scholarly journals Weight Loss After Bariatric Surgery Significantly Improves Carotid and Cardiac Function in Apparently Healthy People with Morbid Obesity

2020 ◽  
Vol 30 (10) ◽  
pp. 3776-3783
Author(s):  
Alessandro Giudici ◽  
Carlo Palombo ◽  
Michaela Kozakova ◽  
Carmela Morizzo ◽  
Lorenzo Losso ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Arterial Stiffness ◽  
Diastolic Function ◽  
Pressure Change ◽  
Left Ventricular ◽  
Lv Function ◽  
Post Surgery ◽  
The Impact

Abstract Purpose Obesity clearly increases cardiovascular risk, often inducing high blood pressure (BP), impaired left ventricular (LV) function, and increased arterial stiffness. Intensive weight loss and bariatric surgery induce improvement in hypertension and diabetes for morbid obesity. Carotid artery haemodynamics is a powerful prognostic indicator for stroke and cognitive decline independent of BP. The aim of this study was to evaluate the impact of a 3-stage bariatric strategy of diet, bariatric surgery, and consequent weight loss on carotid haemodynamics and cardiac diastolic function. Material and Methods This prospective study included 26 patients (45 ± 10 years, 4 men) with severe obesity undergoing bariatric surgery without comorbidities (hypertension, diabetes, etc.). Anthropometry, BP, Doppler echocardiography, and common carotid haemodynamics by ultrasound were measured at three times: (1) baseline, (2) after 1-month diet (post-diet), and (3) 8 months after surgery (post-surgery). The lnDU-loop method was used to estimate local carotid pulse wave velocity (ncPWV). Results Baseline BMI was 47.9 ± 7.1 kg/m2 and reduced by 5% and 30% post-diet and post-surgery, respectively. BP decreased only post-diet, without pulse pressure change. However, ncPWV, 6.27 ± 1.35 m/s at baseline, was significantly reduced by 10% and 23% post-diet and post-surgery, respectively, also adjusted for BP changes. The E/A ratio rose from 0.95 ± 0.20 to 1.27 ± 0.31 (p < 0.005), without change in LV geometry or mass, while heart rate and cardiac output fell substantially. Conclusion Weight loss following diet and bariatric surgery is associated with reduced carotid arterial stiffness and improved LV diastolic function. Diet and bariatric surgery are effective treatments for morbid obesity with its concomitant adverse cardiovascular effects.

scholarly journals Associations between Pre-Bariatric High-Sensitivity C-Reactive Protein and Post-Surgery Outcomes

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 721
Author(s):  
Tannaz Jamialahmadi ◽  
Mohsen Nematy ◽  
Simona Bo ◽  
Valentina Ponzo ◽  
Ali Jangjoo ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Success Rate ◽  
Liver Stiffness ◽  
High Sensitivity ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Post Surgery ◽  
Hs Crp

Background: Obesity is a chronic inflammatory condition associated with increased circulating levels of C-reactive protein (CRP). Bariatric surgery has been reported to be effective in improving both inflammatory and liver status. Our aims were to elucidate the relationships between pre-surgery high sensitivity-CRP (hs-CRP) values and post-surgery weight loss and liver steatosis and fibrosis in patients with severe obesity undergoing Roux-en-Y gastric bypass. Methods: We conducted an observational prospective study on 90 individuals with morbid obesity, who underwent gastric bypass. Anthropometric indices, laboratory assessment (lipid panel, glycemic status, liver enzymes, and hs-CRP), liver stiffness and steatosis were evaluated at baseline and 6-months after surgery. Results: There was a significant post-surgery reduction in all the anthropometric variables, with an average weight loss of 33.93 ± 11.79 kg; the mean percentage of total weight loss (TWL) was 27.96 ± 6.43%. Liver elasticity was significantly reduced (from 6.1 ± 1.25 to 5.42 ± 1.52 kPa; p = 0.002), as well as liver aminotransferases, nonalcoholic fatty liver disease fibrosis score (NFS) and the grade of steatosis. Serum hs-CRP levels significantly reduced (from 9.26 ± 8.45 to 3.29 ± 4.41 mg/L; p < 0.001). The correlations between hs-CRP levels and liver fibrosis (elastography), steatosis (ultrasonography), fibrosis-4 index, NFS, and surgery success rate were not significant. Regression analyses showed that serum hs-CRP levels were not predictive of liver status and success rate after surgery in both unadjusted and adjusted models. Conclusions: In patients with morbid obesity, bariatric surgery caused a significant decrease in hs-CRP levels, liver stiffness and steatosis. Baseline hs-CRP values did not predict the weight-loss success rate and post-surgery liver status.

