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1.
Background
Roux-en-Y gastric bypass (RYGB) is associated with nutrient deficiencies, but the optimal supplement regimen remains unclear. We assessed patient-reported adherence to and efficacy of Mayo Clinic’s post-RYGB vitamin/mineral supplement protocol and the related incidence of common nutrient deficiencies.Methods
Data were collected on 287 obese patients who underwent RYGB. Patient-reported supplement adherence was assessed via medication/supplement lists generated by medication reconciliation in hospital dismissal summaries and clinic notes at 6, 12, and 18–36 months postsurgery. Deficiencies were assessed via measurements of hemoglobin, ferritin, 25-hydroxyvitamin D, and vitamins A, E, and B12 in the setting of our supplementation protocol.Results
Patient-reported adherence to multivitamin/minerals and subcutaneous vitamin B12 was sustained in >92 % of patients, correlating with low rates of vitamin A, E, and B12 deficiencies (4.9, 0, and 3.7 %, respectively). Rates of calcium supplementation decreased (94.1 to 78.7 %) while rates of vitamin D and iron use increased over time (39.7 to 65.8 and 6.3 to 23.1 %, respectively). At 18–36 months, vitamin D deficiency persisted in 16.2 % of patients, iron deficiency in 6.7 % of women and 17.2 % of men, and anemia in 12.2 % of women and 34.3 % of men.Conclusion
Compared to previous reports, we found a lower prevalence of micronutrient deficiencies and excellent patient-reported adherence to a standardized multivitamin/mineral and vitamin B12 regimen. Continued prevalence of vitamin D deficiency prompts consideration of standardized vitamin D supplementation after RYGB. Anemia and iron deficiency were observed at lower rates than previously reported, but were more common in men compared to women.2.
H. J. M. Smelt S. Pouwels M. Said K. A. Berghuis A. K. Boer J. F. Smulders 《Obesity surgery》2016,26(12):2873-2879
Background
The incidence of vitamin B12 deficiency after bariatric surgery can range from 26 to 70 %. There is no consensus on optimal vitamin B12 supplementation in postbariatric patients. The objective of this study was to compare three different regimes.Methods
In this retrospective matched cohort study, we included 63 patients with methylmalonic acid (MMA) levels ≥300 nmol/L. Group A (n?=?21) received 6 intramuscular (im) vitamin B12 injections including a loading dose, group B (n?=?21) received 3 im vitamin B12 injections without loading dose and group C (n?=?21) received no im vitamin B12 injections.Results
The total post-bariatric patient population consisted of 14 males (22.2 %) and 49 women (77.8 %) with a mean current body mass index of 30.6?±?8.0 kg/m2. There was no significant difference in vitamin B12 and MMA levels between 3 groups at baseline. There was a significant difference in follow-up vitamin B12 levels of group A compared to group B (p?=?0.02) and group A compared to group C (p?=?0.03). In the follow-up results, there is also a significant decrease in MMA levels of group A compared to group B (p?=?0.02), group A compared to group C (p?<?0.001), and group B compared to group C (p?<?0.01).Conclusions
In this study, a shorter injection regime is probably not sufficient to treat a vitamin B12 deficiency. An injection regime with 6 injections recovered all vitamin B12 deficiencies biochemically. MMA levels cannot recover spontaneously over time without additional im injection regime.3.
