Sleeve gastrectomy prior to liver transplantation is superior to medical weight loss in reducing post‐transplant metabolic complications

2021 ◽  
Author(s):  
SR Sharpton ◽  
NA Terrault ◽  
MM Tavakol ◽  
AM Posselt
Keyword(s):  
Liver Transplantation ◽  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Metabolic Complications ◽  
Post Transplant ◽  
Medical Weight Loss

Sleeve Gastrectomy Pre-Liver Transplant compared to Medical Weight Loss

@Gijournal ◽  
2021 ◽  
Vol 1 ◽  
Author(s):  
Elizabeth Aby ◽  
Suzanne Sharpton ◽  
Julie Heimbach ◽  
Anjana Pillai
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Liver Transplant ◽  
Patient Outcomes ◽  
De Novo ◽  
Obese Patients ◽  
Metabolic Complications ◽  
Nonalcoholic Fatty Liver ◽  
Medical Weight Loss ◽  
The Impact

Methods to optimize obesity-related metabolic complications post liver transplant (LT) are needed given their impact on patient outcomes.  Some transplant centers also have concerns about offering transplantation for obese patients due to concern for complications. In this study, selected patients with cirrhosis and medically complicated obesity either underwent sleeve gastrectomy (SG) or medical weight loss (MWL) and then were subsequently listed for LT. The impact of pre–LT SG and MWL on post-LT diabetes, post-LT hypertension, and recurrent and de novo nonalcoholic fatty liver disease (NAFLD) were evaluated.1   We summarize the @GIJournal discussion held on May 26, 2021, during which the article by Sharpton et al. “Sleeve gastrectomy prior to liver transplantation is superior to medical weight loss in reducing posttransplant metabolic complications” was critically discussed by our experts, Dr. Suzanne Sharpton (@SharptonSuzanne) and Dr. Julie Heimbach (@JulieHeimbach), and moderated by Dr. Anjana Pillai (@AnjanaPillaiMD).

OPTIFAST®Medical Weight Loss Program—Outcomes in the Endocrinology Clinics at UPMC

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 57-LB
Author(s):  
KARLA B. DETOYA ◽  
KATRINA HAN ◽  
BRENNAN R. REGISTER ◽  
DAVID A. ROMETO
Keyword(s):  
Weight Loss ◽  
Weight Loss Program ◽  
Program Outcomes ◽  
Medical Weight Loss

Comparison of Sleeve Gastrectomy and Conservatory Treatment Effect on Biochemical and Hormonal Profile of Obese Type 2 Diabetes Subjects: CREDOR Randomized Controlled Study Results

2017 ◽  
Vol 68 (7) ◽  
pp. 1622-1627 ◽  
Author(s):  
Diana Simona Stefan ◽  
Andrada Mihai ◽  
Daiana Bajko ◽  
Daniela Lixandru ◽  
Laura Petcu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Beta Cell ◽  
Beta Cell Dysfunction ◽  
Control Group ◽  
Cell Dysfunction ◽  
Randomized Controlled

Metabolic surgery is the most efficacious method for the treatment of morbid obesity and was recently included among the antidiabetes treatments recommended in obese type 2 diabetes (T2D) patients. The aim of this study was to compare in a randomized controlled trial the effect of sleeve gastrectomy (SG) to that of intensive lifestyle intervention plus pharmacologic treatment on some markers of insulin resistance and beta cell function as well as some appetite controlling hormones in a group of male obese T2D subjects. The study groups comprised 20 subjects for SG and 21 control subjects. Fasting blood glucose, insulin, proinsulin, adiponectin, leptin, ghrelin, HOMA-IR, HOMA-%B, proinsulin-to-insulin ratio and proinsulin-to-adiponectin ratio were evaluated at baseline and after one year follow-up. Overall, patients in the SG group lost 78.98% of excess weight loss (%EWL) in comparison with 9.45% in the control group. This was accompanied by a significant improvement of insulin resistance markers, including increase of adiponectin and decrease of HOMA-IR, while no changes were recorded in the control group. Weight loss was also associated with a significant improvement of proinsulin-to-insulin and proinsulin-to-adiponectin ratio, both surrogate markers of beta cell dysfunction. These also improved in the control group, but were only marginally significant. Our findings suggest that improved insulin resistance and decreased beta cell dysfunction after sleeve gastrectomy might explain diabetes remission associated with metabolic surgery.

scholarly journals Reduction of Cardio-Metabolic Risk and Body Weight through a Multiphasic Very-Low Calorie Ketogenic Diet Program in Women with Overweight/Obesity: A Study in a Real-World Setting

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1804
Author(s):  
Elena Tragni ◽  
Luisella Vigna ◽  
Massimiliano Ruscica ◽  
Chiara Macchi ◽  
Manuela Casula ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Waist Circumference ◽  
Real World ◽  
Metabolic Complications ◽  
Multi Centre Study ◽  
Low Calorie ◽  
Ketogenic Diets ◽  
Real World Setting ◽  
Overweight Or Obesity

