions in antidiabetic medication. CONCLUSIONS At group level, weight loss in obese and overweight patients with T2D was consistently accompanied by HbA1c reduction in a dose-dependent manner. The model developed in the present study estimates that for each kg of mean weight loss, there is a mean HbA1c reduction of 0.1 percentage points. HbA1c-lowering is greater in populations with poor glycaemic control than in well controlled populations with the same degree of weight loss. This summary of data from previous trials regarding the effect of weight reduction on HbA1c may be used to support the design and interpretation of future studies that aim to demonstrate the efficacy of weight loss interventions for T2D treatment.
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Affiliation(s)
- Anders Gummesson
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Abstract
PURPOSE OF REVIEW The continued success of bariatric surgery to treat obesity and obesity-associated metabolic conditions creates a need for a strong understanding of clinical nutrition both before and after these procedures. RECENT FINDINGS Surgically induced alteration of gastrointestinal physiology can affect the nutrition of individuals, especially among those who have undergone malabsorptive procedures. While uncommon, a subset of patients may develop protein-calorie malnutrition. In these cases, nutrition support should be tailored to the severity of malnutrition. Among all patients who undergo bariatric surgery, high rates of micronutrient deficiencies have been observed. To mitigate these deficiencies, empiric supplementation with multivitamins, calcium citrate, and vitamin D is generally recommended. Periodic surveillance should be performed for commonly deficient micronutrients, including thiamin (B1), folate (B9), cobalamin (B12), iron, and vitamin D. Following Roux-en-Y gastric bypass, serum levels of copper and zinc should also be monitored. In addition, lipid-soluble vitamins should be monitored following biliopancreatic diversion with/without duodenal switch.
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Affiliation(s)
- Michael A Via
- Division of Endocrinology, Diabetes, and Bone Disease, Mount Sinai Beth Israel Medical Center, 317 East 17th St., New York, NY, 10003, USA.
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jeffrey I Mechanick
- Marie-Josee and Henry R. Kravis Center For Cardiovascular Health, Mount Sinai Heart, New York, NY, USA
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Metabolic Support, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
PURPOSE OF REVIEW Bariatric surgery is currently the most effective treatment for obesity. Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure and results in long-term weight loss. Alterations in food preference and choices may contribute to the long-term benefits of RYGB. This manuscript reviews the available literature documenting changes in food preference in both humans and experimental animals after RYGB and discusses the current theory on the underlying mechanisms involved. RECENT FINDINGS Obesity is associated with an increased preference for sweet and high-fat foods, and the most consistent evidence has been the shift away from these calorie-dense foods in both animal and human studies after RYGB. Self-reporting is the most common method used to record food preferences in humans, while more direct approaches have been used in animal work. This methodological heterogeneity may give rise to inconsistent findings. Future studies in humans should focus on direct measures to permit corroboration of mechanistic insights gained from animal studies.
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Affiliation(s)
- Natasha Kapoor
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Investigative Science, Imperial College London, London, UK
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Investigative Science, Imperial College London, London, UK
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Baldry EL, Aithal GP, Kaye P, Idris IR, Bennett A, Leeder PC, Macdonald IA. Effects of short-term energy restriction on liver lipid content and inflammatory status in severely obese adults: Results of a randomized controlled trial using 2 dietary approaches. Diabetes Obes Metab 2017; 19:1179-1183. [PMID: 28230324 DOI: 10.1111/dom.12918] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 02/02/2023]
Abstract
Short-term very-low-energy diets (VLEDs) are used in clinical practice prior to bariatric surgery, but regimens vary and outcomes of a short intervention are unclear. We examined the effect of 2 VLEDs, a food-based diet (FD) and a meal-replacement plan (MRP; LighterLife UK Limited, Harlow, UK), over the course of 2 weeks in a randomized controlled trial. We collected clinical and anthropometric data, fasting blood samples, and dietary evaluation questionnaires. Surgeons took liver biopsies and made a visual assessment of the liver. We enrolled 60 participants of whom 54 completed the study (FD, n = 26; MRP, n = 28). Baseline demographic features, reported energy intake, dietary evaluation and liver histology were similar in the 2 groups. Both diets induced significant weight loss. Perceived difficulty of surgery correlated significantly with the degree of steatosis on histology. There were reductions in the circulating inflammatory mediators C-reactive protein, fetuin-A and interleukin-6 between baseline (pre-diet) and post-diet. The diets achieved similar weight loss and reduction in inflammatory biomarkers. There were no significant differences in perceived operative difficulty or between patients' evaluation of diet satisfaction, ease of use or hunger frequency. Non-alcoholic fatty liver disease histology assessments post-diet were also not significantly different between diets. The results of this study show the effectiveness of short-term VLEDs and energy restriction, irrespective of macronutrient composition, although the small sample size precluded detection of subtle differences between interventions.