Renee A. Mischler Seth M. Armah Bruce A. Craig Arthur D. Rosen Ambar Banerjee Don J. Selzer Jennifer N. Choi Nana Gletsu-Miller 《Obesity surgery》2018,28(2):369-377
Background
The evidence behind recommendations for treatment of iron deficiency (ID) following roux-en-y gastric bypass surgery (RYGB) lacks high quality studies.Setting
Academic, United StatesObjective
The objective of the study is to compare the effectiveness of oral iron supplementation using non-heme versus heme iron for treatment of iron deficiency in RYGB patients.Methods
In a randomized, single-blind study, women post-RYGB and iron deficient received non-heme iron (FeSO4, 195 mg/day) or heme iron (heme-iron-polypeptide, HIP, 31.5 to 94.5 mg/day) for 8 weeks. Measures of iron status, including blood concentrations of ferritin, soluble transferrin receptor (sTfR), and hemoglobin, were assessed.Results
At baseline, the mean ± standard deviation for age, BMI, and years since surgery of the sample was 41.5 ± 6.8 years, 34.4 ± 5.9 kg/m2, and 6.9 ± 3.1 years, respectively; and there were no differences between FeSO4 (N = 6) or HIP (N = 8) groups. Compliance was greater than 94%. The study was stopped early due to statistical and clinical differences between groups. Values before and after FeSO4 supplementation, expressed as least square means (95% CI) were hemoglobin, 10.8 (9.8, 11.9) to 13.0 (11.9, 14.0) g/dL; sTfR, 2111 (1556, 2864) to 1270 (934, 1737) μg/L; ferritin, 4.9 (3.4, 7.2) to 15.5 (10.6, 22.6) μg/L; and sTfR:ferritin ratio, 542 (273, 1086) to 103 (51, 204); all p < 0.0001. With HIP supplementation, no change was observed in any of the iron status biomarkers (all p > 0.05).Conclusions
In accordance with recommendations, oral supplementation using FeSO4, but not HIP, was efficacious for treatment of iron deficiency after RYGB.4.
Lindsey M. Freeman Andrew T. Strong Gautam Sharma Suriya Punchai John H. Rodriguez Donald F. Kirby Matthew Kroh 《Obesity surgery》2018,28(6):1546-1552
Introduction
Bariatric surgery is generally safe and effective, but co-existing malabsorptive processes may increase the risk of complications or nutritional deficiencies. Bariatric surgery has not been well studied in the setting of pre-existing celiac disease.Materials and Methods
Patients who underwent Roux-en-Y gastric bypass (RYGB) from January 2002 to December 2015 were retrospectively reviewed for either diagnosis of or serum testing for celiac disease. Identified patients were re-reviewed for adherence to American Gastroenterological Association (AGA) diagnostic criteria. Patient demographics, operative data, and post-operative weight loss and nutritional parameters were collected.Results
Of the >?12,000 patients who underwent bariatric surgery during this study period, there were 342 patients that had abnormal serology or pathology results. Expert review confirmed three patients (0.8%) with celiac disease diagnosed before RYGB procedure. All were female, with an average age of 33 years and a mean BMI of 44.07 kg/m2. At the time of surgery, two of the three patients were following a gluten-free diet. At 6 months follow-up, mean % excess weight loss was 76.5%. The patients following a gluten-free diet preoperatively continued post-operatively. No patients were anemic nor had vitamin B12 or iron deficiencies at 12-month follow-up. Two patients had vitamin D insufficiencies and responded to daily oral supplementation.Conclusion
Though many bariatric patients may carry a presumptive diagnosis of celiac disease, a small percentage of these meet AGA diagnostic criteria. RYGB appears safe in this population with comparable weight loss in non-celiac counterparts. Increased attention to vitamin D levels may be warranted post-operatively.5.