scholarly journals Improvement of left ventricular diastolic function and left heart morphology in young women with morbid obesity six months after bariatric surgery

2018 ◽  
Vol 25 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Katarzyna Kurnicka ◽  
Justyna Domienik-Karłowicz ◽  
Barbara Lichodziejewska ◽  
Maksymilian Bielecki ◽  
Marta Kozłowska ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Diastolic Function ◽  
Young Women ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Left Heart ◽  
Ventricular Diastolic Function

scholarly journals Impact of bariatric surgery on non-alcoholic fatty liver disease

2017 ◽  
Vol 89 (2) ◽  
pp. 1-4 ◽  
Author(s):  
Piotr Major ◽  
Michał Pędziwiatr ◽  
Mateusz Rubinkiewicz ◽  
Maciej Stanek ◽  
Anna Głuszewska ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Liver Enzymes ◽  
Alcoholic Fatty Liver ◽  
The Impact ◽  
Alcoholic Fatty Liver Disease

Introduction; p to 300 million people have the body mass index (BMI) greater than 30 kg/m2. Obesity is the cause of many serious diseases, such as type 2 diabetes, hypertension, and non-alcoholic fatty liver disease (NAFLD). Bariatric surgery is the only effective method of achieving weight loss in patients with morbid obesity. Objectives: The aim of the study was to assess the impact of bariatric surgery on non-alcoholic fatty liver disease in patients operated on due to morbid obesity. Material and Methods: We included 20 patients who were qualified for bariatric procedures based on BMI > 40 kg/ m2 or BMI > 35kg/m2 with the presence of comorbidities. The average body weight in the group was 143.85kg, with an average BMI of 49.16kg/m2. Before the procedure, we evaluated the severity of non-alcoholic fatty liver disease in each patient using the Sheriff-Saadeh ultrasound scale. We also evaluated the levels of liver enzymes. Follow-up evaluation was performed twelve months after surgery. Results: Twelve months after surgery, the average weight was 102.34 kg. The mean %WL was 33.01%, %EWL was 58.8%, and %EBMIL was 61.37%. All patients showed remission of fatty liver disease. Liver damage, evaluated with ultrasound imaging, decreased from an average of 1.85 on the Sheriff-Saadeh scale, before surgery, to 0.15 twelve months after surgery (p < 0.001). As regards liver enzymes, the level of alanine aminotransferase decreased from 64.5 (U/l) to 27.95 (U/l) (p < 0.001), and the level of aspartate aminotransferase decreased from 54.4 (U/l) to 27.2 (U/l). Conclusions: Bariatric procedures not only lead to a significant and lasting weight loss, but they also contribute to the reduction of fatty liver disease and improve liver function.

scholarly journals 0876 Obstructive Sleep Apnea, Low PAP Use, and Daytime Sleepiness are Associated with Weight Regain Following Bariatric Surgery in Adolescents with Severe Obesity

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A334-A334
Author(s):  
J L Kaar ◽  
L Patten ◽  
A Kaizer ◽  
S M Hawkins ◽  
J M Moore ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Daytime Sleepiness ◽  
Weight Regain ◽  
Protective Factor ◽  
Severe Obesity ◽  
Post Surgery ◽  
Obstructive Sleep ◽  
Ameliorative Effect ◽  
The Impact

