scholarly journals Accuracy of prediction equations for calculating resting energy expenditure in morbidly obese patients

2012 ◽  
Vol 94 (2) ◽  
pp. 129-132 ◽  
Author(s):  
S Ullah ◽  
R Arsalani-Zadeh ◽  
J MacFie
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Indirect Calorimetry ◽  
Resting Energy Expenditure ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Prediction Equations ◽  
The Mean ◽  
Accuracy Of Prediction

INTRODUCTION The accuracy of prediction equations for estimating resting energy expenditure (REE) in morbidly obese patients is unclear. The aim of this study was to compare the REE measured using bedside indirect calorimetry with commonly used prediction equations. METHODS A total of 31 morbidly obese patients were studied. Pre-operative REE was measured with indirect calorimetry and compared with estimated REE using the Harris–Benedict and Schofield equations. All patients subsequently underwent a Roux-en-Y gastric bypass and measurements were repeated at six weeks and three months following surgery. RESULTS The mean age of the patients was 47 years. The mean pre-operative body mass index was 46kg/m2. The mean REE measured using indirect calorimetry was 1,980kcal/day. The estimated REE using the Harris–Benedict and Schofield formulae was 2,195 and 2,129kcal/day respectively. The equations overestimated REE by 10% and 7%. Body weight and body mass index reduced significantly following Roux-en-Y gastric bypass. There was no significant change in measured REE over the three-month period. After weight loss the difference between the estimated and measured REE reduced to 1–3%. CONCLUSIONS Prediction equations overestimate REE in morbidly obese patients. Their accuracy improved after surgery induced weight loss, confirming their validity for the normal weight population. Indirect calorimetry should be used in morbid obesity.

Hypometabolizers: Characteristics of Obese Patients with Abnormally Low Resting Energy Expenditure

2014 ◽  
Vol 80 (3) ◽  
pp. 290-294 ◽  
Author(s):  
Armando Rosales-Velderrain ◽  
Ross F. Goldberg ◽  
Gretchen E. Ames ◽  
Ronald L. Stone ◽  
Scott A. Lynch ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Energy Expenditure ◽  
Resting Energy Expenditure ◽  
Calorie Intake ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Phenotypic Characteristics ◽  
The Mean ◽  
The Difference ◽  
Resting Energy

Weight gain or loss is determined by the difference between calorie intake and energy expenditure. The Mifflin metabolic equation most accurately predicts resting energy expenditure (REE) in morbidly obese patients. Hypometabolizers have a measured REE that is much less than predicted and pose the greatest challenge for weight loss induced by restriction of calorie intake. We studied 628 morbidly obese patients (467 female and 161 men, aged 52.5 ± 15.7 years, body mass index [BMI] of 42.6 ± 7.6 m/kg2 [mean ± SD]). REE was measured using the MedGem® device (REEm) and the percentage variance (δREE%) from the Mifflin-predicted expenditure (REEp) was calculated. Patients with δREE% more than 1 standard deviation from the mean were defined as hypometabolizers (REEm greater than 27% below REEp) and hypermetabolizers (REEm less than 13% above REEp), respectively. Hypometabolizers had greater REEp (1900 ± 301 vs 1719 ± 346 calories, P = 0.005) and lower REEm (1244 ± 278 vs 2161 ± 438 calories, P < 0.0001) than hypermetabolizers. Hypometabolizers, when compared with hypermetabolizers, were taller (167.2 ± 8.4 vs 164.0 ± 10.9 cm, P = 0.04), heavier (123.6 ± 22.2 vs 110.2 ± 23.1 kg, P = 0.006), and had increased BMI (44.1 ± 6.5 vs 40.8 ± 6.5 kg/m2, P = 0.04). Other measured anthropometrics were not different between hypo- and hypermetabolizers. Hypometabolizers were less likely to be diabetic (23 vs 43%, P = 0.03) and more likely to be black (25 vs 5%, P = 0.002) than hypermetabolizers. This study defines hypometabolizers as having variance in REEm more than 27 per cent below that predicted by the Mifflin equation. We could not identify any distinguishing phenotypic characteristics of hypometabolizers, suggesting an influence unrelated to body composition.

