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1.
E. Pardina A. Lecube R. Llamas R. Catalán R. Galard J. M. Fort H. Allende V. Vargas J. A. Baena-Fustegueras J. Peinado-Onsurbe 《Obesity surgery》2009,19(8):1150-1158
Background Although bariatric surgery is currently the most common practice for inducing weight loss in morbidly obese patients (BMI > 40 kg/m2), its effect on the lipid content of adipose tissue and its lipases (lipoprotein lipase [LPL] and hormone-sensitive lipase
[HSL]) are controversial.
Methods We analyzed LPL and HSL activities and lipid content from plasma as well as subcutaneous (SAT) and visceral (VAT) adipose
tissue of 34 morbidly obese patients (MO) before and after (6 and 12 months) Roux-en-Y gastric bypass surgery and compare
the values with those of normal weight (control) patients.
Results LPL activity was significantly higher in MO (SAT = 32.9 ± 1.0 vs VAT = 36.4 ± 3.3 mU/g tissue; p < 0.001) than in control subjects (SAT = 8.2 ± 1.4 vs VAT = 6.8 ± 1.0 mU/g tissue) in both adipose depots. HSL activity had
similar values in both types of tissue (SAT = 32.8 ± 1.6 and VAT = 32.9 ± 1.6 mU/g) of MO. In the control group, we found
similar results but with lower values (SAT = 11.9 ± 1.4 vs VAT = 12.1 ± 1.4 mU/g tissue). Twelve months after surgery, SAT
LPL activity diminished (9.8 ± 1.4 mU/g tissue, p < 0.001 vs morbidly obese), while HSL (46.6 ± 3.7 mU/g tissue) remained high. All lipids in tissue and plasma diminished
after bariatric surgery except plasma nonesterified fatty acids, which maintained higher levels than controls (16 ± 3 vs 9 ± 0 mg/dL;
p < 0.001, respectively).
Conclusions When obese patients lose weight, they lose not only part of the lipid content of the cells but also the capacity to store
triacylglycerides in SAT depots.
E. Pardina and A. Lecube contributed equally to this study.
J.A. Baena-Fustegueras and J. Peinado-Onsurbe share senior authorship. 相似文献
2.
Roth CL Reinehr T Schernthaner GH Kopp HP Kriwanek S Schernthaner G 《Obesity surgery》2009,19(1):29-35
Background Ghrelin and obestatin are derived from the same gene but have different effects: Ghrelin stimulates appetite, and previous—albeit
inconsistent—data show that obestatin may be involved in satiety. The present study was designed to test the hypothesis that
Roux-en-Y gastric bypass (RYGB) surgery and/or the weight loss that reliably results from this procedure would alter levels
of ghrelin and obestatin and ghrelin/obestatin ratios in a cohort of morbidly obese women.
Methods This is a longitudinal follow-up study in 18 morbidly obese women (mean weight 131.2 kg, mean body mass index [BMI] 47.4).
Clinical parameters and fasting serum concentrations of ghrelin, obestatin, triglycerides, low-density lipoprotein cholesterol,
glucose, and insulin were measured before and 2 years after RYGB surgery, which was associated with body weight reductions
of 41.5 ± 11.6 kg (mean 62.5% excess weight loss).
Results Ghrelin concentrations (−12%, p = 0.022) and ghrelin/obestatin ratios (−14%, p = 0.017) were lower after surgery than before, while obestatin levels did not change. Changes in ghrelin concentrations correlated
with changes in insulin levels (r = 0.45, p = 0.011). Most cardiovascular risk factors studied improved postsurgically (p < 0.01).
Conclusion In contrast to previous weight loss studies involving gastric banding, ghrelin levels decreased and obestatin levels remained
stable after massive weight loss in long-term follow-up. The favorable gastrointestinal hormone profiles observed are likely
to contribute to the long-term weight loss success rate attributed to RYGB.
C.L. Roth and T. Reinehr contributed equally to this work. 相似文献
3.
