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- Abdelhafez, A. H. K., et al.
(author)
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Impact of Abdominal Subcutaneous Fat Reduction on Glycemic Control in Obese Patients with Type 2 Diabetes Mellitus
- 2018
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In: Bariatric Surgical Practice and Patient Care. - : Mary Ann Liebert Inc. - 2168-023X .- 2168-0248. ; 13:1, s. 25-32
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Journal article (peer-reviewed)abstract
- Background: The effect on type 2 diabetes mellitus (T2DM) when adipose tissue is removed is controversial. This study aimed to evaluate and compare the effect of the abdominoplasty and bariatric surgery on glycemic control in patients with T2DM. Methods: Patients with T2DM undergoing abdominoplasty for cosmesis were studied (n=25). Subjects were 36.91.3 years with a preoperative body mass index (BMI) of 40.60.5kg/m(2) and mean glycated hemoglobin (HbA1c) of 7.4%+/- 0.2%. Fifteen matched patients undergoing bariatric surgery were selected as a comparator group. Weight, BMI, waist circumference (WC), random blood glucose (RBG), and HbA1c were evaluated at baseline and 3, 6, and 12 months postsurgery. Results: By 12 months, abdominoplasty reduced weight by 5.6 +/- 0.3kg p<0.01), and HbA1c was reduced to 6.8%+/- 0.3% (p<0.01). After 12 months, bariatric surgery reduced BMI from 42.2 +/- 1kg/m(2) to 26.6 +/- 0.4kg/m(2) (p<0.01). HbA1c reduced from 7.9%+/- 0.4% to 5.5%+/- 0.2% (p<0.01). WC was similar between both groups at 3 months, although HbA1c reductions were superior after bariatric surgery. Conclusions: Reducing subcutaneous adipose tissue with abdominoplasty results in a small improvement in glycemic control in patients with T2DM. Despite equivalent WC at 3 months, bariatric surgery outperformed abdominoplasty on all metabolic parameters then and thereafter.
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| 2. |
- Al-Najim, W., et al.
(author)
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Integrated insights into the role of alpha-melanocyte stimulatory hormone in the control of food intake and glycaemia
- 2018
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In: Peptides. - : Elsevier BV. - 0196-9781. ; 100, s. 243-248
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Journal article (peer-reviewed)abstract
- Identifying peptide hormones with multipotent actions on both weight and glycaemia can have a significant impact on therapeutic options in the treatment of obesity and diabetes. This has been exemplified by recent advances involving pharmacological exploitation of glucagon-like peptide 1 biology. Herein, we summarise evidence supporting the potential candidacy in this light of alpha-melanocyte stimulatory hormone, an endogenous peptide hormone and a breakdown product of the neuropeptide pro-opiomelanocortin. We reference its well described central actions in the control of food intake and moreover highlight new data pointing to an important role for this peptide hormone in the periphery, in relation to glycaemic control.
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| 3. |
- Chuah, L. L., et al.
(author)
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Measurement of glomerular filtration rate in patients undergoing obesity surgery
- 2018
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In: Bmc Nephrology. - : Springer Science and Business Media LLC. - 1471-2369. ; 19
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Journal article (peer-reviewed)abstract
- BackgroundMost studies on obesity surgery have measured renal function using the estimated GFR. However, due to the reduction of muscle mass, and therefore creatinine that accompanies weight loss, such measures can falsely suggest an improvement in renal function. To balance the risks of surgery versus any potential benefits on renal function, we need to be able to determine renal function using valid and reliable methodologies. In this pilot study we aimed to measure renal function in patients with CKD undergoing obesity surgery using the gold standard Cr-51-EDTA GFR clearance methodology which is independent of measures of muscle mass.MethodsNine consecutive obese patients with CKD underwent obesity surgery. Their renal function was assessed using Cr-51-EDTA GFR, cystatin C and serum creatinine as well as using eGFR equations including MDRD CKD Epi, Cockcroft Gault and CKD Epi cystatin before and 12months after surgery.ResultsRenal function using the Cr-51-EDTA measured GFR did not change significantly after surgery. Similar results were obtained when Cystatin C, CKD Epi cystatin, CKD Epi cystatin creatinine and adjusted Cockcroft Gault Creatinine clearance methods were used. In contrast there were either trends or significant improvements in renal function measured using the MDRD and CKD Epi equations.ConclusionsIn this pilot study using the gold standard Cr-51-EDTA method we found stabilisation in renal function after obesity surgery. Until further definitive data emerge it is critical to balance the risk and benefits of surgery, especially if renal function may not improve as often as previously suggested.
