Weight loss after Swedish Adjustable Gastric Banding: relationships to insulin resistance and metabolic syndrome

Background:The metabolic syndrome is a cluster of cardiovascular risk factors (central obesity, hypertension,dyslipidemia, disturbance in glucose metabolism) associated with insulin-resistance. The cluster of risk factors defining the metabolic syndrome increases cardiovascular risk more than each single component. The aim of the present longitudinal study was to evaluate the relationship between weight loss and changes in insulin-resistance and in the prevalence of the metabolic syndrome 1-year after SAGB implantation. Methods: 51 premenopausal severely obese women (mean age 35.2±8.8 years, BMI 43.3±6.9) were enrolled. As a control group, 51 premenopausal nonobese women (BMI<30) were enrolled. All obese subjects underwent successful implantation of the SAGB via videolaparoscopy. In all subjects insulinresistance was estimated by HOMA index and metabolic syndrome was defined according to the criteria of the European Group for the Study of Insulin Resistance. Results: HOMA (4.2±2.0 vs 1.9±0.8, P<0.001) and the prevalence of the metabolic syndrome (58.8% vs 7.8%, P<0.001) were significantly higher in obese than non-obese women. 1 year after SAGB, BMI significantly decreased from 43.3±6.9 to 34.5±7.4 (P<0.001). HOMA index showed a significant dramatic breakdown (4.2±2.0 vs 2.4±1.0, P<0.001). The prevalence of the metabolic syndrome declined significantly (58.8% vs 21.6%, P<0.001). Conclusion: Our study shows that in severely obese women, insulin-resistance and the prevalence of the metabolic syndrome significantly decrease 1 year after SAGB. Our findings indicate that SAGB could be a useful tool to reduce the global cardiovascular risk in severely obese people and to improve their long-term prognosis.     

Evaluation of microalbuminuria in obese children and its relation to metabolic syndrome

Several epidemiologic studies have clearly demonstrated that obesity increases the risk of kidney diseases. We have attempted to evaluate the association of obesity with albuminuria, an early marker of kidney disease, among obese children and its relation to metabolic syndrome. This study included 150 obese children. Blood pressure, fasting blood glucose, plasma insulin and the lipid profile were assessed. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to calculate in vivo insulin resistance. Urinary albumin and creatinine were estimated. Microalbuminuria was detected in 22 (14.7%) of the obese children. Waist circumference, blood pressure, triglyceride, low-density lipoprotein (LDL), insulin resistance and fasting blood glucose were significantly higher in obese children with microalbuminuria than in those with normoalbuminuria and showed significant positive correlations with microalbuminuria. High-density lipoprotein (HDL) was significantly lower in obese children with microalbuminuria than in those with normoalbuminuria, with a significant negative correlation with microalbuminuria. We found that body mass index, abdominal obesity, hypertension, impaired fasting glucose level and insulin resistance significantly increased the odds of microalbuminuria in the obese children enrolled in this study. Moreover, high triglyceride, high LDL and low HDL were significantly associated with microalbuminuria. In our patient group, childhood obesity was a risk factor for the development of microalbuminuria, which in turn was significantly associated with metabolic syndrome and its different constituents.     

The Influence of Laparoscopic Sleeve Gastrectomy on Metabolic Syndrome Parameters in Obese Patients in Own Material

Popularity of laparoscopic sleeve gastrectomy (LSG) has been growing gradually. The aim of this study was to determine changes in metabolic syndrome parameters as well as insulin, total cholesterol, and LDL cholesterol, and to describe the influence of body weight loss on co-morbidities in obese patients after LSG with 1-year follow-up. The material consists of 130 patients who underwent LSG (2007–2010) in order to treat morbid obesity and who had met before the surgery at least three criteria necessary for the diagnosis of metabolic syndrome according to the International Diabetes Federation. The influence of LSG on co-morbidities was also analyzed. During 1-year follow-up after LSG, we obtained a statistically significant decrease in BMI (from 53.18 ± 7.5 kg/m² to 31.4 ± 3.75 kg/m², p < 0.00001) and a reduction in waist circumference. Twelve months after the surgery, excess weight loss (EWL) was 59.42 ± 7.21% and excess body mass index loss (EBL) was 61.03 ± 6.50%. One year after LSG, the amount of patients with diagnosed metabolic syndrome decreased in 61 patients (53.08%). After 1 year, none of the patients met five criteria of metabolic syndrome. According to efficiency in body mass loss presented by %EWL and %EBL, LSG is gaining approval as a method of obesity and metabolic syndrome treatment, although it is a relatively new procedure. LSG is rather an easy procedure; the time of performance and hospitalization are shorter which entails normalization in all parameters of metabolic syndrome and decreases the percentage of obese patients with metabolic syndrome.     

