Obesity in the Liver Transplant Setting

The obesity epidemic has resulted in an increased prevalence of obesity in liver transplant (LT) candidates and in non-alcoholic fatty liver disease (NAFLD) becoming the fastest growing indication for LT. LT teams will be dealing with obesity in the coming years, and it is necessary for them to recognize some key aspects surrounding the LT in obese patients. Obesity by itself should not be considered a contraindication for LT, but it should make LT teams pay special attention to cardiovascular risk assessment, in order to properly select candidates for LT. Obese patients may be at increased risk of perioperative respiratory and infectious complications, and it is necessary to establish preventive strategies. Data on patient and graft survival after LT are controversial and scarce, especially for long-term outcomes, but morbid obesity may adversely affect these outcomes, particularly in NAFLD. The backbone of obesity treatment should be diet and exercise, whilst being careful not to precipitate or worsen frailty and sarcopenia. Bariatric surgery is an alternative for treatment of obesity, and the ideal timing regarding LT is still unknown. Sleeve gastrectomy is probably the procedure that has the best evidence in LT because it offers a good balance between safety and efficacy.

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ID: 3522307 LIVER TRANSPLANT PATIENTS WITH INTRAHEPATIC STRICTURES ARE AT INCREASED RISK OF POST-ERCP INFECTIOUS COMPLICATIONS

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2021.03.947 ◽

2021 ◽

Vol 93 (6) ◽

pp. AB133

Author(s):

Ian Holmes ◽

Muhammad Bashir ◽

Thomas E. Kowalski ◽

David E. Loren ◽

Anand Kumar ◽

...

Keyword(s):

Liver Transplant ◽

Infectious Complications ◽

Transplant Patients ◽

Increased Risk

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Molecular Mechanisms Underlying the Relationship between Obesity and Male Infertility

Metabolites ◽

10.3390/metabo11120840 ◽

2021 ◽

Vol 11 (12) ◽

pp. 840

Author(s):

Federica Barbagallo ◽

Rosita A. Condorelli ◽

Laura M. Mongioì ◽

Rossella Cannarella ◽

Laura Cimino ◽

...

Keyword(s):

Male Infertility ◽

Molecular Mechanisms ◽

Premature Mortality ◽

Male Reproduction ◽

Increased Risk ◽

Inflammatory Processes ◽

Prevalence Of Obesity ◽

Treatment Of Obesity ◽

The Relationship ◽

And Oxidative Stress

In recent decades, the worldwide prevalence of obesity has risen dramatically and is currently estimated to be around 20%. Obesity is linked to an increased risk of comorbidities and premature mortality. Several studies have shown that obesity negatively impacts male fertility through various mechanisms. This review aims to investigate the molecular mechanisms through which obesity impairs male reproduction, including obesity-associated hypogonadism and its effects on spermatogenesis, chronic inflammation, and oxidative stress. Obesity negatively impacts both conventional and biofunctional sperm parameters, and it also induces epigenetic changes that can be transferred to offspring. Moreover, obesity-related diseases are linked to a dysregulation of adipocyte function and micro-environmental inflammatory processes. The dysregulated adipokines significantly influence insulin signaling, and they may also have a detrimental effect on testicular function. Sirtuins can also play an important role in inflammatory and metabolic responses in obese patients. Understanding the molecular mechanisms that are involved in obesity-induced male infertility could increase our ability to identify novel targets for the prevention and treatment of obesity and its related consequences.

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Lead Anti-Obesity Compounds from Nature

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530320666200504092012 ◽

2020 ◽

Vol 20 (10) ◽

pp. 1637-1653

Author(s):

Vinesh Dahiya ◽

Neeru Vasudeva ◽

Sunil Sharma ◽

Ashok Kumar ◽

David Rowley

Keyword(s):

Mechanisms Of Action ◽

Natural Sources ◽

Promising Strategy ◽

Electronic Search ◽

Global Issue ◽

Biological Studies ◽

Increased Risk ◽

Diet And Exercise ◽

Prevalence Of Obesity ◽

And Control

Background : Obesity has become a global issue, leading to increased risk of metabolic syndrome, which encompasses diabetes, cardiovascular disease, stroke, hypertension, and certain cancers. However, obesity is difficult to control through diet and exercise alone, as they are difficult to implement. Objective: The objective of this review is to elucidate the active constituents that can be obtained from various natural sources that act as anti-obesity agents. Due to the global rise in the prevalence of obesity, an urgent need to prevent and control it has arisen. Methods: For this review, we compiled information about natural anti-obesity products through an electronic search of the articles available via PubMed, Scopus, and other internet sources for the period 1975-2019 and included our own research. We analyzed and organized data on various natural products in popular use in addition to relevant pharmacognostic and biological studies. The products’ mechanisms of action were also investigated. Conclusion: Consumption of diets that include high amounts of active anti-obesity natural compounds is a promising strategy for the suppression of lipid accumulation and adipogenesis in obese individuals.

