scholarly journals Nephrological aspects of surgical weight correction in morbid obesity

2018 ◽  
Vol 90 (6) ◽  
pp. 98-104
Author(s):  
I N Bobkova ◽  
S S Gussaova ◽  
E V Stavrovskaya ◽  
A V Struve
Keyword(s):  
Morbid Obesity ◽  
Weight Loss ◽  
Kidney Damage ◽  
Long Term Effects ◽  
Dialysis Patients ◽  
Leading Position ◽  
End Stage ◽  
Nephroprotective Effect

Obesity, including morbid obesity, is a growing worldwide problem. The adverse effect of obesity on the kidneys is associated with the development of comorbid conditions, such as insulin resistance (IR), metabolic syndrome (MS), diabetes mellitus (DM), arterial hypertension (AH), which are the recognized risk factors of chronic kidney disease (СKD). Obesity also causes direct kidney damage with the development of non-immune focal segmental glomerulosclerosis. The leading pathophysiological mechanisms of kidney damage in obesity are intrarenal hemodynamic disorders with the formation of hyperfiltration and damaging effects of adipokines produced by adipose tissue. Bariatric surgery (BS) has taken a leading position in the treatment of morbid obesity, demonstrating its effectiveness not only in long-term weight loss, but also in the correction of IR, MS, DM, AH. Nephroprotective effect of significant and persistent weight loss is caused by the elimination of hyperfiltration and damaging effect of adipokines. Results of the observational studies of the immediate and long-term effects of BS have demonstrated positive renal outcomes, in particular, the decrease in albuminuria/proteinuria, the improvement or stabilization of glomerular filtration rate, the delay of end-stage renal failure development; surgical correction of body weight in dialysis patients with morbid obesity lets them realize subsequent kidney transplantation. Large, randomized prospective studies with a longer follow-up are needed; analysis of the long-term renal consequences of BS in obesity patients with pre-existing renal impairment, including dialysis patients, is required; stratification of the BS risk of renal complications (acute kidney damage, nephrolithiasis, nephrocalcinosis) and effective strategy for managing these risks need to be developed.

scholarly journals Outcomes of Biliointestinal Bypass among Iranian Obese Patients

2018 ◽  
Vol 04 (04) ◽  
pp. e197-e200
Author(s):  
Seyed Naeini ◽  
Alireza Khalaj ◽  
Ali Abbaszadeh-Kasbi ◽  
Seyed Miri
Keyword(s):  
Morbid Obesity ◽  
Weight Loss ◽  
Surgical Approaches ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Liver Transaminases ◽  
Biliointestinal Bypass ◽  
A Prospective Study

Background There are several surgical approaches to treat obesity not cured with medical approaches. Each method has its advantages and complications. In here, we have conducted a study to evaluate complications of biliointestinal bypass surgery (BIBP). Methods A prospective study was conducted in a private hospital from 2002 to 2016. Those patients, not previously operated for morbid obesity, were eligible. Mean follow-up period was 89 months ( ± 54 months; range: 73–108 months). Main outcome measures were weight, BMI (body mass index), concentrations of blood lipids and glucose, liver transaminases, and obesity-related comorbidities and complications. Results Twenty-three consecutive patients with morbid obesity, including 16 women (69.7%) and seven men (31.3%) with mean age 38.47 ± 10 years (range: 26–57 years) underwent surgery. At the end of follow-up period, a mean BMI reduction of 12.2 kg/m2 kg/m2 (p < 0.001)] was observed. An excess weight loss (EWL) of 63% ( ± 34) was achieved at the end of the study. Additionally, total cholesterol and triglyceride levels decreased postoperative significantly. The main long-term complications were flatulence (60%), borborygmus (47.8%), mal odorous stool (30.4%), and diarrhea (21.7%). Revision rate was 4.34%. There were no cases with irreversible hepatic injury, deaths due to the surgery, or progressive renal failure. Conclusion BIBP seems to be a safe, easily reversible, and one of valid therapeutic approaches in morbidly obese patients. BIBP has the potential to achieve durable weight loss and offers an improved quality of life.

scholarly journals Bariatric surgery in adolescents with obesity - long term perspectives and potential alternatives

2021 ◽  
Author(s):  
Rana Halloun ◽  
Ram Weiss
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Severe Obesity ◽  
Lifestyle Modification ◽  
Perioperative Complications ◽  
Nutritional Deficiencies ◽  
Long Term Effects ◽  
Long Term Outcome

Background: Severe obesity among adolescent shows a worrisome trend in regard of its increasing prevalence and poses a great challenge for treatment. Conservative measures have modest effects on weight loss, usually fail in achieving a sustainable weight loss and resolution of comorbidities. This has led to greater utilization of bariatric surgery (BS) that offers a fast reduction in body mass index (BMI) with little perioperative complications. Despite the increasing utilization of BS, data is still insufficient, regarding their long-term outcome in adolescents. We review short and long-term effects of bariatric surgery and their implications on bone health and nutritional deficiencies in adolescents. In addition, we discuss possible pharmaceutical alternatives. Summary: BS results in a substantial weight loss of roughly 37% in the first-year post-operation and is superior to conservative measures in resolution of metabolic comorbidities. BS significantly improves health-related quality of life. Longer follow up, shows weight regain in 50% of patients. Furthermore, reduced bone mass and nutritional deficiencies were reported in up to 90% of patients. Most recently, alternative to BS became more relevant with approval of GLP-1 analogues use in adolescents. GLP-1 analogues are potent enough to induce moderate clinically meaningful weight loss and improvement of metabolic component. Key Messages: We conclude that obese adolescents without major obesity related complications may benefit from pharmacological interventions with lifestyle modification. We advise considering BS as treatment approach in adolescents with severe obesity and major obesity related complications with proper pre-operative preparation and post operative follow up in excellence centers.

scholarly journals Childhood Obesity, Weight Loss and Long Term Development in Quality-of-Life: A Longitudinal Follow-Up Study.

