scholarly journals The role of endoluminal interventions in the preparation of high-risk patients with super-obesity for bariatric surgery

2021 ◽  
Author(s):  
O. Y. Ioffe ◽  
M. S. Kryvopustov ◽  
O. P. Stetsenko ◽  
T. V. Tarasiuk ◽  
Y. P. Tsiura
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Morbid Obesity ◽  
High Risk ◽  
Intragastric Balloon ◽  
Conservative Therapy ◽  
Control Group ◽  
Obese Patients ◽  
Super Obesity

Obesity causes increased morbidity, disability and mortality rates as well as affects the quality of life. Given the known risks to the patient’s health, the International Federation for the Surgery of Obesity and Metabolic Disorders pays special attention to the problem of morbid obesity (body mass index ≥ 40 kg/m2), with particular emphasis on super‑obesity (body mass index ≥ 50 kg/m2). Objective is to investigate the role of endoluminal interventions in the preparation of super obese patients with high risk of surgical and anaesthesia‑related complications for bariatric surgery. Materials and methods. From 2011 to 2018, 97 patients with morbid obesity and high risk of surgery and anaesthesia‑related complications (ASA PS III — IV) underwent a course of treatment at the clinical setting of the Department of General Surgery No2 of Bohomolets National Medical University. The treatment was carried out in 2 stages. In the main group (n = 60), the first stage of treatment included the intragastric balloon placement for a term of 6 months. The control group (n = 37) received a six‑month conservative therapy. In the second stage of treatment the patients of both groups underwent a surgical procedure for the morbid obesity management. Results. The outcomes of the first stage of treatment showed that the patients, who underwent the intragastric balloon placement, had statistically significantly (p < 0.001) higher mean the percentage of excess weight loss (% EWL) than the patients who received conservative therapy. In the main group, the average ASA PS score, which is identified as an anaesthetic and surgical risk indicator, decreased from 3.28 (95 % confidence interval (CI) 3.17 — 3.40) to 2.15 (95 % CI 2.06 — 2.24, p < 0.001), and in the control group — from 3.24 (95 % CI 3.10 — 3.39) to 3.14 (95 % CI 2.96 — 3.31, p > 0.05). Conclusions. The results of the study provide strong evidence that the intragastric balloon placement for a term of 6 months reduces surgical and anaesthetic risks, contributes to the improved function of the cardiovascular and respiratory systems as well as gives a boost to carbohydrate metabolism, and, therefore, can be suggested for the preparation of super obese patients with high risk of surgical and anaesthesia‑related complications for bariatric surgery.  

scholarly journals Personalized Nutrition for Management of Micronutrient Deficiency—Literature Review in Non-bariatric Populations and Possible Utility in Bariatric Cohort

2020 ◽  
Vol 30 (9) ◽  
pp. 3570-3582
Author(s):  
Shannon Galyean ◽  
Dhanashree Sawant ◽  
Andrew C. Shin
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Genetic Testing ◽  
High Risk ◽  
Genetic Variants ◽  
Micronutrient Deficiency ◽  
High Dose ◽  
Micronutrient Deficiencies ◽  
Personalized Nutrition

Abstract Background Bariatric surgery can effectively treat morbid obesity; however, micronutrient deficiencies are common despite recommendations for high-dose supplements. Genetic predisposition to deficiencies underscores necessary identification of high-risk candidates. Personalized nutrition (PN) can be a tool to manage these deficiencies. Methods Medline, PubMed, and Google Scholar were searched. Articles involving genetic testing, micronutrient metabolism, and bariatric surgery were included. Results Studies show associations between genetic variants and micronutrient metabolism. Research demonstrates genetic testing to be a predictor for outcomes among obesity and bariatric surgery populations. There is limited research in bariatric surgery and micronutrient genetic variants. Conclusion Genotype-based PN is becoming feasible to provide an effective treatment of micronutrient deficiencies associated with bariatric surgery. The role of genomic technology in micronutrient recommendations needs further investigation.

scholarly journals Study on Psychiatric Evaluation of Morbidly Obese Patients

2021 ◽  
pp. 8-16
Author(s):  
Asmaa Reda Elsayed Elshazly ◽  
Mohammad Abdelhakeem Seleem ◽  
Mohamed Hamdy Abo-Ryia ◽  
Adel Abdel-Kareem Badawy
Keyword(s):  
Mental Health ◽  
Body Mass Index ◽  
Morbid Obesity ◽  
Binge Eating ◽  
Psychiatric Disorders ◽  
Body Mass ◽  
Eating Attitude ◽  
Control Group ◽  
Morbidly Obese ◽  
Obese Patients