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| 4. |
- Holland, J. A., et al.
(author)
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Impact of intentional weight loss on diabetic kidney disease
- 2019
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In: Diabetes Obesity & Metabolism. - : Wiley. - 1462-8902 .- 1463-1326. ; 21:10, s. 2338-2341
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Journal article (peer-reviewed)abstract
- Type 2 diabetes mellitus (T2DM) and obesity constitute interwoven pandemics challenging healthcare systems in developed countries, where diabetic kidney disease (DKD) is the most common cause of end-stage renal disease. Obesity accelerates renal functional decline in people with T2DM. Intentional weight loss (IWL) strategies in this population hold promise as a means of arresting DKD progression. In the present paper, we summarize the impact of IWL strategies (stratified by lifestyle intervention, medications, and metabolic surgery) on renal outcomes in obese people with DKD. We reviewed the Medline, EMBASE and Cochrane databases for relevant randomized control trials and observational studies published between August 1, 2018 and April 15, 2019. We found that IWL improves renal outcomes in the setting of DKD and obesity. Rate of progression of DKD slows with IWL, but varying outcome measures among studies makes direct comparison difficult. Furthermore, established means of estimating renal function are imperfect owing to loss of lean muscle mass with IWL strategies. The choice of optimal IWL strategy needs to be individualized; future work should establish the comparative efficacy of IWL strategies in obese people with DKD to better inform such decisions.
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| 5. |
- Kapoor, N., et al.
(author)
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Shifts in Food Preferences After Bariatric Surgery: Observational Reports and Proposed Mechanisms
- 2017
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In: Current Obesity Reports. - : Springer Science and Business Media LLC. - 2162-4968. ; 6:3, s. 246-252
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Journal article (peer-reviewed)abstract
- Bariatric surgery is currently the most effective treatment for obesity. Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure and results in long-term weight loss. Alterations in food preference and choices may contribute to the long-term benefits of RYGB. This manuscript reviews the available literature documenting changes in food preference in both humans and experimental animals after RYGB and discusses the current theory on the underlying mechanisms involved. Obesity is associated with an increased preference for sweet and high-fat foods, and the most consistent evidence has been the shift away from these calorie-dense foods in both animal and human studies after RYGB. Self-reporting is the most common method used to record food preferences in humans, while more direct approaches have been used in animal work. This methodological heterogeneity may give rise to inconsistent findings. Future studies in humans should focus on direct measures to permit corroboration of mechanistic insights gained from animal studies.
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| 6. |
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| 7. |
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| 8. |
- Abdeen, G., et al.
(author)
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Mechanism Underlying the Weight Loss and Complications of Roux-en-Y Gastric Bypass. Review
- 2016
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In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 26:2, s. 410-421
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Research review (peer-reviewed)abstract
- Various bariatric surgical procedures are effective at improving health in patients with obesity associated co-morbidities, but the aim of this review is to specifically describe the mechanisms through which Roux-en-Y gastric bypass (RYGB) surgery enables weight loss for obese patients using observations from both human and animal studies. Perhaps most but not all clinicians would agree that the beneficial effects outweigh the harm of RYGB; however, the mechanisms for both the beneficial and deleterious (for example postprandial hypoglycaemia, vitamin deficiency and bone loss) effects are ill understood. The exaggerated release of the satiety gut hormones, such as GLP-1 and PYY, with their central and peripheral effects on food intake has given new insight into the physiological changes that happen after surgery. The initial enthusiasm after the discovery of the role of the gut hormones following RYGB may need to be tempered as the magnitude of the effects of these hormonal responses on weight loss may have been overestimated. The physiological changes after RYGB are unlikely to be due to a single hormone, or single mechanism, but most likely involve complex gut-brain signalling. Understanding the mechanisms involved with the beneficial and deleterious effects of RYGB will speed up the development of effective, cheaper and safer surgical and non-surgical treatments for obesity.