Eva Wolf Markus Utech Peter Stehle Martin Büsing Hans-Peter Helfrich Birgit Stoffel-Wagner Sarah Egert Birgit Alteheld Raute Riege Annette Knapp Sabine Ellinger 《Obesity surgery》2016,26(8):1821-1829
Background
Osteomalacia and cardiometabolic disorders are favored in morbidly obese patients due to an inadequate vitamin D (VD) status. Former trials supplementing orally VD (20–50 μg/day) in crystalline form after sleeve gastrectomy (SG) could not stabilize serum 25-hydroxycholecalciferol levels at predefined concentrations (≥50 nmol/l). We hypothesized that VD in an oily suspension would increase its bioavailability resulting in normal serum VD levels minimizing markers of cardiometabolic risk.Methods
Morbidly obese patients (n?=?94, BMI 51.8?±?11.5 kg/m2) received orally 80 μg/day VD3 dissolved in oil or placebo (pure oil) in a randomized, double-blind, parallel-group study for 12 weeks after SG. 25-hydroxycholecalciferol, parathyroid hormone, albumin, alkaline phosphatase, phosphate, magnesium, calcium, creatinine, C-reactive protein, lipids, glucose, and glycated hemoglobin were determined in serum/plasma before surgery and after 4 and 12 weeks of supplementation. Intake of energy, fat, and VD were monitored using a 3-day food record.Results
Seventy-nine patients were included in statistical analysis. Preoperatively, 77.2 and 40.5 % presented 25-hydroxycholecalciferol levels <75 and <50 nmol/l, respectively. After 12 weeks of supplementation, significantly more patients in the VD group exhibited levels >50 nmol/l (92 %) and >75 nmol/l (68 %) compared to the placebo group (54 and 22 %, respectively). Parameters of mineral metabolism and cardiometabolic risk were not modulated by intervention.Conclusion
Supplementation of 80 μg/day VD3 by oil is an effective and safe measure to prevent VD deficiency and to treat a preexisting undersupply in patients after SG. Cardiometabolic risk factors were, however, not affected; probably, higher VD doses might be necessary.Clinical Trial Registration
This trial was registered retrospectively on November 14, 2014, at the German Clinical Trials Register as DRKS00007143.6.
P.?Srikanth R.?F.?Chun M.?Hewison J.?S.?Adams R.?Bouillon D.?Vanderschueren N.?Lane P.?M.?Cawthon T.?Dam E.?Barrett-Connor L.?B.?Daniels J.?M.?Shikany M.?L.?Stefanick J.?A.?Cauley E.?S.?Orwoll C.?M.?Nielson for the Osteoporotic Fractures in Men Study Research Group 《Osteoporosis international》2016,27(7):2291-2300
Summary
Vitamin D is hypothesized to suppress inflammation. We tested total and free vitamin D metabolites and their association with inflammatory markers. Interleukin-6 levels were lower with higher 25-hydroxyvitamin D. 1,25-dihydroxyvitamin D and free 25OHD associations mirrored those of 25OHD. However, associations for the two metabolites diverged for tumor necrosis factor alpha (TNF-α) soluble receptors.Introduction
Vitamin D is hypothesized to suppress inflammation, and circulating 25-hydroxyvitamin D (25OHD) and inflammatory markers are inversely correlated. However, total serum 25OHD may not be the best indicator of biologically active vitamin D.Methods
We tested serum total 25OHD, total 1,25(OH)2D, vitamin D binding protein (DBP), and estimated free 25OHD and free 1,25(OH)2D associations with inflammatory markers serum interleukin-6 (IL-6), TNF-α and their soluble receptors, interleukin-10 (IL-10), and C-reactive protein (CRP) as continuous outcomes and the presence of ≥2 inflammatory markers in the highest quartile as a dichotomous outcome, in a random subcohort of 679 men in the Osteoporotic Fractures in Men (MrOS) study.Results
IL-6 was lower in men with higher 25OHD (?0.23 μg/mL per standard deviation (SD) increase in 25OHD, 95 % confidence intervals (CI) ?0.07 to ?0.38 μg/mL) and with higher 1,25(OH)2D (?0.20 μg/mL, 95 % CI ?0.0004 to ?0.39 μg/mL); free D associations were slightly stronger. 25OHD and DBP, but not 1,25(OH)2D, were independently associated with IL-6. TNF-α soluble receptors were inversely associated with 1,25(OH)2D but positively associated with 25OHD, and each had independent effects. The strongest association with ≥2 inflammatory markers in the highest quartile was for free 1,25(OH)2D (odds ratios (OR) 0.70, 95 % CI 0.54 to 0.89 per SD increase in free 1,25(OH)2D).Conclusions
Associations of 1,25(OH)2D and free 25OHD with IL-6 mirrored those of 25OHD, suggesting that 1,25(OH)2D and free D do not improve upon 25OHD in population-based IL-6 studies. However, associations for the two metabolites diverged for TNF-α soluble receptor, warranting examination of both metabolites in studies of TNF-α and its antagonists.7.