Prevalence of Sleep Apnea in Morbidly Obese Patients who Presented for Weight Loss Surgery Evaluation: More Evidence for Routine Screening for Obstructive Sleep Apnea before Weight Loss Surgery

2008 ◽  
Vol 74 (9) ◽  
pp. 834-838 ◽  
Author(s):  
Peter P. Lopez ◽  
Bianca Stefan ◽  
Carl I. Schulman ◽  
Patricia M. Byers
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Weight Loss Surgery ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
The Mean

The incidence of obstructive sleep apnea has been underestimated in morbidly obese patients who present for evaluation for weight loss surgery. This retrospective study shows that the incidence of obstructive sleep apnea in this patient population is greater than 70 per cent and increases in incidence as the body mass index increases. Obstructive sleep apnea (OSA) is a common comorbidity in obese patients who present for evaluation for gastric bypass surgery. The incidence of sleep apnea in obese patients has been reported to be as high as 40 per cent. A retrospective review of our prospectively collected database was performed. All patients being evaluated for weight loss surgery for obesity were screened preoperatively for OSA using a sleep study. The overall incidence of sleep apnea in our patients was 78 per cent (227 of 290). All 227 were diagnosed by formal sleep study. There were 63 (22%) males and 227 (78%) females. The mean age was 43 years (range, 17–75 years). The mean body mass index (BMI) was 52 kg/m2 (range, 31–94 kg/m2). The prevalence of OSA in the severely obese group (BMI 35–39.9 kg/m2) was 71 per cent. For the morbidly obese group (BMI 40–40.9 kg/m2), the prevalence was 74 per cent and for the superobese group (BMI 50–59.9 kg/m2) 77 per cent. Those with a BMI 60 kg/m2 or greater, the prevalence of OSA rose to 95 per cent. The incidence of sleep apnea in patients presenting for weight loss surgery was greater than 70 per cent in our study. Patients presenting for weight loss surgery should undergo a formal sleep study to diagnose OSA before bariatric surgery.

GLP-1 and Adiponectin: Effect of Weight Loss After Dietary Restriction and Gastric Bypass in Morbidly Obese Patients with Normal and Abnormal Glucose Metabolism

2008 ◽  
Vol 19 (3) ◽  
pp. 313-320 ◽  
Author(s):  
Camila Puzzi de Carvalho ◽  
Daniela Miguel Marin ◽  
Aglécio Luiz de Souza ◽  
José Carlos Pareja ◽  
Elintom Adami Chaim ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Glucose Metabolism ◽  
Dietary Restriction ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Abnormal Glucose Metabolism

scholarly journals Association of Circulating Irisin Concentrations with Weight Loss after Roux-en-Y Gastric Bypass Surgery

2019 ◽  
Vol 16 (4) ◽  
pp. 660 ◽  
Author(s):  
Yeon Lee ◽  
Yoonseok Heo ◽  
Ji-Ho Choi ◽  
Sunghyouk Park ◽  
Kyoung Kim ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Bypass Surgery ◽  
Excess Weight Loss ◽  
Gastric Bypass Surgery ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Preoperative Serum ◽  
One Year