Background: Obesity is becoming an important issue for health promotion. The World Health Organization estimated that around 1.5 billion adults were overweight (body mass index (BMI) 25 kg/m2) and about 500 million people were obese (BMI 30 kg/m2) in 2008. The relationship between obesity and mental health is also considered important. In a community-based study, obesity was positively associated with several mental disorders, especially mood disorders and anxiety disorders. The aim of the study is the assessment of current and lifetime psychiatric disorders among morbidly obese patients. Methods: This case control study was conducted on 60 participants from outpatient clinic of GIT surgery unit and community. All participants were subjected to: Body weight and body mass index, Psychiatric interview for diagnosis of psychiatric disorders by Arabic version of MINI, Scale for diagnosis of Bulimia nervosa by Shokeer, Scale for diagnosis of Anorexia Nervosa by Shokeer, Binge Eating Disorder Screener-7, Eating attitude test, Hamilton Depressions Rating Scale and Hamilton anxiety scale. Results: There was a significant increase in anxiety in patients with morbid obesity compared to control group. There was a significant difference between both groups showing the high prevalence of depression in patients with morbid obesity. Based on EAT test, there was a significant prevalence of abnormal eating behaviors in patients group compared to none of control group. A screening test for the presence of Binge eating symptoms revealed significant increase of symptoms in patients’ group. Conclusions: Psychiatric disorders are prevalent in morbidly obese patients and are associated with significantly worse quality of life. In addition, morbidly obese patients had significantly worse physical and mental health relative to control group from general population. High rates of psychiatric disorders among morbidly obese patients seem to be the rule rather than an exception.

scholarly journals Role of Preoperative Esophagogastroduodenoscopy (EGD) in Bariatric Treatment

2021 ◽  
Vol 10 (13) ◽  
pp. 2982
Author(s):  
Regina Sierżantowicz ◽  
Jerzy R. Ładny ◽  
Krzysztof Kurek ◽  
Jolanta Lewko
Keyword(s):  
Bariatric Surgery ◽  
Body Weight ◽  
Sleeve Gastrectomy ◽  
Gastrointestinal Tract ◽  
Odds Ratio ◽  
Control Group ◽  
Obese Patients ◽  
Routine Examination ◽  
Normal Body Weight

Background: The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) in patients qualified for bariatric surgeries are still a matter of debate. The aim of this study was to analyze the pathologies on preoperative EGD in patients qualified for bariatric surgeries. Materials and Methods: This study included 222 patients, divided into two groups. The obesity group consisted of patients with obesity (BMI ≥ 40 kg/m2), for whom EGD was a routine part of the preparation for laparoscopic sleeve gastrectomy (LSG). The control group of patients with normal body weight (BMI) qualified for EGD because of gastrointestinal ailments. Results: Regarding preoperative EGD in patients qualified for bariatric surgeries, we analyzed the prevalence of endoscopic pathologies in various gastrointestinal tract segments. Patients with obesity were shown to present with esophageal pathologies significantly more often than persons in the control group (n = 23, 20.91% vs. n = 12, 10.91%, p = 0.042). The odds ratio of esophageal pathologies in patients with obesity versus the control group equaled 2.15 (95%CI: 1.01–4.59). In turn, the odds ratio of duodenal pathologies in patients from the control group was 3.31 (95%Cl: 1.16–9.47), which means that persons from this group were approximately three times more likely to be diagnosed with those pathologies compared to obese patients. Moreover, patient sex was a significant predictor of duodenal pathologies, with an odds ratio of 4.03 (95%CI: 1.53–10.61). Conclusions: Preoperative EGD can identify a broad spectrum of pathologies in obese patients, which suggests a routine examination before bariatric surgery.

scholarly journals Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Euthyroid Patients with Morbid Obesity

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 1121 ◽  
Author(s):  
Paula Juiz-Valiña ◽  
Elena Outeiriño-Blanco ◽  
Sonia Pértega ◽  
Bárbara María Varela-Rodriguez ◽  
María García-Brao ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Thyroid Stimulating Hormone ◽  
Control Group ◽  
Obese Patients ◽  
Excess Bmi Loss ◽  
Tsh Levels ◽  
Over Time ◽  
Stimulating Hormone

Obesity is associated with several endocrine abnormalities, including thyroid dysfunction. The objective of this study was to investigate the effect of weight loss after bariatric surgery on thyroid-stimulating hormone (TSH) levels in euthyroid patients with morbid obesity. We performed an observational study, evaluating patients with morbid obesity submitted to bariatric surgery. We included 129 patients (92 women) and 31 controls (21 women). Clinical, anthropometric, biochemical, and hormonal parameters were evaluated. The primary endpoint was circulating TSH (µU/mL). Fasting TSH levels were higher in the obese group (3.3 ± 0.2) than in the control group (2.1 ± 0.2). The mean excessive body mass index (BMI) loss (EBMIL) 12 months after bariatric surgery was 72.7 ± 2.1%. TSH levels significantly decreased in the obese patients after surgery; 3.3 ± 0.2 vs. 2.1 ± 0.2 before and 12 months after surgery, respectively. Free thyroxine (T4) (ng/dL) levels significantly decreased in the obese patients after surgery; 1.47 ± 0.02 vs. 1.12 ± 0.02 before and 12 months after surgery, respectively. TSH decreased significantly over time, and the decrement was associated with the EBMIL. In euthyroid patients with morbid obesity, weight loss induced by bariatric surgery promotes a significant decline of the increased TSH levels. This decrement of TSH is progressive over time after surgery and significantly associated with excess BMI loss.