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Affiliation(s)
- Emma L Baldry
- Faculty of Medicine and Health Sciences, University of Nottingham Medical School, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Guruprasad P Aithal
- National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham Medical School, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Philip Kaye
- Department of Cellular Pathology, Nottingham Digestive Diseases Centre Biomedical Research Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Iskandar R Idris
- MRC Musculoskeletal Physiology and Ageing, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Andrew Bennett
- Faculty of Medicine and Health Sciences, University of Nottingham Medical School, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Paul C Leeder
- East-Midlands Bariatric and Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | - Ian A Macdonald
- Faculty of Medicine and Health Sciences, University of Nottingham Medical School, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, Ben-Porat T, Sinai T. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr 2017; 8:382-394. [PMID: 28298280 PMCID: PMC5347111 DOI: 10.3945/an.116.014258] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [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] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.
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Affiliation(s)
- Shiri Sherf Dagan
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, and
| | - Ariela Goldenshluger
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Inbal Globus
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Chaya Schweiger
- The Israel Dietetic Association, Herzliya, Israel
- Herzliya Medical Center, Herzliya, Israel
- Nutrition Service, Rabin Medical Center, Petach Tiqva, Israel; and
| | - Yafit Kessler
- The Israel Dietetic Association, Herzliya, Israel
- The Israeli Center for Bariatric Surgery of Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Galit Kowen Sandbank
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Tair Ben-Porat
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tali Sinai
- The Israel Dietetic Association, Herzliya, Israel;
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
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Rigamonti AE, Bini S, Rocco MC, Giardini V, Massimini D, Crippa MG, Saluzzi A, Casati M, Marazzi N, Perotti M, Cimino V, Grassi G, Sartorio A, Pincelli AI. Post-prandial anorexigenic gut peptide, appetite and glucometabolic responses at different eating rates in obese patients undergoing laparoscopic sleeve gastrectomy. Endocrine 2017; 55:113-123. [PMID: 27022941 DOI: 10.1007/s12020-016-0933-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/17/2016] [Indexed: 12/11/2022]
Abstract
Although different hypotheses have been proposed, the underlying mechanism(s) of the weight loss induced by laparoscopic sleeve gastrectomy (LSG) is still unknown. The aim of this study was to determine whether eating the same meal at different rates (fast vs. slow feeding) evokes different post-prandial anorexigenic gut peptide responses in ten obese patients undergoing LSG. Circulating levels of GLP-1, PYY, glucose, insulin and triglycerides were measured before and 3 months after LSG. Visual analogue scales were used to evaluate the subjective feelings of hunger and satiety. Irrespective of the operative state, either fast or slow feeding did not stimulate GLP-1 release (vs. 0 min); plasma levels of PYY were increased (vs. 0 min) by fast and slow feeding only after LSG. There were no differences in post-prandial levels of GLP-1 when comparing fast to slow feeding or pre-to-post-operative state. Plasma levels of PYY after fast or slow feeding were higher in post, rather than pre-operative state, with no differences when comparing PYY release after fast and slow feeding. Hunger and satiety were decreased and increased, respectively, (vs. 0 min) by food intake. Fast feeding evoked a higher satiety than slow feeding in both pre- and post-operative states, with no differences in hunger. In both pre- and post-operative states, there were similar responses for hunger and satiety after food intake. Finally, LSG improved insulin resistance after either fast or slow feeding. These (negative) findings would suggest a negligible contribution of the anorexigenic gut peptide responses in LSG-induced weight loss.
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Affiliation(s)
- Antonello Emilio Rigamonti
- Department of Clinical Sciences and Community Health, University of Milan, via Vanvitelli, 32, 20129, Milan, Italy.
| | - Silvia Bini
- Department of Clinical Sciences and Community Health, University of Milan, via Vanvitelli, 32, 20129, Milan, Italy
| | - Maria Cristina Rocco
- Division of Internal Medicine, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Vittorio Giardini
- Division of Bariatric Surgery, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Diego Massimini
- Division of Bariatric Surgery, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Maria Grazia Crippa
- Division of Internal Medicine, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Antonella Saluzzi
- Division of Internal Medicine, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Marco Casati
- Laboratory of Chemical and Clinical Analyses, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Nicoletta Marazzi
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research, Milan, Verbania, Italy
| | - Mario Perotti
- Division of Internal Medicine, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Vincenzo Cimino
- Division of Internal Medicine, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Guido Grassi
- Division of Internal Medicine, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research, Milan, Verbania, Italy
| | - Angela Ida Pincelli
- Division of Internal Medicine, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
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Taus M, Fumelli D, Busni D, Borroni F, Sebastianelli S, Nicolai G, Nicolai A. A very low calorie ketogenic diet improves weight loss and quality of life in patients with adjustable gastric banding. Ann Ital Chir 2017; 88:S0003469X17026550. [PMID: 28604374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Often, in severe obesity, diet and physical activity are not enough to achieve a healthy BMI. Bariatric surgical approach, in particular laparoscopic adjustable gastric banding (LAGB), has encouraging results in terms of weight loss and resolution of obesity-related comorbidities. However, several months after LAGB, some patients are enable to lose weight anymore and don't tolerate a further calibration because of its collateral effects (excessive sense of fullness, heartburn, regurgitation and vomiting). AIM The aim of this study is to identify the potential role of high protein-low carbohydrate ketogenic diet (KD) in managing weight loss in patients who underwent gastric banding and didn't lose weight anymore. METHODS 50 patients underwent LAGB between January 2010 and December 2013. In twenty patients (GROUP A) we observed a stop in weight loss so we divided this patients into two groups. One group (group A1: 10 patients) continued to follow a LCD low calorie diet and underwent a further calibration; the other group (group A2: 10 patients) started to follow a KD for the next 8 weeks. RESULTS Both group resumed a significant weight loss, however group A1 patients reported collateral effects due to calibration and a higher Impact of Weight on Quality of Life - Lite (IWQOL-Lite) that correlates with a lower quality of life than patients following KD. CONCLUSIONS KD can improve the weight loss and quality of life in patients who underwent LAGB and failed at losing more weight allowing a weight loss comparable to that obtained with a further calibration and it is useful to avoid drastic calibrations and their collateral effects. KEY WORDS Laparoscopic adjustable gastric binding, Quality of life, Very low calory ketogenic binding.