Weight Loss Associated with Bariatric Surgery Does Not Restore Short Telomere Length of Severe Obese Patients After 1 Year

Background

Telomere shortening is physiologically associated with ageing but it may be influenced by oxidative stress and chronic inflammation, linked to obesity. Thus, obesity might represent an additional cause of telomere attrition. We aim to study relative telomere length (RTL) in obese subjects with and without metabolic syndrome and to assess the effect of weight loss induced by bariatric surgery.

Methods

We evaluated RTL in 107 obese subjects (62 with metabolic syndrome and 45 without metabolic syndrome), compared to 130 age-matched non-obese subjects. We also measured RTL in a subgroup of 93 obese patients prior to and 3, 6, 9 and 12 months after surgery.

Results

RTL of obese subjects was significantly shorter (p?<?0.0001) than non-obese subjects but without differences between patients with and without metabolic syndrome (p?=?0.19). RTL was significantly shorter than baseline at 3, 6, 9 and 12 months after bariatric surgery.

Conclusions

These results confirm that obese subjects have shorter telomeres compared to non-obese subjects, but RTL is not influenced by the presence of metabolic syndrome. RTL shows an additional attrition during the immediate post-operative period, probably due to a catabolic state.     

Some Hormonal Changes Before and After Vertical Banded Gastroplasty for Severe Obesity

Background: Hormonal disturbances play a role in the development of obesity, but may be a consequence of obesity itself. In this study we assessed the influence of the surgically-induced weight loss on some important hormonal abnormalities in the morbidly obese patients. Material and Methods: Fasting serum prolactin, insulin, cortisol and thyroid hormones: free thyroxin (FT4),free triiodothyronine (FT3) and thyrotropin (TTH), have been studied by radioimmune methods before vertical banded gastroplasty (VBG) and after operation in the early (10-14 days) and late period when excess weight loss (EWL) 51.7-57.1% had been achieved. Results: On the 10-14 day after VBG, prolactin increased significantly in women (p<0.05), but decreased after weight loss (p<0.01). Fasting insulin was lowered significantly (p<0.05) soon after VBG in the hyperinsulinemic (51.7 % of the total group) and diabetic (n-9) patients. After weight loss, insulin decreased significantly (p< 0.0001) vs. preoperative. Concentration of cortisol was unchanged both in the early and in the late postoperative period. On the days 10-14, significant elevation of TTH and decrease of FT3 (p<0.05) have been noted. After essential weight loss TTH dropped significantly vs. preoperative (p< 0.05) with no changes in FT3 and FT4 concentration. Conclusions: VBG and consequent weight loss favorably influence the hormonal abnormalities in the morbidly obese. Further studies are needed to make clear a relationship between this and other parameters of metabolic syndrome. The hormonal abnormalities may influence the indications for surgery in less than morbidly obese patients with metabolic syndrome.     