Abstract Introduction Significant weight loss is seen following bariatric surgery, leading to an ameliorative effect on obesity-related comorbidities such as OSA. Weight loss maintenance is a priority, and identifying factors that may be associated with weight loss outcomes following bariatric surgery is of high importance. The current study examined whether OSA symptoms and PAP therapy were associated with weight outcomes following bariatric surgery in adolescents. Methods Participants from the Teen-LABS Study, which follows adolescents undergoing bariatric surgery were examined. Demographic and anthropometric data, OSA diagnosis, and PAP prescription and self-reported usage information were assessed 6 months before surgery. Pediatric Sleep Questionnaire (PSQ) responses were utilized from baseline to 48 months post-surgery. All analyses were adjusted for time, age, sex, surgery type, and ethnicity. Results 242 adolescents (76% female, 72% White, age at surgery = 16.6 [1.6] years) were included. 57% had a diagnosis of OSA at pre-surgical baseline, and 56% of adolescents with OSA reported PAP use at pre-surgery. BMI increase over time from year 1-4 post-surgery was 11% more for those with high PSQ severity compared to those with low PSQ severity (p = 0.01). Those with pre-surgical OSA that reported using PAP “often” or “always” at baseline had an 8% lower increase in BMI from year 1-4 post-surgery compared to those that reported using PAP “rarely” or “sometimes” at baseline (p = 0.004). Finally, endorsing daytime sleepiness on the PSQ was associated with a 11% greater increase in BMI during years 1-4 post-surgery (p = 0.01). Conclusion OSA and daytime sleepiness may be associated with greater weight regain following bariatric surgery in adolescents. Adherence to PAP therapy pre-surgery may be a protective factor in preventing or reducing weight regain following surgery. Daytime sleepiness may be an effect of OSA, or due to the insufficient sleep that is prevalent among adolescents. Research is needed to examine the impact of additional aspects of sleep health such as duration, timing, and quality on health outcomes, as well as the impact of PAP adherence and sleep interventions on weight regain following bariatric surgery in adolescents with severe obesity. Support None.

scholarly journals The relationship between specialized pro-resolving lipid mediators, morbid obesity and weight loss after bariatric surgery

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Fabian Schulte ◽  
Abdul Aziz Asbeutah ◽  
Peter N. Benotti ◽  
G. Craig Wood ◽  
Christopher Still ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
White Blood Cells ◽  
Diabetes Remission ◽  
Lipid Mediators ◽  
Morbidly Obese ◽  
Post Surgery ◽  
Obesity And Diabetes ◽  
Obese Subjects

AbstractObesity and diabetes are associated with chronic inflammation. Specialized pro-resolving lipid mediators (SPMs)—resolvins (Rv), protectins (PD) and maresins (MaR)—actively resolve inflammation. Bariatric surgery achieves remission of diabetes, but mechanisms are unclear. We measured SPMs and proinflammatory eicosanoid levels using liquid chromatography-tandem mass spectrometry in 29 morbidly obese subjects (13 with diabetes) and 15 nondiabetic, mildly obese subjects. Compared to the mildly obese, the morbidly obese had higher levels of SPMs—RvD3, RvD4 and PD1—and white blood cells (WBC) and platelets. Post-surgery, SPM and platelet levels decreased in morbidly obese nondiabetic subjects but not in diabetic subjects, suggesting continued inflammation. Despite similar weight reductions 1 year after surgery (44.6% vs. 46.6%), 8 diabetes remitters had significant reductions in WBC and platelet counts whereas five non-remitters did not. Remitters had a 58.2% decrease (p = 0.03) in 14-HDHA, a maresin pathway marker; non-remitters had an 875.7% increase in 14-HDHA but a 36.9% decrease in MaR1 to a median of 0. In conclusion, higher levels of RvD3, PD1 and their pathway marker, 17-HDHA, are markers of leukocyte activation and inflammation in morbid obesity and diabetes and diminish with weight loss in nondiabetic but not diabetic subjects, possibly representing sustained inflammation in the latter. Lack of diabetes remission after surgically-induced weight loss may be associated with reduced ability to produce MaR1 and sustained inflammation.

scholarly journals Is Insulin Resistance at Baseline a Predictor of Weight Loss After Bariatric Surgery?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A18-A19
Author(s):  
Marta Borges-Canha ◽  
João Sérgio Neves ◽  
Fernando Mendonça ◽  
Maria Manuel Silva ◽  
Cláudia Costa ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Cell Function ◽  
First Year ◽  
Model Assessment ◽  
Post Surgery ◽  
Homeostatic Model Assessment ◽  
Homeostatic Model

