Abstract 195: Effects of Vertical Sleeve Gastrectomy on HDL Function in Adolescents with Severe Obesity

Severe obesity is a major problem among US adolescents and traditional weight loss strategies, including lifestyle intervention, have had limited efficacy. Bariatric surgery has grown in popularity because it results in rapid weight loss while improving cardiovascular disease risk factors, including raising high density lipoprotein cholesterol (HDL-C). Whether this rise in HDL-C translates into improved HDL cardioprotective function is not clear, particularly in adolescents. We studied the impact of weight loss surgery (vertical sleeve gastrectomy) in adolescents with severe obesity on HDL function pre and one year post operatively. Adolescents underwent laparoscopic vertical sleeve gastrectomy between in 2008-2011. HDL function (cholesterol efflux, HDL oxidation, and HDL inflammatory index) was measured pre and post-surgery on stored serum (-80°C) after apolipoprotein B depletion with polyethylene glycol. Only males were studied in this pilot study to minimize the known effects of sex and the menstrual cycle on lipoproteins. Changes pre and post-surgery were evaluated using paired t-tests. Participants (n=10, 90% Caucasian) were a mean±SD age of 17.4±1.6 years at baseline and 18.4 ±1.5 years at follow-up. After vertical sleeve gastrectomy, BMI was 32% lower than baseline (p<0.01). All lipid measurements improved and HDL-C increased by 23%. HDL function significantly improved post vertical sleeve gastrectomy compared to baseline, all p<0.01 (cholesterol efflux by 12%, HDL oxidation potential by 30%, and HDL inflammatory index by 25%). We conclude that vertical sleeve gastrectomy results in a significant improvement in HDL cholesterol levels and HDL function in adolescents with severe obesity. Whether these changes result in long term improvement in cardiovascular health remains to be determined.

Download Full-text

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

SLEEP ◽

10.1093/sleep/zsaa056.872 ◽

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.

Download Full-text

OR22-06 Bone Outcomes Following Sleeve Gastrectomy in Adolescents and Young Adults with Obesity Versus Non-Surgical Controls

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.732 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Madhusmita Misra ◽

Vibha Singhal ◽

Brian Carmine ◽

Amita Bose ◽

Megan Moriarty Kelsey ◽

...

Keyword(s):

Weight Loss ◽

Young Adults ◽

Sleeve Gastrectomy ◽

Distal Radius ◽

Severe Obesity ◽

Distal Tibia ◽

Bone Geometry ◽

Volumetric Bmd ◽

The Impact ◽

Surgical Group

Abstract Background: Sleeve gastrectomy is the most commonly performed weight loss surgery in adolescents with moderate-to-severe obesity. While studies in adults have reported on the deleterious effects of gastric bypass surgery on bone structure and strength estimates, data are lacking for the impact of sleeve gastrectomy on these measures in adolescents. Objective: To evaluate the impact of sleeve gastrectomy on bone outcomes in adolescents and young adults over 12 months using dual energy x-ray absorptiometry (DXA) and high resolution peripheral quantitative computed tomography (HRpQCT). Participants and Methods: We enrolled 33 youth 14-22 years old with moderate to severe obesity; 17 underwent sleeve gastrectomy and 16 were followed without surgery. DXA was used to assess areal bone mineral density (aBMD). HRpQCT was used to assess bone geometry, microarchitecture and volumetric BMD (vBMD) and finite element analysis to assess strength estimates (stiffness and failure load) at the distal tibia and distal radius at baseline and 12 months. 25(OH) vitamin D (25OHD) levels were obtained at baseline and follow-up. Results: The surgical group lost 28.2% of total body weight compared to 1.4% in the non-surgical group. The groups did not differ for changes in 25OHD levels (P=0.181). After controlling for age and sex, compared to the non-surgical group, the surgical group had reductions in aBMD Z-scores at the femoral neck and total hip (p≤ 0.0005). At the distal tibia, there were reductions in cortical thickness and trabecular number, and increases in trabecular separation and cortical vBMD, without changes in strength estimates in the surgical group vs. controls (p≤0.043). Changes were less marked at the distal radius. While sleeve gastrectomy resulted in deleterious effects on most bone parameters, there was an increase in cortical vBMD at both sites, possibly from a decrease in cortical porosity. Most differences were attenuated after adjusting for changes in BMI over 12 months. Conclusions: Over 12 months, weight loss associated with sleeve gastrectomy in adolescents had deleterious effects on areal BMD, bone geometry and trabecular microarchitecture at weight-bearing sites. However, strength estimates did not decrease, possibly because of a simultaneous increase in cortical volumetric BMD. Additional research is necessary to determine the relative contribution(s) of weight loss and the metabolic effects of surgery, and whether the observed effects on bone stabilize or progress over time.