Background: The prevention and treatment of obesity and its cardio-metabolic complications are relevant issues worldwide. Among lifestyle approaches, very low-calorie ketogenic diets (VLCKD) have been shown to lead to rapid initial weight loss, resulting in better long-term weight loss maintenance. As no information on VLCKD studies carried on in a real-world setting are available, we conducted this multi-centre study in a real-world setting, aiming at assessing the efficacy and the safety of a specific multiphasic VLCKD program in women with overweight or obesity. Methods: A multi-center, prospective, uncontrolled trial was conducted in 33 outpatient women (age range 27–60 y) with overweight or obesity (BMI: 30.9 ± 2.7 kg/m2; waist circumference: 96.0 ± 9.4 cm) who started a VLCKD dietary program (duration: 24 weeks), divided into four phases. The efficacy of VLCKD was assessed by evaluating anthropometric measures and cardiometabolic markers; liver and kidney function biomarkers were assessed as safety parameters. Results: The VLCKD program resulted in a significant decrease of body weight and BMI (−14.6%) and waist circumference (−12.4%). At the end of the protocol, 33.3% of the participants reached a normal weight and the subjects in the obesity range were reduced from 70% to 16.7%. HOMA-IR was markedly reduced from 3.17 ± 2.67 to 1.73 ± 1.23 already after phase 2 and was unchanged thereafter. Systolic blood pressure decreased after phase 1 (−3.5 mmHg) and remained unchanged until the end of the program. Total and LDL cholesterol and triglycerides were significantly reduced by VLCKD along with a significant HDL cholesterol increase. Liver, kidney and thyroid function markers did not change and remained within the reference range. Conclusions: The findings of a multi-center VLCKD program conducted in a real-world setting in a cohort of overweight/obese women indicate that it is safe and effective, as it results in a major improvement of cardiometabolic parameters, thus leading to benefits that span well beyond the mere body weight/adiposity reduction.

scholarly journals Holter-Derived Autonomic Function, Arrhythmias and Carbohydrate Metabolism in Patients with Class III Obesity Treated with Laparoscopic Sleeve Gastrectomy

2021 ◽  
Vol 10 (10) ◽  
pp. 2140
Author(s):  
Piotr Bienias ◽  
Zuzanna Rymarczyk ◽  
Justyna Domienik-Karłowicz ◽  
Wojciech Lisik ◽  
Piotr Sobieraj ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Heart Rate ◽  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Carbohydrate Metabolism ◽  
Autonomic Function ◽  
Young Patients ◽  
Resistance Index ◽  
Class Iii

The effects of weight loss following bariatric surgery on autonomic balance, arrhythmias and insulin resistance are still of interest. We prospectively investigated 50 patients with BMI > 40 kg/m2, aged 36.5 (18–56) years who underwent laparoscopic sleeve gastrectomy. Among other examinations, all subjects had 24-h Holter monitoring with heart rate variability (HRV) and heart rate turbulence (HRT) evaluation. After a median of 15 months, BMI decreased from 43.9 to 29.7 kg/m2, the incidence of hypertension decreased from 54 to 32% (p = 0.04) and any carbohydrate disorders decreased from 24 to 6% (p = 0.02). Fasting insulin concentration and insulin resistance index improved significantly (p < 0.001). Improvements in HRV parameters related to the sympathetic autonomic division were also observed (p < 0.001), while HRT evaluation was not conclusive. The enhancement of autonomic tone indices was correlated with reduction of BMI (SDNN-I r = 0.281 p = 0.04; SDNN r = 0.267 p = 0.05), but not with reduction of waist circumference, and it was also associated with decrease of mean heart rate (OR 0.02, 95%CI 0.0–0.1, p < 0.001). The incidence of arrhythmias was low and similar before and after follow-up. In conclusion, improvement of homeostasis of carbohydrate metabolism and autonomic function is observed in relatively young patients after weight loss due to laparoscopic sleeve gastrectomy.

Five-year Outcomes of Sleeve Gastrectomy: A Prospective Multicenter study

2021 ◽  
pp. 000313482199198
Author(s):  
Imad El Moussaoui ◽  
Etienne Van Vyve ◽  
Hubert Johanet ◽  
André Dabrowski ◽  
Arnaud Piquard ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Body Mass ◽  
Excess Weight Loss ◽  
Prospective Multicenter Study ◽  
Weight Loss Failure ◽  
Obstructive Sleep ◽  
The Mean ◽  
Predictors Of Weight Loss

Background Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure in the world. Our purpose was to evaluate the percentage of excess weight loss (%EWL), resolution of obesity-related comorbidities after SG, and identify predictive factors of weight loss failure. Methods A prospective cohort study of adults who underwent SG during 2014 in 7 Belgian-French centers. Their demographic, preoperative, and postoperative data were prospectively collected and analyzed statistically. Results Overall, 529 patients underwent SG, with a mean preoperative weight and body mass index (BMI) of 118.9 ± 19.9 kg and 42.9 ± 5.5 kg/m2, respectively. Body mass index significantly decreased to 32.2 kg/m2 at 5 years ( P < .001). The mean %EWL was 63.6% at 5 years. A significant reduction in dyslipidemia (28.0%-18.2%), obstructive sleep apnea (OSAS) (34.6%-25.1%), and arterial hypertension (HTN) (30.4%-21.5%) was observed after 5 years, but not for diabetes and gastroesophageal reflux disease (GERD). At multivariate analysis, age >50 years old, BMI >50 kg/m2, and previous laparoscopic adjustable gastric banding (LAGB) remained independent predictors of weight loss failure. Conclusions Five years after SG, weight loss was satisfactory; the reduction of comorbidities was significant for dyslipidemia, OSAS, and HTN, but not diabetes and GERD. Age >50 years old, BMI >50 kg/m2, and previous LAGB were independent predictors of weight loss failure.

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