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Gagner M, Almutlaq L, Cadiere GB, Torres AJ, Sanchez-Pernaute A, Buchwald JN, Abuladze D. Side-to-side magnetic duodeno-ileostomy in adults with severe obesity with or without type 2 diabetes: early outcomes with prior or concurrent sleeve gastrectomy. Surg Obes Relat Dis 2024; 20:341-352. [PMID: 38114385 DOI: 10.1016/j.soard.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/19/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Conventional metabolic/bariatric surgical anastomoses with sutures/staples may cause severe adverse events (AEs). OBJECTIVES The study aim was to evaluate the feasibility, safety, and effectiveness of primary and revisional side-to-side duodeno-ileostomy (DI) bipartition using a novel magnetic compression anastomosis device (Magnet Anastomosis System [MS]). SETTING Multicenter: private practices and university hospitals. METHODS In patients with body mass index ([BMI, kg/m2] ≥35.0 to ≤50.0 with/without type 2 diabetes [T2D] glycosylated hemoglobin [HbA1C > 6.5 %]), two linear MS magnets were delivered endoscopically to the duodenum and ileum with laparoscopic assistance and aligned, initiating magnet fusion and gradual DI (MagDI). The MagDI-after-SG group had undergone prior sleeve gastrectomy (SG); the MagDI + SG group underwent concurrent SG. AEs were graded by Clavien-Dindo Classification (CDC). RESULTS Between November 22, 2021 and May 30, 2023, 43 patients (88.0% female, mean age 43.7 ± 1.3 years) underwent the study procedures. The MS met feasibility criteria of magnet device placement, creation of patent anastomoses confirmed radiologically, and magnet passage in 100.0% of patients. There were 64 AEs, most were CDC grade I and II, significantly fewer in the MagDI-after-SG group (P < .001). No device-related AEs including anastomotic leakage, bleeding, obstruction, infection, or death. The MagDI-after-SG group experienced 6-month mean weight loss of 8.0 ± 2.5 kg (P < .01), 17.4 ± 5.0% excess weight loss (EWL). The MagDI + SG group had significantly greater weight loss (34.2 ± 1.6 kg, P < .001), 66.2 ± 3.4% EWL. All patients with T2D improved. CONCLUSIONS In early results of a multicenter study, the incisionless, sutureless Magnet System formed patent, complication-free anastomoses in side-to-side DI with prior or concurrent SG.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, Westmount, Quebec, Canada.
| | - Lamees Almutlaq
- Department of Surgery, Westmount Square Surgical Center, Westmount, Quebec, Canada
| | | | - Antonio J Torres
- Department of Surgery, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Jane N Buchwald
- Medwrite Medical Communications, Maiden Rock, Wisconsin, USA
| | - David Abuladze
- Department of Surgery, Innova Medical Center, Tbilisi, Republic of Georgia
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Greene ME, Grieco A, Evans-Labok K, Ko CY, Hutter MM. First report of outcomes from the patient-reported outcome measures program in the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program. Surg Obes Relat Dis 2024; 20:173-183. [PMID: 37949691 DOI: 10.1016/j.soard.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/14/2023] [Accepted: 09/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Health-related quality-of-life (HRQoL) is one of the most important outcomes to metabolic and bariatric surgery (MBS) patients but was not measured by the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP). A patient-reported outcome measures (PROMs) program pilot started in 2016 with MBSAQIP implementation in 2019. OBJECTIVES To measure how MBS impacts patient HRQoL 1 and 2 years after primary laparoscopic Roux-en-Y gastric bypass (bypass) or laparoscopic sleeve gastrectomy (sleeve). SETTING The 82 centers in the United States participating in the MBSAQIP PROMs program. METHODS Preoperative HRQoL scores and satisfaction were compared with postoperative scores 1 and 2 years after surgery with univariate comparisons and adjusted regression models. RESULTS There were 13,901 PROMs responses from 11,146 patients. Patient satisfaction with their MBS decision was 97%. On average, patients had significant improvement in Obesity-related Problem (OP) scores (65.8 preoperatively, 23.0 at 1 yr, and 26.3 at 2 yr; P <.05), Obesity and Weight-Loss Quality-of-Life (OWLQOL) scores (36.7 preoperatively, 77.2 at 1 yr, and 74.6 at 2 yr; P < .05), their physical health (39.2 preoperatively versus 51.7 at 1 yr and 50.0 at 2 yr), and mental health (45.6 preoperatively versus 53.3 at 1 yr and 51.4 at 2 yr). Compared with bypass patients, sleeve patients had significantly lower odds of having low OP scores postoperatively (odds ratio [95% CI) ] .67 [.53, .83]) and lower odds of high OWLQOL (.61 [.48, .77]) at 1 year. CONCLUSION All patients regardless of procedure on average report significant improvement in their scores for OP, OWLQOL, and physical and mental health after MBS. At 1 and 2 years, bypass patients reported greater improvement in their obesity-related PROMs than sleeve patients.
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Affiliation(s)
- Meridith E Greene
- Department of Surgery, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Clifford Y Ko
- American College of Surgeons, Chicago, Illinois; Department of Surgery, University of California Los Angeles David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Matthew M Hutter
- Department of Surgery, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Leang YJ, Mayavel N, Yang WTW, Kong JCH, Hensman C, Burton PR, Brown WA. Robotic versus laparoscopic gastric bypass in bariatric surgery: a systematic review and meta-analysis on perioperative outcomes. Surg Obes Relat Dis 2024; 20:62-71. [PMID: 37730445 DOI: 10.1016/j.soard.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/22/2023] [Accepted: 08/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Robotic-assisted surgery has emerged as a compelling approach to bariatric surgery. However, current literature has not consistently demonstrated superior outcomes to laparoscopic bariatric surgery to justify its higher cost. With its mechanical advantages, the potential gains from the robotic surgical platform are likely to be apparent in more complex cases such as gastric bypass, especially revisional cases. OBJECTIVE This systematic review and meta-analysis aimed to summarize the literature and evaluate the peri-operative outcomes of patients with obesity undergoing robotic gastric bypass versus laparoscopic gastric bypass surgery. SETTING Systematic review. METHODS A literature search of Embase, Medline, Pubmed, Cochrane library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing outcomes of robotic and laparoscopic gastric bypass for obesity were included. RESULTS Twenty-eight eligible studies comprised a total of 82,155 patients; 9051 robotic bypass surgery (RBS) versus 73,104 laparoscopic bypass surgery (LBS) were included. All included studies compared Roux-en-Y gastric bypass. RBS was noted to have higher reoperation rate within 30 days (4.4% versus 3.4%; odds ratio 1.31 [95% CI, 1.04-1.66]; P = .027; I2 = 43.5%) than LBS. All other endpoints measured (complication rate, anastomotic leak, anastomotic stricture, surgical site infections, hospital readmission, length of stay, operative time, conversion rate and mortality) did not show any difference between RBS and LBS. CONCLUSION This systematic review and meta-analysis showed that there was no significant difference in key outcome measures in robotic versus laparoscopic gastric bypass. RBS was associated with a slightly higher reoperation rate and there was no reduction in overall complication rate with the use of robotic platform.
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Affiliation(s)
- Yit J Leang
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
| | - Naveen Mayavel
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Wilson T W Yang
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Joseph C H Kong
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Chrys Hensman
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Paul R Burton
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Wendy A Brown
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
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Hanssen HM, Fjellstad MS, Skjevling L, Johnsen PH, Kulseng B, Goll R, Almå KH, Valle PC. Randomised, placebo-controlled, double-blinded trial of fecal microbiota transplantation in severe obesity: a study protocol. BMJ Open 2023; 13:e073242. [PMID: 38151280 DOI: 10.1136/bmjopen-2023-073242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Obesity is one of the main threats to public health in western countries and increases the risk of several diseases, overall morbidity and mortality. Sustained weight loss will reduce risk factors and improve several obesity comorbidities. Options are conservative treatment such as lifestyle changes, bariatric surgery or medications. Conservative treatment has a low success rate, and bariatric surgery is typically not reversible, with the risk of complications and recurrences. Treatment of obesity with medications has in recent years shown great promise, but the side effects are many, and the long-term effect is unknown. There is also a need for an option for patients where surgery has contraindications and conservative follow-up does not succeed.The research on obesity and gut microbiota has yielded promising results regarding weight reduction and metabolic health, but more research is needed to better understand the relationship between gut microbiota and severe obesity. This study could show proof of concept that gut microbiota from a lean donor could, in addition to lifestyle intervention, contribute to weight reduction in people suffering from severe obesity. METHOD AND ANALYSIS This study aims to investigate if a fecal microbiota transplantation (FMT) from a lean donor leads to weight reduction in participants suffering from severe obesity. The study is a single-centre, double-blinded, placebo-controlled, parallel-group study with 60 participants. Participants will be randomised 1:1 for FMT from a lean donor or placebo. FMT or placebo will be delivered once by enema.We will include participants from the outpatient clinic for severe obesity, at the Medical Department, University Hospital of North Norway, Harstad, by invitation only. The study has a follow-up period of 12 months, with study visits of 3, 6 and 12 months post FMT. The primary endpoint is a weight reduction of ≥10%, 12 months after intervention.The results of the study will be published in open access journals. At the end of the study, the participants will receive information on which treatment group they belong to. ETHICS AND DISSEMINATION The Regional Ethical Committee in North Norway (REK) approved the study protocol (2017/1655/REK Nord). We plan to present the results from the study at (inter)national conferences and publish in open-access general peer-reviewed journals. The enema method for FMT administration used in this study was developed by our study team. TRIAL REGISTRATION NUMBER NCT03273855.
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Affiliation(s)
- Hege Marie Hanssen
- Medical Department, University Hospital of North Norway, Harstad, Norway
- Faculty of Health Science, UiT The Arctic University of Norway, Tromso, Norway
| | | | - Linn Skjevling
- Medical Department, University Hospital of North Norway, Harstad, Norway
- Faculty of Health Science, UiT The Arctic University of Norway, Tromso, Norway
| | - Peter Holger Johnsen
- Medical Department, University Hospital of North Norway, Harstad, Norway
- Faculty of Health Science, UiT The Arctic University of Norway, Tromso, Norway
| | - Bård Kulseng
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
| | - Rasmus Goll
- Faculty of Health Science, UiT The Arctic University of Norway, Tromso, Norway
- Department of Gastroenterology, University Hospital of North Norway, Tromso, Norway
| | - Kristin Helen Almå
- Medical Department, University Hospital of North Norway, Harstad, Norway
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Lee Y, Kazi T, Dang J, Kroh M, Doumouras AG, Hong D. Financial toxicity risk among patients with gastric banding complications in the United States: analysis of the National Inpatient Sample. Surg Obes Relat Dis 2023; 19:1405-1414. [PMID: 37550162 DOI: 10.1016/j.soard.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/25/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (AGB) was historically among the most performed bariatric procedures but has fallen out of favor in recent years due to poor long-term weight loss and high revisional surgery rates. Significant financial hardship of medical care, known as "financial toxicity," can occur from experiencing unexpected complications of AGB. OBJECTIVE To investigate the risk of financial toxicity among patients being admitted for AGB complications. SETTING United States. METHODS All uninsured and privately-insured patients who were admitted for AGB complications were identified from the National Inpatient Sample 2015-2019. Publicly available government data (U.S. Census Bureau, Bureau of Labor, The Centers for Medicare and Medicaid Services) were utilized to estimate patient income, food expenditures, and average maximum out-of-pocket expenditures. Financial toxicity was defined as total admission cost from AGB complications ≥40% of postsubsistence income. RESULTS Among 28,005 patients, 66% patients had private insurance and 44% patients were uninsured. Median total admission cost was $12,443 (interquartile range $7959-$19,859) and $15,182 for those who received revisional bariatric surgery. Approximately 55% of the uninsured patients and 1% of insured patients were at risk of financial toxicity after admission for banding-related complications. Patients who had an emergency admission, revisional surgery, or postoperative intensive care unit admission were more likely to experience financial catastrophe following admission (P < .01). CONCLUSIONS About 1 in 2 uninsured patients admitted for AGB-related complications were at risk of financial toxicity. In addition to surgical risks, providers should consider the potential financial consequences of AGB when counselling patients on their choice of surgery.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Tania Kazi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jerry Dang
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matthew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.
