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

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.

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

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.36.suppl_1.195 ◽

2016 ◽

Vol 36 (suppl_1) ◽

Author(s):

Amy S Shah ◽

Thomas Inge ◽

Hannah Sexmith ◽

Anna Heink ◽

W S Davidson

Keyword(s):

Weight Loss ◽

Sleeve Gastrectomy ◽

Cholesterol Efflux ◽

Severe Obesity ◽

Rapid Weight Loss ◽

Vertical Sleeve Gastrectomy ◽

Inflammatory Index ◽

Post Surgery ◽

Hdl Function ◽

The Impact

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.

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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

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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.

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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.

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The effects of age on weight loss after sleeve gastrectomy

Integrative Journal of Medical Sciences ◽

10.15342/ijms.2021.433 ◽

2021 ◽

Vol 8 ◽

Author(s):

Taha Anbara

Keyword(s):

Diabetes Mellitus ◽

Weight Loss ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Statistical Significance ◽

Age Groups ◽

Primary Treatment ◽

Morbidly Obese ◽

Safe Procedure ◽

The Impact

Introduction: Laparoscopic sleeve gastrectomy is a primary treatment of obesity among older adults and its satisfactory outcomes would be the main reason behind the popularity of this procedure. We aim to evaluate the impact of age on excess weight loss in adult morbidly obese subjects older than 60 years old following LSG.Methods: In this retrospective survey, 3,072 subjects were included in the study that underwent LSG in Erfan Hospital. Screening follow-up period was 12 months. The level of statistical significance was set at P < 0.05. We hired comorbid conditions to avoid bias results including hypertension, diabetes mellitus and dyslipidemia. Results: Of 3072 patients, 1879 cases were females (61.2%) and 1193 subjects were males (38.8 %). Mean %EBMIL of the group 12 months after surgery was 78.9 %. In younger than 60 years old group, mean %EBMIL 12 months postoperative 83 % and patients over 60 years demonstrated mean %EBMIL 74.9 %. There was an obvious difference among age groups in presence of diabetes mellitus and hypertension in the older group which was more frequent. Conclusion: To sum up, laparoscopic sleeve gastrectomy is safe procedure for older groups. Albeit, %EBMIL was significantly lower in older group compared to younger subjects, but resolution in comorbidities was satisfactory.

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Quality of Life before and after Sleeve Gastrectomy in Lebanese Population

Journal of Obesity ◽

10.1155/2019/1952538 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Marwan Alkassis ◽

Fady Gh Haddad ◽

Joseph Gharios ◽

Roger Noun ◽

Ghassan Chakhtoura

Keyword(s):

Quality Of Life ◽

Bariatric Surgery ◽

Weight Loss ◽

Sleeve Gastrectomy ◽

Sexual Pleasure ◽

Life Questionnaire ◽

Before And After ◽

The Mean ◽

The Impact

Introduction. Obesity is increasing worldwide and in Lebanon with a negative impact on the quality of life. The primary objective of this study is to measure the quality of life in obese subjects before and after bariatric surgery, depending on age, sex, and degree of weight loss. A secondary objective is to determine the impact of bariatric surgery on comorbidities associated with obesity. Materials and methods. Patients undergoing laparoscopic sleeve gastrectomy for BMI ≥ 30 kg/m2 between August 2016 and April 2017 were included. Participants completed the Moorehead-Ardelt Quality of Life Questionnaire II (MA II) prior to operation and one year after. Statistical analysis was carried out using SPSS statistics version 20.0. Results. 75 patients participated in the study. The majority were women (75%), and the mean age was 36.3 years. The mean weight loss was 36.57 kg (16–76). Initially, the total MA II score was −0.33 ± 0.93. Postoperatively, it increased to 1.68 ± 0.62 (p≤0.001). All MA II parameters improved after surgery (p≤0.001), but this improvement was independent of age and sex. Improvement in self-esteem, physical activity, work performance, and sexual pleasure was influenced by the degree of weight loss (p≤0.001). All comorbidities associated with obesity regressed significantly after sleeve gastrectomy (p<0.05) with the exception of gastroesophageal reflux and varicose veins of the lower limbs. Conclusion. Sleeve gastrectomy improves quality of life and allows reduction of comorbidities.

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Weight loss after sleeve gastrectomy in developmentally delayed adolescents and young adults

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2019.07.029 ◽

2019 ◽

Vol 15 (10) ◽

pp. 1662-1667 ◽

Cited By ~ 2

Author(s):

Gillian R. Goddard ◽

Meera Kotagal ◽

Todd M. Jenkins ◽

Linda M. Kollar ◽

Thomas H. Inge ◽

...

Keyword(s):

Weight Loss ◽

Young Adults ◽

Sleeve Gastrectomy ◽

Adolescents And Young Adults ◽

Developmentally Delayed

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Impact of Laparoscopic Sleeve Gastrectomy on Esophageal Physiology

Romanian Journal of Internal Medicine ◽

10.2478/rjim-2021-0008 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Andrada-Loredana Popescu ◽

Florentina Ioniţa-Radu ◽

Mariana Jinga ◽

Vasile-Daniel Balaban ◽

Raluca-Simona Costache ◽

...