2020 ◽  
Author(s):  
Rasmus Møller Jørgensen ◽  
Esben Thyssen Vestergaard ◽  
Britta Kremke ◽  
Rikke Frederiksen Bahnsen ◽  
Bent Windelborg Nielsen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Standard Deviation Score ◽  
Long Term Effects ◽  
Follow Up Study ◽  
Vas Scores

Abstract Background To evaluate long-term effects of a multifactorial lifestyle intervention on measures of quality-of-life (QoL) in children with obesity. Methods One hundred and twenty children age 4-17 years with a BMI standard deviation score (BMI-SDS) >2 participated in a multifactorial lifestyle intervention. QoL and wellbeing were measured by a 6-item Visual Analogue Scale (VAS) throughout the intervention.Results Follow-up time was 26.4 months (13.9 SD). VAS scores decreased on bullying (0.6 vs. 0.0 median) and in motivation (10.0 vs. 9.6). QoL increased in children with a BMI-SDS reduction (0.65 (2.49 SD)) opposite children with no-change or increasing BMI-SDS who reported reduced QoL (-0.36 (1.55 SD) and -0.96 (2.27 SD)). Boys experienced reduced appetite (6.7 (2.3 SD) to 5.7 (2.6 SD)), bullying (median 0.4 vs. 0.0) and motivation (median 10.0 vs. 8.9), while girls experienced reduction in bullying (median 0.6 vs. 0.0) and an enhancement in Joy of Life compared to boys (0.73 (2.10 SD) vs. -0.04 (2.08 SD)).Conclusion Multifactorial lifestyle intervention for children with obesity induces long-term BMI-SDS reduction for the majority, and exerts significant reduction in bullying and improves QoL if weight loss is obtained and maintained.

scholarly journals Preoperative μ-opioid receptor availability predicts weight loss following bariatric surgery

2021 ◽  
Author(s):  
Henry K. Karlsson ◽  
Lauri Tuominen ◽  
Semi Helin ◽  
Paulina Salminen ◽  
Pirjo Nuutila ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Opioid Receptor ◽  
Weight Regain ◽  
Postoperative Weight Loss ◽  
Weight Loss Outcomes ◽  
Preoperative Weight

AbstractBackgroundBariatric surgery is the most effective method for weight loss in morbid obesity. There is significant individual variability in the weight loss outcomes, yet factors leading to postoperative weight loss or weight regain remain elusive. Alterations in the µ-opioid receptor (MOR) and dopamine D2 receptor (D2R) systems are associated with obesity, appetite control, and reward processing. The magnitude of initial brain receptor system perturbation is a plausible predictor of long-term surgical weight loss outcomes. The aim was to test this hypothesis by measuring obese subjects’ MOR and D2R availability with positron emission tomography (PET) preoperatively before bariatric surgery and then assessing their weight development association with regional MOR and D2R availabilities at 2-year follow-up.MethodsWe studied 19 morbidly obese women (mean BMI 40, mean age 43) scheduled to undergo bariatric surgery, i.e. Roux-en-Y gastric bypass or sleeve gastrectomy, according to their standard clinical treatment. Preoperative MOR and D2R availabilities were measured using PET with [11C]carfentanil and [11C]raclopride, respectively. Subject weight was recorded at 3, 6, 12, and 24 months after surgery. Radiotracer binding potentials (BPND) were extracted and correlated with patient weight at different time points. ROIs were delineated in the striatum and in limbic and paralimbic components of the emotion and reward networks.ResultsMOR availabilities were not correlated with preoperative weight. MOR availabilities in the amygdala (r = −0.54), insula (r = −0.46), ventral striatum (r = −0.48) and putamen (r = −0.49) were associated with subject weight at 3 months. Significant association was found in the amygdala at 6 months (r = −0.53), 12 (r = −0.49), and 24 months (r = −0.50). D2R availabilities were associated with neither preoperative weight nor weight loss at any follow-up time point.ConclusionsTo our knowledge, this is the first study to demonstrate that neuroreceptor markers prior to bariatric surgery in patients with morbid obesity are associated with the postoperative weight loss. Preoperative MOR availability in the amygdala was associated with long-term postoperative weight development after surgery suggesting that postoperative weight regain may derive from dysfunction in the opioid system. Postoperative weight loss outcomes after bariatric surgery may be partially predicted based on preoperative receptor availability opening up new potential for treatment possibilities.Clinical Trials RegistrationSleevePET2, NCT01373892, http://www.clinicaltrials.gov

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