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Kermansaravi M, Husain FA, Bashir A, Valizadeh R, Abbas SI, Abouzeid T, Amini M, Davarpanah Jazi AH, Elfawal MH, Gado W, Gee T, Habeeb TAAM, Al Hadhrami B, Inam A, Vaziri NM, Mokhber S, Al-Momani H, Omerov T, Pazouki A, Rezapanah A, Rezvani M, Sadat Mansouri M, Sewefy AM, Taskin HE, Yunus T, Kassir R, Nimeri A. International survey on complications of religious fasting after metabolic and bariatric surgery. Sci Rep 2023; 13:20189. [PMID: 37980363 PMCID: PMC10657384 DOI: 10.1038/s41598-023-47673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/16/2023] [Indexed: 11/20/2023] Open
Abstract
Religious fasting in Ramadan the 9th month of the lunar year is one of five pillars in Islam and is practiced for a full month every year. There may be risks with fasting in patients with a history of metabolic/bariatric surgery (MBS). There is little published evidence on the possible complications during fasting and needs stronger recommendations and guidance to minimize them. An international survey was sent to surgeons to study the types of complications occurring during religious fasting in patients with history of MBS to evaluate the risk factors to manage and prepare more evidence-based recommendations. In total, 21 centers from 11 countries participated in this survey and reported a total of 132 patients with complications occurring during religious fasting after MBS. The mean age of patients with complications was 36.65 ± 3.48 years and mean BMI was 43.12 ± 6.86 kg/m2. Mean timing of complication occurring during fasting after MBS was 14.18 months. The most common complications were upper GI (gastrointestinal) symptoms including [gastroesophageal reflux disease (GERD), abdominal pain, and dyspepsia], marginal ulcers and dumping syndrome in 24% (32/132), 8.3% (11/132) and 23% (31/132) patients respectively. Surgical management was necessary in 4.5% of patients presenting with complications (6/132) patients due to perforated marginal or peptic ulcer in Single Anastomosis Duodenoileostomy with Sleeve gastrectomy (SADI-S), one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG), obstruction at Jejunojenostomy after Roux-en-Y gastric bypass (RYGB) (1/6) and acute cholecystitis (1/6). Patients after MBS should be advised about the risks while fasting including abdominal pain, dehydration, and peptic ulcer disease exacerbation, and a thorough review of their medications is warranted to minimize complications.
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Affiliation(s)
- Mohammad Kermansaravi
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Farah A Husain
- Department of Surgery, Banner University of Arizona-Phoenix, Phoenix, USA
| | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Amman, Jordan
| | | | | | - Tarek Abouzeid
- Department of Surgery, Ain-Shams University, Cairo, Egypt
| | - Masoud Amini
- Laparoscopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Waleed Gado
- Endocrine and Bariatric Surgery Unit, Mansoura University, Mansoura, Egypt
| | - Tikfu Gee
- Department of Medical Science, School of Healthcare and Medical Sciences, Sunway University Jalan University, Selangor Darul Ehsan, Bandar Sunway, Petaling Jaya, Malaysia
| | - Tamer A A M Habeeb
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Atif Inam
- In Charge Metabolic, Thoracic and General Surgery Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Nader Moein Vaziri
- Laparoscopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somayyeh Mokhber
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Taryel Omerov
- First Surgical Disease Department, Azerbaijan Medical University, Baku, Azerbaijan
| | - Abdolreza Pazouki
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rezapanah
- Department of Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Rezvani
- Inova Fair Oaks Hospital, COE Bariatric Center, 14904 Jefferson Davis Hwy, Suite 205, Woodbridge, VA, 22191, USA
| | | | - Alaa M Sewefy
- Department of Surgery, Minia University Hospital, Minia, Egypt
| | - Halit Eren Taskin
- Cerrahpasa Medical Faculty, Department of Surgery, Istanbul University Cerrahpasa, Istanbul, Turkey
| | | | - Radwan Kassir
- Department of Digestive Surgery, Centre Hospitalier Universitaire Félix Guyon, St Denis de La Réunion, France
| | - Abdelrahman Nimeri
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Griffin RL, Varley AN, Hajnal A, Booth JL. Severe Anemia in Sprague-Dawley Rats After Roux-en-Y Gastric Bypass Surgery. Comp Med 2023; 73:194-199. [PMID: 37258053 PMCID: PMC10290484 DOI: 10.30802/aalas-cm-22-000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/30/2022] [Accepted: 12/16/2022] [Indexed: 06/02/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) surgery is one of the most commonly performed bariatric procedures for weight loss in humans. However, this procedure is not risk-free, and patients may experience complications that include small bowel obstruction, gastrointestinal bleeding, chronic diarrhea, ulcers, malnutrition, and anemia. In particular, anemia is a recognized long-term complication and can be severe. Rats have been used as a model to study the effects of gastric bypass surgeries. They can experience similar complications as people, but the development of severe anemia has not previously been reported in rats. We observed 2 cases of severe anemia in female Sprague-Dawley rats after RYGB surgery. These cases prompted us to further investigate the frequency and severity of anemia after RYGB in rats. Blood work and necropsies were performed on 9 additional female Sprague-Dawley rats (5 with RYGB, 4 with sham surgery). In these 9 rats, only one had signs of clinical anemia. These 3 anemic rats displayed moderate to severe pallor of the eyes and ears. Necropsy findings in anemic RYGB rats included pale internal organs and eccentric heart enlargement, which led to a significantly higher heart:body weight ratio in RYGB rats as compared with sham controls. Anemic rats had either a macrocytic normochromic anemia, consistent with vitamin B12 or folate deficiency, or microcytic hypochromic anemia, indicative of iron deficiency. Researchers who perform RYGB surgery in rats should be aware of the potential complication of severe anemia. Plans for the diagnosis and management of this complication and the development of criteria for humane endpoints for severe anemia are recommended as a refinement to these studies.
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Affiliation(s)
- Rachel L Griffin
- Pennsyvania State University College of Medicine, Department of Comparative Medicine, Hershey, Pennsylvania
| | - Ashley N Varley
- Pennsyvania State University College of Medicine, Department of Comparative Medicine, Hershey, Pennsylvania
| | - Andras Hajnal
- Pennsylvania State University College of Medicine, Department of Neural & Behavioral Science, Hershey, Pennsylvania † Current affiliation: Inotiv, Denver, Pennsylvania
| | - Jennifer L Booth
- Pennsyvania State University College of Medicine, Department of Comparative Medicine, Hershey, Pennsylvania;,
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Dutta A, Sethi N, Puri GD, Sood J, Choudhary PK, Jain AK, Panday BC, Gupta M. Automated Closed-Loop Propofol Anesthesia Versus Desflurane Inhalation Anesthesia in Obese Patients Undergoing Bariatric Surgery: A Comparative Randomized Analysis of Recovery Profile. Asian J Anesthesiol 2023; 61:61-70. [PMID: 37386923 DOI: 10.6859/aja.202306_61(2).0003] [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: 09/15/2023]
Abstract
INTRODUCTION Precision general anesthesia (GA) techniques that minimize the presence of residual anesthetic and facilitate recovery, are desirable in patients with morbid obesity. Automated administration of propofol total intravenous anesthesia (TIVA), which facilitates precision propofol delivery by factoring in continuous patient input variable (bispectral index) to establish a closed feedback loop system, may help mitigate concerns related to propofol's lipid solubility and adverse accumulation kinetics in patients with morbid obesity. This randomized study evaluated the recovery of patients with morbid obesity undergoing bariatric surgery under propofol TIVA automated by a closed-loop anesthesia delivery system (CLADS) versus desflurane GA. METHODS Forty patients, randomly allocated to receive propofol TIVA (CLADS group) or desflurane GA (desflurane group), were evaluated for postoperative recovery (early and intermediate) (primary objective); they were evaluated for intraoperative hemodynamics, anesthesia depth consistency, anesthesia delivery performance characteristics, patient satisfaction, and incidence of adverse events (sedation, pain, postoperative nausea, and vomiting) (secondary objective). RESULTS No difference was found for the time-to-eye-opening (CLADS group: 4.7 [3.0, 6.7] min vs. desflurane group: 5.6 [4.0, 6.9] min, P = 0.576), time-to-tracheal-extubation (CLADS group: 6.7 [4.7, 9.3] min vs. desflurane group: 7.0 [5.8, 9.2] min, P = 0.528), ability-to-shift score from operating room table to the transport bed (CLADS group: 3 [3.0, 3.5] vs. desflurane group: 3 [3.0, 4.0], P = 0.703), and time to achieve a modified Aldrete score 9/10 (CLADS group: 15 [15.0, 37.5] min vs. desflurane group: 15 [15.0, 43.7] min, P = 0.867). CONCLUSION Automated propofol TIVA as administered by CLADS, which matched desflurane GA with respect to depth of anesthesia consistency and postanesthesia recovery profile, can be explored further as an alternative anesthesia technique in patients with morbid obesity.
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Affiliation(s)
- Amitabh Dutta
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Nitin Sethi
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Goverdhan D Puri
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayashree Sood
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Prabhat Kumar Choudhary
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Kumar Jain
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Bhuwan Chand Panday
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Manish Gupta
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Dutta A, Sethi N, Puri GD, Sood J, Choudhary PK, Jain AK, Panday BC, Gupta M. Automated Closed-Loop Propofol Anesthesia Versus Desflurane Inhalation Anesthesia in Obese Patients Undergoing Bariatric Surgery: A Comparative Randomized Analysis of Recovery Profile. Asian J Anesthesiol 2023; 61:61-70. [PMID: 37386923 DOI: 10.6859/aja.202306/pp.0001] [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: 07/01/2023]
Abstract
INTRODUCTION Precision general anesthesia (GA) techniques that minimize the presence of residual anesthetic and facilitate recovery, are desirable in patients with morbid obesity. Automated administration of propofol total intravenous anesthesia (TIVA), which facilitates precision propofol delivery by factoring in continuous patient input variable (bispectral index) to establish a closed feedback loop system, may help mitigate concerns related to propofol's lipid solubility and adverse accumulation kinetics in patients with morbid obesity. This randomized study evaluated the recovery of patients with morbid obesity undergoing bariatric surgery under propofol TIVA automated by a closed-loop anesthesia delivery system (CLADS) versus desflurane GA. METHODS Forty patients, randomly allocated to receive propofol TIVA (CLADS group) or desflurane GA (desflurane group), were evaluated for postoperative recovery (early and intermediate) (primary objective); they were evaluated for intraoperative hemodynamics, anesthesia depth consistency, anesthesia delivery performance characteristics, patient satisfaction, and incidence of adverse events (sedation, pain, postoperative nausea, and vomiting) (secondary objective). RESULTS No difference was found for the time-to-eye-opening (CLADS group: 4.7 [3.0, 6.7] min vs. desflurane group: 5.6 [4.0, 6.9] min, P = 0.576), time-to-tracheal-extubation (CLADS group: 6.7 [4.7, 9.3] min vs. desflurane group: 7.0 [5.8, 9.2] min, P = 0.528), ability-to-shift score from operating room table to the transport bed (CLADS group: 3 [3.0, 3.5] vs. desflurane group: 3 [3.0, 4.0], P = 0.703), and time to achieve a modified Aldrete score 9/10 (CLADS group: 15 [15.0, 37.5] min vs. desflurane group: 15 [15.0, 43.7] min, P = 0.867). CONCLUSION Automated propofol TIVA as administered by CLADS, which matched desflurane GA with respect to depth of anesthesia consistency and postanesthesia recovery profile, can be explored further as an alternative anesthesia technique in patients with morbid obesity.