Lieke Mitrov-Winkelmolen Marie-Christine W. van Buul-Gast Dingeman J. Swank Hans W P M Overdiek Ron H. N. van Schaik Daan J. Touw 《Obesity surgery》2016,26(9):2051-2058
Background
Data on the absorption of orally administered drugs following Roux-en-Y gastric bypass (RYGB) surgery in obese patients are limited and inconclusive. As it is difficult to predict changes in absorption, studies on frequently used drugs in this population are necessary. Acetylsalicylic acid (ASA) and omeprazole are two commonly prescribed drugs in obese patients.Methods
In this repeated measures study, omeprazole and salicylic acid (SA) serum concentrations were measured before and after RYGB in 34 morbidly obese subjects. Time to maximum concentration (Tmax), lag time (Tlag), maximum concentration (Cmax), and area under the serum concentration versus time curve (AUC) were calculated for both drugs to determine possible differences in drug absorption after the procedure.Results
For SA, Tmax significantly decreased after RYGB, while both Cmax and AUC0–24 significantly increased. For omeprazole, both Tmax and Tlag significantly decreased after RYGB, while Cmax significantly increased. Mean AUC0–12 significantly decreased post-surgery. The difference in AUC0–12 before and after surgery varied between subjects.Conclusions
Our study shows a faster absorption of both ASA and omeprazole after RYGB. The exposure to ASA is higher post-surgery, but the standard dose of 80 mg does not need to be modified, considering its range in effective dose. The exposure to omeprazole is, on average, decreased after surgery. Clinicians should be aware to increase the dose of omeprazole if symptoms suggest inadequate response.8.
Background
Nutritional deficiencies occur after weight loss surgery. Despite knowledge of nutritional risk, there is little uniformity of postoperative vitamin and mineral supplementation. The objective of this study was to evaluate a composite supplement based on the clinical practice guidelines proposed in 2008 regarding vitamin and mineral supplementation after Roux-en-Y gastric bypass. The composite included iron (Fe) and calcium as well.Methods
A retrospective chart review of 309 patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) was evaluated for the development of deficiencies in iron and vitamins A, B1, B12, and D. Patients were instructed to take a custom vitamin and mineral supplement that was based on society-approved guidelines. The clinical practice guidelines were modified to include 1600 international units (IU) of vitamin D3 instead of the recommended 800 IU.Results
The compliant patients’ deficiency rates were significantly lower than those of the noncompliant patients for iron (p?=?0.001), vitamin A (p?=?0.01), vitamin B12 (p?≈?0.02), and vitamin D (p?<?0.0001). Women’s menstrual status did not significantly influence the development of iron deficiency.Conclusions
Use of a composite based on guidelines proposed by the AACE, TOS, and the ASMBS appears to be effective for preventing iron and vitamins A, B1, B12, and D deficiencies in the LRYGB patients during the first postoperative year. Separation of calcium and Fe does not need to be mandatory. Even with simplification, compliance is far from universal.9.
Background
Iron deficiency can occur in patients after Roux-en-y gastric bypass due to altered absorption. Pica, the compulsive craving and intake of non-nutritive substances, is a rare and poorly understood presentation of iron deficiency. To our knowledge, the rate of pica after RYGB has never been reported.Methods
The medical records of patients who underwent laparoscopic RYGB from 2001 to 2011 were reviewed. Patients with pica or other abnormal cravings were identified.Results
Pica was identified in 16/959 (1.7%) patients who underwent RYGB during the study period. The most common presenting sign was pagophagia. All patients with pica were female and had multiple risk factors for iron deficiency with 13/16 being premenopausal and 7/16 non-compliant with oral iron supplementation. Pica symptoms presented at a mean of 3.9 ± 1.9 years after RYGB. Iron deficiency was identified in all 16 patients, with a median ferritin level of 5.0 ng/mL (range 2–27). All 16 patients received intravenous iron and pica symptoms resolved.Conclusions
Pica is a rare phenomenon associated with iron deficiency and can occur despite oral iron supplementation. In our experience, intravenous iron can relieve symptoms. Patients considering bariatric surgery should be counseled on pica. Patients with unusual cravings should be evaluated for iron deficiency.10.