Keyword(s):

Weight Loss ◽

Sleeve Gastrectomy ◽

High Resolution ◽

Laparoscopic Sleeve Gastrectomy ◽

Lower Esophageal Sphincter ◽

Esophageal Manometry ◽

Morbidly Obese ◽

Esophageal Physiology ◽

Esophageal Sphincter ◽

The Impact

Abstract Introduction: Laparoscopic sleeve gastrectomy (LSG) is a popular weight loss surgery technique, but the impact on esophageal physiology and esophagogastric junction is still debatable. The aim of our study was to evaluate the manometric changes of the lower esophageal sphincter (LES) after LSG in order to indicate LES manometry pre- procedure. Methods: In a prospective study we evaluated clinically, with upper gastrointestinal endoscopy, and high-resolution esophageal manometry 45 morbidly obese patients before, and 6-12 months after LSG. Results: The BMI (body mass index) decreased from 46.28±5.79 kg/m2 to 32.28±4.65 kg/m2 postoperatively (p <0.01), with a reduction of ~14 kg/m2 of BMI, 39.9 (±11.9) kg body weight and 29.9 (± 6.2)% of the TWL (Total Weight Loss index), in a median interval of 7.9 months. Gastroesophageal reflux disease (GERD) prevalence increased from 17.8% to 31.1% postoperatively, with new GERD onset in 22.2%, but mild symptomatology (the median GERDHRQL score increased from 1.56 to 2.84 points). Postoperatory reflux was associated with lower esophageal sphincter (LES) hypotonia, shortening of LES length and IIGP (increased intragastric pressure). Hiatal hernia repair rate was 17.8%, and proton pump inhibitor consumption 20%. After weight loss, the 10 cases of esophagitis discovered preoperatively cured, but 3 patients were diagnosed with de novo esophagitis. The prevalence of manometric dysmotility after LSG was 28.9%, lower than before surgery (44.4%). Conclusion: Even if GERD remains the main limitation of LSG, the high-resolution esophageal manometry has proved useful and should be implemented in morbidly obese evaluation protocol, to better select the bariatric procedure.

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A sympathetic gut connection drives the metabolic benefits of Roux-en-Y gastric bypass

Cell Stress ◽

10.15698/cst2020.12.236 ◽

2020 ◽

Vol 4 (12) ◽

pp. 265-269

Author(s):

Mohammed K. Hankir

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Body Weight ◽

Sleeve Gastrectomy ◽

Severe Obesity ◽

Resting Metabolic Rate ◽

Splanchnic Nerve ◽

Negative Energy ◽

Recent Issue ◽

White Fat

Surgery is regarded by many as the go-to treatment option for severe obesity; yet how physically altering the gastrointestinal tract produces such striking results on body weight and overall metabolic health is poorly understood. In a recent issue of Cell Reports Ye et al. (2020) compare mouse models of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the two most commonly performed weight loss surgeries in the clinic today, to show that the former reconfiguring procedure selectively increases resting metabolic rate through splanchnic nerve-mediated browning of mesenteric white fat. More significantly, they demonstrate that this effect for RYGB is required for the maintained negative energy balance and improved glycemic control that it confers.

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The Impact of the Pre-operative Neutrophil-lymphocyte Ratio as the Predictive Marker of Post-operative Weight Loss and Improving Diabetes in Sleeve Gastrectomy.

10.21203/rs.3.rs-131065/v1 ◽

2020 ◽

Author(s):

Hideya Kashihara ◽

Mitsuo Shimada ◽

Kozo Yoshikawa ◽

Jun Higashijima ◽

Takuya Tokunaga ◽

...

Keyword(s):

Weight Loss ◽

Sleeve Gastrectomy ◽

Hemoglobin A1c ◽

Excess Weight Loss ◽

Predictive Marker ◽

Obese Patients ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Remission Of Diabetes ◽

The Impact

Abstract Background: The aim of this study was to investigate the impact of the neutrophil-lymphocyte ratio (NLR) in sleeve gastrectomy (SG).Methods: 15 obese patients were enrolled in this study. They consisted of 5 males and 10 females: mean body weight (BW) 127.5kg; mean body mass index (BMI) 46.7kg/m2. 10 of these were diabetics who underwent a SG. The impact of the pre-operative NLR on the percentage of excess weight loss (%EWL) and remission of diabetes 1 year post-operative were examined.Results: The BMI, %EWL and %TWL at 1 year post-operative were 35.1 kg/m2, 46.3% and 26.2%, respectively. Improvements were also evident in the diabetes at 1 year post-operative: complete remission (CR) (No medication and hemoglobin A1c (HbA1c) HbA1c<6.0%) 40%, PR (HbA1c<6.5) 20%; and (decrease of anti diabetic drug and HbA1c<7.0%) 40%. Comparing pre-operative NLR in %EWL<50% and >50% in one (1) year post-operative, <50% was 2.64 and >50% was 2.03 (p<0.05). The NLR in CR and partial remission (PR) was significantly lower than that in improved (Improve) (2.22 vs 3.27, p<0.05).Conclusions: The pre-operative NLR may be a predictive marker of weight loss and improving diabetes after SG.

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