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| 9. |
- Abdeen, G. N., et al.
(author)
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Sugar Detection Threshold After Laparoscopic Sleeve Gastrectomy in Adolescents
- 2018
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In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 28:5, s. 1302-1307
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Journal article (peer-reviewed)abstract
- Obesity in young people is one of the most serious public health problems worldwide. Moreover, the mechanisms preventing obese adolescents from losing and maintaining weight loss have been elusive. Laparoscopic sleeve gastrectomy (LSG) is successful at achieving long-term weight loss in patients across all age groups, including children and adolescents. Anecdotal clinical observation as well as evidence in rodents suggests that LSG induces a shift in preference of sugary foods. However, it is not known whether this shift is due to a change in the threshold for gustatory detection of sucrose, or whether LSG induces behavioral change without affecting the gustatory threshold for sugar. The objective of this study was to determine whether adolescents who undergo LSG experience a change in their threshold for detecting sweet taste. We studied the sucrose detection threshold of 14 obese adolescents (age 15.3 +/- 0.5 years, range 12-18) who underwent LSG 2 weeks before surgery and at 12 and 52 weeks after surgery. Matched non-surgical subjects were tested on two occasions 12 weeks apart to control for potential learning of the test that may have confounded the results. Seven sucrose concentrations were used and were tested in eight blocks with each block consisting of a random seven sucrose and seven water stimuli. The subjects were asked to report whether the sample contained water or not after they tasted 15 ml of the fluid for 10 s. The bodyweight of the LSG group decreased from 136.7 +/- 5.4 to 109.6 +/- 5.1 and 86.5 +/- 4.0 kg after 12 and 52 weeks, respectively (p < 0.001). There was no significant difference after surgery in taste detection threshold of patients after LSG (p = 0.60), and no difference was observed comparing the taste detection threshold of the LSG group with the non-surgical controls (p = 0.38). LSG did not affect the taste detection threshold for sucrose, suggesting that the shift in preference for sugary foods may be due to factors other than fundamental changes in taste sensitivity.
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| 10. |
- Abdeen, G. N., et al.
(author)
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Vertical sleeve gastrectomy in adolescents reduces the appetitive reward value of a sweet and fatty reinforcer in a progressive ratio task
- 2019
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In: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 15:2, s. 194-199
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Journal article (peer-reviewed)abstract
- Background: Adolescent obesity is challenging to treat even if good multidisciplinary approaches are started early. Vertical sleeve gastrectomy (VSG) is an effective intervention for long-term weight loss, but the underlying mechanisms that result in reduced calorie intake are controversial. Anecdotal evidence from the clinic and evidence in rodents after VSG suggest a decrease in the reward value of high-calorie dense foods. Objectives: To determine changes in appetitive behavior of candies (high in sugar and fat) after VSG in adolescents with obesity. Setting: University hospital. Methods: Sixteen adolescents with obesity (age 15.3 ±.5 yr) who had VSG and 10 control patients (age 13.8 ±.6 yr) who had not undergone surgery were studied. Both groups completed a progressive ratio task by clicking a computer mouse on a progressive ratio schedule to receive a candy high in sugar and fat. In the task, patients were required to expend an increasing amount of effort to obtain the reinforcer until they reach a breakpoint (measure of the reward value of the reinforcer). The task was performed before VSG and 12 and 52 weeks after VSG. Results: The VSG group's bodyweight decreased from the baseline 136.6 ± 5.1 to 110.9 ± 5.2 to 87.4 ± 3.7 kg after 12 and 52 weeks, respectively (P <.001). The median breakpoint for candies decreased after VSG from the baseline 320 (160–640) to 80 (50–320) to 160 (80–560) after 12 and 52 weeks, respectively (P =.01). Breakpoints for the control patients did not change (480 [160–640] versus 640 [280–640], P =.17). Conclusion: VSG resulted in a reduction in the reward value of a candy, as suggested by the reduced amount of effort adolescents were prepared to expend to obtain the high-sugar and high-fat candy. The effect was most pronounced 12 weeks after surgery but was largely maintained at 1 year. Long-term attenuation of appetitive behavior may be the key to weight loss and weight loss maintenance after VSG in adolescents. © 2018
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