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Affiliation(s)
- Amitabh Dutta
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Nitin Sethi
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Goverdhan D Puri
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayashree Sood
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Prabhat Kumar Choudhary
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Kumar Jain
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Bhuwan Chand Panday
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Manish Gupta
- Institute of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Jayaprakash MS, Beavers DP, Miller GD, McNatt S, Fernandez A, Edwards-Hampton SA, Ard JD. Impact on Cardiovascular Health of Using Phentermine/Topiramate in Combination With Laparoscopic Sleeve Gastrectomy in Super Obesity. J Surg Res 2023; 286:41-48. [PMID: 36753948 DOI: 10.1016/j.jss.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/06/2022] [Accepted: 12/24/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Management of patients with BMI≥50 kg/m2 is challenging. In previous work, pre and postoperative pharmacotherapy with phentermine/topiramate plus laparoscopic sleeve gastrectomy (PT + SG) promoted greater weight loss than sleeve gastrectomy (SG) alone at 24 mo postoperatively. This current secondary analysis studied the impact of PT + SG on blood pressure (BP), heart rate, and antihypertensive usage. METHODS Patients with BMI≥50 kg/m2 planning to have SG (n = 13) were recruited from 2014 to 2016, at an academic medical center in Winston-Salem, North Carolina, for this open-label trial. Participants took phentermine/topiramate (PT; 7.5/46-15/92 mg/d) for ≥3 mo preoperatively and 24 mo postoperatively. The control group (n = 40) underwent SG during the same time frame. We used mixed models for BP and heart rate to compare PT + SG versus SG alone over time, adjusted for age, sex, and initial BP. RESULTS By 24 mo postoperatively the model adjusted changes in systolic blood pressure/diastolic blood pressure (SBP/DBP) (mm Hg) were -24.44 (-34.46,-14.43)/-28.60 (-40.74,-16.46) in the PT + SG group versus -11.81 (-17.58,-6.05)/-13.89 (-21.32,-6.46) in the control group (SBP P = 0.02; DBP P = 0.03). At baseline 8 (61.5%) participants in the PT + SG arm and 22 (55.0%) in the control group used antihypertensives. Excluding patients lost to follow-up (n = 3), by 24 mo postoperatively, none of the PT + SG participants were on antihypertensives compared to 14 (41.2%) in the control group (P = 0.01). CONCLUSIONS Patients with BMI≥50 kg/m2 treated with PT + SG had greater improvement in BP with no use of antihypertensive medication at 24 mo postoperatively versus SG alone, where 41% continued medication use. Larger trials are required to evaluate this.
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Affiliation(s)
| | - Daniel P Beavers
- Department of Statistical Sciences, Wake Forest University, Winston Salem, North Carolina
| | - Gary D Miller
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, North Carolina
| | - Stephen McNatt
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston Salem, North Carolina
| | - Adolfo Fernandez
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston Salem, North Carolina
| | - Shenelle A Edwards-Hampton
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston Salem, North Carolina.
| | - Jamy D Ard
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston Salem, North Carolina; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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11
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Alessandris R, Moroso F, Michelotto M, Fassan M, Angerilli V, Callegari L, Foletto M. Preoperative endoscopy and pathology report of the specimen to be recommended in sleeve gastrectomy? Pathologica 2023; 115:90-96. [PMID: 37017300 PMCID: PMC10463000 DOI: 10.32074/1591-951x-781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/12/2022] [Indexed: 04/06/2023] Open
Abstract
Objective Preoperative upper gastrointestinal endoscopy (UGIE) and postoperative histopathological examination (HPE) of resected specimens are still controversial issues in bariatric surgery. Methods A retrospective review of prospectively collected laparoscopic sleeve gastrectomies (SG) performed at our institution for morbid obesity was carried out. All patients underwent pre-operative UGIE with biopsy, post-operative HPE and conventional post-operative follow-up. Results From January 2019 through January 2021 we performed a total of 501 laparoscopic SG. A total of 12 (2.4%) neoplasms were found, 2 evident at preoperative UGIE, 4 detected during operation, and 6 at HPE. Eight of these 12 cases had some malignant potential and 5 would not have been detected without HPE of the specimen. The most significant unexpected case was a fundic gland type adenocarcinoma in a 64-year-old female with severe obesity. Conclusion On the basis of our clinical experience, we recommend both preoperative endoscopic assessment and postoperative HPE of the specimen to provide the best available treatment to these patients.
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Affiliation(s)
- Remo Alessandris
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| | - Federico Moroso
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| | - Mauro Michelotto
- Surgical Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
- Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Valentina Angerilli
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - Linda Callegari
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| | - Mirto Foletto
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
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Edwards MA, Muraleedharan D, Spaulding A. Racial disparities in reasons for mortality following bariatric surgery. J Racial Ethn Health Disparities 2023; 10:526-535. [PMID: 35132607 DOI: 10.1007/s40615-022-01242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) remains a safe and effective treatment for patients with severe obesity. Recent studies have highlighted racial disparities in perioperative outcomes, including up to a twofold higher mortality rate in non-Hispanic black (NHB) (vs. non-Hispanic white (NHW)) patients. Causality for these disparate outcomes remains unclear and largely unexplored. OBJECTIVE Our study aim was to determine reasons for mortality among racial and ethnic cohorts and MBS patients. SETTING Academic Hospital. METHODS Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) cases were identified using the 2015 to 2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) database using current procedural (CPT) codes 43,664, 43,645, and 43,775. Multivariate regression analyses were performed to determine independent predictors of overall and bariatric-related mortality. Reasons for mortality were identified and compared between racial and ethnic cohorts. RESULTS Of 650,903 RYGB and SG cases, 512,041 were included in our analysis (73% SG). For the entire cohort, all-cause and bariatric-related mortality rates were 0.095% and 0.05%, respectively. Age, male gender, ASA 4, functional status, therapeutic anticoagulation, smoking, COPD, and RYGB were independently associated with both overall and bariatric-related mortality. NHB had increased odds (2.13, p < 0.001) of bariatric-related mortality. Compared to NHW patients (13.3%), venous thromboembolic (VTE) complication was the most common reason for overall mortality in NHB (27.8%) and Hispanic (25%) patients (p < 0.001). VTE-related mortality directly associated with the bariatric procedure was also higher in NHB (34.6%) and Hispanic (33.3%) (vs. NHW 21.0%) patients (p 0.05). When stratified by procedure, mortality causes in RYGB cases were similar between racial and ethnic cohorts. In the SG cohort, the proportion of VTE-related mortality varied significantly (p 0.043) between NHB (39.2%), Hispanic 40.0%, and NHW (20.5%) patients. CONCLUSION There are racial and ethnic differences in causes of mortality following bariatric surgery. The predominant cause of overall and bariatric-related mortality in NHB bariatric surgery patients is postoperative venous thromboembolism. More granular MBSAQIP data capture is needed to determine the role of patient risk versus practice patterns in these disparate outcomes.
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Affiliation(s)
- Michael A Edwards
- Department Surgery, Mayo Clinic Alix School of Medicine, Jacksonville, FL, 32224, USA.
| | - Divya Muraleedharan
- Department Surgery, Mayo Clinic Alix School of Medicine, Jacksonville, FL, 32224, USA
| | - Aaron Spaulding
- Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, FL, 32224, USA
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de Heide LJM, Wouda SHT, Peters VJT, Oosterwerff-Suiker M, Gerdes VA, Emous M, van Beek AP. Medical and surgical treatment of postbariatric hypoglycaemia: Retrospective data from daily practice. Diabetes Obes Metab 2023; 25:735-747. [PMID: 36377811 DOI: 10.1111/dom.14920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
AIM To evaluate medical and surgical treatment of postbariatric hypoglycaemia (PBH) in daily practice. MATERIALS AND METHODS Retrospective data were extracted from medical records from four hospitals. PBH was defined by neuroglycopenic symptoms together with a documented glucose <3.0 mmol/L in the postprandial setting after previous bariatric surgery. Data were scored semiquantitatively on efficacy and side effects by two reviewers independently. Duration of efficacy and of use were calculated. RESULTS In total, 120 patients were included with a median follow-up of 27 months with a mean baseline age of 41 years, total weight loss of 33% and glucose nadir 2.3 mmol/L. Pharmacotherapy consisted of acarbose, diazoxide, short- and long-acting octreotide and glucagon-like peptide-1 receptor agonist analogues (liraglutide and semaglutide) with an overall efficacy in 45%-75% of patients. Combination therapy with two drugs was used by 30 (25%) patients. The addition of a second drug was successful in over half of the patients. Long-acting octreotide and the glucagon-like peptide-1 receptor agonist analogues scored best in terms of efficacy and side effects with a median duration of use of 35 months for octreotide. Finally, 23 (19%) patients were referred for surgical intervention. Efficacy of the surgical procedures, pouch banding, G-tube placement in remnant stomach and Roux-en-Y gastric bypass reversal, pooled together, was 79% with a median duration of initial effect of 13 months. CONCLUSIONS In daily practice, pharmacotherapy for PBH was successful in half to three quarters of patients. Combination therapy was often of value. One in five patients finally needed a surgical procedure, with overall good results.
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Affiliation(s)
- Loek J M de Heide
- Centre for Obesity Northern Netherlands, Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Sterre H T Wouda
- Department of Biomedical Science, University of Groningen, Groningen, The Netherlands
| | - Vincent J T Peters
- Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Management, Tilburg University, Tilburg, The Netherlands
| | | | - Victor A Gerdes
- Department of Internal Medicine, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Marloes Emous
- Centre for Obesity Northern Netherlands, Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hlavin C, Ingraham P, Byrd T, Hyre N, Gabriel L, Agrawal N, Allen L, Kenkre T, Watson A, Kaynar M, Ahmed B, Courcoulas A. Clinical Outcomes and Hospital Utilization Among Patients Undergoing Bariatric Surgery With Telemedicine Preoperative Care. JAMA Netw Open 2023; 6:e2255994. [PMID: 36763357 PMCID: PMC9918871 DOI: 10.1001/jamanetworkopen.2022.55994] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/11/2022] [Accepted: 12/28/2022] [Indexed: 02/11/2023] Open
Abstract
Importance Bariatric surgery is the mainstay of treatment for medically refractory obesity; however, it is underutilized. Telemedicine affords patient cost and time savings and may increase availability and accessibility of bariatric surgery. Objective To determine clinical outcomes and postoperative hospital utilization for patients undergoing bariatric surgery who receive fully remote vs in-person preoperative care. Design, Setting, and Participants This cohort study comparing postoperative clinical outcomes and hospital utilization after telemedicine or in-person preoperative surgical evaluation included patients treated at a US academic hospital. Participants underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy after telemedicine or in-person preoperative surgical evaluation between July 1, 2020, to December 22, 2021, or January 1, 2018, to December 31, 2019, respectively. Follow-up was 60 days from date of surgery. Exposures Telemedicine-based preoperative care. Main Outcomes and Measures Clinical outcomes, including operating room delay, procedure duration, length of hospital stay (LOS), and major adverse events (MAE), and postoperative hospital resource utilization, including emergency department (ED) visit or hospital readmission within 30 days of the surgical procedure. Results A total of 1182 patients were included; patients in the telemedicine group were younger (mean [SD] age, 40.8 [12.5] years vs 43.0 [12.2] years; P = .01) and more likely to be female (230 of 257 [89.5%] vs 766 of 925 [82.8%]; P = .01) compared with the control group. The control group had a higher frequency of comorbidity (887 of 925 [95.9%] vs 208 of 257 [80.9%]; P < .001). The telemedicine group was found to be noninferior to the control group with respect to operating room delay (mean [SD] minutes, 7.8 [25.1]; 95% CI, 5.1-10.5 vs 4.2 [11.1]; 95% CI, 1.0-7.4; P = .002), procedure duration (mean [SD] minutes, 134.4 [52.8]; 95% CI, 130.9-137.8 vs 105.3 [41.5]; 95% CI, 100.2-110.4; P < .001), LOS (mean [SD] days, 1.9 [1.1]; 95% CI, 1.8-1.9 vs 2.1 [1.0]; 95% CI, 1.9-2.2; P < .001), MAE within 30 days (3.8%; 95% CI, 3.0%-5.7% vs 1.6%; 95% CI, 0.4%-3.9%; P = .001), MAE between 31 and 60 days (2.2%; 95% CI, 1.3%-3.3% vs 1.6%; 95% CI, 0.4%-3.9%; P < .001), frequency of ER visits (18.8%; 95% CI, 16.3%-21.4% vs 17.9%; 95% CI, 13.2%-22.6%; P = .03), and hospital readmission (10.1%; 95% CI, 8.1%-12.0% vs 6.6%; 95% CI, 3.9%-10.4%; P = .02). Conclusions and Relevance In this cohort study, clinical outcomes in the telemedicine group were not inferior to the control group. This observation suggests that telemedicine can be used safely and effectively for bariatric surgical preoperative care.