Download Full-text

828-P: The Impact of Diabetes and Depression Status on Weight Loss Outcomes in Mexican Patients with Severe Obesity

Diabetes ◽

10.2337/db19-828-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 828-P

Author(s):

MARCELA RODRIGUEZ FLORES ◽

SYLVANA STEPHANO Z. ◽

MARÍA RABASA ◽

JUANA MONTOYA ◽

CLAUDIA VELEZ ◽

...

Keyword(s):

Weight Loss ◽

Severe Obesity ◽

Depression Status ◽

Weight Loss Outcomes ◽

The Impact ◽

Mexican Patients

Download Full-text

Central Noradrenergic Neurotransmission and Weight Loss 6 Months After Gastric Bypass Surgery in Patients with Severe Obesity

Obesity Surgery ◽

10.1007/s11695-021-05657-7 ◽

2021 ◽

Author(s):

J. Marvin Soeder ◽

Julia Luthardt ◽

Michael Rullmann ◽

Georg A. Becker ◽

Mohammed K. Hankir ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Severe Obesity ◽

Occipital Cortex ◽

Brain Regions ◽

General Tendency ◽

Strong Positive Correlation ◽

Reference Tissue ◽

Efficient Treatment ◽

Post Surgery

Abstract Purpose Roux-en-Y gastric bypass (RYGB) surgery is currently the most efficient treatment to achieve long-term weight loss in individuals with severe obesity. This is largely attributed to marked reductions in food intake mediated in part by changes in gut-brain communication. Here, we investigated for the first time whether weight loss after RYGB is associated with alterations in central noradrenaline (NA) neurotransmission. Materials and Methods We longitudinally studied 10 individuals with severe obesity (8 females; age 43.9 ± 13.1 years; body mass index (BMI) 46.5 ± 4.8 kg/m2) using (S,S)-[11C]O-methylreboxetine and positron emission tomography to estimate NA transporter (NAT) availability before and 6 months after surgery. NAT distribution volume ratios (DVR) were calculated by volume-of-interest analysis and the two-parameter multilinear reference tissue model (reference region: occipital cortex). Results The participants responded to RYGB surgery with a reduction in BMI of 12.0 ± 3.5 kg/m2 (p < 0.001) from baseline. This was paralleled by a significant reduction in DVR in the dorsolateral prefrontal cortex (pre-surgery 1.12 ± 0.04 vs. post-surgery 1.07 ± 0.04; p = 0.019) and a general tendency towards reduced DVR throughout the brain. Furthermore, we found a strong positive correlation between pre-surgery DVR in hypothalamus and the change in BMI (r = 0.78; p = 0.01). Conclusion Reductions in BMI after RYGB surgery are associated with NAT availability in brain regions responsible for decision-making and homeostasis. However, these results need further validation in larger cohorts, to assess whether brain NAT availability could prognosticate the outcome of RYGB on BMI. Graphical abstract

Download Full-text

Assessment of Protein Intake in the First Three Months after Sleeve Gastrectomy in Patients with Severe Obesity

Nutrients ◽

10.3390/nu13030771 ◽

2021 ◽

Vol 13 (3) ◽

pp. 771

Author(s):

Lucrezia Bertoni ◽

Romina Valentini ◽

Alessandra Zattarin ◽

Anna Belligoli ◽

Silvia Bettini ◽

...

Keyword(s):

Weight Loss ◽

Sleeve Gastrectomy ◽

Protein Intake ◽

Severe Obesity ◽

Protein Supplementation ◽

Fat Free Mass ◽

The Third ◽

Total Protein Intake ◽

Dietary Record ◽

Protein Rich

An adequate protein intake prevents the loss of fat-free mass during weight loss. Laparoscopic sleeve gastrectomy (SG) jeopardizes protein intake due to post-operative dietary restriction and intolerance to protein-rich foods. The purpose of this study is to evaluate protein intake in the first three months after SG. We evaluated, 1 month and 3 months after surgery, 47 consecutive patients treated with SG. Protein intake, both from foods and from protein supplementation, was assessed through a weekly dietary record. Patients consumed 30.0 ± 10.2 g of protein/day on average from foods in the first month, with a significant increase to 34.9 ± 4.8 g of protein/day in the third month (p = 0.003). The use of protein supplementation significantly increased total protein intake to 42.3 ± 15.9 g protein/day (p < 0.001) in the first month and to 39.6 ± 14.2 g of protein/day (p = 0.002) in the third one. Compliance with supplement consumption was 63.8% in the first month and only 21.3% in the third month. In conclusion, both one and three months after SG, protein intake from foods was not sufficient. The use of modular supplements seems to have a significant impact on protein intake, but nevertheless it remains lower than recommended.