Background Co-morbidities and the metabolic response to intervention in morbid obesity have been reported to vary among different ethnic
groups. We compared the rate of weight loss, effectiveness of gastric bypass surgery, and variables influencing success after
gastric bypass in Hispanics compared to Caucasians.
Methods Morbidly obese adult (>18 years old) patients (body mass index [BMI] 40 or above) evaluated by our bariatric group from 2005
to 2006 who underwent Roux-en-Y gastric bypass (RYGBP) were studied. Every patient was evaluated for height, weight, BMI,
percent body fat, fat mass, serum metabolic analysis (SMA) 12, lipid profile, complete blood count (CBC), iron, ferritin,
Vitamins A, D, and B1, complete urinalysis and Fibrospect score II. Weight loss was evaluated at 1, 3, 6, and 12 months.
Results Seventy-five patients underwent successful open RYGBP with no mortality. Regardless of the significant difference in age and
co-morbidities, the mean percentage of total weight loss after 1 year of follow-up was 32% for Hispanics and 30% for Caucasians
with no significant difference (p > .5). When comparing the percentage of excess weight lost (% EWL) at 1, 3, 6, and 12 months, there was no significant difference
between both groups. Using multiple regression analysis, we found that high-density lipoprotein (HDL) and systolic blood pressure
(SBP) significantly predicted EWL at 12 months in Caucasians and Fibrospect predicted significantly EWL at 1 year.
Conclusion At 1 year after RYGBP, both ethnic groups lost ∼77–80% of their EWL and BMI. All Caucasians and 95.7% of Hispanics achieved
successful weight loss (>50% EWL). 相似文献
4.
Forty morbidly obese asthmatic patients who underwent gastric restrictive surgery more than 2 years earlier were evaluated
to determine the influence of weight loss on asthma outcome. Mean percentage excess weight loss in this group was 68% and
body mass index (BMI) fell from a mean of 46 to 30. Following surgery, 90% showed improvement in asthma symptoms. Complete
remission of asthma occurred in 48% and a further 12.5% became asthma free on reduced medications dosage. Of those taking
daily medications for asthma before surgery, 42% were completely off medication following weight loss surgery, and another
18.5% experienced fewer asthma attacks on reduced medication dosage. Of the 22 patients with severe asthma (> 10 attacks per
year) on routine daily medications for asthma preoperatively, 8(36%) required no medication after surgery, 7(32%) used medication
only on an ‘as-needed’ basis, and 7(32%) controlled their asthma on reduced medication dosage. Five patients gained weight
during the follow-up period. All developed an increased incidence of asthma attacks, which again abated after successfully
losing weight following revisional surgery. Coexistent factors of smoking and clinically apparent esophageal reflux were evaluated,
but no statistically significant correlation was shown with either smoking or reflux and improvement in asthma. Possible etiologies
of the improvement in asthma with weight loss are discussed. 相似文献
5.
Hue O Berrigan F Simoneau M Marcotte J Marceau P Marceau S Tremblay A Teasdale N 《Obesity surgery》2008,18(9):1112-1118
BACKGROUND: Decrease in fat mass and fat-free mass have been observed with weight loss induced by a dietary intervention or surgery. There are concerns that fat-free mass decrease could have some negative functional consequences. The aim of this study was to examine how weight loss affects strength and force control in obese and morbidly obese men. METHODS: Weight loss was obtained in obese individuals by a hypocaloric diet program until resistance to lose fat and in morbidly obese individuals by bariatric surgery. Maximal force was measured for upper and lower limb and the ability to maintain 15% and 40% of that force. These measures were taken at baseline, in those dieting once resistant to weight loss and 1 year after surgery for those operated on. Normal weight individuals used for control were evaluated twice (6 to 12 months apart). RESULTS: At baseline, there was no significant difference between groups for maximal forces and capabilities to maintain force levels. Weight loss averaged 11.1% of the initial body weight after dieting and 46.3% 1 year after surgery. At the same time, there was for the lower limb a loss of 10.1% in maximal force after dieting and 33.5% after surgery. For the upper limb, there was no change in maximal force after dieting whereas a decrease of 14.4% was observed after surgery. When transformed in force related to body weight, there was no change in relative force for the lower limb after dieting whereas an increased relative force after surgery. There was no significant difference for the ability for maintaining force levels. CONCLUSION: Despite a large force loss, particularly for the lower limbs in morbidly obese individuals after surgery, this loss is relatively well tolerated because the relation between force and body weight is even improved and the ability to maintain that force is preserved. 相似文献
6.