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Affiliation(s)
- Callie Hlavin
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Phoebe Ingraham
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tamara Byrd
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nathan Hyre
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lucine Gabriel
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nishant Agrawal
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura Allen
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tanya Kenkre
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew Watson
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Murat Kaynar
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bestoun Ahmed
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Mokhber S, Sheidaei A, Farsi F, Setarehdan SA, Mansournia MA, Solaymani-Dodaran M, Kabir A, Abdolhosseini MR, Pazouki A. A Representative Percentile Chart for Prediction of Weight Loss Trend after Sleeve Gastrectomy. Obes Facts 2023; 16:62-68. [PMID: 36282073 PMCID: PMC9889720 DOI: 10.1159/000527721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION It could be valuable for surgeons and patients to use one chart in different groups and evaluate weight loss during the post-surgery period. METHODS This retrospective study used the Iran National Obesity Surgery Database. Patients with clinically severe obesity aged 18-70 undergoing sleeve gastrectomy participated in this study. Body mass index (BMI) reduction and 5 other metrics measured over the study period were modeled using lambda-mu-sigma method. Our data were split into the train (70%) and test (30%) sets. RESULTS In this study, 1,258 patients (75% female) met the eligibility criteria to participate. Mean age and initial BMI were 36.87 ± 10.51 and 42.74 (40.37-46.36), respectively. Percentile charts for various metrics have been presented for the first 2 years after surgery. CONCLUSIONS For sleeve surgery, all metrics are acceptable for clinical applications. Using the statistical view, BMI reduction is the most acceptable metric according to the lowest bias values and its variation between all the metrics.
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Affiliation(s)
- Somayeh Mokhber
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnaz Farsi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amin Setarehdan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Solaymani-Dodaran
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- *Masoud Solaymani-Dodaran,
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
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Mazzini GS, Campos GM. Comment on: Glycemic outcomes in patients with type 2 diabetes after bariatric surgery compared with routine care: a population-based, real-world cohort study in the United Kingdom. Surg Obes Relat Dis 2023; 19:e1. [PMID: 36470812 DOI: 10.1016/j.soard.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Guilherme S Mazzini
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Guilherme M Campos
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
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Connolly CT, Fox NS. Incidence and Risk Factors for a Malpositioned Intrauterine Device Detected on Three-Dimensional Ultrasound Within Eight Weeks of Placement. J Ultrasound Med 2022; 41:1525-1536. [PMID: 34580900 DOI: 10.1002/jum.15836] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To estimate the incidence of intrauterine device (IUD) malpositioning detected on three-dimensional (3D) transvaginal ultrasound within 8 weeks of placement and identify risk factors for malpositioning. METHODS Retrospective study of women who had an IUD placed at a large obstetrics and gynecology practice from January 1, 2015, to December 31, 2020. All patients underwent two-dimensional ultrasound at the time of insertion and routine three-dimensional ultrasound within 8 weeks. Baseline characteristics and potential risk factors were compared between women with correctly positioned and malpositioned IUDs. Odds ratios were calculated by logistic regression to identify risk factors independently associated with malpositioning. RESULTS A total of 763 IUD placements were included, and 127 malpositioned IUDs were identified representing an overall rate of malpositioning of 16.6% (95% confidence interval [CI] 14.0-19.3) with 8.8% (95% CI 6.8-10.8) requiring removal. Patients with malpositioned IUD had higher rates of morbid obesity (13.4% versus 3.8%, adjusted odds ratio [aOR] 2.46, 95% CI 1.10-5.50), prior uterine window or rupture (9.0% versus 2.2%, aOR 2.78, 95% CI 1.06-7.30), copper IUD placement (64.2% versus 47.4%, aOR 1.99, 95% CI 1.31-3.03), and symptoms such as bleeding or pain at follow-up (35.8% versus 20.1%, aOR 2.58, 95% CI 1.67-3.98). Parity, breastfeeding, difficult insertion, and uterine size and positioning were not significant. CONCLUSIONS The incidence of malpositioned IUD within 8 weeks of placement on 3D ultrasound is 16.6%, with 8.8% requiring removal. Significant risk factors for malpositioning include morbid obesity, prior uterine window or rupture, and copper IUD placement. These findings support the importance of routine follow-up 3D ultrasound after seemingly successful IUD placement.
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Affiliation(s)
- Courtney T Connolly
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathan S Fox
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Maternal Fetal Medicine Associates, PLLC, New York, NY, USA
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Abstract
It has been increasingly acknowledged that bariatric surgery adversely affects skeletal health. After bariatric surgery, the extent of high-turnover bone loss is much greater than what would be expected in the absence of a severe skeletal insult. Patients also experience a significant deterioration in bone microarchitecture and strength. There is now a growing body of evidence that suggests an association between bariatric surgery and higher fracture risk. Although the mechanisms underlying the high-turnover bone loss and increase in fracture risk after bariatric surgery are not fully understood, many factors seem to be involved. The usual suspects are nutritional factors and mechanical unloading, and the roles of gut hormones, adipokines, and bone marrow adiposity should be investigated further. Roux-en-Y gastric bypass (RYGB) was once the most commonly performed bariatric procedure worldwide, but sleeve gastrectomy (SG) has now become the predominant bariatric procedure. Accumulating evidence suggests that RYGB is associated with a greater reduction in BMD, a greater increase in markers of bone turnover, and a higher risk of fracture than SG. These findings should be taken into consideration in determining the most appropriate bariatric procedure for patients, especially those at higher fracture risk. Before and after all bariatric procedures, sufficient calcium, vitamin D and protein intake, and adequate physical activity, are needed to counteract negative impacts on bone. There are no studies to date that have evaluated the effect of osteoporosis treatment on high-turnover bone loss after bariatric surgery. However, in patients with a diagnosis of osteoporosis, anti-resorptive agents may be considered.
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Affiliation(s)
- Julien Paccou
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France.
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, 2, Avenue Oscar Lambret, 59037, Lille, France.
| | - Robert Caiazzo
- Inserm, Endocrine and Metabolic Surgery, UMR 1190, CHU Lille, Univ. Lille, 59000, Lille, France
| | - Eric Lespessailles
- Department of Rheumatology, CHR Orléans, I3MTO EA 4708, Univ. Orléans, 45067, Orléans, France
| | - Bernard Cortet
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
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19
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van der Ven RGFM, de Vos R, Lodewijks Y, van Hout GCM, Lichthart S, Nienhuijs SW. Additional preconditioning program for bariatric surgery: Any benefits? A large cohort study. Clin Obes 2022; 12:e12507. [PMID: 35040265 DOI: 10.1111/cob.12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/25/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
Postbariatric outcomes may improve by providing an additional preconditioning program (APP) in targeted patients. However, APPs are a demand for health resources while only little and inconsistent evidence consists to support their effectiveness. This cohort study aims to evaluate the effectiveness of APP, by comparing outcomes of patients with and without such APP. We carried out a retrospective single-centre cohort study in a before-after design. Patients signing up for primary gastric bypass or sleeve gastrectomy and eligible for surgery were included if screened as vulnerable patients. Vulnerable patients screened between September 2017 and March 2018 followed an APP and formed the APP-group. Due to a policy change, APPs were no longer performed since September 2018. Vulnerable patients screened between September 2018 and March 2019 thus did not receive an APP (comparator-group). Multidisciplinary follow-up remained unchanged. Endpoints included percentage total weight loss (%TWL), bodyweight, evolution of comorbidities, protein intake, and number of no-shows. The APP-group comprised 231 patients and the comparator-group 153. %TWL differed statistically significantly at 7 (Δ1.5%, p = .01) and 12 months postoperative (Δ2.8%, p < .01) in favour of the comparator-group, as did bodyweight 12 months postoperative (Δ1.8 kg, p < .01). Statistically significant differences were also found in the evolution of comorbidities, protein intake, and the number of no-shows, most in favour for the comparator-group. APP proofed not to be superior to Non-App. It is debatable whether statically significant differences are clinically relevant given their small magnitude. A care pathway without an APP seems at least as effective as a care pathway without.
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Affiliation(s)
| | - Rien de Vos
- Department of Clinical Epidemiology and Biostatistics, Department of Medical Education, Amsterdam University Medical Center, The Netherlands
| | - Yentl Lodewijks
- Department of Surgery, Obesity Center Catharina Hospital, Eindhoven, The Netherlands
| | - Gerbrand C M van Hout
- Department of Psychology, Obesity Center Catharina Hospital, Eindhoven, The Netherlands
| | - Sacha Lichthart
- Department of Dietetics, Obesity Center Catharina Hospital, Eindhoven, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Obesity Center Catharina Hospital, Eindhoven, The Netherlands
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20
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Saeed S, Arslan M, Manzoor J, Din SM, Janjua QM, Ayesha H, Ain QT, Inam L, Lobbens S, Vaillant E, Durand E, Derhourhi M, Amanzougarene S, Badreddine A, Berberian L, Gaget S, Khan WI, Butt TA, Bonnefond A, Froguel P. Genetic Causes of Severe Childhood Obesity: A Remarkably High Prevalence in an Inbred Population of Pakistan. Diabetes 2020; 69:1424-1438. [PMID: 32349990 DOI: 10.2337/db19-1238] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/25/2020] [Indexed: 11/13/2022]
Abstract
Monogenic forms of obesity have been identified in ≤10% of severely obese European patients. However, the overall spectrum of deleterious variants (point mutations and structural variants) responsible for childhood severe obesity remains elusive. In this study, we genetically screened 225 severely obese children from consanguineous Pakistani families through a combination of techniques, including an in-house-developed augmented whole-exome sequencing method (CoDE-seq) that enables simultaneous detection of whole-exome copy number variations (CNVs) and point mutations in coding regions. We identified 110 (49%) probands carrying 55 different pathogenic point mutations and CNVs in 13 genes/loci responsible for nonsyndromic and syndromic monofactorial obesity. CoDE-seq also identified 28 rare or novel CNVs associated with intellectual disability in 22 additional obese subjects (10%). Additionally, we highlight variants in candidate genes for obesity warranting further investigation. Altogether, 59% of cases in the studied cohort are likely to have a discrete genetic cause, with 13% of these as a result of CNVs, demonstrating a remarkably higher prevalence of monofactorial obesity than hitherto reported and a plausible overlapping of obesity and intellectual disabilities in several cases. Finally, inbred populations with a high prevalence of obesity provide unique, genetically enriched material in the quest of new genes/variants influencing energy balance.