Psychological Distress in Morbid Obesity in Relation to Weight History

Background Very few data are available on psychological distress in morbidly obese subjects in relation to the history of their weight. In subjects with childhood obesity, psychological distress might be better than in adult-onset obesity, because of progressive adaptation to the social stigma. Methods Psychological distress was tested in relation to BMI at age 20 years (BMI-20), weight history and somatic co-morbidities in 632 treatment-seeking, morbidly obese participants from the QUOVADIS cohort (130 men, 502 women; mean age 45.5 years). The number of dieting attempts/year, BMI increase and cumulative BMI loss since age 20 were calculated as weight cycling parameters.The Symptom Check List-90 (SCL-90), the Psychological General Well-Being (PGWB), the Binge-Eating Scale, and the ORWELL-97 questionnaire were used to score psychometry and health-related quality of life (HRQL). Complications were quantitatively assessed by a modified Charlson’s score. Results BMI-20 was normal in 35% of cases and >35 kg/m2 in only 14%. Psychometric scores were not different in relation to BMI-20, when corrected for age, with the exception of the General Health scale of PGWB, showing a greater distress in subjects with normal BMI-20. In most cases, the prevalence of pathological results of questionnaires showed a Jshaped curve, with participants with normal BMI-20 or those with Class II–III obesity in early adulthood having the highest prevalence of psychological/psychiatric distress and poor HRQL.Weight cycling was a risk factor for binge–eating, depression and interpersonal sensitivity in SCL–90, whereas somatic co–morbidities adversely affected most SCL–90 and all PGWB scales. Conclusion Weight cycling and somatic co–morbidities, but not age of onset of obesity, are the main factors negatively influencing psychological health in treatment–seeking, morbidly obese subjects. A complete list of participants in the QUOVADIS study has been previously published in Diabetes Nutr Metab 2003; 16: 115–24     

Morbid obesity in Cushing's syndrome: A nonentity?

Review of twenty-nine surgically proven cases of Cushing's syndrome disclosed that only three patients met criteria of morbid obesity. The history and physical signs and symptoms of morbid obesity contrast markedly with Cushing's syndrome. Investigation for Cushing's syndrome should not be included in the routine preoperative evaluation of morbidly obese patients.     

Metabolic Syndrome Components After Pediatric Liver Transplantation: Prevalence and the Impact of Obesity and Immunosuppression

Metabolic syndrome is associated with long‐term morbidity and mortality after adult liver transplantation (LT). Whether pediatric LT recipients have a higher prevalence of metabolic syndrome remains controversial. In a cross‐sectional study, we evaluated pediatric LT recipients aged 8–30 years using National Health and Nutrition Examination Survey (NHANES) protocols. LT recipients were matched by gender, race/ethnicity, and age with controls from NHANES. Pediatric LT recipients (n = 83), after adjusting for overweight/obesity and glucocorticoid use, had increased prevalence of prehypertension and hypertension, impaired glucose tolerance (IGT; 2‐h glucose after oral glucose tolerance test ≥140 mg/dL), and low high‐density lipoprotein compared to matched NHANES controls (n = 235) despite a lower prevalence of overweight/obesity. Among LT recipients, the adjusted odds of IGT doubled for every 7.5 years taking calcineurin inhibitors (odds ratio = 2.10, 95% confidence interval 1.06–4.17 per 7.5 years taking calcineurin inhibitors, p = 0.03). Among all subjects with IGT, LT recipients had a lower prevalence of overweight/obesity and less insulin resistance (homeostatic model assessment of insulin resistance) than did controls with IGT. Among normal weight subjects, LT recipients were significantly more likely than controls to have prehypertension/hypertension, IGT, low high‐density lipoprotein, and metabolic syndrome. Pediatric LT recipients have unique metabolic syndrome profiles and risk factors and will require tailored screening and management protocols.     

Relationships of serum leptin to clinical and anthropometric findings in obese patients

Background: The authors evaluated the relationship between leptin and the clinical, anthropometric and metabolic variables connected to the metabolic syndrome in obese individuals. Methods: A large group of patients with different degrees of obesity was investigated: body mass index (BMI) values, serum leptin, fasting glucose and insulin, triglycerides and HDL-cholesterol concentrations, insulin resistance index and blood pressure were measured. Results: On multiple regression analysis, serum leptin levels appeared to be positively correlated to the BMI and to the serum HDL-cholesterol concentration. Principal component factor analysis revealed three factors, explaining 61.3% of the total variance of the sample. General features of these factors were: factor 1 - BMI values and serum leptin and fasting glucose concentration; factor 2 - systolic and diastolic blood pressure and serum triglycerides and HDL-cholesterol concentration; factor 3 - fasting serum insulin concentration and insulin resistance index. Conclusions: In obese subjects multiple factors underlie the metabolic syndrome and therefore more than one mechanism may account for the clustering characteristics. In obese patients leptin loads only one factor, and therefore leptin does not appear to be a key feature in the metabolic syndrome. On the contrary, multiple correlation and factor analysis data give rise to the hypothesis that in obese patients, leptin may play a protective role against cardiovascular risk.     