scholarly journals The Role of Three‐Dimensional Magnetic Resonance Elastography in the Diagnosis of Nonalcoholic Steatohepatitis in Obese Patients Undergoing Bariatric Surgery

Hepatology ◽  
2019 ◽  
Vol 71 (2) ◽  
pp. 510-521 ◽  
Author(s):  
Alina M. Allen ◽  
Vijay H. Shah ◽  
Terry M. Therneau ◽  
Sudhakar K. Venkatesh ◽  
Taofic Mounajjed ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Magnetic Resonance ◽  
Nonalcoholic Steatohepatitis ◽  
Three Dimensional ◽  
Magnetic Resonance Elastography ◽  
Obese Patients

Low-frequency coding variants associated with body-mass-index impact the success of bariatric surgery

2021 ◽  
Author(s):  
Darlène Antoine ◽  
Rosa-Maria Guéant-Rodriguez ◽  
Jean-Claude Chèvre ◽  
Sébastien Hergalant ◽  
Tanmay Sharma ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Morbid Obesity ◽  
General Population ◽  
Body Mass ◽  
Intervention Program ◽  
Low Frequency ◽  
European Ancestry ◽  
Frequency Coding ◽  
Coding Variants

Abstract Context A recent study identified 14 low-frequency coding variants associated with body-mass-index (BMI) in 718,734 individuals predominantly of European ancestry. Objective and design The 14 low-frequency coding variants were genotyped or sequenced in 342 French adults with severe/morbid obesity and 574 French adult controls from the general population. We built risk and protective genetic scores (GS) based on 6 BMI-increasing and 5 BMI-decreasing low-frequency coding variants that were polymorphic in our study. We investigated the association of the two GS with i) the risk of severe/morbid obesity, ii) BMI variation before weight-loss intervention, iii) BMI change in response to an 18-month lifestyle/behavioral intervention program, and iv) BMI change up to 24 months after bariatric surgery. Results While the risk GS was not associated with severe/morbid obesity status, BMI-decreasing low-frequency coding variants were significantly less frequent in patients with severe/morbid obesity than in French adults from the general population. Neither the risk nor the protective GS was associated with BMI before intervention in patients with severe/morbid obesity, nor did they impact BMI change in response to a lifestyle/behavioral modification program. The protective GS was associated with a greater BMI decrease following bariatric surgery. The risk and protective GS were associated with a higher and lower risk of BMI regain after bariatric surgery. Conclusion Our data indicate that in populations of European descent, low-frequency coding variants associated with BMI in the general population also impact the outcomes of bariatric surgery in patients with severe/morbid obesity.

Platelet Functions are Decreased in Obesity and Restored after Weight Loss: Evidence for a Role of the SERCA3-Dependent ADP Secretion Pathway

2019 ◽  
Vol 119 (03) ◽  
pp. 384-396 ◽  
Author(s):  
Ziane Elaïb ◽  
Jose Lopez ◽  
Muriel Coupaye ◽  
Kevin Zuber ◽  
Yann Becker ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass Surgery ◽  
Calcium Signalling ◽  
Adenosine Diphosphate ◽  
Control Group ◽  
Obese Patients ◽  
Secretion Pathway ◽  
Healthy Control ◽  
Platelet Functions

AbstractIn obesity, platelets are described as hyperactive, mainly based on increased platelet size and presence of pro-thrombotic plasmatic molecules. We explored platelet functions, including calcium signalling in obesity, and the effect of weight loss. We included 40 obese patients (women with body mass index [BMI] of ≥ 35 kg/m2) who were to undergo gastric bypass surgery and 40 healthy lean subjects (women with BMI of < 25 kg/m2) as a control group. Approximately 1 year after surgery, the obese patients lost weight (75% had a BMI < 35 kg/m2). They were explored a second time with the same healthy control for the same platelet experiments. Compared with controls, obese patients' platelets displayed reduced sensitivity to thrombin (aggregation EC50 increased by 1.9 ± 0.3-fold, p = 0.005) and a lower Ca2+ response (70 ± 7% decrease, p < 10−4). In 17 pairs of patients, we performed additional experiments: in obese patients' platelets, thrombin-induced αIIbβ3 activation was significantly lower (p = 0.003) and sarco-endoplasmic reticulum Ca2+ATPase (SERCA3) expression was decreased (48 ± 6% decrease, p < 10−4). These differences were abolished after weight loss. Interestingly, pharmacological inhibition of SERCA3 activity in control group's platelets mimicked similar alterations than in obese patients' platelets and was associated with defective adenosine diphosphate (ADP) secretion. Addition of ADP to agonist restored platelet functions in obese patients and in SERCA3-inhibited control platelets (five experiments) confirming the direct involvement of the SERCA3-dependent ADP secretion pathway. This is the first study demonstrating that platelets from obese patients are hypo-reactive, due to a deficiency of SERCA3-dependent ADP secretion. Weight loss restores SERCA3 activity and subsequent calcium signalling, αIIbβ3 activation, platelet aggregation and ADP secretion.