de Carvalho CP Marin DM de Souza AL Pareja JC Chaim EA de Barros Mazon S da Silva CA Geloneze B Muscelli E Alegre SM 《Obesity surgery》2009,19(3):313-320
Background It has been proposed that there is improvement in glucose and insulin metabolism after weight loss in patients who underwent
diet restriction and bariatric surgery.
Methods Eleven normal glucose tolerant (NGT) morbidly obese patients [body mass index (BMI), 46.1 ± 2.27 g/m2] and eight abnormal glucose metabolism (AGM) obese patients (BMI, 51.20 kg/m2) were submitted to diet-restriction and bariatric surgery. Prospective study on weight loss changes, over the glucose, insulin
metabolism, glucagon-like peptide-1 (GLP-1), and adiponectin levels were evaluated by oral glucose tolerance test during three
periods: T1 (first evaluation), T2 (pre-surgery), and T3 (9 months after surgery).
Results Insulin levels improved after surgery. T1 was 131.1 ± 17.60 pmol/l in the NGT group and 197.57 ± 57.94 pmol/l in the AGM group,
and T3 was 72.48 ± 3.67 pmol/l in the NGT group and 61.2 ± 9.33 pmol/l in the AGM group. The major reduction was at the first
hour of the glucose load as well as fasting levels. At 9 months after surgery (T3), GLP-1 levels at 30 and 60 min had significantly
increased in both groups. It was observed that the AGM group had higher levels of GLP-1 at 30 min (34.06 ± 6.18 pmol/l) when
compared to the NGT group (22.69 ± 4.04 pmol/l). Homeostasis model assessment of insulin resistance from the NGT and AGM groups
had a significant reduction at periods T3 in relation to T1 and T2. Adiponectin levels had increased concentration in both
groups before and after surgical weight loss. However, it did not have any statistical difference between periods T1 vs. T2.
Conclusions Weight loss by surgery leads to improvement in the metabolism of carbohydrates in relation to sensitivity to the insulin,
contributing to the reduction of type 2 diabetes incidence. This improvement also was expressed by the improvement of the
levels of adiponectin and GLP-1. 相似文献
7.
Background Laparoscopic adjustable gastric banding (LAGB) is seen as a safe surgical procedure in individuals with morbid obesity, with
satisfactory weight loss and significant postoperative improvement in quality of life (QoL). The present study investigates
the predictive value of various parameters such as age, gender, weight loss, and preoperative psychiatric disorders with regard
to QoL after LAGB.
Methods 300 obesity surgery patients were sent questionnaires to assess a variety of personal parameters. QoL was assessed using the
Ardelt-Moorehead Quality of Life Questionnaire. Questionnaires were completed by 140 (63%) female patients and 36 (45%) male
patients.
Results Average weight loss in both sexes was 14.7 kg/m2; however, not all patients successfully lost weight. No difference was seen in satisfaction with weight loss among the age
groups. Some correlations were seen between the amount of weight loss and QoL scores in females, but not in males. Greater
weight loss showed a statistically significant positive correlation to self-esteem, physical activity, social relationships,
sexuality, and eating pattern. Obese females with no preoperative psychiatric diagnosis had better self-esteem, more physical
activity, and more satisfying social and sexual relationships than those with psychiatric diagnoses at follow-up.
Conclusion A majority of morbidly obese patients show psychological and interpersonal improvement after surgery. However, some obese
patients, particularly those having a preoperative psychiatric or personality disorder, need more individual strategies for
psychosocial intervention than do obese individuals with no psychiatric disorder. 相似文献
8.
9.
