Faculty Opinions recommendation of Safety and effectiveness of bariatric surgery: Roux-en-Y gastric bypass is superior to gastric banding in the management of morbidly obese patients.

Abdominal obesity is associated with hypertension, increased fasting glucose, HbA1c, and cholesterol. Body mass index (BMI) is frequently used to measure and define obesity and as inclusion criteria for bariatric surgery. Sagittal abdominal diameter (SAD) has been suggested to predict the amount of visceral fat, metabolic traits, and cardiometabolic risk superior to BMI. The aim was to test whether SAD has stronger correlations to glucometabolic traits compared to BMI. One hundred and fifty-five (108 women, 47 men) morbidly obese patients undergoing bariatric surgery were evaluated before (baseline), 6 and 12 months after Roux-en-Y gastric bypass (RYGBP). BMI was reduced from 43.7 kg/m2 (baseline) to 31.3 kg/m2 (12 months) and SAD from 32.6 to 23.2 cm (both p <0 .001 ). SAD correlated with CRP ( p = 0.04 ), fasting glucose ( p = 0.008 ), HbA1c ( p = 0.016 ), triglycerides ( p = 0.017 ), systolic blood pressure ( p = 0.032 ), and vitamin D ( p = 0.027 ). BMI correlated with CRP ( p = 0.006 ), triglycerides ( p = 0.016 ), vitamin D ( p = 0.002 ), and magnesium ( p = 0.037 ). Despite RYGBP surgery, vitamin D was significantly increased. Liver enzymes were significantly lowered after RYGBP and the change over time in SAD correlated with gamma-glutamyltransferase. SAD was superior to BMI to predict glucose disturbance and dyslipidemia implying increased use of SAD as it is cost effective and simple to perform in the clinic and could be of value when considering patients for bariatric surgery.

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Evaluation of Metabolic Syndrome in morbidly Obese Patients Submitted to Laparoscopic Bariatric Surgery: Comparison of the Results between Roux-En-Y Gastric Bypass and Sleeve Gastrectomy

Obesity Surgery ◽

10.1007/s11695-017-2547-3 ◽

2017 ◽

Vol 27 (7) ◽

pp. 1719-1723 ◽

Cited By ~ 8

Author(s):

Rodrigo Koprovski Menguer ◽

Antônio Carlos Weston ◽

Helena Schmid

Keyword(s):

Bariatric Surgery ◽

Metabolic Syndrome ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Morbidly Obese ◽

Laparoscopic Bariatric Surgery ◽

Obese Patients ◽

Comparison Of The Results

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Roux-en-Y-Bariatric Surgery Reduces Markers of Metabolic Syndrome in Morbidly Obese Patients

Obesity Surgery ◽

10.1007/s11695-019-04190-y ◽

2019 ◽

Vol 30 (2) ◽

pp. 391-400 ◽

Cited By ~ 5

Author(s):

G. Rega-Kaun ◽

C. Kaun ◽

G. Jaegersberger ◽

M. Prager ◽

M. Hackl ◽

...

Keyword(s):

Bariatric Surgery ◽

Metabolic Syndrome ◽

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Morbidly Obese ◽

Diabetic Patients ◽

Obese Patients ◽

C Peptide ◽

Hepatic Insulin Clearance

Abstract Background Obesity is closely linked to increased markers of metabolic syndrome and development of diabetes. Roux-en-Y bariatric surgery reduces hyperinsulinemia and improves insulin sensitivity and hence benefits morbidly obese patients. Aim To determine changes in markers of metabolic syndrome, pancreatic function, and hepatic insulin sensitivity in patients before and 1 year after undergoing Roux-en-Y gastric bypass surgery. Methods We enrolled 43 consecutive patients in a single center. Markers for metabolic syndrome included proinsulin, insulin, C-peptide, liver enzymes, and serum levels of selected microRNAs hsa-miR-122, hsa-miR-130, hsa-miR-132, and hsa-miR-375. Results After surgery, all patients showed a significant 37% drop of body mass index (p < 0.001). Furthermore, proinsulin (59% reduction, p < 0.001), insulin (76% reduction, p < 0.001), and C-peptide (56% reduction, p < 0.001) were all reduced 1 year after surgery. Using the hepatic insulin clearance score, we determined a significant increase in hepatic insulin clearance after surgery (76% increase, p < 0.001). Especially diabetic patients showed a marked 2.1-fold increase after surgery. Hepatic enzymes ALT (35% reduction, p = 0.002) and γGT (48% reduction, p < 0.001) were significantly reduced in all patients with similar improvement in diabetic and non-diabetic patients. miRNAs hsa-miR-122, hsa-miR-130, and hsa-miR-132 were all significantly reduced whereas hsa-miR-375 was increased after gastric bypass surgery (p < 0.001 for all miRNAs). Conclusion Both liver and pancreatic stress parameters were reduced significantly 1 year after Roux-en-Y gastric bypass surgery suggesting an overall amelioration of the metabolic syndrome in all patients regardless of previous health status.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16040660 ◽

2019 ◽

Vol 16 (4) ◽

pp. 660 ◽

Cited By ~ 3

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.