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Affiliation(s)
- Sadia Saeed
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Muhammad Arslan
- School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Jaida Manzoor
- Department of Paediatric Endocrinology, Children's Hospital, Lahore, Pakistan
| | - Sadia M Din
- Institute of Molecular Biology and Biotechnology, University of Lahore, Lahore, Pakistan
| | - Qasim M Janjua
- Institute of Molecular Biology and Biotechnology, University of Lahore, Lahore, Pakistan
- Department of Physiology, University College of Medicine and Dentistry, University of Lahore, Lahore, Pakistan
| | - Hina Ayesha
- Department of Paediatrics, Punjab Medical College, Faisalabad, Pakistan
| | - Qura-Tul Ain
- Institute of Molecular Biology and Biotechnology, University of Lahore, Lahore, Pakistan
| | - Laraib Inam
- School of Life Sciences, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Stephane Lobbens
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
| | - Emmanuel Vaillant
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
| | - Emmanuelle Durand
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
| | - Mehdi Derhourhi
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
| | - Souhila Amanzougarene
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
| | - Alaa Badreddine
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
| | - Lionel Berberian
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
| | - Stefan Gaget
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
| | - Waqas I Khan
- The Children Hospital and the Institute of Child Health, Multan, Pakistan
| | - Taeed A Butt
- Department of Pediatrics, Fatima Memorial Hospital, Lahore, Pakistan
| | - Amélie Bonnefond
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
| | - Philippe Froguel
- Université de Lille, INSERM UMR1283, CNRS-UMR 8199-European Genomic Institute for Diabetes, and Lille University Hospital, Lille, France
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
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21
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Santonicola A, Gagliardi M, Asparago G, Carpinelli L, Angrisani L, Iovino P. Anhedonia and functional dyspepsia in obese patients: Relationship with binge eating behaviour. World J Gastroenterol 2020; 26:2632-2644. [PMID: 32523316 PMCID: PMC7265144 DOI: 10.3748/wjg.v26.i20.2632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/09/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obese patients (Ob) with a binge eating disorders (BED) behavior pattern have a higher prevalence of postprandial distress syndrome (PDS) compared to Ob without a BED behavior pattern, while an increase of PDS has been described in Ob after sleeve gastrectomy (SG). Hedonic response to a meal is dissociable from satiation in healthy subjects. Anhedonia is the lowered ability to experience pleasure. There are no studies investigating the presence of anhedonia in Ob with and without SG and its relationship to PDS symptoms.
AIM To assess the relationship among anhedonia, BED and upper gastrointestinal symptoms in two group of morbidly Ob with and without SG.
METHODS Eighty-one Ob without SG, 45 Ob with SG and 55 healthy controls (HC) were studied. All subjects fulfilled the binge eating scale (BES) to investigate BED, the validated 14 items Snaith-Hamilton pleasure scale (SHAPS) to assess Anhedonia as well as the Beck Depression Inventory-II (BDI II) and State Trait Anxiety Inventory (STAI) questionnaires to screen for depression and anxiety. All patients underwent a standardized questionnaire investigating the intensity-frequency scores (0-6) of upper gastrointestinal symptoms and were diagnosed for the presence of functional dyspepsia (FD) and its subtypes according to ROME IV criteria.
RESULTS Ob without SG who were positive for BED had a 4.7 higher risk of FD compared to Ob without SG who were negative for BED (OR: 4.7; 95.0%CI 1.23-18.24; P = 0.02). STAI-Y2 scores were significantly higher in Ob without SG positive for BED (42.2 ± 1.5 vs Ob negative for BED: 39.6 ± 1 .0, P = 0.04), while SHAPS scores and BDI II did not differ in the two groups (1.16 ± 1.30 vs 0.89 ± 1.02, P = 0.49). A lower prevalence of BED (BES > 17: 11.4% vs 40.7%, P = 0.001) and BDI-II (6.8 ± 1.2 vs 13.8 ± 1.9, P = 0.005) was reported in Ob with SG than Ob without SG, on the contrary total mean scores of STAI-Y1 and STAI-Y2 were significantly higher in Ob with SG than Ob without SG. Thirty-five percent of Ob with SG fulfilled the diagnosis of FD. SHAPS mean scores and the prevalence of anhedonia did not differ among the two groups (18.2 vs 8.1%, P = 0.2). Fifty-four percent of Ob with SG achieved surgical success excess weight loss > 50%. Excess weight loss was negatively related to SHAPS total mean scores [adjusted B: -7. 099 (95%CI: -13.91 to -0.29), P = 0.04].
CONCLUSION Ob without SG showed a higher prevalence of PDS, mood disorders and anxiety when positive for BE behavior compared to those negative for BE behavior, whereas no differences were found in SHAPS score. Ob with SG showed a higher prevalence of PDS compared to Ob without SG. Concerning psychological aspect, BED and depression are less frequent in the Ob with SG, while both state and trait anxiety are significantly higher. Moreover, the more an Ob with SG is anhedonic, less surgical success was achieved.
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Affiliation(s)
- Antonella Santonicola
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
| | - Mario Gagliardi
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
| | - Giovanni Asparago
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
| | - Luna Carpinelli
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
| | - Luigi Angrisani
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples 80100, Italy
| | - Paola Iovino
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
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22
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Abstract
Importance The prevalence of extreme obesity continues to increase among adults in the US, yet there is an absence of subnational estimates and geographic description of extreme obesity. This shortcoming prevents a thorough understanding of the geographic distribution of extreme obesity, which in turn limits the ability of public health agencies and policy makers to target areas with a known higher prevalence. Objectives To use small-area estimation to create county-level estimates of extreme obesity in the US and apply spatial methods to identify clusters of high and low prevalence. Design, Setting, and Participants A cross-sectional analysis was conducted using multilevel regression and poststratification with data from the 2012 Behavioral Risk Factor Surveillance System and the US Census Bureau to create prevalence estimates of county-level extreme obesity (body mass index ≥40 [calculated as weight in kilograms divided by height in meters squared]). Data were included on adults (aged ≥18 years) living in the contiguous US. Analysis was performed from June 4 to December 28, 2018. Main Outcomes and Measures Multilevel logistic regression models estimated the probability of extreme obesity based on individual-level and area-level characteristics. Census counts were multiplied by these probabilities and summed by county to create county-level prevalence estimates. Moran index values were calculated to assess spatial autocorrelation and identify spatial clusters of hot and cold spots. Estimates of moderate obesity were obtained for comparison. Results Overall, the weighted prevalence of extreme obesity was 4.0% (95% CI, 3.9%-4.1%) and the prevalence of moderate obesity was 23.7% (95% CI, 23.4%-23.9%). County-level prevalence of extreme obesity ranged from 1.3% (95% CI, 1.3%-1.3%) to 15.7% (95% CI, 15.3%-16.0%). The Pearson correlation coefficient comparing model-predicted estimates with direct estimates was 0.81 (P < .001). The Moran index I score was 0.35 (P < .001), indicating spatial clustering. Significant clusters of high and low prevalence were identified. Hot spots indicating clustering of high prevalence of extreme obesity in several regions, including the Mississippi Delta region and the Southeast, were identified, as well as clusters of low prevalence in the Rocky Mountain region and the Northeast. Conclusions and Relevance Substantial geographic variation was identified in the prevalence of extreme obesity; there was considerable county-level variation even in states generally known as having high or low prevalence of obesity. The results suggest that extreme obesity prevalence demonstrates spatial dependence and clustering and may support the need for substate analysis and benefit of disaggregation of obesity by group. Findings from this study can inform local and national policies seeking to identify populations most at risk from very high body mass index.
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Affiliation(s)
- Carrie W Mills
- Center for Systems and Community Design, The City University of New York Graduate School of Public Health & Health Policy, New York, New York
- CUNY Institute for Demographic Research, The City University of New York, New York, New York
| | - Glen Johnson
- Center for Systems and Community Design, The City University of New York Graduate School of Public Health & Health Policy, New York, New York
| | - Terry T K Huang
- Center for Systems and Community Design, The City University of New York Graduate School of Public Health & Health Policy, New York, New York
| | - Deborah Balk
- CUNY Institute for Demographic Research, The City University of New York, New York, New York
- Marxe School of Public and International Affairs, Baruch College, The City University of New York, New York, New York
| | - Katarzyna Wyka
- Center for Systems and Community Design, The City University of New York Graduate School of Public Health & Health Policy, New York, New York
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23
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Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. NCHS Data Brief 2020:1-8. [PMID: 32487284] [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: 06/11/2023]
Abstract
Obesity is associated with serious health risks (1). Severe obesity further increases the risk of obesity-related complications, such as coronary heart disease and end-stage renal disease (2,3). From 1999-2000 through 2015-2016, a significantly increasing trend in obesity was observed (4). This report provides the most recent national data for 2017-2018 on obesity and severe obesity prevalence among adults by sex, age, and race and Hispanic origin. Trends from 1999-2000 through 2017-2018 for adults aged 20 and over are also presented.
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24
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Chen C, Jin Z, Yang Y, Jiang F, Huang H, Liu S, Jin X. Association of low birth weight with thinness and severe obesity in children aged 3-12 years: a large-scale population-based cross-sectional study in Shanghai, China. BMJ Open 2019; 9:e028738. [PMID: 31152041 PMCID: PMC6549709 DOI: 10.1136/bmjopen-2018-028738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Low birth weight (BW) is a general symbol of inadequate intrauterine conditions that elicit abnormal fetal growth and development. The aim of current study is to investigate the relationship between low BW and thinness or severe obesity during maturation. DESIGN A large-scale cross-sectional population-based survey. SETTING 134 kindergartens and 70 elementary schools. PARTICIPANTS 70 284 Chinese children aged 3-12 years. OUTCOME MEASURES International Obesity Task Force body mass index (BMI) cut-offs were used to define grade 1, grade 2 and grade 3 thinness, overweight, obesity and severe obesity. Multinomial logistic regression was used to estimate the association between BW and BMI category. RESULTS A total of 70 284 children participated in the survey. The percentage of grade 1 thinness and severe obesity in children with low BW is significantly higher than that in children with normal BW (p<0.05). Low BW was associated with an increased risk of grade 1 thinness (OR 1.56, 95% CI 1.38 to 1.75), grade 2 thinness (OR 1.34, 95% CI 1.10 to 1.64), grade 3 thinness (OR 1.99, 95% CI 1.63 to 2.42) and severe obesity (OR 1.27, 95% CI 1.03 to 1.55) but was not associated with obesity (OR 0.85, 95% CI 0.67 to 1.06). CONCLUSION There is a positive association between low BW and thinness or severe obesity risk.
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Affiliation(s)
- Chang Chen
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhijuan Jin
- Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - You Yang
- Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Jiang
- Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Huang
- Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shijian Liu
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingming Jin
- Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Developmental and Behavioral Pediatrics, Shanghai Pubin Children Hospital, Shanghai, China
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25
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Venant V, Pouget M, Lahaye C, Gentes E, Pereira B, Lambert C, Debarges J, Domingues-Faria C, Palmier-Forestier C, Farigon N, Miolanne M, Boirie Y. Depression Severity as a Risk Factor of Sarcopenic Obesity in Morbidly Obese Patients. J Nutr Health Aging 2019; 23:761-767. [PMID: 31560036 DOI: 10.1007/s12603-019-1218-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/06/2023]
Abstract
SETTING Etiopathogenic factors of physical disability in obesity are numerous, underestimated and not sought in the non-geriatric population. Amongst these factors, depression may favor the development of sarcopenic obesity by reducing strength and physical performance even in the absence of overt muscle loss. Objectives and participants: To study the link between depression status and muscle functional disorders (dynapenia) in a population of adult subjects with severe and morbid obesity. MEASUREMENTS Patients were assessed for body composition, grip strength, the Short Physical Performances Battery test (SPPB), for depression according to the Beck II score as well as for metabolic parameters through biological tests. RESULTS In 373 obese subjects (mean age 44 ± 13y and BMI 43 ± 6 kg/m²), the prevalence of depression was 53% with 18% having mild depression, 18% moderate depression and 16% severe depression. Depression was significantly related to dynapenia: 62% of dynapenic (D) patients suffered from depression compared to 50% of non-dynapenic (ND) patients (p = 0.036). The Beck questionnaire score for D patients was 20 ± 13 and 15 ± 10 for ND patients (p = 0.001). The depression intensity was significantly correlated with dynapenia with D patients having a higher severe depression degree than ND patients (30% versus 11%; p < 0.0001). Fat-free to fat mass ratio was also significantly correlated with dynapenia (p = 0.01). In multivariate analysis, the presence of depression was twice as likely to be associated with dynapenia. CONCLUSIONS Depression is associated with a reduction of muscle function in severe obesity in relation to its severity and to changes in fat to fat-free mass, suggesting that screening and prevention of sarcopenic obesity should be considered in adult obese patients with depression.
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Affiliation(s)
- V Venant
- Pr. Yves Boirie. Clermont-Ferrand University Hospital, Clinical Nutrition Department, 58 rue Montalembert, 63003 Clermont-Ferrand, France. Tel+33(0)473754937.