Background Weight loss and long-term weight maintenance in bariatric surgery patients are related to maintaining satiety. It can be related
to glycemic load (GL) and carbohydrate (g CHO) intake. The aim of this study was to investigate the effect of g CHO and GL
and in weight loss on patients who had undergone bariatric surgery.
Method The following measurements/calculations were conducted as follows: current body weight (kg), current BMI, percentage of excess
weight loss (PEWL), average monthly weight loss (AMWL), energy intake (kcal per day), and GL calculation. Correlations were
found among the studied variables. A multiple linear regression analysis of diet variables executed with GL and weight loss.
Results The population presented 66% of EWL. The average of total energy intake (TEI) was 1220 ± 480, and the calculated GL resulted
in an average of 73.2. Negative correlations were found between AMWL and TEI (p = 0.04), and between AMWL and GL (p = 0.009); furthermore, a negative correlation was found between carbohydrate intake in grams and AMWL (p = 0.003). A positive correlation (p = 0.017) was found between GL and TEI. Weight loss and GL were also correlated. Among the intake variables, GL and g CHO
consumed are held accountable for 62 percent of AMWL. The multiple linear regression analysis showed that GL and carbohydrate
grams (g CHO) account for 62% of AMWL.
Conclusion The glycemic load and grams of carbohydrate are intake factors that can be useful tools in weight loss and long-term weight
maintenance on patients who have undergone Roux-en-Y Gastric Bypass (RYGB). 相似文献
10.
Background The aim of this study is to examine the relationship between oxidative plasma protein and thiol stress and weight loss after
laparoscopic adjustable gastric banding (LAGB).
Methods Plasma protein carbonyl (PCO) concentration as a marker of protein oxidation, plasma thiol (PSH) and erythrocyte glutathione
concentration (GSH, major intracellular thiol), as an antioxidant and metabolic markers, such as Homeostatic Model Assessment
– Insulin resistance (HOMA-IR), BMI and plasma lipids were determined in morbidly obese patients (n 22, mean age 34.7 ± 11
years, BMI 48.4 ± 6.4 kg/m2) at baseline and 1 and 6 months after operation. Baseline levels in patients were also compared with the levels in agematched
controls (n 20, BMI 21.3 ± 1.8 kg/m2). Plasma PCO and thiols and erythrocyte GSH concentrations were determined spectrophotometrically.
Results Plasma PCO were significantly higher and plasma and erythrocyte thiol concentrations were significantly lower in morbidly
obese patients than in controls (for each comparison, P < 0.01). BMI, plasma triglycerides and HOMA-IR were positively correlated with plasma PCO and negatively correlated with
plasma P-SH and erythrocyte GSH (for each comparison, P < 0.01). Plasma HDL-cholesterol levels were positively correlated with plasma erythrocyte GSH (r = 0.405, P < 0.01) and negative correlated with plasma PCO (r = −0.273, P < 0.01). One and 6 months after the LAGB operation, total weight loss was 13.2 ± 6.3 and 35.5 ± 7.5 kg, respectively. Plasma
PCO concentrations were decreased and P-SH and erythrocyte GSH concentrations were elevated following weight loss (for each,
P < 0.01). Only plasma P-SH levels were restored to the control levels 6 months after LAGB.
Conclusions Obesity and insulin resistance appear to be associated with plasma protein oxidation and thiol concentrations. Protein and
thiol oxidative stress was improved by weight loss after LAGB in the short-term. 相似文献
11.
12.
Melissas J Malliaraki N Papadakis JA Taflampas P Kampa M Castanas E 《Obesity surgery》2006,16(3):314-320
Background: Oxidative stress may play a critical role in the pathogenesis and development of obesity-associated co-morbidities.
Reactive oxygen and nitrogen species are produced as a consequence of normal aerobic metabolism and removed and/or inactivated
in vivo by both endogenous (uric acid, bilirubin, thiols) and diet-derived (exogenous) antioxidants. The purpose of this study is
to measure the total plasma antioxidant capacity (TAC), as well as the corrected TAC (cTAC, an index of exogenous provided antioxidants) in morbidly obese patients before and after surgical weight reduction.