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P52 LIVER REDUCTION DIET IN PATIENTS UNDERGOING GASTRO-OESOPHAGECTOMIES

Diseases of the Esophagus ◽

10.1093/dote/doz092.52 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Veeralakshmanan Pushpa ◽

Wadhawan Himanshu ◽

Sanders Grant ◽

M Humphreys Lee ◽

Berrisford Richard ◽

...

Keyword(s):

Hybrid Approach ◽

Gastric Surgery ◽

Oesophageal Adenocarcinoma ◽

Obese Patients ◽

Operative Death ◽

Chyle Leak ◽

Thoracoscopic Approach ◽

Increased Risk ◽

Prevalence Of Obesity ◽

Fatty Livers

Abstract Aim The prevalence of obesity has nearly doubled in the last 10 years and is a known risk factor for oesophageal adenocarcinoma [1]. There is an increasing popularity with minimally invasive esophagectomies employing laparoscopic and/or thoracoscopic approach [2]. Obesity can complicate technical aspects of surgery. There is increased risk of retraction trauma from fatty livers and the operative field of the gastro-oesophageal area is limited in obese patients. Pre-operative liver reduction diet (LRD) is a common practice in patients undergoing bariatric surgery. We propose a pre-operative LRD for obese patients undergoing oesophago-gastric surgery for cancer to be safe and can help with the overall complexity of the surgery. Background & Methods In our regional tertiary unit, we adopted a 2-week pre-operative LRD for patients undergoing oesophago-gastric surgery with BMI >30 Kg m-2. Data was collected prospectively from January 2017 to January 2019 for all patients undergoing oesophago-gastric surgery. Results 142 patients underwent oesophago-gastric surgery in the study period, 31 with a BMI >30 Kg m-2. 20 of the 31 (64.5%) received and completed LRD prior to their operation. For 9 patients, no reason was documented for incompletion of diet and 2 were unable to manage the diet. For 75% (15/20) of these patients, surgery was randomized and completed using the hybrid approach (laparoscopic abdomen and open chest) and the rest undergoing open procedure, as per the ROMIO trial [3]. Although a small number of cases for comparison, there were no significant differences observed in length of stay (LOS), complications including pneumonia, chyle leak and anastomotic leak in our patient group receiving LRD compared to high BMI patients in the literature without LRD. Conclusion Oesophago-gastric surgeons in our unit find pre-operative LRD in obese patients leads to improved flexibility of the liver for easier retraction and a better exposure of the operating field, especially around the hiatus. Implementation of pre-operative LRD in obese patients undergoing oesophago-gastric cancer surgery has been shown to be safe. We aim to continue to record post-operative complications, peri-operative death and LOS and expand the sample size for our study.

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Present and Future: Pharmacologic Treatment of Obesity

Journal of Obesity ◽

10.1155/2011/636181 ◽

2011 ◽

Vol 2011 ◽

pp. 1-13 ◽

Cited By ~ 27

Author(s):

Mariela Glandt ◽

Itamar Raz

Keyword(s):

Side Effects ◽

Cardiovascular Events ◽

Term Treatment ◽

Pharmacologic Treatment ◽

Increased Risk ◽

Long Term Treatment ◽

Diet And Exercise ◽

Prevention And Treatment ◽

Treatment Of Obesity

Obesity now presents one of the biggest health problems of our times. Diet and exercise are best for both prevention and treatment; unfortunately, both require much discipline and are difficult to maintain. Medications offer a possible adjunct, but their effect is modest, they are limited by side effects, and the weight loss lasts only as long as the drug is being taken, since as soon as treatment is stopped, the weight is regained. Sibutramine, a sympathomimetic medication which was available for long-term treatment, is the most recent of the drugs to be withdrawn from the market due to side effects; in this case it was an increased risk of cardiovascular events. This paper reviews those medications which are available for treatment of obesity, including many of those recently taken off the market. It also discusses some of the newer treatments that are currently being investigated.