Abstract Background: Obesity is a multifactorial disease that is strongly associated to other metabolic disorders, such as insulin resistance and type 2 diabetes. Bariatric surgery is nowadays considered the most effective treatment of morbid obesity. The role of insulin resistance (IR) in weight loss after bariatric surgery is highly unknown. Aim: To evaluate the association between Insulin Resistance (IR) and percentage of excess weight loss (EWL%) one, two, three and four years after bariatric surgery in patients with morbid obesity. Methods: Retrospective longitudinal study in patients with morbid obesity followed in our centre between January 2010 and July 2018 were included. Patients were excluded if they had diabetes. We evaluated baseline Homeostatic Model Assessment of IR (HOMA-IR), Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index (QUICKI) and Matsuda and DeFronzo index, and performed a linear regression concerning each year’s EWL%. Results: After applying the exclusion criteria, 1723 patients were included in this analysis. The logarithm of HOMA-beta was negatively associated with EWL% at second-, third- and fourth-years post-surgery (β=-1.04 [-1.82 to -0.26], p&lt;0.01; β=-1.16 [-2.13 to -0.19], p=0.02; β=-1.29 [-2.64 to 0.06], p=0.061, respectively), adjusting for age, sex, body mass index and type of surgery. This was not observed in the first-year post-surgery nor for the other indexes. Glycaemia at baseline was also positively associated to EWL% at second- and third-years post-surgery. Conclusion: IR at baseline seems to be associated to long term weight loss, explicitly after the first year post bariatric surgery.

scholarly journals Beta Cell Function as a Baseline Predictor of Weight Loss After Bariatric Surgery

2021 ◽  
Vol 12 ◽  
Author(s):  
Marta Borges-Canha ◽  
João Sérgio Neves ◽  
Fernando Mendonça ◽  
Maria Manuel Silva ◽  
Cláudia Costa ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Beta Cell ◽  
Beta Cell Function ◽  
Cell Function ◽  
Model Assessment ◽  
Post Surgery ◽  
Homeostatic Model Assessment ◽  
Β Cell Function

BackgroundObesity is a multifactorial disease, which is strongly associated to other metabolic disorders. Bariatric surgery is the most effective treatment of morbid obesity. The role of beta cell function in weight loss after bariatric surgery is uncertain.AimTo evaluate the association between beta cell function and percentage of total body weight loss (TBWL%) 1, 2, 3, and 4 years after bariatric surgery in patients with morbid obesity.MethodsRetrospective longitudinal study in patients with morbid obesity followed in our center between January 2010 and July 2018. Patients were excluded if they had diabetes at baseline or missing data on the needed parameters. We evaluated baseline Homeostatic Model Assessment of IR, Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index, and Matsuda and DeFronzo index, and TBWL% at years 1 to 4. Linear regression models were used to evaluate the association of indexes of insulin resistance with TBWL% (unadjusted and adjusted for age, sex, BMI, and type of surgery).ResultsThere were 1,561 patients included in this analysis. HOMA-beta was negatively associated with TBWL% at second, third, and fourth years post-surgery (β = −1.04 [−1.82 to −0.26], p&lt;0.01; β = −1.16 [−2.13 to −0.19], p=0.02; β = −1.29 [−2.64 to 0.06], p=0.061, respectively). This was not observed in the first year post-surgery nor for the other indexes. Glycemia at baseline was positively associated to EWL% at second and third years post-surgery.Conclusionβ-cell function at baseline seems to be associated to long-term weight loss, explicitly after the first year post bariatric surgery. This might be a helpful predictor of weight loss in clinical practice.

Abstract P276: Discordance Between Changes in NT-proBNP and Cardiac Function Following Bariatric Surgery

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Amelia S Wallace ◽  
Carine E Hamo ◽  
Amil M Shah ◽  
Roberta Florido ◽  
Justin B Echouffo Tcheugui ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Cardiac Function ◽  
Cardiac Dysfunction ◽  
Left Ventricular ◽  
Ventricular Dilation ◽  
Post Surgery ◽  
Left Ventricular Dilation ◽  
Heart Study ◽  
Cardiac Filling

Background: The N-Terminal of pro-B-type natriuretic peptide (NT-proBNP) is a potent biomarker for heart failure (HF), reflecting left ventricular dilation and stress. The association among obesity, HF, and NT-proBNP is complex, with paradoxically lower levels of NT-proBNP in obese individuals, despite their elevated HF risk. Furthermore, a few studies have reported decreased HF risk, but also increases in NT-proBNP, after weight loss via bariatric surgery. However, studies have not simultaneously evaluated changes in NT-proBNP and cardiac function after bariatric surgery. Hypothesis: There will be discordance between improvements in cardiac filling pressures (as reflected by E/e’) and increases in NT-proBNP with weight loss following bariatric surgery. Methods: We conducted a single-center analysis of participants in the BARI-Heart Study who underwent bariatric surgery and attended study visits 3-6 months and 2 weeks before surgery, and 6 and 12 months after surgery. We examined pre- and post-surgery changes in NT-proBNP and in echocardiographic measures of cardiac function. We also assessed the correlation between NT-pro-BNP and E/e’, at 2 weeks pre- and 6 months post-surgery. Results: Among 71 BARI-Heart participants (mean age 45 years, 74% female, 87% white, mean BMI 47.0 kg/m 2 ), there were no significant pre-surgery changes in BMI, NT-proBNP, or E/e’. By 6-12 months, there were marked reductions in BMI and significant increases in NT-proBNP, but decreases in E/e’ ( Figure ). Changes from surgery to the 6 month visit in NT-proBNP and E/e’ were associated (r=0.295; p=0.02). There was a tendency towards stronger correlations between NT-proBNP and E/e’ post- (r= 0.436; p<0.001) versus pre-surgery (r = 0.209; p=0.09). Conclusions: Weight loss is associated with increases in NT-proBNP despite reduced LV filling pressures, suggesting a non-cardiac etiology underlying increases in NT-proBNP after weight loss. The interpretation of NT-proBNP for cardiac dysfunction may change with decreasing adiposity.