Thomas Datzmann Karl Träger Bernd Schröppel Helmut Reinelt Philipp von Freyberg 《International urology and nephrology》2018,50(6):1143-1149
Introduction
During continuous renal replacement therapy, achievement of recommended treatment dose is important. However, relevant substrate loss may occur and recommended nutrition during critical illness could not be sufficient for higher dialysis doses. We investigated the correlation of dialysis dose and substrate loss for a broad range of dialysis doses.Methods
Forty critically ill patients with acute kidney injury undergoing citrate CVVHD were included in this prospective study. Three different corresponding blood flow (BF) and dialysate flow (DF) rates were applied (BF/DF: 100 ml/min, 2000 ml/h; 80 ml/min, 1500 ml/h; 120 ml/min, 2500 ml/h). Delivered effluent flow rate (DEFR) was calculated and correlated with losses of vitamins, electrolytes, and trace elements during recommended nutritional supplementation.Results
For folic acid, vitamin B12, zinc, inorganic phosphate, and magnesium, no correlation of losses and DEFR was detected. For ionized calcium, a correlation was observed and additional substitution was required.Conclusion
Clinically relevant loss of folic acid, vitamin B12, zinc, inorganic phosphate, and magnesium was not observed for differently used dialysis doses of CVVHD, and the loss was covered sufficiently by daily recommended nutritional supplementation. Increased loss of ionized calcium for higher dialysis doses occurred during citrate CVVHD. Therefore, a strict protocol must maintain calcium homeostasis to avoid calcium depletion.11.
Daniel Berglind Mikaela Willmer Per Tynelius Ata Ghaderi Erik Näslund Finn Rasmussen 《Obesity surgery》2016,26(7):1463-1470
Background
Roux-en-Y gastric bypass (RYGB) patients report significant pre- to post-surgery increases in physical activity (PA). Conversely, objectively assessed PA does not increase after RYGB. The aim of the study was to compare self-reported and accelerometer-measured changes in moderate-to-vigorous PA (MVPA) and exercise from pre- to post-surgery, in women undergoing RYGB.Methods
Forty-three women with an average pre-surgery body mass index of 39.2 kg/m2 (SD 3.1) were recruited at Swedish hospitals. PA was measured by the Actigraph GT3X+ and by a previously validated short PA questionnaire, at home visits 3 months before and 9 months after surgery, thus limiting seasonal effects.Results
Self-reported time spent in exercise increased with 75 % and time spent in MVPA increased with 51 %, whereas accelerometer-assessed time spent in exercise increased with 0.9 % and time spent in MVPA increased with 2.1 %, from before to after surgery. Correlations comparing accelerometers with the questionnaire were 0.35 (P?=?0.02) for MVPA and 0.13 (P?=?0.4) for exercise before RYGB and 0.52 (P?≤?0.001) for MVPA and 0.12 (P?=?0.4) for exercise after RYGB.Conclusions
Pre- to post-RYGB surgery increases in self-reported PA were not confirmed by accelerometer-measured PA. Thus, health care workers should use objective measures of PA in patients undergoing RYGB, in order to assess whether patients achieve sufficient levels of PA.12.
Sabrina Pereira da Cruz Andréa Matos Silvia Pereira Carlos Saboya Suelem Pereira da Cruz Andréa Ramalho 《Obesity surgery》2018,28(1):114-121
Objective
The objectives of this study are to compare the nutritional status of vitamin A in women who previously underwent Roux-en-Y gastric bypass (RYGB) who became pregnant or did not, in the same period after surgery, and to assess its effects on mother and child health.Methodology
A retrospective longitudinal study conducted with women who previously underwent RYGB, paired by age and BMI measured before surgery, divided into group 1 (G1) comprising 77 women who did not become pregnant and group 2 (G2) with 39 women in their third gestational trimester. Both groups were assessed before surgery (T0) and in the same interval after surgery: less than or equal to 1 year (T1) or over 1 year (T2), during a maximum of 2 years. Serum concentrations of retinol and β-carotene, night blindness (NB), and gestational and neonatal complications were investigated [urinary tract infection, iron deficiency anemia, hypertensive syndrome of pregnancy, dumping syndrome, birth weight, gestational age at birth (GAB), and correlation between weight and GAB]. Data were analyzed by the Statistical Package for Social Sciences 21.0 (p < 0.05).Results
RYGB reduced the serum levels of retinol and β-carotene, especially before the first postsurgical year. When associated with pregnancy, inadequacy rate was 55% higher in T1 and T2. Comparing G1 to G2, we noted that pregnancy in women undergoing RYGB can contribute to increased inadequacy of retinol and β-carotene, reaching a higher percentage of women with NB after 1 postsurgical year. High prevalence of pregnancy/neonatal complications was found in T1 and T2. NB was correlated with inadequacy of β-carotene.Conclusion
Pregnancy after RYGB aggravates vitamin A deficiency, increases the percentage of NB cases, and can contribute to pregnancy and neonatal complications even in 1 postsurgical year.13.