Methods: 16 morbidly obese (5 male and 11 female) candidates for surgical intervention, median age 34 (range 22-56) years,
median weight 128 (range 96-186) kg, median excess weight 62 (range 28-115) kg and median BMI 44.4 (range 33.7-60.1) kg/m2 were evaluated before and 6 months after implantation of an intragastric balloon. 15 healthy blood donors (4 male and 11
female) on a normal diet, median age 35 (range 21-52) years, median weight 64.3 (range 46-78) kg and median BMI 24.2 (range
23.7-25.2) kg/m2 were also evaluated. Blood samples for routine clinical chemistry, TAC and cTAC determination were drawn, and weight and
BMI calculation were performed once in the control group, and in the morbidly obese patients (MO) before and 6 months after
the balloon implantation. Results: 6 months after balloon placement, weight and BMI of the MO patients were statistically
significantly reduced from the preoperative values (P<0.001). Plasma TAC and cTAC values in the MO group were significantly lower preoperatively, compared to the control group
(P<0.05 and P<0.001 respectively). cTAC values in the MO patients increased significantly following weight loss (P<0.001) and were restored to normal. However, the postoperative TAC values in the MO group did not change significantly and
remained lower than in the normal controls. A significant decrease (P<0.001) in uric acid values was also noticed in the MO group after weight loss. Conclusion: Plasma TAC and cTAC values are
impaired in morbidly obese patients. Weight loss from an intragastric balloon is associated with significant increase in plasma
cTAC values. Plasma TAC values, after the weight loss remain unchanged, possibly due to a decrease in uric acid, an important
endogenous antioxidant. 相似文献
13.
Syed M Rosati C Torosoff MT El-Hajjar M Feustel P Alger S Singh P Fein S 《Obesity surgery》2009,19(1):36-40
Background Obesity frequently results in structural and physiologic changes in the cardiovascular system. Whether weight reduction leads
to reversal of these changes is not well-established. This investigation sought to identify the effect of a weight reduction
program on right and left ventricular structure and function.
Methods Sixty-two patients presenting to the eating disorders clinic at a single academic institution for weight loss programs were
prospectively enrolled. Baseline and follow-up transthoracic echocardiograms were obtained after at least 10% weight reduction
or 6 months after baseline echocardiogram. Complete 2-dimensional echocardiograms were performed with M-mode, flow Doppler,
and tissue Doppler evaluation.
Results Patients lost an average of 28.2 ± 3 kg over a period of 266 ± 36 days. Left ventricular mass decreased significantly from
255.87 ± 12 to 228 ± 11 gm. There were no statistically significant changes in contractility or diastolic indices. The ratios
of early-to-late diastolic mitral inflow velocities (E/A) increased from 1.30 ± 0.05 to 1.32 ± 0.06. The ratio of early mitral
flow to early annular velocity (E/Em) also increased from 5.57 ± 0.22 cm to 5.82 ± 0.23 cm. Deceleration time increased from
213.26 ± 5.3 s to 228.47 ± 5.7 s.
Conclusions Weight reduction is associated with decrease in left ventricular diastolic size and left ventricular mass. This weight reduction
is not associated with statistically significant improvement in systolic or diastolic function. 相似文献
14.
Background This study reviews outcomes after laparoscopic adjustable gastric band (LAGB) placement in patients with weight loss failure
after Roux-en-Y gastric bypass (RYGBP).
Methods All data was prospectively collected and entered into an electronic registry. Characteristics evaluated for this study included
pre-operative age and body mass index (BMI), gender, conversion rate, operative (OR) time, length of stay (LOS), percentage
excess weight loss (EWL), and postoperative complications.
Results 11 patients (seven females, four males) were referred to our program for weight loss failure after RYGBP (six open, five laparoscopic).
Mean age and BMI pre-RYGBP were 39.5 years (24–58 years) and 53.2 kg/m2 (41.2–71 kg/m2), respectively. Mean EWL after RYGBP was 38% (19–49%). All patients were referred to us for persistent morbid obesity due
to weight loss failure or weight regain.