Psychopathologic patterns in obesity

The problem of relationship between obesity and psychological distress is debated in the literature wherein a lot of studies exists with controversial results. The phenomenon of obesity is actually considered with criteria aimed to evaluate almost exclusively the weight excess. Even if such criteria have the advantage to permit a scientific communicability, in the clinical settings the focus of obesity involves medical as well psychiatric aspects. The psychological aspects that may have a relevant role in the development of obesity must be recognized and distinguished from those that may be a direct consequence of obesity itself. In fact, certain obese subjects (no-binge obese) may not experience any psychological distress during lifetime whereas other obese subjects (binge obese) may have a significant and highly distressing psychological suffering. Therefore, obese persons seem to represent a heterogeneous population with different adaptive characteristics who may show several and complex psychological mechanisms and distresses. A psychotherapeutic approach seems to be essential to treat such psychological distress that may heavily concur to the development and the maintenance of obesity.     

Metabolic Implications of Obesity,Weight Loss and Energy Expenditure following Gastric Restrictive Surgery

This review examines the energetics and metabolic parameters which influence the effectiveness of gastric restrictive surgery in achieving weight loss in the clinically severely obese patient. Among the subjects discussed are the metabolic determinents and consequences of obesity, energy expenditure and its components, factors other than dietary restriction and weight loss which affect energy expenditure, and the metabolic risk factors for weight gain. The role of exercise is reviewed, including the effects of exercise on energy balance and the thermic effect of food. The value of combining exercise with diet restriction, the effect of caloric restriction on the capacity to exercise and the place of exercise in the obese diabetic are examined. Finally, the metabolic consequences of gastric restrictive surgery, the adaptive response to surgically induced weight loss and nutritional recommendations following gastric restrictive surgery are reviewed.     

Severe Obesity and P-Wave Dispersion: The Effect of Surgically Induced Weight Loss

Background Recent data have shown that obesity is an important potential risk factor for atrial fibrillation (AF). The mechanism of development of AF in obesity patients is still unclear and may be related to atrial refractoriness heterogeneity. The aim of our study was to determine the influence of bariatric surgery with a consequent substantial weight loss on P-wave dispersion in morbidly obese population. Methods We enrolled in this study 40 severe obese patients, and 40 age-matched non-obese healthy subjects were also recruited as controls. All subjects underwent conventional 12-lead electrocardiography for the analysis of P-wave dispersion. All subjects underwent bariatric surgery and were resubmitted to electrocardiography, biochemical, and anthropometric examination within 12 months after intervention. Results Severe obese patients had greater values in P-wave duration and dispersion than the normal weight controls. Bariatric surgery reduced significantly P-wave dispersion. There was a significant correlation between decrease of atrial refractoriness heterogeneity and bariatric-surgery-induced weight loss. Conclusions In severe obese patients, surgically induced weight loss reduction is associated with significant decreased in P-wave dispersion. The reduction of the atrial refractoriness heterogeneity may be of clinical significance by reducing the risk of atrial fibrillation in morbidly obese subjects.     

Leptin and Insulin Action in Severely Obese Women

Background: The authors investigated the interrelationships between the components of the metabolic syndrome in severe obesity. Methods: In non-diabetic, severely obese women, the degree of obesity (BMI), the insulin sensitivity (from the Homeostatic Model of Assessment, HOMA), the serum leptin concentration and the presence of dyslipidemia and arterial hypertension were evaluated. Results: In insulin-resistant patients, an overall impaired metabolic status and a greater cardiovascular risk were observed, while serum leptin concentration was higher than in the insulin-sensitive ones. Leptin levels and HOMA data correlated independent of BMI findings, while the presence of dyslipidemia and hypertension was unrelated to the other metabolic syndrome factors. Conclusion: In severely obese women, although other factors independently intervene, serum leptin has a role in developing the metabolic syndrome.     