Meltem Akcaboy Serdar Kula Tayfun Göktas Bijen Nazlıel Semiha Terlemez Nurullah Celik Bülent Celik Necla Buyan 《Pediatric nephrology (Berlin, Germany)》2016,31(3):473-483
Background
Hypertension (HT) is a major comorbidity of obesity that is associated with an increased risk of cardiovascular disease and higher mortality. The aim of our study was to evaluate cardiac function in obese hypertensive (OHT) and obese normotensive (ONT) pediatric patients and determine the effects of plasma nitric oxide (NOx) values on cardiac function, while demonstrating the role of plasma NOx in HT in obese pediatric patients.Methods
The study population consisted of 62 patients (27 boys, 35 girls), aged 13–18 years and 21 age-matched healthy controls. All subjects enrolled in the study underwent echocardiography (Echo) evaluation and ambulatory blood pressure monitoring for HT. Plasma NOx and biochemical values were studied in both patient groups separately.Results
Plasma NOx levels were found to be lower in the OHT group than in the ONT and control groups (p?<?0.001) and to be negatively correlated with left ventricular mass index values (p?<?0.05). Both the OHT and ONT groups had concentric hypertrophy of the heart.Conclusions
Plasma NOx plays an essential role in obesity-induced HT. Concentric hypertrophy of the left ventricle was found in both the OHT and ONT groups, indicating structural deformation of the heart.14.
S. Gallo T. Hazell C. A. Vanstone S. Agellon G. Jones M. L’Abbé C. Rodd H. A. Weiler 《Osteoporosis international》2016,27(8):2459-2466
Summary
Whether infant vitamin D supplementation may have long-term bone benefits is unclear. In this study, breastfed infants who received vitamin dosages greater than 400 IU/day did not have higher bone mineralization at 3 years. This study provides important data to inform pediatric public health recommendations for vitamin D.Introduction
North American health agencies recommend breastfed infants should be supplemented with 400 IU of vitamin D/day to support bone health. Few studies examined the long-term benefits of early life vitamin D supplementation on bone mineralization. The objective of this study was to determine if a dose-response relationship exists between infant vitamin D supplementation, vitamin D status, and bone outcomes at 3 years of age.Methods
This was a double-blind randomized trial of 132, 1-month-old healthy, breastfed infants from Montréal, Canada, between 2007 and 2010. In this longitudinal analysis, 87 infants (66 %) returned for follow-up at 3 years of age, between 2010 and 2013. At 1 month of age, participants were randomly assigned to receive oral cholecalciferol (vitamin D3) supplements of 400, 800, 1200, or 1600 IU/day until 12 months of age. Lumbar spine vertebrae 1–4 (LS) bone mineral density (BMD), LS and whole body bone mineral content (BMC), and mineral accretion were measured by dual-energy x-ray absorptiometry at 3 years.Results
At follow-up, the treatment groups were similar in terms of diet, sun exposure, and demographics. There were no significant differences among the groups in LS or whole body BMC, BMD, or accretion. Although, 25(OH)D concentrations were not different among the groups, higher doses (1200 and 1600 IU/day) achieved higher 25(OH)D area under the curve from 1 to 36 months vs. 400 IU/day.Conclusions
This is the first longitudinal follow-up of an infant vitamin D dose-response study which examines bone mineralization at 3 years of age. Dosages higher than 400 IU/day do not appear to provide additional benefits to the bone at follow-up. Larger studies with more ethnically diverse groups are needed to confirm these results.15.
