Glucose Abnormalities and Inappropriate Weight Gain Predict Negative Pregnancy Outcomes After Gastric Bypass Surgery

AbstractWeight gain is often associated with the pleasure of eating foods rich in calories and lack of willpower to reduce such food cravings, but empirical evidence is sparse. Here we investigated the role that connectivity within the brain’s hedonic valuation system (BVS, the ventral striatum and the ventromedial prefrontal cortex) at rest plays (1) to predict weight gain or loss over time and (2) for homeostatic hormone regulation. We found that intrinsic connectivity within the BVS at rest (RSC) predicted out-of-sample weight changes over time in lean and obese participants. Counterintuitively, such BVS RSC was higher in lean versus obese participants before the obese participants underwent a drastic weight loss intervention (Roux-en-Y gastric bypass surgery, RYGB). The RYGB surgery increased BVS RSC in the obese after surgery. The obese participants’ increase in BVS RSC correlated with decreases in fasting state systemic leptin, a homeostatic hormone signalling satiety that has been previously linked to dopamine functioning. Taken together, our results indicate a first link between brain connectivity in reward circuits in a more tonic state at rest, homeostatic hormone regulation involved in dopamine functioning and ability to lose weight.Significance statementWith obesity rates on the rise, advancing our understanding of what factors drive people’s ability to lose and gain weight is crucial. This research is the first to link what we know about the brain’s hedonic valuation system (BVS) to weight loss and homeostatic hormone regulation. We found that connectivity at rest (RSC) within the BVS system predicted changes in weight, differentiated between lean and obese participants, and increased after a weight loss intervention (gastric bypass surgery). Interestingly, the extent to which BVS RSC improved after surgery correlated to decreases in circulating levels of the satiety hormone leptin. These findings are the first to reveal the neural and hormonal determinants of weight loss, combining hedonic and homeostatic drivers of (over-)eating.

Download Full-text

Influence of the gastric stump’s volume on the long-term results of laparoscopic Roux-en-Y gastric bypass surgery

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2021-180-1-81-88 ◽

2021 ◽

Vol 180 (1) ◽

pp. 81-88

Author(s):

A. G. Khitaryan ◽

D. A. Melnikov ◽

A. A. Orekhov ◽

A. V. Mezhunts ◽

S. A. Adizov ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Weight Gain ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Long Term Results ◽

Gastric Stump ◽

Insufficient Weight Loss

The objective was to retrospectively analyze the dependence of long-term results of laparoscopic Roux-en-Y gastric bypass surgery according to the size of the formed gastric stumpMethods and materials. We retrospectively analyzed the long-term results of 207 morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass surgery by two different techniques. The median follow-up was 36 months. Two groups of patients were identified according to the method of formation of the gastric stump: using 2 (1st group) or 3 (2nd group) stapler cassettes and performing of computed tomography volumetry to determine thevolume of the created gastric stump.Results. Statistically significant differences in the volume of the formed gastric stump, depending on the method of operation, were as follows: 23.8 ml (8.9–37.3 ml) in the 1st group and 47.7 ml (31.9–72.8 ml) in the 2nd group (p<0.0001). Significant differences were observed in the following indicators: relapse of weight gain or insufficient weight loss (loss of < 70 % overweight) at median follow-up of 36 months were observed in 2 (2.3 %) and 12 (9.9 %) cases in the 1st and 2nd groups, respectively (p<0.05).Conclusion. We revealed that the formation of the gastric stump of a very small volume by 2 stapler cassettes compared to using 3 stapler cassettes contributes to improving the results in the long-term postoperative period and minimizing the frequency of relapse of weight gain and insufficient weight loss. The restrictive component of the surgery with equal malabsorptive is fundamental for the clinical parameters of its effectiveness, that leads to increasing the frequency of relapses of weight gain and insufficient weight loss in the 2nd group in comparison with the 1st and group of patients (p<0.05). Based on computed tomography volumetry, the volume of a small-sized stomach stump can be reliably measured and, accordingly, weight loss is predicted in the long term after the surgery, as well as the absence of relapses of weight gain or insufficient weight loss.

Download Full-text