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Lips MA, van Klinken JB, Pijl H, Janssen I, Willems van Dijk K, Koning F, van Harmelen V. Weight loss induced by very low calorie diet is associated with a more beneficial systemic inflammatory profile than by Roux-en-Y gastric bypass. Metabolism 2016; 65:1614-1620. [PMID: 27733249 DOI: 10.1016/j.metabol.2016.07.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/07/2016] [Accepted: 07/22/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Weight loss interventions such as Roux-en-Y gastric bypass (RYGB) and very low calorie diets (VLCD) lead to improvement of glucose metabolism in obese individuals with type-2 diabetes. Weight loss can also positively influence the unfavorable inflammatory profile associated with obesity. However, a direct comparison of the effect of VLCD and RYGB on systemic inflammation is lacking. METHODS Systemic inflammation was investigated in age- and BMI-matched morbidly obese T2DM women by determining the number and activation- or memory status of peripheral blood leukocytes by flow cytometry, in addition to measuring circulating levels of cytokines and CRP. Systemic inflammation was assessed one month before and three months after RYGB (n=15) or VLCD (n=12). An age matched group of lean women (n=12) was studied as control group. RESULTS Three months after the intervention, CRP and leptin levels were reduced whereas adiponectin levels were increased both by RYGB and VLCD. TNF-α levels were increased by RYGB, but reduced by VLCD. IL-2 and IL-6 levels were reduced and IL-4 levels were increased by VLCD but not affected by RYGB. The number of activated peripheral cytotoxic T (CD8+CD25+) and B (CD19+CD38+) cells was significantly higher after RYGB than after VLCD. CONCLUSION In conclusion, RYGB and VLCD have differential effects on the activation status of peripheral leukocytes and levels of cytokines in obese women with T2DM, despite comparable weight loss three months after the intervention. VLCD seems to have more favorable effects on the inflammatory profile as compared to RYGB.
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Affiliation(s)
- Mirjam A Lips
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Bert van Klinken
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Hanno Pijl
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Ignace Janssen
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Ko Willems van Dijk
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands; Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits Koning
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Vanessa van Harmelen
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands.
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Tam CS, Redman LM, Greenway F, LeBlanc KA, Haussmann MG, Ravussin E. Energy Metabolic Adaptation and Cardiometabolic Improvements One Year After Gastric Bypass, Sleeve Gastrectomy, and Gastric Band. J Clin Endocrinol Metab 2016; 101:3755-3764. [PMID: 27490919 PMCID: PMC6459006 DOI: 10.1210/jc.2016-1814] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT It is not known whether the magnitude of metabolic adaptation, a greater than expected drop in energy expenditure, depends on the type of bariatric surgery and is associated with cardiometabolic improvements. OBJECTIVE To compare changes in energy expenditure (metabolic chamber) and circulating cardiometabolic markers 8 weeks and 1 year after Roux-en-y bypass (RYGB), sleeve gastrectomy (SG), laparoscopic adjustable gastric band (LAGB), or a low-calorie diet (LCD). Design, Setting, Participants, and Intervention: This was a parallel-arm, prospective observational study of 30 individuals (27 females; mean age, 46 ± 2 years; body mass index, 47.2 ± 1.5 kg/m2) either self-selecting bariatric surgery (five RYGB, nine SG, seven LAGB) or on a LCD (n = 9) intervention (800 kcal/d for 8 weeks, followed by weight maintenance). RESULTS After 1 year, the RYGB and SG groups had similar degrees of body weight loss (33-36%), whereas the LAGB and LCD groups had 16 and 4% weight loss, respectively. After adjusting for changes in body composition, 24-hour energy expenditure was significantly decreased in all treatment groups at 8 weeks (-254 to -82 kcal/d), a drop that only persisted in RYGB (-124 ± 42 kcal/d; P = .002) and SG (-155 ± 118 kcal/d; P = .02) groups at 1 year. The degree of metabolic adaptation (24-hour and sleeping energy expenditure) was not significantly different between the treatment groups at either time-point. Plasma high-density lipoprotein and total and high molecular weight adiponectin were increased, and triglycerides and high-sensitivity C-reactive protein levels were reduced 1 year after RYGB or SG. CONCLUSIONS Metabolic adaptation of approximately 150 kcal/d occurs after RYGB and SG surgery. Future studies are required to examine whether these effects remain beyond 1 year.