Saachi Sachdev Qi Wang Charles Billington John Connett Leaque Ahmed William Inabnet Streamson Chua Sayeed Ikramuddin Judith Korner 《Obesity surgery》2016,26(5):957-965
Background
This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment.Methods
Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n?=?15) or RYGB (n?=?15).Results
Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5?±?0.5) was less than in the IMM group (4.6?±?0.3). After RYGB, FGF19 increased in the fasted (93?±?15 to 152?±?19 pg/ml; P?=?0.008) and postprandial states (area under the curve (AUC), 10.8?±?1.9 to 23.4?±?4.1 pg?×?h/ml?×?103; P?=?0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×103, 6.63?±?1.3 to 15.16?±?2.56 μM?×?h; P?=?0.003) and decreased after IMM (AUC ×103, 8.22?±?1.24 to 5.70?±?0.70; P?=?0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r?=?0.54, P?=?0.04) and trended negatively with HbA1c (r?=??0.44; P?=?0.09); these associations were not observed after IMM.Conclusions
BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.16.
Kaijing Wang Xiaogang Zhou Giang Quach Jiajun Lu Wei Gao Anan Xu Jiangfan Zhu 《Obesity surgery》2016,26(4):797-804
Background
Sleeve gastrectomy plus side-to-side jejunoileal anastomosis (JI-SG), a relatively new approach to bariatric surgeries, has shown promising results for treating obesity and metabolic comorbidities. This study investigated the feasibility and safety of JI-SG in weight loss and diabetes remission compared with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).Methods
Forty 10-week-old male Zucker diabetic fatty rats were randomly assigned to four groups: control, SG, JI-SG, and RYGB. Their body weights, food intake, and levels of gut hormones (ghrelin, insulin, and glucagon-like peptide-1 (GLP-1)) and lipids were measured.Results
Rats in the SG, JI-SG, and RYGB groups demonstrated lower food intake and more weight loss 2 weeks postoperatively compared with control rats. Furthermore, rats in the JI-SG group achieved more weight loss (mean 242.7?±?11.2 g) compared with those in the SG and RYGB groups (SG, 401.4?±?15.1 g and RYGB, 298?±?12 g, both P?<?0.01). All surgery groups demonstrated a decreased fasting insulin, serum glucose, lipid levels, and increased GLP-1 postoperatively. The JI-SG group had lower fasting ghrelin levels than the RYGB group (168?±?19.8 ng/L vs. 182?±?16.7 ng/L, P?<?0.01) and higher fasting GLP-1 levels than the SG group (1.99?±?0.11 pmol/L vs. 1.71?±?0.12 pmol/L, P?<?0.01) at 12 weeks postoperatively. Over the experimental period, the ghrelin levels slowly increased in all surgical groups but remained lower than the preoperative and control levels.Conclusions
JI-SG induced higher ghrelin and GLP-1 levels and improved glycemic control in Zucker diabetic fatty rats. Compared with SG and RYGB, JI-SG appeared to be a simple, relatively safe, and more effective procedure for treating type 2 diabetes and obesity in this animal model.17.