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Bariatric Surgery and Perioperative Infections

10.1093/med/9780190608347.003.0011 ◽

2018 ◽

Author(s):

Mohammad Alsulaimy ◽

Seyed Mohammad Kalantar Motamedi

Keyword(s):

Bariatric Surgery ◽

Urinary Tract ◽

Respiratory Infections ◽

Operative Procedure ◽

Surgical Site Infections ◽

Infectious Complications ◽

Obese Patients ◽

Preventative Measures ◽

Increased Risk ◽

Tract Infections

Morbid obesity is associated with an increased risk of infectious complications including surgical site, urinary tract, and pulmonary infections. Surgical site infections (SSI) are the most common, followed by urinary and respiratory infections. Various risk factors in obese patients including impaired immunity, and altered pulmonary and circulatory systems contribute to the increased susceptibility of morbid obese patients to infectious complications. Perioperative infections are defined to occur within 30 days of the initial operative procedure. Surgical site and urinary tract infections usually occur within 7–10 days post-operatively. Therefore, it is recommended that patients should be followed up between 7 to 10 days post-op to examine surgical sites, and to screen for possible urinary tract symptoms. This chapter will discuss the diagnosis, treatment, and possible preventative measures of the aforementioned infectious complications in the bariatric surgery population.

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Surgery for early stage endometrial carcinoma in the obese patient

Asian Journal of Oncology ◽

10.4103/2454-6798.197373 ◽

2016 ◽

Vol 02 (02) ◽

pp. 063-068

Author(s):

E. Leblanc ◽

F. Narducci ◽

L. Bresson ◽

N. Hudry ◽

R. Sekhon

Keyword(s):

Body Mass Index ◽

Endometrial Cancer ◽

Endometrial Carcinoma ◽

Active Treatment ◽

Early Stage ◽

Obese Patients ◽

Increased Risk ◽

Interesting Approach ◽

Treatment Of Obesity ◽

Severity Of The Disease

AbstractObese patients have increased risk of developing endometrial cancer proportional to the excess in body mass index. In this review, we explored the latest information on surgical management and its adaptation to the obese condition. Mini-invasive treatments (laparoscopic, robotic, vaginal, or combinations) should be systematically considered. Prevention and active treatment of obesity seem an interesting approach to reduce incidence and severity of the disease.

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The Role of Lipid Profile as an Independent Predictor of Non-alcoholic Steatosis and Steatohepatitis in Morbidly Obese Patients

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.682352 ◽

2021 ◽

Vol 8 ◽

Author(s):

Narges Ashraf Ganjooei ◽

Tannaz Jamialahmadi ◽

Mohsen Nematy ◽

Ali Jangjoo ◽

Ladan Goshayeshi ◽

...

Keyword(s):

Liver Fibrosis ◽

Lipid Profile ◽

Liver Steatosis ◽

Hdl Cholesterol ◽

Total Serum ◽

Total Serum Cholesterol ◽

Morbidly Obese ◽

Obese Patients ◽

Alcoholic Fatty Liver ◽

Increased Risk

Background and Aims: Obesity is one of the major health problems worldwide. Morbid obesity (body mass index >40 kg/m2 or over 35 with a comorbidity) is associated, apart from other diseases, with an increased risk of non-alcoholic fatty liver disease (NAFLD). Moreover, dyslipidemia is an important comorbidity that is frequently found in NAFLD patients. The aim of this study was to analyze whether serum lipids in morbidly obese patients are associated with the spectrum of NAFLD.Methods: Total serum cholesterol, LDL cholesterol, HDL cholesterol, non-HDL cholesterol, VLDL, and triglycerides were analyzed in 90 morbidly obese patients. The association of lipid profile parameters with histopathological, elastographic, and sonographic indices of NAFLD, non-alcoholic steatohepatitis (NASH), and liver fibrosis were explored.Results: The mean levels of serum total cholesterol, LDL-C, and non-HDL cholesterol in patients with positive histology for liver steatosis and NASH were significantly higher than those in patients with negative histology. None of the indices showed a strong association with NAFLD, NASH, or liver fibrosis after adjustment for potential confounders.Conclusion: A slight predictive value of lipid profile is not sufficiently enough to use solely as a non-invasive test in predicting NASH or liver fibrosis.

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