Race and comorbid factors predict nonalcoholic fatty liver disease histopathology in severely obese patients

PURPOSE: Nonalcoholic fatty liver disease (NAFLD) is a common and potentially serious form of chronic liver disease. Although NAFLD is known to be associated with obesity and some comorbid conditions, less is known about the severity of NAFLD among different racial groups. METHODS: We prospectively studied 237 consecutive morbidly obese patients presenting for bariatric surgery. All patients underwent intraoperative liver biopsy and chart review. After excluding subjects who reported alcohol use (n = 37) or who had missing biopsy data (n = 11), 189 patients were available for analysis. Clinical and laboratory associations with each of the histological components of NAFLD were assessed using multiple logistic regression analysis. RESULTS: The mean age was 43.1 years, 84% were female, and 13% were African American. It was found that 88% had steatosis, including 35% with moderate to severe steatosis (> 33% of hepatocytes involved). Of these patients, 67% had inflammation, 46% had fibrosis, and 45% met Brunt's criteria for NASH. Compared with Caucasians and after adjustment, African Americans had significantly lower odds of severe hepatic pathology, with adjusted odds ratios of 0.1 (P = .02) for the presence of moderate or severe steatosis, 0.2 for inflammation (P = .006), 0.3 for fibrosis (P = .05), and 0.2 for NASH (P = .02). In addition, participants with one or more features of the metabolic syndrome (ie, diabetes, hypertension, or dyslipidemia) or elevated aminotransferase levels had significantly higher odds of severe hepatic histopathology. CONCLUSION: Among obese patients presenting for bariatric surgery, NAFLD is more common in Caucasians, patients with features of the metabolic syndrome, and those with elevated aminotransferase levels.     

Obesity and sexual dysfunction, male and female

Obesity has become a worldwide public health problem of epidemic proportions, as it may decrease life expectancy by 7 years at the age of 40 years: excess bodyweight is now the sixth most important risk factor contributing to the overall burden of disease worldwide. Overweight and obesity may increase the risk of erectile dysfunction (ED) by 30-90% as compared with normal weight subjects. On the other hand, subjects with ED tend to be heavier and with a greater waist than subjects without ED, and also are more likely to be hypertensive and hypercholesterolemic. The metabolic syndrome, characterized by a clustering of risk factors associated with insulin resistance and abdominal obesity, associates with ED. Moreover, women with the metabolic syndrome have an increased prevalence of sexual dysfunctions as compared with matched control women. Lifestyle changes aimed at reducing body weight and increasing physical activity induce amelioration of both erectile and endothelial functions in obese men. Moreover, preliminary evidence suggests that a Mediterranean-style diet might be effective in ameliorating sexual function in women with the metabolic syndrome. Lifestyle changes, mainly focussing on regular physical activity and a healthy diet, are effective and safe ways to reduce cardiovascular diseases and premature mortality in all population groups; they may also prevent and treat sexual dysfunctions in both sexes.     

Terapia de privación de andrógenos y obesidad mórbida: ¿tienen en común el riesgo cardiovascular por síndrome metabólico?

BackgroundAlthough the use of androgen deprivation therapy (ADT) has resulted in improved survival in men with advanced prostate cancer, the resulting hypogonadism is associated with profound adverse effects comparable to those found in morbid obesity, being cardiovascular risk among the most lethal.ObjectivesEvaluate metabolic syndrome, metabolic abnormalities and cardiovascular risk in patients with prostate cancer under ADT, not under ADT and morbid obese men.MethodsThis is a cross-sectional study that involves 79 men presenting prostate cancer, of whom 54 under ADT and 25 not under ADT and 91 morbidly obese patients paired by sex and age. To define metabolic syndrome, we used the International Diabetes Federation (IDF) criteria. Metabolic abnormalities, metabolic markers and Framingham score to predict the ten year coronary heart disease risk were compared among patients under ADT, not under ADT and morbid obese.ResultsPatients under ADT presented significantly greater occurrence of diabetes and central obesity and higher levels of total cholesterol and low density lipoprotein (LDL) compared to eugonadal men. The mean cardiovascular risk was significantly higher in patients under ADT (39.97 ± 12.53% vs. 26.09 ± 14.80%; p = 0.021). Morbidly obese subjects had increased ten year coronary heart disease risk; comparable to patients under ADT (p = 0.054).ConclusionThis study suggests that patients under ADT show higher prevalence of metabolic abnormalities and cardiovascular risk similar to those found in morbidly obese subjects. It is possible that both processes share cardiovascular risk through metabolic syndrome.     