Download Full-text

Impact of weight loss achieved through a multidisciplinary intervention on appetite in patients with severe obesity

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00322.2017 ◽

2018 ◽

Vol 315 (1) ◽

pp. E91-E98 ◽

Cited By ~ 11

Author(s):

S. R. Coutinho ◽

J. F. Rehfeld ◽

J. J. Holst ◽

B. Kulseng ◽

C. Martins

Keyword(s):

Weight Loss ◽

Severe Obesity ◽

Peptide Yy ◽

Plasma Concentrations ◽

Cardiovascular Fitness ◽

Ghrelin Concentration ◽

Time Points ◽

Diet And Exercise ◽

The Impact

The impact of lifestyle-induced weight loss (WL) on appetite in patients with obesity remains controversial. This study aimed to assess the short- and long-term impact of WL achieved by diet and exercise on appetite in patients with obesity. Thirty-five (22 females) adults with severe obesity (body mass index: 42.5 ± 5.0 kg/m2) underwent a 2-yr WL program focusing on diet and exercise. Body weight (BW), cardiovascular fitness (V̇o2max), appetite feelings, and plasma concentrations of insulin, active ghrelin (AG), glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and cholecystokinin (CCK), in the fasting and postprandial states, were measured at baseline (B), week 4 (W4), and 1 and 2 yr (and average values for all fasting and postprandial time points computed). BW was significantly reduced and V̇o2max(ml·kg−1·min−1) increased at all time points compared with B (3.5, 8.1, and 8.4% WL and 7, 11, and 8% increase at W4 and 1 and 2 yr, respectively). Basal hunger and average hunger and desire to eat were significantly increased at 1 and 2 yr. Basal fullness was significantly increased at W4, and average ratings were reduced at 1 yr. Average AG and PYY were significantly increased, and insulin was reduced, at all time points compared with B. Average GLP-1 was reduced at W4, and CCK was increased at 2 yr. After lifestyle-induced WL, patients with severe obesity will, therefore, have to deal with increased hunger in the long term. In conclusion, sustained WL at 2 yr achieved with diet and exercise is associated with increased hunger feelings and ghrelin concentration but also increased postprandial concentrations of satiety hormones.

Download Full-text

The impact of rapid weight loss (4%) on leptin, adiponectin, and insulin resistance in elite adult free style wrestlers

The Journal of Sports Medicine and Physical Fitness ◽

10.23736/s0022-4707.16.06004-7 ◽

2017 ◽

Vol 57 (4) ◽

Author(s):

Mohammad Talaei ◽

Farzad Nazem ◽

Kamal Ranjbar

Keyword(s):

Insulin Resistance ◽

Weight Loss ◽

Rapid Weight Loss ◽

The Impact

Download Full-text

Rapid Weight Loss, Central Obesity Improvement and Blood Glucose Reduction Are Associated with a Stronger Adaptive Immune Response Following COVID-19 mRNA Vaccine

Vaccines ◽

10.3390/vaccines10010079 ◽

2022 ◽

Vol 10 (1) ◽

pp. 79

Author(s):

Mikiko Watanabe ◽

Angela Balena ◽

Davide Masi ◽

Rossella Tozzi ◽

Renata Risi ◽

...

Keyword(s):