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Affiliation(s)
- Charmaine S Tam
- Charles Perkins Centre and School of Life and Environmental Sciences (C.S.T.), The University of Sydney, Sydney, NSW 2006, Australia; Pennington Biomedical Research Center (C.S.T., L.M.R., F.G., E.R.), Baton Rouge, Louisiana 70808; and Our Lady of the Lake Physician Group (K.A.L., M.G.H.), Baton Rouge, Louisiana 70808
| | - Leanne M Redman
- Charles Perkins Centre and School of Life and Environmental Sciences (C.S.T.), The University of Sydney, Sydney, NSW 2006, Australia; Pennington Biomedical Research Center (C.S.T., L.M.R., F.G., E.R.), Baton Rouge, Louisiana 70808; and Our Lady of the Lake Physician Group (K.A.L., M.G.H.), Baton Rouge, Louisiana 70808
| | - Frank Greenway
- Charles Perkins Centre and School of Life and Environmental Sciences (C.S.T.), The University of Sydney, Sydney, NSW 2006, Australia; Pennington Biomedical Research Center (C.S.T., L.M.R., F.G., E.R.), Baton Rouge, Louisiana 70808; and Our Lady of the Lake Physician Group (K.A.L., M.G.H.), Baton Rouge, Louisiana 70808
| | - Karl A LeBlanc
- Charles Perkins Centre and School of Life and Environmental Sciences (C.S.T.), The University of Sydney, Sydney, NSW 2006, Australia; Pennington Biomedical Research Center (C.S.T., L.M.R., F.G., E.R.), Baton Rouge, Louisiana 70808; and Our Lady of the Lake Physician Group (K.A.L., M.G.H.), Baton Rouge, Louisiana 70808
| | - Mark G Haussmann
- Charles Perkins Centre and School of Life and Environmental Sciences (C.S.T.), The University of Sydney, Sydney, NSW 2006, Australia; Pennington Biomedical Research Center (C.S.T., L.M.R., F.G., E.R.), Baton Rouge, Louisiana 70808; and Our Lady of the Lake Physician Group (K.A.L., M.G.H.), Baton Rouge, Louisiana 70808
| | - Eric Ravussin
- Charles Perkins Centre and School of Life and Environmental Sciences (C.S.T.), The University of Sydney, Sydney, NSW 2006, Australia; Pennington Biomedical Research Center (C.S.T., L.M.R., F.G., E.R.), Baton Rouge, Louisiana 70808; and Our Lady of the Lake Physician Group (K.A.L., M.G.H.), Baton Rouge, Louisiana 70808
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Laurenius A, Engström M. Early dumping syndrome is not a complication but a desirable feature of Roux-en-Y gastric bypass surgery. Clin Obes 2016; 6:332-40. [PMID: 27487971 DOI: 10.1111/cob.12158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/27/2016] [Accepted: 07/03/2016] [Indexed: 12/31/2022]
Abstract
Early dumping syndrome after gastric bypass surgery due to rapid delivery of hyperosmolar nutrients into the bowel causing intense symptoms is often described as a complication. Twelve patients, mean age 47 years, were interviewed approximately 9 years post-operation. The interviews were audiotaped and transcribed verbatim, followed by an inductive content analysis to reveal patients' experience of the dumping syndrome. The core category 'Dumping syndrome is a positive consequence of Roux-en-Y gastric bypass surgery and a tool to control food intake' was identified based on the following four sub-categories: (i) 'The multidimensional emergence and effects of dumping syndrome', (ii) 'Dumping syndrome as something positive although unpleasant', (iii) 'Developing coping mechanisms and ingenious strategies' and (iv) 'My own fault if I expose myself to dumping syndrome'. From the patients' perspective, dumping syndrome gives control over food intake; although the symptoms were unpleasant, patients considered dumping syndrome as a positive protection against over-consumption. Hence, healthcare professionals should not present dumping syndrome as a complication but rather as an aid to control eating behaviour and excessive food intake.
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Affiliation(s)
- A Laurenius
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - M Engström
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Deb S, Voller L, Palisch C, Ceja O, Turner W, Rivas H, Morton JM. Influence of Weight Loss Attempts on Bariatric Surgery Outcomes. Am Surg 2016; 82:916-920. [PMID: 27779973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Many payors require an additional attempt at nonsurgical weight loss before approval of bariatric procedures. This study evaluates this requirement by characterizing the prior weight loss attempts (WLAs) undergone by bariatric surgery patients and correlating those attempts to postoperative weight loss outcomes. Number and duration of WLAs were obtained from a preoperative clinic assessment. Body mass index (BMI) and percentage of excess weight loss (%EWL) were used to assess weight loss. Kruskal-Wallis and Spearman Correlation tests were performed to analyze data using GraphPad Prism 6. Mean number of WLAs before surgery was 3.5 ± 0.2 attempts, with an average duration of 15.2 ± 1.1 years. There was a significant negative correlation between duration of WLAs and preoperative BMI (r = -0.2637, P = 0.0025). No significant difference was found for preoperative BMI or mean 12-month %EWL among any WLA groups. The number and duration of dietary attempts before surgery do not significantly affect long-term weight loss outcomes after bariatric surgery. Given these data, an additional preoperative WLA may not be efficacious in improving patients' chances at weight loss.