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26
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Denzer C, Denzer F, Lennerz BS, Vollbach H, Lustig RH, Wabitsch M. Treatment of Hypothalamic Obesity with Dextroamphetamine: A Case Series. Obes Facts 2019; 12:91-102. [PMID: 30844799 PMCID: PMC6465734 DOI: 10.1159/000495851] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 04/20/2018] [Accepted: 11/22/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A limited number of published case reports suggest a positive effect of dextroamphetamine, an adrenergic agonist affecting both the central nervous system (CNS) and peripheral nervous system, on physical activity and weight in patients with hypothalamic obesity (intractable obesity following CNS insult). Here, we present our clinical experience with dextroamphetamine treatment for hypothalamic obesity. METHODS The clinical course of all patients started on dextroamphetamine treatment for severe hypothalamic obesity at our institution between 2010 and 2013 is reported. Dextroamphetamine administration was initiated at a single dose of 5 mg per day and titrated to effect up to a dose of 20 mg/day. BMI z-score velocity was calculated as change in BMI z-score over standardized intervals of 12 months. Parameters of treatment success and adverse events were assessed in a standardized fashion. RESULTS Seven patients (2 males; mean age 17.6 years [range 12.9-24.5]) underwent individual treatment attempts with dextroamphetamine between 2010 and 2013. The primary diagnoses were craniopharyngioma (n = 4), ganglioglioma WHO I (n = 1), astrocytoma (n = 1), and neonatal meningitis (n = 1). Time from initial CNS insult to initiation of dextroamphetamine treatment averaged 5.2 years (range 2.4 months to 16.5 years). All patients demonstrated a steady increase in BMI z-score from the time of initial diagnosis until initiation of dextroamphetamine treatment. Mean baseline BMI z-score was +3.17 ± 0.93 (+1.9 to +4.4). Mean BMI z-score velocity decelerated to -0.18 ± 0.12 per year during the first year of treatment and stabilized at +0.05 ± 0.32 per year during the second year of treatment. No significant adverse events were reported. CONCLUSION Dextroamphetamine treatment led to stabilization or reduction of BMI z-score in a cohort of 7 patients with hypothalamic obesity, with no adverse effects. Considering the projected increase in BMI z-score according to the natural course of the disease, these findings are promising and warrant further study.
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Affiliation(s)
- Christian Denzer
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany,
| | - Friederike Denzer
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
| | | | - Heike Vollbach
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
| | - Robert H Lustig
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, California, USA
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
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27
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Rebours V, Garteiser P, Ribeiro-Parenti L, Cavin JB, Doblas S, Pagé G, Bado A, Couvineau A, Ruszniewski P, Paradis V, Le Gall M, Van Beers BE, Couvelard A. Obesity-induced pancreatopathy in rats is reversible after bariatric surgery. Sci Rep 2018; 8:16295. [PMID: 30390093 PMCID: PMC6214994 DOI: 10.1038/s41598-018-34515-3] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/19/2018] [Indexed: 02/08/2023] Open
Abstract
Obesity is a risk factor for pancreatic diseases. Bariatric surgery is one of the most efficient treatments of morbid obesity. The aims were to assess pancreatic endocrine and exocrine lesions in obese rats, to analyze effects of bariatric surgery. Sixty-three male Wistar rats were included in five groups: 2 fed with high fat diet (HFD) or normal diet for 3 months, 2 fed with HFD or normal diet for 6 months; 1 group fed with HFD and undergoing bariatric surgery (n = 30). Quantitative MR imaging was performed in HFD6, ND6 and HFD3-BS. Pancreas specimens were analyzed after sacrifice for adipocyte infiltration, fibrosis, acinar-ductal metaplasia, abnormality of Langerhans islets (HHF: hypertrophy, hypervascularisation, fibrosis), and hemosiderin deposits in acinar or endocrine locations. We found that HFD6 rats had more fibro-inflammatory islets (P = 0.0139) and acinar-ducal metaplasia (P = 0.0843) than HFD3 rats. Rats with HFD3+6 had more fibro-inflammatory islets (P < 0.0001), hemosiderin deposits (p < 0.0001), fat infiltration (P = 0.0008) and acinar-ductal metaplasia lesions (P = 0.0424). Weight increase was associated with glycoregulation abnormalities (r = 0.44, P = 0.08) and adipocyte infiltrations (P = 0.009). After surgery, less fibro-inflammatory islets (P = 0.0004), fat and iron infiltrates (P = 0.005 and P = 0.06), and acino-ductal metaplasia (P = 0.05) were observed compared to HFD6 rats. MR image quantifications revealed increased elasticity, fat fraction, and R2 and a decreased elasticity wave dispersion coefficient in the high fat groups that reversed after surgery. MRI parameters were in strong correlation with respective histological counterparts. In conclusion, obese rats develop pancreatic inflammatory lesions with acinar-ductal metaplasia in acinar location and the endocrine-exocrine interface. These changes can be prevented by bariatric surgery. Quantitative MR imaging is accurate in identifying early pancreatic lesions.
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Affiliation(s)
- Vinciane Rebours
- Pancreatology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, and Paris-Diderot University, Paris, France.
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France.
| | | | - Lara Ribeiro-Parenti
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
- General and Digestive Surgery, Bichat Hospital, AP-HP, and Paris-Diderot University, Paris, France
| | | | - Sabrina Doblas
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
| | - Gwenaël Pagé
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
| | - André Bado
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
| | - Alain Couvineau
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
| | - Philippe Ruszniewski
- Pancreatology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, and Paris-Diderot University, Paris, France
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
| | - Valérie Paradis
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
- Pathology Department, Beaujon Hospital, DHU Unity, AP-HP, and Paris-Diderot University, Paris, France
| | - Maude Le Gall
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
| | - Bernard E Van Beers
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
- Radiology Department, Beaujon Hospital, DHU Unity, AP-HP, Clichy, and Paris-Diderot University, Paris, France
| | - Anne Couvelard
- Inserm UMR1149, DHU Unity, and Paris-Diderot University, Paris, France
- Pathology Department, Bichat Hospital, DHU Unity, AP-HP, and Paris-Diderot University, Paris, France
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Franco RR, Fonoff ET, Alvarenga PG, Alho EJL, Lopes AC, Hoexter MQ, Batistuzzo MC, Paiva RR, Taub A, Shavitt RG, Miguel EC, Teixeira MJ, Damiani D, Hamani C. Assessment of Safety and Outcome of Lateral Hypothalamic Deep Brain Stimulation for Obesity in a Small Series of Patients With Prader-Willi Syndrome. JAMA Netw Open 2018; 1:e185275. [PMID: 30646396 PMCID: PMC6324383 DOI: 10.1001/jamanetworkopen.2018.5275] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Deep brain stimulation (DBS) has been investigated for treatment of morbid obesity with variable results. Patients with Prader-Willi syndrome (PWS) present with obesity that is often difficult to treat. OBJECTIVE To test the safety and study the outcome of DBS in patients with PWS. DESIGN, SETTING, AND PARTICIPANTS This case series was conducted in the Hospital das Clínicas, University of São Paulo, Brazil. Four patients with genetically confirmed PWS presenting with severe obesity were included. EXPOSURE Deep brain stimulation electrodes were bilaterally implanted in the lateral hypothalamic area. After DBS implantation, the treatment included the following phases: titration (1-2 months), stimulation off (2 months), low-frequency DBS (40 Hz; 1 month), washout (15 days), high-frequency DBS (130 Hz; 1 month), and long-term follow-up (6 months). MAIN OUTCOMES AND MEASURES Primary outcome measures were adverse events recorded during stimulation and long-term DBS treatment. Secondary outcomes consisted of changes in anthropometric measures (weight, body mass index [calculated as weight in kilograms divided by height in meters squared], and abdominal and neck circumference), bioimpedanciometry, and calorimetry after 6 months of treatment compared with baseline. The following evaluations and measurements were conducted before and after DBS: clinical, neurological, psychiatric, neuropsychological, anthropometry, calorimetry, blood workup, hormonal levels, and sleep studies. Adverse effects were monitored during all follow-up visits. RESULTS Four patients with PWS were included (2 male and 2 female; ages 18-28 years). Baseline mean (SD) body mass index was 39.6 (11.1). Two patients had previous bariatric surgery, and all presented with psychiatric comorbidity, which was well controlled with the use of medications. At 6 months after long-term DBS, patients had a mean 9.6% increase in weight, 5.8% increase in body mass index, 8.4% increase in abdominal circumference, 4.2% increase in neck circumference, 5.3% increase in the percentage of body fat, and 0% change in calorimetry compared with baseline. Also unchanged were hormonal levels and results of blood workup, sleep studies, and neuropsychological evaluations. Two patients developed stimulation-induced manic symptoms. Discontinuation of DBS controlled this symptom in 1 patient. The other required adjustments in medication dosage. Two infections were documented, 1 associated with skin picking. CONCLUSIONS AND RELEVANCE Safety of lateral hypothalamic area stimulation was in the range of that demonstrated in patients with similar psychiatric conditions receiving DBS. In the small cohort of patients with PWS treated in our study, DBS was largely ineffective.
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Affiliation(s)
- Ruth R. Franco
- Children’s Institute, Division of Pediatric Endocrinology, University of São Paulo Medical School, São Paulo, Brazil
| | - Erich T. Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro G. Alvarenga
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Eduardo J. L. Alho
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Antonio Carlos Lopes
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Raquel R. Paiva
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Anita Taub
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Roseli G. Shavitt
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Euripides C. Miguel
- Institute of Psychiatry, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Manoel J. Teixeira
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Durval Damiani
- Children’s Institute, Division of Pediatric Endocrinology, University of São Paulo Medical School, São Paulo, Brazil
| | - Clement Hamani
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
- Harquail Centre for Neuromodulation, Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Neves AG, Kasawara KT, Godoy-Miranda AC, Oshika FH, Chaim EA, Surita FG. Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study. Clinics (Sao Paulo) 2017; 72:547-553. [PMID: 29069258 PMCID: PMC5629704 DOI: 10.6061/clinics/2017(09)05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/07/2017] [Accepted: 06/30/2017] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. METHODS We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. RESULTS Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. CONCLUSIONS Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age.
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Affiliation(s)
- Amanda Gonçalves Neves
- Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, BR
| | - Karina Tamy Kasawara
- Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, BR
| | - Ana Carolina Godoy-Miranda
- Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, BR
| | - Flávio Hideki Oshika
- Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, BR
| | - Elinton Adami Chaim
- Departamento de Cirurgia, Faculdade de Medicina, Universidade de Campinas, Campinas, SP, BR
| | - Fernanda Garanhani Surita
- Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, BR
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Abstract
PURPOSE OF REVIEW This review examines the risk of obesity in migrant groups-specifically migrants from countries with lower prevalence of obesity to countries with higher prevalence of obesity. We examine obesity prevalence within migrant groups compared with native populations and the evidence on factors that might shape obesity risk in these migrant groups. RECENT FINDINGS Migrants may arrive in new countries with a health advantage including generally a healthier body weight. Genetic and epi-genetic factors, as well as body size preference, socio-economic factors, and stress exposure, may play a role in increasing unhealthy weight gain in migrant populations. This unhealthy weight gain leads to similar or greater obesity risk in migrant populations compared with native populations 10-15 years after migration. Meeting the challenge of prevention and treatment of obesity in diverse populations will require greater attention to minority groups in research in the future.