The average time between RYGBP and LAGB was 5.5 years (1.8–20 years). Mean age and BMI pre-LAGB were 46.1 years (29–61 years)
and 43.4 kg/m2 (36–57 kg/m2), respectively. Vanguard (VG) bands were placed laparoscopically in most patients. There was one conversion to open. Mean
OR time and LOS were 76 minutes and 29 hours, respectively. The 30-day complication rate was 0% and mortality was 0%. There
were no band slips or erosions; however, one patient required reoperation for a flipped port. The average follow-up after
LAGB was 13 months (2–32 months) with a mean BMI of 37.1 kg/m2 (22.7–54.5 kg/m2) and an overall mean EWL of 59% (7–96%). Patients undergoing LAGB after failed RYGBP lost an additional 20.8% EWL (6–58%).
Conclusion Our experience shows that LAGB is a safe and effective solution to failed RYGBP. 相似文献
15.
Langer FB Bohdjalian A Shakeri-Manesch S Felberbauer FX Ludvik B Zacherl J Prager G 《Obesity surgery》2008,18(11):1381-1386
Background Beside complications like band migration, pouch-enlargement, esophageal dilation, or port-site infections, laparoscopic adjustable
gastric banding (LAGB) has shown poor long-term outcome in a growing number of patients, due to primary inadequate weight
loss or secondary weight regain. The aim of this study was to assess the safety and efficacy of laparoscopic conversion to
Roux-en-Y gastric bypass (RYGBP) in these two indications.
Methods A total of 25 patients, who underwent laparoscopic conversion to RYGBP due to inadequate weight loss (n = 10) or uncontrollable weight regain (n = 15) following LAGB, were included to this prospective study analyzing weight loss and postoperative complications.
Results All procedures were completed laparoscopically within a mean duration of 219 ± 52 (135–375) min. Mean body weight was reduced
from 131 ± 22 kg (range 95–194) at time of the RYGBP to 113 ± 25, 107 ± 22, and 100 ± 21 kg at 3, 6, and 12 months, respectively,
which results in excess weight losses (EWL) of 28.3 ± 9.9%, 40.5 ± 12.3%, and 50.8 ± 15.2%. No statistically significant differences
were found comparing weight loss within these two groups.
Conclusion RYGBP was able to achieve EWLs of 37.6 ± 16.1%, 48.5 ± 15.1%, and 56.9 ± 15.0% at 3, 6, and 12 months following conversion,
respectively, based on the body weight at LAGB. 相似文献
16.
Russo V Ammendola E De Crescenzo I Docimo L Santangelo L Calabrò R 《Obesity surgery》2008,18(1):90-96
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. 相似文献
17.
Ciovica R Takata M Vittinghoff E Lin F Posselt AM Rabl C Stein HJ Campos GM 《Obesity surgery》2008,18(1):5-10
Background Extending the length of the Roux limb (RL) in gastric bypass (GBP) may improve weight loss in super obese patients (body mass
index [BMI] > 50 kg/m2), but no consensus exists about the optimal length of the RL. We sought to determine the impact of RL length on weight loss
in super obese patients 1 year after GBP.
Materials and Methods One-year weight loss outcomes were analyzed in all super obese patients who underwent consecutive and primary laparoscopic
or open GBP between January 2003 and June 2006. Patients were divided into two groups according to RL length (100 vs. 150 cm).
The RL length was at the discretion of the attending surgeon. Baseline and follow-up data were collected prospectively. Multiple
linear regression was used to adjust for potential confounders in the weight loss outcomes.
Results Twelve-month follow-up data were available in 137 (85%) of 161 patients with a BMI ≥ 50 who underwent GBP during the study
period. An RL of 100 or 150 cm was used in 102 (74.5%) and 35 patients (25.5%), respectively. In multivariate analysis, patients
with the 150-cm RL lost more weight (68.5 vs. 55.3 kg, p < 0.01), had a greater change in BMI (25 vs. 21 kg/m2, p = 0.01), and had greater excess weight loss (64 vs. 53%, p < 0.01).