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Affiliation(s)
- Sayantan Deb
- Stanford School of Medicine, Section of Bariatric and Minimally Invasive Surgery, Stanford, California, USA
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Nicoletti CF, Kimura BM, de Oliveira BAP, de Pinhel MAS, Salgado W, Marchini JS, Nonino CB. Role of UCP2 polymorphisms on dietary intake of obese patients who underwent bariatric surgery. Clin Obes 2016; 6:354-8. [PMID: 27256164 DOI: 10.1111/cob.12148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/05/2016] [Accepted: 04/12/2016] [Indexed: 12/26/2022]
Abstract
Uncoupling protein 2 ( UCP2 ) plays an important role in body weight and energy metabolism and may be related to the control of food consumption. This study aimed to investigate the contribution of UCP2 gene variants on the dietary intake on a population after bariatric surgery. This study enrolled 150 obese patients (body mass index ≥ 35kg m(-2) ) who submitted to Roux-en-Y gastric bypass. Weight (kg), BMI (kg m(-2) ), energy (kcal d(-1) ) and macronutrients intake (g d(-1) ) of preoperative and 1-year postoperative period were collected from medical records. Ala55Val and -866G>A polymorphisms in the UCP2 gene were genotyped through allelic discrimination method in real-time polymerase chain reaction using the TaqMan pre-designed SNP Genotyping Assays kits. Hardy-Weinberg equilibrium, t-test and regression models were performed in statistical analysis (P<0.05).We found an allelic frequency of 0.44 for allele Val and 0.41 for allele A. In the postoperative period, patients with at least one rare allele for polymorphisms and with at least one rare allele for both polymorphisms together (haplotype) present a greater energy and carbohydrate intake, even after adjusting for gender, age and weight. Genetic variants in UCP2 gene were associated with the dietary consumption after Roux-En-Y gastric bypass.
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Affiliation(s)
- C F Nicoletti
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of São Paulo, RibeirãoPreto, Brazil
| | - B M Kimura
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of São Paulo, RibeirãoPreto, Brazil
| | - B A P de Oliveira
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of São Paulo, RibeirãoPreto, Brazil
| | - M A S de Pinhel
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of São Paulo, RibeirãoPreto, Brazil
| | - W Salgado
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University of São Paulo, RibeirãoPreto, Brazil
| | - J S Marchini
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of São Paulo, RibeirãoPreto, Brazil
| | - C B Nonino
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of São Paulo, RibeirãoPreto, Brazil.
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Kalarchian MA, Marcus MD, Courcoulas AP, Lutz C, Cheng Y, Sweeny G. Structured dietary intervention to facilitate weight loss after bariatric surgery: A randomized, controlled pilot study. Obesity (Silver Spring) 2016; 24:1906-12. [PMID: 27466039 DOI: 10.1002/oby.21591] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/30/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the potential utility of a structured dietary intervention to assist bariatric surgery patients with weight management. METHODS Participants who underwent Roux-en-Y gastric bypass surgery 1 year previously were randomly assigned to a structured dietary intervention incorporating portion-controlled foods (intervention, n = 20) or a comparison group (control, n = 20). Both groups received instruction in behavioral weight loss (one 60-min session) followed by four monthly coaching telephone calls. Assessments were conducted at baseline, 4 months (post-intervention), and 6 months. RESULTS Participants were 85% female and 80% White. Average age was 46.9 (11.1) years, and body mass index was 31.3 (5.4) kg/m(2) at enrollment. Percent weight change from enrollment was significantly greater for intervention compared with control participants at 4 months [-4.56% vs. -0.13%, t(30) = -3.29, P = 0.003] and 6 months [-4.07% vs. -0.14%, t(31) = -2.03, P = 0.05]. Change in average daily calorie intake was greater among intervention compared with control [-108 vs. 116, t(30) = -2.01, P = 0.05] at 4 months only. CONCLUSIONS A structured dietary intervention increased weight loss and reduced calorie intake when initiated 1 year following Roux-en-Y gastric bypass. This approach holds promise for optimizing postsurgery lifestyle change.
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Affiliation(s)
- Melissa A Kalarchian
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA
| | - Anita P Courcoulas
- Department of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA
| | - Calvin Lutz
- Department of Statistics, University of Pittsburgh, Pennsylvania, USA
| | - Yu Cheng
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA
- Department of Statistics, University of Pittsburgh, Pennsylvania, USA
| | - Gina Sweeny
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA
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Floerchinger AM, Jackson MI, Jewell DE, MacLeay JM, Hahn KA, Paetau-Robinson I. Effect of feeding a weight loss food beyond a caloric restriction period on body composition and resistance to weight gain in cats. J Am Vet Med Assoc 2016. [PMID: 26225608 DOI: 10.2460/javma.247.4.365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effect of feeding a food with coconut oil and supplemental L-carnitine, lysine, leucine, and fiber on weight loss and maintenance in cats. DESIGN Prospective clinical study. ANIMALS 50 overweight cats. PROCEDURES The study consisted of 2 trials. During trial 1, 30 cats were allocated to 3 groups (10 cats/group) to be fed a dry maintenance cat food to maintain body weight (group 1) or a dry test food at the same amount on a mass (group 2) or energy (group 3) basis as group 1. During trial 2, each of 20 cats was fed the test food and caloric intake was adjusted to maintain a weight loss rate of 1%/wk (weight loss phase). Next, each cat was fed the test food in an amount calculated to maintain the body weight achieved at the end of the weight loss phase (weight maintenance phase). Cats were weighed and underwent dual-energy x-ray absorptiometry monthly. Metabolomic data were determined before (baseline) and after each phase. RESULTS During trial 1, cats in groups 2 and 3 lost significantly more weight than did those in group 1. During trial 2, cats lost a significant amount of body weight and fat mass but retained lean body mass during the weight loss phase and continued to lose body weight and fat mass but gained lean body mass during the weight maintenance phase. Evaluation of metabolomic data suggested that fat metabolism was improved from baseline for cats fed the test food. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that feeding overweight cats the test food caused weight loss and improvements in body condition during the weight maintenance phase, possibly because the food composition improved energy metabolism.