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Affiliation(s)
- Marie Murphy
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Wendy Robertson
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
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Shoemaker A, Proietto J, Abuzzahab MJ, Markovic T, Malloy J, Kim DD. A randomized, placebo-controlled trial of beloranib for the treatment of hypothalamic injury-associated obesity. Diabetes Obes Metab 2017; 19:1165-1170. [PMID: 28261955 DOI: 10.1111/dom.12928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 12/01/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 01/10/2023]
Abstract
AIMS Hypothalamic injury-associated obesity (HIAO) results from damage to the hypothalamus that often occurs with surgical removal/radiation therapy of tumours in the hypothalamic region, such as craniopharyngioma. There is currently no rigorously studied pharmaceutical treatment for the intractable weight gain and cardiometabolic consequences that occur in patients with HIAO. We aimed to assess efficacy, safety and tolerability of beloranib treatment for 4 to 8 weeks in patients with HIAO. MATERIALS AND METHODS This Phase 2a, double-blind, placebo-controlled study included 14 patients with HIAO, randomized to receive beloranib 1.8 mg or placebo subcutaneously twice weekly for 4 weeks with an optional 4-week open-label extension in which all patients received beloranib. The primary endpoint was change in weight from baseline to Week 4. RESULTS Participants were 64% female, with a mean (SD) age of 32 (9) years, BMI of 43 (7) kg/m2 and weight of 126 (22) kg. Compared with placebo (N = 4), beloranib 1.8 mg (N = 8) resulted in a mean (95% CI) difference in weight of -3.2 (-5.4, -0.9) kg after 4 weeks. Weight loss continued through the 8 weeks in patients randomized to beloranib (mean -6.2 [-8.2, -4.1] kg). Beloranib treatment was associated with improvements in high-sensitivity CRP. Adverse events were mild to moderate. No patients who received beloranib discontinued treatment. CONCLUSION Beloranib treatment resulted in progressive weight loss in patients with HIAO that was comparable to that observed with beloranib in patients with exogenous obesity. These findings indicate a novel mechanism for treating obesity in patients with HIAO.
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Affiliation(s)
- Ashley Shoemaker
- Division of Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph Proietto
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia
| | - M Jennifer Abuzzahab
- McNeely Pediatric Diabetes Center and Endocrine Clinic, Children's Hospitals and Clinics of Minnesota, St. Paul, Minnesota
| | - Tania Markovic
- Boden Institute of Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
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Curry A. Weighty Matters. The pitfalls and payoff of dropping pounds. Diabetes Forecast 2016; 69:50-55. [PMID: 29693916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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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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Khan MJ, Gerasimidis K, Edwards CA, Shaikh MG. Role of Gut Microbiota in the Aetiology of Obesity: Proposed Mechanisms and Review of the Literature. J Obes 2016; 2016:7353642. [PMID: 27703805 PMCID: PMC5040794 DOI: 10.1155/2016/7353642] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/21/2016] [Accepted: 08/21/2016] [Indexed: 02/06/2023] Open
Abstract
The aetiology of obesity has been attributed to several factors (environmental, dietary, lifestyle, host, and genetic factors); however none of these fully explain the increase in the prevalence of obesity worldwide. Gut microbiota located at the interface of host and environment in the gut are a new area of research being explored to explain the excess accumulation of energy in obese individuals and may be a potential target for therapeutic manipulation to reduce host energy storage. Several mechanisms have been suggested to explain the role of gut microbiota in the aetiology of obesity such as short chain fatty acid production, stimulation of hormones, chronic low-grade inflammation, lipoprotein and bile acid metabolism, and increased endocannabinoid receptor system tone. However, evidence from animal and human studies clearly indicates controversies in determining the cause or effect relationship between the gut microbiota and obesity. Metagenomics based studies indicate that functionality rather than the composition of gut microbiota may be important. Further mechanistic studies controlling for environmental and epigenetic factors are therefore required to help unravel obesity pathogenesis.
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Affiliation(s)
- Muhammad Jaffar Khan
- Institute of Basic Medical Sciences, Khyber Medical University, Phase V Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical Veterinary and Life Sciences, University of Glasgow, Level 3, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow G31 2ER, UK
- *Muhammad Jaffar Khan:
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical Veterinary and Life Sciences, University of Glasgow, Level 3, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow G31 2ER, UK
| | - Christine Ann Edwards
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical Veterinary and Life Sciences, University of Glasgow, Level 3, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow G31 2ER, UK
| | - M. Guftar Shaikh
- Department of Endocrinology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, UK
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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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Meijneke RWH, Schouten-van Meeteren AYN, de Boer NY, van Zundert S, van Trotsenburg PAS, Stoelinga F, van Santen HM. Hypothalamic obesity after treatment for craniopharyngioma: the importance of the home environment. J Pediatr Endocrinol Metab 2015; 28:59-63. [PMID: 25381948 DOI: 10.1515/jpem-2014-0338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 08/08/2014] [Accepted: 09/29/2014] [Indexed: 11/15/2022]
Abstract
Hypothalamic obesity after treatment for craniopharyngioma is a well-recognized, severe problem. Treatment of hypothalamic obesity is difficult and often frustrating for the patient, the parents and the professional care-giver. Because hypothalamic obesity is caused by an underlying medical disorder, it is often assumed that regular diet and exercise are not beneficial to reduce the extraordinarily high body mass index, and in fact, lifestyle interventions have been shown to be insufficient in case of extreme hypothalamic obesity. Nevertheless, it is important to realize that also in this situation, informal care delivered by the family and appropriate parenting styles are required to minimize the obesity problem. We present a case in which weight gain in the home situation was considered unstoppable, and a very early mortality due to complications of the severe increasing obesity was considered inevitable. A permissive approach toward food intake became leading with rapid weight increase since a restrictive lifestyle was considered a senseless burden for the child. By admission to our hospital for a longer period of time, weight reduction was realized, and the merely permissive approach could be changed into active purposeful care by adequate information, instruction, guidance and encouragement of the affected child and her parents. This case illustrates that, although this type of obesity has a pathological origin, parental and environmental influences remain of extreme importance.
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Richardson AS, Dietz WH, Gordon-Larsen P. The association between childhood sexual and physical abuse with incident adult severe obesity across 13 years of the National Longitudinal Study of Adolescent Health. Pediatr Obes 2014; 9:351-61. [PMID: 24115589 PMCID: PMC3961565 DOI: 10.1111/j.2047-6310.2013.00196.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [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: 01/08/2013] [Revised: 06/21/2013] [Accepted: 07/26/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Severe obesity has increased, yet childhood antecedents of adult severe obesity are not well understood. OBJECTIVE Estimate adult-onset severe obesity risk in individuals with history of childhood physical and/or sexual abuse compared with those who did not report abuse. METHODS Longitudinal analysis of participants from the US National Longitudinal Study of Adolescent Health (n = 10,774) wave II (1996; aged 12-22 years) followed through wave IV (2008-2009; aged 24-34 years). New cases of adult-onset severe obesity (body mass index [BMI] ≥ 40 kg/m2 using measured height and weight) in individuals followed over 13 years who were not severely obese during adolescence (BMI <120% of 95th percentile Centers for Disease Control and Prevention National Center for Health Statistics growth curves). RESULTS The combined occurrence of self-reported sexual and physical abuse during childhood was associated with an increased risk of incident severe obesity in adulthood in non-minority females (hazard ratio [HR; 95% Confidence Interval] = 2.5; 1.3, 4.8) and males (HR = 3.6; 1.5, 8.5) compared with individuals with no history of abuse. CONCLUSION In addition to other social and emotional risks, exposure to sexual and physical abuse during childhood may increase risk of severe obesity later in life. Consideration of the confluence of childhood abuse might be considered as part of preventive and therapeutic approaches to address severe obesity.
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Affiliation(s)
- A S Richardson
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, Chapel Hill, NC, USA
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Abstract
Although there has been extensive research around the etiology of moderate obesity, there are still important questions relating to the development and lived experience of extreme obesity. We present a synthesis of data from two in-depth qualitative studies in which morbidly obese participants (N = 31) were able to explain the development of the condition in their own terms. We identified consistent themes in the two datasets, and undertook a detailed data synthesis. Particularly salient themes in the development of morbid obesity related to family structures and early socialization experiences, and the role of emotional distress was dominant in both initial weight gain and ongoing cycles of loss and regain. All informants accepted some responsibility for their health state, but identified a number of mitigating factors that limited personal culpability that were often related to the fulfillment of gendered social expectations.
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Affiliation(s)
| | | | - Joanna Coast
- University of Birmingham, Birmingham, United Kingdom
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Deshcherevskaia NP, Deshcherevskaia NO. [A new hypothesis about the role of water in the mechanisms of morbid obesity formation]. Biofizika 2014; 59:612-620. [PMID: 25715606] [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
For the first time a comparative analysis is performed for water and fat metabolism in human bodies. In light of known data from the scientific literature on the interconnection of biosynthesis processes of water and palmitic acid, a hypothesis on water and fat mutual circulation in the human body is discussed. It is suggested that one of the possible reasons of morbid obesity may lie in the excessive activation of a system of the endogenous water biosynthesis (that results in the excessive enhancement of the fatty acids biosynthesis) owing to the chronic shortage of the water introduced from the outside. An assumption that the adult morbid obesity can arise as a delayed consequence of the pathological situation of shortage of liquid occurring in early childhood is discussed.
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Abstract
Professionalism requires that physicians uphold the best interests of patients while simultaneously insuring just use of health care resources. Current articulations of these obligations like the American Board of Internal Medicine (ABIM) Foundation's Physician Charter do not reconcile how these obligations fit together when they conflict. This is the problem of dual agency. The most common ways of dealing with dual agency: "bunkering"--physicians act as though societal cost issues are not their problem; "bailing"--physicians assume that they are merely agents of society and deliver care typically based on a strongly consequentialist public health ethic; or "balancing"--a vaguely specified attempt to uphold both patient welfare and societal need for judicious resource use simultaneously--all fail. Here I propose how the problem of dual agency might begin to be addressed with rigor and consistency. Without dealing with the dual agency problem and getting more specific about how to reconcile its norms when they conflict, the expectations of professionalism risk being written off as cute, nonbinding aphorisms from the medical profession.
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Sima LV, Sima AC, Dan RG, Breaza GM, Cretu OM. Complications of Roux-en-Y gastric bypass. Chirurgia (Bucur) 2013; 108:180-183. [PMID: 23618566] [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] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Bariatric surgery is a method of treating morbid obesity, which has been raising more and more interest in the past years. Among all types of intervention, the most frequently used is Roux-en-Y gastric bypass, an intervention both restrictive and malabsorptive, which leads to best results in weight loss. In Romania, bariatric surgery, and especially Roux-en-Y gastric bypass, is not widely practiced due to poor addressability of patients, both due to lack of information, and to poor recommendation from general practitioners and specialists in metabolic diseases. MATERIAL AND METHOD The study group includes 14 patients aged between 18 and 65 years old, with BMI above 40 kg m2. The study aims to present the complications that occurred in this group of patients in which we performed Roux-en-Y gastric bypass in the Surgery Department of the Emergency City Hospital Timişoara. The surgery was performed by xifo-umbilical laparotomy technique. Subsequently, patients were followed postoperatively at 1 month, and then every 3 months, up to 2 years. RESULTS The only complications we found were wound infections (7/14 - 50%) and incisional hernias (5/14 - 35.71%). CONCLUSIONS We only found in our group only complications related to the postoperative wound that can be minimized by modifying the suturing technique of the abdominal wall. Gastric bypass should be performed despite all incriminated risks, providing a better lifestyle to obese patients.