Irisin is a myokine with potential anti-obesity properties that has been suggested to increase energy expenditure in obese patients. However, there is limited clinical information on the biology of irisin in humans, especially in morbidly obese patients undergoing bariatric surgery. We aimed to assess the association of circulating irisin concentrations with weight loss in obese patients undergoing bariatric surgery. This was a pilot, single-centre, longitudinal observational study. We recruited 25 morbidly obese subjects who underwent Roux-en-Y gastric bypass surgery (RYGBP), and blood samples from 12 patients were taken to measure serum irisin concentrations before, and one and nine months after surgery. Their clinical characteristics were measured for one year. The preoperative serum irisin concentration (mean 1.01 ± 0.23 μg/mL, range 0.73–1.49) changed bidirectionally one month after RYGBP. The mean concentration at nine months was 1.11 ± 0.15 μg/mL (range 0.92–1.35). Eight patients had elevated irisin levels compared with their preoperative values, but four did not. Elevations of irisin levels nine months, but not one month, after surgery, were associated with lower preoperative levels (p = 0.016) and worse weight reduction rates (p = 0.006 for the percentage excess weight loss and p = 0.032 for changes in body mass index). The preoperative serum irisin concentrations were significantly correlated with the percentage of excess weight loss for one year (R2 = 0.612; p = 0.04) in our study. Our results suggest that preoperative circulating irisin concentrations may be at least in part associated with a weight loss effect of bariatric surgery in morbidly obese patients. Further large-scale clinical studies are needed to ratify these findings.

PL-206: Protein intake compliane of morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass and its effect on weight loss, leptin and albumin

2010 ◽  
Vol 6 (3) ◽  
pp. S11-S12
Author(s):  
Kristine O'Hara ◽  
Bruce Bernstein ◽  
Ravi Chhatrala ◽  
Balaji Jangam ◽  
Judy Carty ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Protein Intake ◽  
Morbidly Obese ◽  
Obese Patients

scholarly journals 711 Effect of Roux-En-Y Gastric Bypass on HbA1c As Well As Number of Medications in Diabetic Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Bhandari ◽  
M Rao ◽  
G Bussa ◽  
C Rao
Keyword(s):  
Diabetes Mellitus ◽  
Gastric Bypass ◽  
Glycosylated Haemoglobin ◽  
Morbidly Obese ◽  
Diabetic Patients ◽  
Obese Patients ◽  
The Mean ◽  
The Impact

Abstract Aim Roux en Y gastric bypass (RYGB) is known to ameliorate Type 2 Diabetes Mellitus (T2DM) in morbidly obese patients. We aimed to determine both the reduction in the glycosylated haemoglobin (HbA1c) and the number of anti-diabetic medications (including insulin) in diabetic patients undergoing RYGB over a five-year period. Method We reviewed data of diabetic patients (n = 530) who underwent RYGB from January 2012 – December 2017, including those with a minimum of a 2-year post-operative follow up (n = 47). Preoperatively, BMI, HbA1c and the number of anti-diabetic medications and the duration of T2DM since diagnosis were recorded. These measurements were repeated at the end of the two year follow up. Results At the time of enrolment in the bariatric programme, the median BMI was 42.5 (range, 31.7-61.5) kg/m2, mean duration of T2DM was 58 months and median HbA1c was 59 (37-118) mmol/mol. The mean number of anti-diabetic medications taken, including insulin, was 2. At the end of 2-year follow-up, the median BMI was 32 (range, 24-41) kg/m2 and HbA1c was 41(range, 33-91) mmol/mol. 15 patients (31.9%) still required anti-diabetic medication, 12 of whom had a diagnosis of T2DM for 3 years or more at time of enrolment. Conclusions RYGB is strongly associated with a resolution of T2DM in morbidly obese patients. In those who were not resolved, the number of anti-diabetic medications taken and HbA1c were reduced. The impact of the surgery is dependent on the duration of T2DM since diagnosis preoperatively.

scholarly journals Different Limb Lengths in Gastric Bypass Surgery: Study Protocol for A Swiss Multicenter Randomized Controlled Trial (SLIM)

2020 ◽  
Author(s):  
Marko Kraljević ◽  
Romano Schneider ◽  
Bettina Wölnerhanssen ◽  
Marco Bueter ◽  
Tarik Delko ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Weight Loss ◽  
Randomized Controlled Trial ◽  
Gastric Bypass ◽  
Body Mass ◽  
Controlled Trial ◽  
Morbidly Obese ◽  
Randomized Controlled ◽  
Multicenter Randomized Controlled Trial