P4582The role of TDI diastolic measurements for prognostic prediction early and late after surgical ventricular reconstruction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Iliuta
Keyword(s):  
Diastolic Function ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Function Evaluation ◽  
Diastolic Filling ◽  
Lv Function ◽  
Surgical Ventricular Reconstruction ◽  
Ventricular Reconstruction ◽  
The Impact ◽  
Dimension Index

Abstract Aim 1. To evaluate the impact of preoperative left ventricular (LV) diastolic performance on early and late outcomes in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) and surgical ventricular reconstruction (SVR). 2. To investigate LV diastolic function dynamics according to the results of tissue Doppler imaging (TDI) in these patients. 3. To assess the echographic predictors for persistence of the restrictive LV diastolic filling pattern (LVDFP) late after CABG and SVR. Material and method Prospective study on 157 pts with LV systolic dysfunction (LVEF <30%) who underwent CABG and SVR, evaluated including TDI preoperatively, early (<1 month), medium (3 and 12 months) and late postoperatively (mean 4,8 years). Statistical analysis used SYSTAT and SPSS. The primary outcome was the time to death from any cause or hospitalization for cardiac causes. Results 1. The preoperative restrictive LVDFP was an independent and predominant predictor for increasing the early and late postoperative risk of cardiovascular events (p=0.001). At 5 years postoperatively, cardiovascular event-free survival was significantly higher in pts with nonrestrictive LVDFP (75%) compared with restrictive LVDFP (55,74%) (p<0.0001). 2. Conventional transmitral diastolic Doppler indices before and after CABG +SVR remained unchanged. TDI showed significant improvement before and in 3 and 12months postoperatively of both LV systolic (S: 6.1±0.9, 7.5±1.1 and 7.3±1.2 cm/sec, p<0.01) and diastolic function (e': 7.2±1.8, 8.3±1.4 and 8.8±1.5 cm/sec; E/e' ratio: 17.8±2.1, 13.1±1.7 and 11.3±1.8; Vp 3.2±0.55, 2.4±0.28 and 1.9±0.26, p<0.01). 3. The evolution of LVEF, LV end-diastolic volume (LVEDV) and mitral regurgitation (MR) severity was different in nonrestrictive group (early and late postoperatively these variables improved) compared with restrictive group (late after surgery the variables deteriorated: LVEF from 27±8% to 22±6%, LVEDV from 181±49 to 234±63 cm3 and MR degree from 0.9±0.6 to 1.8±0.7; p<0.005). 4. Regression analysis identified as predictors for persistence of a restrictive LVDFP late after surgery: E/E' ratio >14 (RR=19.3), LA dimension index >30 mm/m2 (RR=9.2), LVEDV >200 cm3 (RR=9.6), severe PHT (RR=11.4), 2 degree MR (RR=14.8). Conclusions 1. TDI evaluation demonstrate significant improvement of LV systolic diastolic function in CABG + SVR pts, regardless of transmitral flow pattern. TDI is more sensitive and preload independent method of LV function evaluation. 2. The preoperative LVDFP has an independent and incremental prognostic value in CABG+SVR pts, strongly related to higher mortality with aggravation of LV systolic function, MR severity or LV remodeling. This might be attributable to deterioration of diastolic function induced by SVR. 3. Late after CABG+SVR the restrictive LVDFP persistence was predicted by: E/E' ratio >14, LA dimension index >30 mm/m2, LVEDV >200 cm3, severe PHT and 2 degree MR.

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