Conclusion A 150-cm RL provides better weight loss outcomes in super obese patients at 1-year follow-up. 相似文献
18.
Background The ghrelin and leptin levels have been reported to be correlated with weight loss after bariatric surgery. However, the serial
changes of ghrelin and leptin levels after laparoscopic minigastric bypass surgery (LMGBP) have not been reported yet. Therefore,
we aimed to evaluate their serial changes and to analyze their relations to weight reduction after LMGBP.
Methods Serial fasting serum leptin and ghrelin concentrations were measured in 68 morbidly obese patients before (M0) and 1 (M1),
3 (M3), 6 (M6), and 12 (M12) months after LMGBP surgery. The correlations between ghrelin, insulin, and leptin concentrations
and weight reduction were analyzed.
Results Leptin levels were significantly reduced at 1, 3, 6, and 12 months after surgery, respectively (vs M0, p < 0.001), whereas the ghrelin concentrations were not significantly changed after surgery. The percent of excess BMI lost
(%EBL) 12 months after surgery was negatively correlated with higher preoperative ghrelin concentrations (p = 0.004) and larger preoperative BMI (p = 0.002) in the multivariate analysis.
Conclusion Higher preoperative ghrelin concentrations and larger BMI are predictive of less %EBL at 12 months after LMGBP surgery. 相似文献
19.
Background Gastric bypass surgery for morbid obesity has dramatically increased in volume over the past decade. Caucasian patients have
been noted previously to lose more weight after bariatric surgery than African-Americans patients. Data regarding predictors
of maintaining weight loss after surgery are minimal. We sought to determine predictors of long-term weight loss after bariatric
surgery.
Methods Retrospective analysis using a multivariate logistic regression model of all patients undergoing Roux-en-Y gastric bypass
surgery at the Medical University of South Carolina from May 1993 to December 2004 for whom 2 years of follow-up data was
available. Our dependent variable was the percentage of weight lost from baseline, dichotomized at ±35%. Our primary independent
variable was race, defined as Caucasian, African-American, or other. Relevant covariates were added to the model to control
for their potential effects on outcome.
Results One hundred eleven patients (17 male/94 female; 85% Caucasian, mean age 44 years (range 18–68 years). In our model, Caucasian
subjects (adjusted odds ratio [OR] = 7.60, 95% confidence intervals [95%CI] = 1.83–31.5) and late post surgical complications
(adjusted OR = 2.67, 95%CI = 1.05–6.80) significantly predicted weight loss at 2 years, after controlling for relevant confounders.
Other covariates did not significantly impact the model.
Conclusion Race and late post surgical complications significantly impacted the percentage of weight loss at 2 years for patients undergoing
Roux-en-Y gastric bypass surgery at our institution. Future research should be directed at determining potential genetic and/or
social reasons for these differences. 相似文献
20.
Background Gastric bypass and gastric banding are widely used to treat morbid obesity and both procedures offer certain advantages. The
indication for these two treatment options continue to be subject to debate.
Methods A single-center case-controlled matched-pair cohort study was performed. Fifty-three primary gastric bypass patients (GB)
operated between January 2002 and May 2005 were matched by gender, age, race, and initial bodyweight to 53 patients who underwent
laparoscopic adjustable gastric banding (LAGB) in the same time period.
Results Both groups were comparable regarding age, race, gender, preoperative body mass index, and excessive weight. Severe early
complications occurred in six patients (11.3%) in the GB group and were not seen in the LAGB group. Severe late complications
occurred in three patients (5.7%) in the GB group and one patient (1.9%) in the LAGB group. No mortality occurred in either
group. Weight loss was significantly lower in the LAGB group than in the GB group at all time points during the follow-up.
Significantly more patients were treated successfully (excess weight loss >50%) in the GB group than in the LAGB group. After
2 years, 76% of the patients in the GB group were treated successfully versus 40% of the patients in the LAGB group (P = 0.03).
Conclusion Gastric bypass and gastric banding are safe and without mortality. Gastric bypass is more effective in terms of weight loss
and the number of successfully treated patients. Gastric banding is a procedure with less severe complications. 相似文献