scholarly journals Iron deficiency anemia and megaloblastic anemia in obese patients

2017 ◽  
Vol 55 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Mahmoud Arshad ◽  
Sara Jaberian ◽  
Abdolreza Pazouki ◽  
Sajedeh Riazi ◽  
Maryam Aghababa Rangraz ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Morbid Obesity ◽  
Iron Deficiency ◽  
Vitamin B12 ◽  
Iron Deficiency Anemia ◽  
Megaloblastic Anemia ◽  
Vitamin B12 Deficiency ◽  
Deficiency Anemia ◽  
Obese Patients ◽  
B12 Deficiency

Abstract Background. The association between obesity and different types of anemia remained uncertain. The present study aimed to assess the relation between obesity parameters and the occurrence of iron deficiency anemia and also megaloblastic anemia among Iranian population. Methods and Materials. This cross-sectional study was performed on 1252 patients with morbid obesity that randomly selected from all patients referred to Clinic of obesity at Rasoul-e-Akram Hospital in 2014. The morbid obesity was defined according to the guideline as body mass index (BMI) equal to or higher than 40 kg/m2. Various laboratory parameters including serum levels of hemoglobin, iron, ferritin, folic acid, and vitamin B12 were assessed using the standard laboratory techniques. Results. BMI was adversely associated with serum vitamin B12, but not associated with other hematologic parameters. The overall prevalence of iron deficiency anemia was 9.8%. The prevalence of iron deficiency anemia was independent to patients’ age and also to body mass index. The prevalence of vitamin B12 deficiency was totally 20.9%. According to the multivariable logistic regression model, no association was revealed between BMI and the occurrence of iron deficiency anemia adjusting gender and age. A similar regression model showed that higher BMI could predict occurrence of vitamin B12 deficiency in morbid obese patients. Conclusion. Although iron deficiency is a common finding among obese patients, vitamin B12 deficiency is more frequent so about one-fifth of these patients suffer vitamin B12 deficiency. In fact, the exacerbation of obesity can result in exacerbation of vitamin B12 deficiency.

scholarly journals Bariatric Surgery Normalizes Protein Glycoxidation and Nitrosative Stress in Morbidly Obese Patients

Antioxidants ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 1087
Author(s):  
Barbara Choromańska ◽  
Piotr Myśliwiec ◽  
Magdalena Łuba ◽  
Piotr Wojskowicz ◽  
Hanna Myśliwiec ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Oxidative Damage ◽  
Nitrosative Stress ◽  
High Specificity ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Plasma Tryptophan ◽  
Nitrative Stress ◽  
Specificity And Sensitivity

The results of recent studies indicate the key role of nitrosative stress and protein oxidative damage in the development of morbid obesity. Nevertheless, the effect of bariatric surgery on protein oxidation/glycation and nitrosative/nitrative stress is not yet known. This is the first study evaluating protein glycoxidation and protein nitrosative damage in morbidly obese patients before and after (one, three, six and twelve months) laparoscopic sleeve gastrectomy. The study included 50 women with morbid obesity as well as 50 age- and gender-matched healthy controls. We demonstrated significant increases in serum myeloperoxidase, plasma glycooxidative products (dityrosine, kynurenine, N-formyl-kynurenine, amyloid, Amadori products, glycophore), protein oxidative damage (ischemia modified albumin) and nitrosative/nitrative stress (nitric oxide, peroxy-nitrite, S-nitrosothiols and nitro-tyrosine) in morbidly obese subjects as compared to lean controls, whereas plasma tryptophan and total thiols were statistically decreased. Bariatric surgery generally reduces the abnormalities in the glycoxidation of proteins and nitrosative/nitrative stress. Noteworthily, in the patients with metabolic syndrome (MS+), we showed no differences in most redox biomarkers, as compared to morbidly obese patients without MS (MS−). However, two markers: were able to differentiate MS+ and MS− with high specificity and sensitivity: peroxy-nitrite (>70%) and S-nitrosothiols (>60%). Further studies are required to confirm the diagnostic usefulness of such biomarkers.

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