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Affiliation(s)
- L V Sima
- University of Medicine and Pharmacy "Victor Babeş", Timişoara, Roamnia
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Milagro FI, Gómez-Abellán P, Campión J, Martínez JA, Ordovás JM, Garaulet M. CLOCK, PER2 and BMAL1 DNA methylation: association with obesity and metabolic syndrome characteristics and monounsaturated fat intake. Chronobiol Int 2012; 29:1180-94. [PMID: 23003921 DOI: 10.3109/07420528.2012.719967] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The circadian clock system instructs 24-h rhythmicity on gene expression in essentially all cells, including adipocytes, and epigenetic mechanisms may participate in this regulation. The aim of this research was to investigate the influence of obesity and metabolic syndrome (MetS) features in clock gene methylation and the involvement of these epigenetic modifications in the outcomes. Sixty normal-weight, overweight and obese women followed a 16-weeks weight reduction program. DNA methylation levels at different CpG sites of CLOCK, BMAL1 and PER2 genes were analyzed by Sequenom's MassARRAY in white blood cells obtained before the treatment. Statistical differences between normal-weight and overweight + obese subjects were found in the methylation status of different CpG sites of CLOCK (CpGs 1, 5-6, 8 and 11-14) and, with lower statistical significance, in BMAL1 (CpGs 6-7, 8, 15 and 16-17). The methylation pattern of different CpG sites of the three genes showed significant associations with anthropometric parameters such as body mass index and adiposity, and with a MetS score. Moreover, the baseline methylation levels of CLOCK CpG 1 and PER2 CpGs 2-3 and 25 correlated with the magnitude of weight loss. Interestingly, the percentage of methylation of CLOCK CpGs 1 and 8 showed associations with the intake of monounsaturated and polyunsaturated fatty acids. This study demonstrates for the first time an association between methylation status of CpG sites located in clock genes (CLOCK, BMAL1 and PER2) with obesity, MetS and weight loss. Moreover, the methylation status of different CpG sites in CLOCK and PER2 could be used as biomarkers of weight-loss success, particularly CLOCK CPGs 5-6.
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Affiliation(s)
- Fermín I Milagro
- Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain
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Affiliation(s)
- Bjørn Hofmann
- Section for Medical Ethics, University of Oslo, Oslo, Norway.
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Bardugo E, Moses L, Shemmer M, Dubman I. [Gain for pain: a model of a healthy lifestyle intervention in a population of mentally disabled adults]. Harefuah 2010; 149:645-683. [PMID: 21568059] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Mental retardation is an intellectual disability affecting adaptable, conceptual, social and practical skills, with onset prior to 18 years of age. Prevalence of obesity among women with mental retardation is 18-30% greater than that among women without mental retardation. In the Nachman Village, a governmental institution for adults with mental retardation, the main nutritional difficulties result from residents eating snacks in addition to their balanced meals. Psychological complexity and the ambivalent attitude of families, caregivers and residents prevented the achievement of balanced diets and healthy body weights. The women's house mother took upon herself to detect residents with nutritional problems and started an intervention program aiming at promoting a healthy lifestyle and maintenance of normal body weight. METHODS The program 'House Queen' was Launched on a voluntary basis. The staff encouraged the residents to engage in physical activity, restrict snack consumption and amounts of food at meals, eat vegetables and not waste pocket money on non-nutritional foods. Each month one or two residents who lost weight while maintaining a healthy lifestyle received a prize and the title "House Queen". The statistical analysis included 22 residents and was conducted retrospectively from data coLlected during a routine medical follow-up. RESULTS A total of 59.1% of the residents were morbidly obese and 27.3% were obese at the beginning of the program. Seventeen months later, they weighed an average of 8 kg Less, and only 36.4% and 18.2% of them were morbidly obese and obese, respectively. CONCLUSION These results suggest a correlation between the 'House Queen' program and Lowering body weight, which encourage the authors to broaden the program to other residents in the Village and combine supportive and restrictive attitudes towards a healthy lifestyle for mentally disabled people.
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Sutton-Tyrrell K, Zhao X, Santoro N, Lasley B, Sowers M, Johnston J, Mackey R, Matthews K. Reproductive hormones and obesity: 9 years of observation from the Study of Women's Health Across the Nation. Am J Epidemiol 2010; 171:1203-13. [PMID: 20427327 PMCID: PMC2915490 DOI: 10.1093/aje/kwq049] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 02/18/2010] [Indexed: 12/27/2022] Open
Abstract
The effect of change in reproductive hormones and menopause on incident obesity (body mass index > or =30 kg/m(2)) and severe obesity (body mass index > or =35 kg/m(2)) was evaluated over 9 years in 3,260 US women recruited in the multiethnic Study of Women's Health Across the Nation in 1996-1997. After 9 years, cumulative incidences of obesity and severe obesity reached 21.8% and 12.3%, respectively. In multivariate analysis, hormone changes, chronic health conditions, lower physical activity, race/ethnicity, and age were significantly associated with incident obesity and/or severe obesity. The odds of incident severe obesity increased with surgical menopause (odds ratio (OR) = 5.07, 95% confidence interval (CI): 2.29, 11.20; P < 0.001) and initiation of hormone therapy prior to 12 months of amenorrhea (OR = 2.94, 95% CI: 1.14, 7.58; P = 0.03). Predictors of obesity included an increase in free androgen index (OR = 1.37, 95% CI: 1.12, 1.68; P = 0.002) and a decrease in sex hormone-binding globulin (OR = 0.60, 95% CI: 0.45, 0.80; P = 0.0005). Similar results were found for severe obesity. Obesity rates varied by race, but no hormone-by-race interactions were observed. These longitudinal data demonstrate that higher androgens, lower sex hormone-binding globulin, surgical menopause, and early hormone therapy use predict incident obesity and/or severe obesity in a multiracial cohort of women transitioning into menopause.
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Affiliation(s)
- Kim Sutton-Tyrrell
- Department of Epidemiology, University of Pittsburgh, Pennsylvania 15261, USA.
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Anic GM, Titus-Ernstoff L, Newcomb PA, Trentham-Dietz A, Egan KM. Sleep duration and obesity in a population-based study. Sleep Med 2010; 11:447-51. [PMID: 20363668 DOI: 10.1016/j.sleep.2009.11.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [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: 08/14/2009] [Revised: 11/20/2009] [Accepted: 11/26/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous studies have demonstrated an association between sleep duration and obesity, but few population-based studies have examined the association. We examined the relationship between recent and usual lifetime sleep duration with the odds of obesity in 5549 women that participated in a population-based telephone survey. METHODS The structured telephone interview included questions on usual sleep duration in adult life and the recent past, as well as height and weight and other demographic and lifestyle characteristics. We examined odds of overweight (BMI: 25-29.9 kg/m(2)), obesity (BMI: 30-39.9 kg/m(2)) and extreme obesity (BMI: 40 kg/m(2)) according to reported sleep duration. RESULTS Compared to women who slept 7-7.9h per night, women who slept an average of <6h per night in the recent past had significantly greater odds of obesity (Odds Ratio [OR]: 1.89; 95% Confidence Interval [CI]: 1.45-2.47) and extreme obesity (OR: 3.12; CI: 1.70-5.75), adjusting for potential confounding factors. Weaker associations were noted for short lifetime sleep duration. Current short sleep (<7h) was associated with greater odds of obesity (30 kg/m(2)) in those reporting less than 7h (OR: 1.59; 95% CI: 0.93-2.78) and in those reporting 8 or more hours (OR: 1.75; 95% CI: 1.33-2.32) of sleep throughout adult life. CONCLUSIONS Current short sleepers were more likely to be obese regardless of their usual sleep duration earlier in life. These findings do not support the hypothesis that sleep duration is a causal factor in obesity.
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Affiliation(s)
- Gabriella M Anic
- H. Lee Moffitt Cancer Center and Research Institute, Medical Research Center, 2nd Floor, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Miller JL, Couch JA, Leonard CM, Schwenk K, Towler SD, Shuster J, Goldstone AP, He G, Driscoll DJ, Liu Y. Sylvian fissure morphology in Prader-Willi syndrome and early-onset morbid obesity. Genet Med 2009; 9:536-43. [PMID: 17700392 DOI: 10.1097/gim.0b013e31812f720d] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Prader-Willi syndrome is a well-defined genetic cause of childhood-onset obesity that can serve as a model for investigating early-onset childhood obesity. Individuals with Prader-Willi syndrome have speech and language impairments, suggesting possible involvement of the perisylvian region of the brain. Clinical observations suggest that many individuals with early-onset morbid obesity have similar speech/language deficits, indicating possible perisylvian involvement in these children as well. We hypothesized that similar perisylvian abnormalities may exist in both disorders. METHODS Participants included individuals with Prader-Willi syndrome (n = 27), their siblings (n = 16), individuals with early-onset morbid obesity (n = 13), and their siblings (n = 10). Quantitative and qualitative assessments of sylvian fissure conformation, insula closure, and planum temporale length were performed blind to hemisphere and diagnosis. RESULTS Quantitative measurements verified incomplete closure of the insula in individuals with Prader-Willi syndrome. Planar asymmetry showed its normal bias toward leftward asymmetry in all groups except those with Prader-Willi syndrome maternal uniparental disomy. Individuals with Prader-Willi syndrome and siblings had a normal distribution of sylvian fissure types in both hemispheres, while individuals with early-onset morbid obesity and their siblings had a high proportion of rare sylvian fissures in the right hemisphere. CONCLUSIONS The contrast between the anatomic findings in individuals with Prader-Willi syndrome and early-onset morbid obesity suggests that the language problems displayed by children with these two conditions may be associated with different neurodevelopmental processes.
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Affiliation(s)
- Jennifer L Miller
- Departments of Pediatrics, University of Florida, College of Medicine, Gainesville, Florida 32610-0296, USA.
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Abstract
CONTEXT Obesity resulting from damage to the hypothalamus, i.e. hypothalamic obesity, is a severe condition that currently lacks any effective evidence-based therapy. OBJECTIVE Our goal was to describe the course of hypothalamic obesity in a craniopharyngioma patient treated with distal gastric bypass surgery and to outline distinct aspects of multidisciplinary case management. PATIENT AND METHODS A 29-year-old man, who had undergone craniopharyngioma resection at the age of 8, was referred to our Interdisciplinary Obesity Centre with a body mass index (BMI) of 52.0 kg/m(2), type 2 diabetes and obstructive sleep apnoea syndrome (OSAS). After careful preoperative preparation, including the adjustment of hormone substitution therapy for panhypopituitarism, nutritional counselling and a supervised exercise program, he underwent a distal gastric bypass operation. RESULTS Eighteen months after the operation the patient's BMI had decreased to 31.9 kg/m(2), type 2 diabetes was in complete remission, and OSAS appeared to be improved. Also, feelings of hunger were markedly reduced after the operation. A standard regimen of supplements successfully prevented any severe nutritional deficiencies. After weight loss, the dose of hydrocortisone could be distinctly reduced without any signs of adrenal insufficiency while GH substitution had to be markedly increased to achieve normal IGF1 levels. CONCLUSIONS Our case demonstrates that within a multidisciplinary team approach, a distal gastric bypass operation can be a safe and highly effective therapy for patients with hypothalamic obesity. Also, our findings hint at an effect of gastric bypass surgery on hunger and eating behaviour that may not essentially rely on hypothalamic mechanisms.
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Affiliation(s)
- Bernd Schultes
- Interdisciplinary Obesity Center Department of Radiology, Kantonsspital St Gallen, Heidener Strasse 11, CH-9400 Rorschach, Switzerland.
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Abstract
Craniopharyngioma management is challenging. Although histology is benign, the tumour can be clinically aggressive with local invasion and frequent recurrences. Extensive morbidity may be present at diagnosis and furthermore, occurs as a consequence of neurosurgery and radiotherapy. Hypothalamic symptoms can have a devastating effect on quality of life and may reduce life expectancy. This case highlights both the challenge of managing hyperphagia and morbid obesity and the importance of initial treatment preserving existing hypothalamic function and the need to avoid tumour recurrence and further surgery. A 11-year old boy presented with hydrocephalus secondary to a craniopharyngioma (he had visual failure and hypopituitarism but few hypothalamic symptoms). He underwent radical resection followed by radiotherapy. Following this treatment, he developed psychological and behavioural problems and hyperphagia. Weight gain in the first year (an increase from +1.4 to +3.7 s.d.) resulted in poor mobility and a fall which caused a slipped femoral epiphysis. In the next year, there was a 6-month period of unexpected weight loss (+4.2 to +3.8 s.d.) that culminated in emergency treatment for diabetic ketoacidosis secondary to severe insulin resistance. He developed a left hemiplegia, and a subsequent cerebral angiogram identified multiple stenoses of the Circle of Willis with a Moyamoya appearance secondary to radiotherapy. Weight gain has continued (+3.8 to +5.5 s.d.) so that bariatric surgery is a management option.
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Affiliation(s)
- Helena Gleeson
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester M274HA, UK.
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