Sleep quality and psychopathological features in obese binge eaters

The objectives of this study were to determine the prevalence of Binge Eating Disorder (BED) and to investigate the subjective sleep qualities and the psychopathological features of BED in treatment‐seeking obese patients. Thirty‐six treatment‐seeking obese subjects and 37 control subjects were interviewed with the DSM‐IV research criteria for BED, The Pittsburgh Sleep Quality Index (PSQI), Bulimic Investigatory Test, Edinburg (BITE) and SCL‐90‐R scales. Eight out of 36 treatment‐seeking obese patients (22.2 per cent) met the criteria for BED. The PSQI global scores, sleep latencies and SCL‐PSDI, SCL‐interpersonal sensitivity subscale results were all significantly higher in treatment‐seeking BED obese subjects than non‐BED (N‐BED) subjects and controls. Our findings suggest that BED appears to be a common disorder in treatment‐seeking obese patients. The treatment‐seeking obese BED patients suffer from more psychopathological problems than N‐BED obese patients and controls, and the subjective sleep qualities are likely to be disrupted in patients with BED. Copyright © 2004 John Wiley & Sons, Ltd.     

Metabolic syndrome in severely obese patients

Background: The authors assessed the prevalence of diabetes, hypertension, dyslipidemia and metabolic syndrome in patients with a high degree of obesity. Methods: A retrospective investigation was planned in a cohort of obese patients with a wide range of body mass index (BMI) referred to a large University Hospital for weight loss. Results: An increase in prevalence of diabetes and hypertension with increase in the degree of obesity was observed, while the prevalence of dyslipidemia and metabolic syndrome appeared to be independent of the BMI values. Conclusion: In severely obese patients a still unknown factor which affects differently glucose and lipid metabolism cannot be excluded.     

Changes of gut microbiota between different weight reduction programs

BackgroundGut microbiota may induce obesity, diabetes, and metabolic syndrome. Different weight reduction programs may induce different changes in gut microbiota.ObjectivesTo assess the changes in gut microbiota between obese adults who participated in 2 different weight reduction programs, the dietary counseling (DC) group and sleeve gastrectomy (SG) group, for 3 months.SettingA University Hospital.MethodsTen obese participants from each group were matched according to sex, age, and body mass index. Gut microbiota compositions were determined by metagenomics using next-generation sequencing before and after treatment. Anthropometric indices, metabolic factors, and gut microbiota were compared between and within groups.ResultsAfter 3 months of treatment, compared with subjects in DC group, subjects in SG group experienced a greater reduction in body weight, body mass index, body fat, waist and hip circumference, diastolic blood pressure, hemoglobin, insulin, insulin resistance, glutamate pyruvate transaminase, blood urine nitrogen, and glycated hemoglobin (HbA1C). A total of 8, 17, and 46 species experienced significant abundance changes in DC, in SG, and between the 2 groups, respectively. Diversity of the gut flora increased in SG and between the 2 groups after treatment. The weight change over the course of the weight loss program was further adjusted and only 4 species, including Peptoniphilus lacrimalis 315 B, Selenomonas 4 sp., Prevotella 2 sp., and Pseudobutyrivibrio sp., were found to be significantly different between the 2 weight loss programs. These 4 species may be the different gut microbiota change between internal and surgical weight reduction programs.ConclusionsThere are significant differences not only in anthropometric indices and metabolic factors but also in gut microbiota change between the 2 programs.