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Kanakubo K, Fascetti AJ, Larsen JA. Assessment of protein and amino acid concentrations and labeling adequacy of commercial vegetarian diets formulated for dogs and cats. J Am Vet Med Assoc 2016. [PMID: 26225610 DOI: 10.2460/javma.247.4.385] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine measured crude protein (CP) and amino acid (AA) concentrations and assess labeling adequacy of vegetarian diets formulated for dogs and cats. DESIGN Cross-sectional study. SAMPLE 13 dry and 11 canned vegetarian diets for dogs and cats. PROCEDURES Concentrations of CP and AAs were determined for each diet. Values were compared with the Association of American Feed Control Officials (AAFCO) Dog and Cat Food Nutrient Profiles. Product labels were assessed for compliance with AAFCO regulations. RESULTS CP concentration (dry-matter basis) ranged from 19.2% to 40.3% (median, 29.8%). Minimum CP concentrations for the specified species and life stage were met by 23 diets; the remaining diet passed appropriate AAFCO feeding trials. Six diets did not meet all AA minimums, compared with the AAFCO nutrient profiles. Of these 6 diets, 1 was below AAFCO minimum requirements in 4 AAs (leucine, methionine, methionine-cystine, and taurine), 2 were below in 3 AAs (methionine, methionine-cystine, and taurine), 2 were below in 2 AAs (lysine and tryptophan), and 1 was below in 1 AA (tryptophan). Only 3 and 8 diets (with and without a statement of calorie content as a requirement, respectively) were compliant with all pet food label regulations established by the AAFCO. CONCLUSION AND CLINICAL RELEVANCE Most diets assessed in this study were not compliant with AAFCO labeling regulations, and there were concerns regarding adequacy of AA content. Manufacturers should ensure regulatory compliance and nutritional adequacy of all diets, and pets fed commercially available vegetarian diets should be monitored and assessed routinely.
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Pournaras DJ, Nygren J, Hagström-Toft E, Arner P, le Roux CW, Thorell A. Improved glucose metabolism after gastric bypass: evolution of the paradigm. Surg Obes Relat Dis 2016; 12:1457-1465. [PMID: 27387696 DOI: 10.1016/j.soard.2016.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 01/19/2016] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Glucose metabolism is improved in patients with type 2 diabetes after Roux-en-Y gastric bypass (RYGB). OBJECTIVES To quantify the relative contribution of calorie restriction, rerouting of nutrients, and adipose tissue reduction. SETTING University Hospital. METHODS Fifteen diabetic patients, (47±9 yr, body mass index 41.3±4.2 kg/m2) were randomized to a 2-week very low-calorie diet (VLCD) regimen or normal diet before RYGB. A euglycemic-hyperinsulinemic clamp, indirect calorimetry, and a standard meal test were performed prediet, postdiet (preoperatively), and 2 weeks and 12 months postoperatively. The primary outcome was whole-body insulin sensitivity (M) measured with the clamp 2 weeks postoperatively. RESULTS In the VLCD group, after 2 weeks of calorie restriction, M improved (2.9±1.3 to 4.2±1.1 mg/kg/min, P = .005) with no further change at 2 weeks postoperatively. In the normal diet group 2 weeks postoperatively, M was similar to the VLCD group (4.7±1.7 versus 4.2±1.1, P = .61). One year postoperatively, M improved further in both groups. The improvement in insulin-stimulated glucose uptake after VLCD and RYGB was entirely accounted for by nonoxidative glucose disposal (NOGD), whereas weight loss at 1 year postoperatively was associated with an increase in NOGD and glucose oxidation. Postprandial glucose improved after VLCD (P<.05) and even more 2 weeks after RYGB (P<.05) with no further change after 1 year. CONCLUSION Improved whole-body insulin sensitivity and postprandial glucose response occur early after RYGB. Low calorie intake and rerouting of nutrients contribute through distinct mechanisms. Weight loss contributes by increasing whole-body insulin sensitivity, including glucose oxidation and NOGD. These data suggest that the combination of different mechanisms is what makes RYGB an effective intervention for type 2 diabetes.