Immune Response ◽

Weight Loss ◽

Blood Glucose ◽

Adaptive Immune Response ◽

Humoral Response ◽

Rapid Weight Loss ◽

Low Carbohydrate Diet ◽

Adaptive Immune ◽

Glucose Reduction ◽

The Impact

Obesity is associated with a poor COVID-19 prognosis, and it seems associated with reduced humoral response to vaccination. Public health campaigns have advocated for weight loss in subjects with obesity, hoping to eliminate this risk. However, no evidence proves that weight loss leads to a better prognosis or a stronger immune response to vaccination. We aimed to investigate the impact of rapid weight loss on the adaptive immune response in subjects with morbid obesity. Twenty-one patients followed a hypocaloric, very-low-carbohydrate diet one week before to one week after the two mRNA vaccine doses. The diet’s safety and efficacy were assessed, and the adaptive humoral (anti-SARS CoV-2 S antibodies, Abs) and cell-mediated responses (IFNγ secretion on stimulation with two different SARS CoV-2 peptide mixes, IFNγ-1 and IFNγ-2) were evaluated. The patients lost ~10% of their body weight with metabolic improvement. A high baseline BMI correlated with a poor immune response (R −0.558, p = 0.013 for IFNγ-1; R −0.581, p = 0.009 for IFNγ-2; R −0.512, p = 0.018 for Abs). Furthermore, there was a correlation between weight loss and higher IFNγ-2 (R 0.471, p = 0.042), and between blood glucose reduction and higher IFNγ-1 (R 0.534, p = 0.019), maintained after weight loss and waist circumference reduction adjustment. Urate reduction correlated with higher Abs (R 0.552, p = 0.033). In conclusion, obesity is associated with a reduced adaptive response to a COVID-19 mRNA vaccine, and weight loss and metabolic improvement may reverse the effect.

Download Full-text

Spontaneous Neural Activity Changes after Bariatric Surgery: a resting-state fMRI study

10.1101/2021.04.01.437973 ◽

2021 ◽

Author(s):

Yashar Zeighami ◽

Sylvain Iceta ◽

Mahsa Dadar ◽

Mélissa Pelletier ◽

Mélanie Nadeau ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Visual Cortex ◽

Neural Activity ◽

Dorsolateral Prefrontal Cortex ◽

Severe Obesity ◽

Normal Weight ◽

Post Surgery ◽

Spontaneous Neural Activity ◽

Dorsolateral Prefrontal

1.AbstractBackgroundMetabolic disorders associated with obesity could lead to alterations in brain structure and function. Whether these changes can be reversed after weight loss is unclear. Bariatric surgery provides a unique opportunity to address these questions because it induces marked weight loss and metabolic improvements which in turn may impact the brain in a longitudinal fashion. Previous studies found widespread changes in grey matter (GM) and white matter (WM) after bariatric surgery. However, findings regarding changes in spontaneous neural activity following surgery, as assessed with the fractional amplitude of low frequency fluctuations (fALFF) and regional homogeneity of neural activity (ReHo), are scarce and heterogenous. In this study, we used a longitudinal design to examine the changes in spontaneous neural activity after bariatric surgery (comparing pre- to post-surgery), and to determine whether these changes are related to cardiometabolic variables.MethodsThe study included 57 participants with severe obesity (mean BMI=43.1±4.3kg/m2) who underwent sleeve gastrectomy (SG), biliopancreatic diversion with duodenal switch (BPD), or Roux-en-Y gastric bypass (RYGB), scanned prior to bariatric surgery and at follow-up visits of 4 months (N=36), 12 months (N=29), and 24 months (N=14) after surgery. We examined fALFF and ReHo measures across 1022 cortical and subcortical regions (based on combined Schaeffer-Xiao parcellations) using a linear mixed effect model. Voxel-based morphometry (VBM) based on T1-weighted images was also used to measure GM density in the same regions. We also used an independent sample from the Human Connectome Project (HCP) to assess regional differences between individuals who had normal-weight (N=46) or severe obesity (N=46).ResultsWe found a global increase in the fALFF signal with greater increase within dorsolateral prefrontal cortex, precuneus, inferior temporal gyrus, and visual cortex. This effect was more significant 4 months after surgery. The increase within dorsolateral prefrontal cortex, temporal gyrus, and visual cortex was more limited after 12 months and only present in the visual cortex after 24 months. These increases in neural activity measured by fALFF were also significantly associated with the increase in GM density following surgery. Furthermore, the increase in neural activity was significantly related to post-surgery weight loss and improvement in cardiometabolic variables, such as insulin resistance index and blood pressure. In the independent HCP sample, normal-weight participants had higher global and regional fALFF signals, mainly in dorsolateral/medial frontal cortex, precuneus and middle/inferior temporal gyrus compared to the obese participants. These BMI-related differences in fALFF were associated with the increase in fALFF 4 months post-surgery especially in regions involved in control, default mode and dorsal attention networks.ConclusionsBariatric surgery-induced weight loss and improvement in metabolic factors are associated with widespread global and regional increases in neural activity, as measured by fALFF signal. These findings alongside the higher fALFF signal in normal-weight participants compared to participants with severe obesity in an independent dataset suggest an early recovery in the neural activity signal level after the surgery.

Download Full-text