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Assessment of the Body Composition and the Loss of Fat-Free Mass through Bioelectric Impedance Analysis in Patients Who Underwent Open Gastric Bypass

The Scientific World JOURNAL ◽

10.1155/2014/843253 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Wilson Rodrigues de Freitas Junior ◽

Elias Jirjoss Ilias ◽

Paulo Kassab ◽

Roberto Cordts ◽

Paulo Gustavo Porto ◽

...

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Impedance Analysis ◽

Fat Free Mass ◽

Morbidly Obese ◽

Obese Patients ◽

Bioelectric Impedance Analysis ◽

Open Gastric Bypass ◽

Bioelectric Impedance ◽

The World

Background. Bariatric surgery is considered an effective option for the management of morbid obesity. The incidence of obesity has been gradually increasing all over the world reaching epidemic proportions in some regions of the world. Obesity can cause a reduction of up to 22% in the life expectancy of morbidly obese patients.Objective. The objective of this paper is to assess the weight loss associated with the first 6 months after bariatric surgery using bioelectric impedance analysis (BIA) for the evaluation of fat mass and fat-free mass.Method. A total of 36 morbidly obese patients were subjected to open gastric bypass surgery. The patients weight was monitored before and after the procedure using the bioelectric impedance analysis.Results. Bariatric surgery resulted in an average percentage of weight loss of 28.6% (40 kg) as determined 6 months after the procedure was performed. Analysis of the different components of body weight indicated an undesirable loss of fat-free mass along with the reduction of total body weight.Conclusion. Open gastric bypass induced a significant loss of total weight and loss of fat-free mass in patients six months after the surgery. The use of bioelectric impedance analysis resulted in an appropriate estimation of the total weight components in individuals subjected to bariatric surgery allowing a more real analysis of the variation of weight after the surgery.

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The Neuroendocrine and Metabolic Outcomes of Bariatric Surgery Depend on Presurgical Control over Eating

Neuroendocrinology ◽

10.1159/000500687 ◽

2019 ◽

Vol 110 (1-2) ◽

pp. 63-69

Author(s):

José Ramón Muñoz-Rodríguez ◽

Teresa Rodríguez-Cano ◽

Filomena Polo ◽

Luis Sáenz-Mateos ◽

Andrea Agarrado ◽

...

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Eating Behaviors ◽

Bypass Surgery ◽

Serum Insulin ◽

Gastric Bypass Surgery ◽

Morbidly Obese ◽

Obese Patients ◽

Metabolic Outcomes ◽

Validated Questionnaire

Background: The outcomes of bariatric surgery are very irregular and mostly unpredictable. The search for variables of predictive value is encouraged to help preventing therapeutic failures. Objective: We aimed to confirm the hypothesis that preexisting eating behaviors could predict neuroendocrine and metabolic outcomes of gastric bypass surgery in morbidly obese subjects. Methods: Twenty-one morbidly obese patients from the Bariatric Surgery Program of our hospital were selected according to the specific inclusion and exclusion criteria for this study. The subjects filled out a validated questionnaire to quantify the “loss-of-control” (LC) dimension of food craving and provided serum samples at the onset of the study and 1 year after gastric bypass surgery. Hematological, metabolic, and hormonal variables were studied by conventional clinical tests and enzyme immunoassays and checked for correlations with LC both before and after surgery. Results: Those patients that had exhibited worse eating control at the beginning of the study experienced a better metabolic response 1 year after surgery in terms of reduction of serum insulin, HOMA1-IR, HOMA2-IR, and vitamin D1; all these variables were inversely correlated with presurgical LC. Serum brain-derived neurotrophic factor (BDNF) levels showed the same tendency; in fact, BDNF significantly decreased only in those patients with worse eating control. Conclusions: Problematic eating behaviors may predict a better response of insulin resistance and a specific reduction of serum BDNF in morbidly obese patients after gastric bypass surgery.

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