Rebekah Forbes Danijela Gasevic Emily M. Watson Thomas R. Ziegler Edward Lin John R. Burgess Nana Gletsu-Miller 《Obesity surgery》2016,26(6):1237-1246
Background
Although patients experience hair loss and dry skin which may be attributable to deficiency in essential fatty acids (EFAs), the impact of bariatric surgeries on EFA status is unknown.Methods
This study aimed to assess plasma phospholipid fatty acid profiles following adjustable gastric banding (AGB), which restricts dietary fat intake, versus Roux-en-Y gastric bypass (RYGB), which also promotes fat malabsorption. Serial measures were obtained before and 1 and 6 months from women undergoing RYGB (N?=?13) and AGB (N?=?5). Measures included the composition of plasma fatty acids in phospholipids, dietary intake, and body fat mass. Friedman and Mann–Whitney tests were used to assess differences over time and between groups, respectively, p?<?0.05.Results
Dietary intake of fats decreased equally at 1 and 6 months following RYGB and AGB. By 6 months, the RYGB group lost more body fat. There were no remarkable changes in EFA in plasma phospholipids following AGB. However, following RYGB, a transient increase in 20:4N6 (+18 %) and a decrease in 20:3N6 at 1 (?47 %) and 6 months (?47 %) were observed. Similar changes were observed in N3 fatty acids following RYGB, including a transient increase in 22:6N3 (+11 %) and decreases in 20:5N3 (?79 and ?67 % at 1 and 6 months, respectively). EFA status improved following surgery in the RYGB group.Conclusions
We demonstrate alterations in plasma EFA following RYGB. The status of EFA improved, but the decrease in 20:5N3, the precursor for anti-inflammatory eicosanoids, may be a concern.18.
Ramen Goel Madhu Goel Amrit Manik Nasta Sharmila Vyas Shefali Dharia Shireen Hamrapurkar 《Obesity surgery》2018,28(12):3738-3743
Introduction
Bariatric surgery leads to significant weight loss but the results vary. Application of dietary principles like portion-controlled eating leads to greater weight loss and fewer complications.Aims
To evaluate the improvement in weight loss outcomes by incorporating portion-controlled eating behavior in postbariatric patients.Methods
All patients who underwent bariatric surgery from January 2012 to December 2013 were included in the study. Portion-controlled eating behavior was incorporated in the post-bariatric nutritional protocol. Their demographic, preoperative, and postoperative data were prospectively maintained on Microsoft Office Excel and analyzed statistically.Results
Three hundred and seventy-two (89.6%) underwent laparoscopic sleeve gastrectomy (LSG), while 43 (10.4%) underwent laparoscopic Roux-en-Y gastric bypass (RYGB). In the LSG group, lowest (nadir) BMI was 28.99?±?5.6 kg/m2 and % Excess weight loss (EWL) was 87.3?±?27.2%, achieved between 1 and 2 years. In the RYGB group, lowest (nadir) BMI was 27.5?±?12.09 kg/m and % EWL was 94.32?±?33.12%. Surgical failure (less than 50% EWL) were 10 (3.27%) in the LSG group and 1 (3%) in the RYGB group. There were no leaks reported in our study.Conclusion
Our study highlights the importance of postoperative nutritional interventions like portion-controlled eating for successful bariatric outcome.19.
Background
By treating obesity, one of the major epidemics of this past century, through bariatric surgery, we may cause complications due to malnourishment in a growing population. At present, vitamin D deficiency is of interest, especially in patients with inferior absorption of fat-soluble nutrients after biliopancreatic diversion with duodenal switch (BPD/DS).Methods
Twenty BPD/DS patients, approximately 4 years postoperatively, were randomized to either intramuscular supplementation of vitamin D with a single dose of 600,000 IU cholecalciferol, or a control group. Patients were instructed to limit their supplementation to 1400 IU of vitamin D and to avoid the influence of UV-B radiation; the study was conducted when sunlight is limited (December to May).Results
Despite oral supplementation, a pronounced deficiency in vitamin D was seen (injection 19.3; control 23.2 nmol/l) in both groups. The cholecalciferol injection resulted in elevated 25[OH]D levels at 1 month (65.4 nmol/l), which was maintained at 6 months (67.4 nmol/l). This resulted in normalization of intact parathyroid hormone (PTH) levels. No changes in vitamin D or PTH occurred in the control group.Conclusions
In BPD/DS patients, having hypovitaminosis D despite full oral supplementation, a single injection of 600,000 IU of cholecalciferol was effective in elevating vitamin D levels and normalizing levels of intact PTH. The treatment is simple and highly effective and thus recommended, especially in cases of reduced UV-B radiation.20.
Anália S. Barhouch Alexandre V. Padoin Daniela S. Casagrande Raquel Chatkin Samanta P. Süssenbach Milene A. Pufal Carina Rossoni Cláudio C. Mottin 《Obesity surgery》2016,26(6):1178-1185