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Affiliation(s)
- Dimitri J Pournaras
- The Norfolk and Norwich Oesophagogastric Cancer Centre, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK.
| | - Jonas Nygren
- Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Eva Hagström-Toft
- Department of Medicine, H7, Karolinska Institutet, Stockholm, Sweden
| | - Peter Arner
- Department of Medicine, H7, Karolinska Institutet, Stockholm, Sweden
| | - Carel W le Roux
- Diabetes Complication Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden; Investigative Science, Imperial College London, London, UK
| | - Anders Thorell
- Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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de Hollanda A, Casals G, Delgado S, Jiménez A, Viaplana J, Lacy AM, Vidal J. Gastrointestinal Hormones and Weight Loss Maintenance Following Roux-en-Y Gastric Bypass. J Clin Endocrinol Metab 2015; 100:4677-84. [PMID: 26505823 DOI: 10.1210/jc.2015-3065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Factors underlying variable weight loss (WL) after Roux-en-Y gastric bypass (RYGB) are poorly understood. OBJECTIVE Our objective was to gain insight on the role of gastrointestinal hormones on poor WL maintenance (P-WLM) following RYGB. DESIGN AND PATIENTS First, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and ghrelin responses to a standardized mixed liquid meal (SMLM) were compared between subjects with good WL (G-WL, n = 32) or P-WLM (n = 22). Second, we evaluated food intake (FI) following blockade of gut hormonal secretion in G-WL (n = 23) or P-WLM (n = 19) subjects. Finally, the impact of dietary-induced WL on the hormonal response in subjects with P-WLM (n = 14) was assessed. SETTING This study was undertaken in a tertiary hospital. MAIN OUTCOME MEASURES In studies 1 and 3, the outcomes measures were the areas under the curve of gut hormones following a SMLM; in study 2, FI following subcutaneous injection of saline or octreotide were evaluated. RESULTS P-WLM associated a blunted GLP-1 (P = .044) and PYY (P = .001) responses and lesser suppression of ghrelin (P = .032) following the SMLM challenge. On saline day, FI in the G-WL (393 ± 143 kcal) group was less than in the P-WLM (519 ± 143 Kcal; P = .014) group. Octreotide injection resulted in enlarged FI in both groups (G-WL: 579 ± 248 kcal, P = .014; P-WLM: 798 ± 284 Kcal, P = .036), but the difference in FI between groups remained (P < .001). In subjects with P-WLM, dietary-induced WL resulted in larger ghrelin suppression (P = .046), but no change in the GLP-1 or PYY responses. CONCLUSION Our data show gastrointestinal hormones play a role in the control of FI following RYGB, but do not support that changes in GLP-1, PYY, or ghrelin play a major role as determinants of P-WLM after this type of surgery.
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Affiliation(s)
- Ana de Hollanda
- Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036
| | - Gregori Casals
- Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036
| | - Salvadora Delgado
- Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036
| | - Amanda Jiménez
- Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036
| | - Judith Viaplana
- Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036
| | - Antonio M Lacy
- Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036
| | - Josep Vidal
- Obesity Unit, Hospital Clinic Universitari (A.d.H., S.D., A.J., J.V., A.M.L.), Barcelona, Spain 08036; Center for Biological Diagnostics (G.C.), Hospital Clínic Universitari, Barcelona, Spain 08036; Institut d'Investigacions Biomèdiques August Pi Sunyer (S.D., A.M.L., J.V.), Barcelona, Spain 08036; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (J.P.), Barcelona, Spain 08036
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Turkmen S, Andreen L, Cengiz Y. Effects of Roux-en-Y gastric bypass surgery on eating behaviour and allopregnanolone levels in obese women with polycystic ovary syndrome. Gynecol Endocrinol 2015; 31:301-5. [PMID: 25537661 DOI: 10.3109/09513590.2014.994600] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is associated with abnormal eating habits. We examined whether surgical treatment affected allopregnanolone levels and eating behaviour in nine women with PCOS who qualified for Rou-en-Y gastric bypass surgery. Blood samples were obtained to measure sex-hormone-binding globulin, total testosterone, progesterone, and allopregnanolone, and eating behaviour was evaluated using the Three-Factor Eating Questionnaire before surgery and at 6 and 12 months after surgery. Body mass index and total testosterone levels decreased, and progesterone and sex-hormone-binding globulin levels increased after bariatric surgery compared with pre-surgical values. In patients with anovulatory menstrual cycles, both the serum allopregnanolone level and the allopregnanolone/progesterone ratio were unchanged after surgery. The patients had high uncontrolled and emotional eating scores, and low cognitive restraint scores before surgery, and these scores had improved significantly at 6 and 12 months after surgery. The presurgical allopregnanolone levels were significantly correlated with uncontrolled eating. In conclusion, these results suggest that allopregnanolone appear to be part of the mechanism underlying the abnormal eating behaviour of obese PCOS patients by causing the loss of control over food intake. Roux-en-Y gastric bypass surgery can improve eating behaviour and clinical symptoms, and may facilitate weight loss in obese women with PCOS.