Abstract Background Obesity and type 2 diabetes mellitus (T2DM) are reaching epidemic proportions. In morbidly obese patients, bariatric operations lead to sustained weight loss and relief of comorbidities in the majority of patients. Laparoscopic Roux-Y-gastric bypass (RYGB) is one of the most frequently performed operations, but it is still unknown why some patients respond better than others. Therefore, a number of variations of this operation have been introduced. Recent evidence suggests that a longer bypassed biliopancreatic limb (BPL) has the potential to be more effective compared to the standard RYGB with a shorter BPL length. This article describes the design and protocol of a randomized controlled trial comparing the outcome of a RYGB operation with a long versus short BPL.Methods/Design The trial is designed as a multicenter, randomized, patient and observer blinded trial. The relevant ethics committee has approved the trial protocol. To demonstrate that long BPL RYGB is superior compared to short BPL RYGB in terms of weight loss and resolution of T2DM the study is conducted as a superiority trial. Postoperative percent excess body mass index loss (%EBMIL) is the primary endpoint, whereas morbidity, mortality, remission of obesity related comorbidities and quality of life are secondary endpoints. Eight hundred patients, between 18 and 65 years and with a body mass index (BMI) from 35 to 60 kg/m2 who meet the regulatory rules for bariatric surgery in Switzerland will be randomized. The endpoints and baseline measurements will be assessed pre-, intra- and postoperatively.Discussion With its high number of patients and a 5-year follow-up this study will answer questions about effectiveness and safety of long BPL RYGB and provide level I evidence for improvement of the standard RYGB. These findings might therefore potentially influence global bariatric surgery guidelines.Trial registration This trial was registered on ClinicalTrials.gov under the identifier NCT04219787, on January 7th, 2020.

scholarly journals Risk of Atrial Fibrillation and Stroke After Bariatric Surgery in Patients With Morbid Obesity With or Without Obstructive Sleep Apnea

Stroke ◽  
2021 ◽  
Author(s):  
Ahmed Dalmar ◽  
Maharaj Singh ◽  
Zoe Heis ◽  
Tabitha L. Cumpian ◽  
Cheryl Ceretto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Weight Loss ◽  
Gastric Banding ◽  
Laparoscopic Adjustable Gastric Banding ◽  
Adjustable Gastric Banding ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
New Onset

Background and Purpose: Weight loss in morbidly obese patients reduces atrial fibrillation (AF); however, it is unknown whether similar benefits are maintained in patients with obstructive sleep apnea (OSA). We sought to determine whether incident AF and stroke rates are affected by OSA after weight loss and to identify predictors of AF and stroke. Methods: Differences in laparoscopic adjustable gastric banding–induced weight loss on incident AF and stroke events in those with and without OSA in the entire and in propensity-matched cohorts were determined longitudinally, and independent predictors of AF and stroke were identified. Results: Of 827 morbidly obese patients who underwent laparoscopic adjustable gastric banding (mean age, 44±11 years; mean body mass index, 49±8 kg/m 2 ), incident AF was documented in 4.96% and stroke in 5.44% of patients during a mean 6.0±3.2-year follow-up. Despite a similar reduction in body weight (19.6% and 21% in 3 years), new-onset AF was significantly higher in patients with OSA than without OSA in the entire (1.7% versus 0.5% per year; P <0.001) and propensity-matched cohorts. Incident stroke was higher in the OSA than in the non-OSA group (2.10% versus 0.47% per year; P <0.001), but only 20% of patients with stroke had documented AF. On multivariate analysis, OSA (hazard ratio, 2.88 [95% CI, 1.45–5.73]), age, and hypertension were independent predictors of new-onset AF, and OSA (hazard ratio, 5.84 [95% CI, 3.02–11.30]), depression, and body mass index were for stroke events. Conclusions: In morbidly obese patients who underwent laparoscopic adjustable gastric banding, despite similar weight loss, patients with OSA had a higher incidence of AF and stroke than patients without OSA. Both non-AF and AF-related factors were involved in increasing stroke risk. Further investigation is warranted into whether OSA treatment helps reduce AF or stroke events in this population.

Sign in / Sign up

Export Citation Format

Share Document