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Affiliation(s)
- Sahruh Turkmen
- Department of Clinical Science, Obstetrics & Gynaecology, Sundsvalls Research Unit, Umeå University , Umeå , Sweden
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Jastrzębska-Mierzyńska M, Ostrowska L, Wasiluk D, Konarzewska-Duchnowska E. Dietetic recommendations after bariatric procedures in the light of the new guidelines regarding metabolic and bariatric surgery. Rocz Panstw Zakl Hig 2015; 66:13-19. [PMID: 25813068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
The frequency of obesity occurrence is constantly increasing all over the world and becoming global epidemic. Facing the lack of the efficiency of conservative treatment, patients with II and III degree of obesity are qualified for surgical treatment; however, the efficiency of surgical treatment is connected with permanent change of nutritional habits and previous lifestyle of the patient. Modification of the way of nutrition, regardless of the type of bariatric procedure, should especially include the lowering of food energetic value and change of type, consistency and size of consumed food. Nutritional treatment after bariatric procedures is multistage. It includes clear liquid diet, full liquid diet, pureed diet, mechanically altered soft diet and regular diet. Gradual expanding of the diet protects gastrointestinal tract from chemical, mechanical and thermal irritation by the food. It also should prevent nutritional deficiencies. Significant influence on the result of surgical treatment of obesity has also regular intake of food, consuming products with high nutritional value, avoiding confectionery and fat products, consuming proper amounts of protein (60-80 g/day) and vitamin-mineral supplementation.
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Affiliation(s)
- Marta Jastrzębska-Mierzyńska
- Department of Dietetics and Clinical Nutrition, Faculty of Health Sciences, Medical University of Bialystok, Poland
| | - Lucyna Ostrowska
- Department of Dietetics and Clinical Nutrition, Faculty of Health Sciences, Medical University of Bialystok, Poland
| | - Diana Wasiluk
- Department of Dietetics and Clinical Nutrition, Faculty of Health Sciences, Medical University of Bialystok, Poland
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Jennings A, Hughes CA, Kumaravel B, Bachmann MO, Steel N, Capehorn M, Cheema K. Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care. Clin Obes 2014; 4:254-66. [PMID: 25825858 PMCID: PMC4253319 DOI: 10.1111/cob.12066] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 05/05/2014] [Accepted: 05/26/2014] [Indexed: 12/01/2022]
Abstract
A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m(-2) , or 30 kg·m(-2) with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m(-2) . A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services.
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Affiliation(s)
- A Jennings
- Norwich Medical School, University of East Anglia, Norwich, UK
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Rothberg AE, McEwen LN, Kraftson AT, Fowler CE, Herman WH. Very-low-energy diet for type 2 diabetes: an underutilized therapy? J Diabetes Complications 2014; 28:506-10. [PMID: 24849710 PMCID: PMC4350259 DOI: 10.1016/j.jdiacomp.2014.03.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/14/2014] [Accepted: 03/24/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Current approaches to the management of type 2 diabetes focus on the early initiation of novel pharmacologic therapies and bariatric surgery. OBJECTIVE The purpose of this study was to revisit the use of intensive, outpatient, behavioral weight management programs for the management of type 2 diabetes. DESIGN Prospective observational study of 66 patients with type 2 diabetes and BMI ≥ 32 kg/m² who enrolled in a program designed to produce 15% weight reduction over 12 weeks using total meal replacement and low- to moderate-intensity physical activity. RESULTS Patients were 53 ± 7 years of age (mean ± SD) and 53% were men. After 12 weeks, BMI fell from 40.1 ± 6.6 to 35.1 ± 6.5 kg/m². HbA1c fell from 7.4% ± 1.3% to 6.5% ± 1.2% (57.4 ± 12.3 to 47.7 ± 12.9 mmol/mol) in patients with established diabetes: 76% of patients with established diabetes and 100% of patients with newly diagnosed diabetes achieved HbA1c <7.0% (53.0 mmol/mol). Improvement in HbA1c over 12 weeks was associated with higher baseline HbA1c and greater reduction in BMI. CONCLUSIONS An intensive, outpatient, behavioral weight management program significantly improved HbA1c in patients with type 2 diabetes over 12 weeks. The use of such programs should be encouraged among obese patients with type 2 diabetes.
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Affiliation(s)
- Amy E Rothberg
- University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH).
| | - Laura N McEwen
- University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH)
| | - Andrew T Kraftson
- University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH)
| | - Christine E Fowler
- University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH)
| | - William H Herman
- University of Michigan, Department of Internal Medicine (AER, LNM, ATK, CEF); University of Michigan, Departments of Internal Medicine and Epidemiology (WHH)
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50
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Lavryk AS, Mitchenko OI, Shkr'oba AO, Romanov VI, Chulaievs'ka IV. [Dynamics of indices of the carbohydrate metabolism in patients with morbid obesity after conservative and surgical methods of treatment]. Klin Khir 2014:12-15. [PMID: 25675756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The dynamics of indices of the carbohydrate metabolism was studied in 164 patients, suffering morbid obesity (MO) (body mass index--BMI over 40 kg/M2), before and in 6 mo after conservative and surgical treatment. In 81 patients (I group) for treatment of MO a diet and medicine "Styfimol" were used, and in 83 (II group)--bariatric operations (gastric banding or shunting). In 6 mo after the treatment in patients of both groups a trustworthy reduction of body mass and BMI was observed, including in a group I--by 5.5 kg (4.6%), and in a group II--by 35 kg (22.8%). As a consequence of this a level of insulin and a HOMA index was noted, what have had promoted a reduction of a revealing rate of glucose tolerance violation (GTV) and diabetes mellitus (DM) type II. More essential changes in carbohydrate metabolism were observed in a group II, including a rate of revealing of HGTV--by 41%, DM type II--by 75%.
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