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da Silva DS, da Silva TS, Leal PRF, Lopes KG, Kraemer-Aguiar LG. Early Changes in Eating Behavior Patterns and Their Relationship with Weight Outcomes in Patients Undergoing Bariatric Surgery. Nutrients 2024; 16:3868. [PMID: 39599654 PMCID: PMC11597042 DOI: 10.3390/nu16223868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 11/11/2024] [Accepted: 11/11/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND/OBJECTIVE Eating behaviors (EB) correlate with weight loss after bariatric surgery (BS). Therefore, the investigation of EB could guide interventions to prevent insufficient weight outcomes. METHOD A prospective cohort of 85 patients undergoing Roux-en-Y Gastric Bypass (RYGB; 84.7% female, mean age 44.7 ± 9.3 years) was included. Six months after undergoing RYGB, EB patterns, including cognitive restraint (CR), uncontrolled (UE), and emotional eating (EE), were assessed using the Three-Factor Eating Questionnaire R21 (TFEQ-R21). History, physical examination, and anthropometric assessments were collected pre- and 12 months postoperative. Patients were divided based on the percentage of excess weight loss (%EWL < 80% or ≥80%) and EB patterns were correlated with weight outcomes at 12 months. RESULTS The %EWL ≥ 80% group demonstrated significantly higher scores in CR and EE compared to %EWL < 80% (p < 0.001 and p = 0.01, respectively). UE scores were similar between groups (p = 0.41). At 12 months postoperative, the %EWL ≥ 80% group had negative correlations between CR and BMI and positive correlations between CR and EWL (rho = -0.33 and rho = 0.29; p = 0.04). Multiple logistic regression considering %EWL ≥ 80% as the aim outcome revealed that CR had a significant influence (OR = 1.037; p = 0.058), while age (OR = 0.962; p = 0.145), sex (OR = 2.984; p = 0.135), UE (OR = 0.995; p = 0.736), and EE (OR = 1.017; p = 0.296) did not. CONCLUSIONS EBs influence outcomes after BS, and a model using TFEQ-R21 predicted them. CR six months post-surgery was the strongest predictor of higher EWL at 12 months. Further research is needed to understand the relationship between restrictive EB and BS outcomes, possibly identifying strategies to prevent disordered EB in patients with higher scores.
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Affiliation(s)
- Daniel Sant’Anna da Silva
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
| | - Thiago Sant’Anna da Silva
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
| | - Paulo Roberto Falcão Leal
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
- General Surgery Department, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
| | - Karynne Grutter Lopes
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Postgraduate Program in Clinical and Experimental Physiopathology (FISCLINEX), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil; (D.S.d.S.); (T.S.d.S.); (P.R.F.L.); (K.G.L.)
- Obesity Unit, Multiuser Clinical Research Center (CePeM), Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
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Hoyt T, Walter FA, Michl TM. Psychological Profiles and 12-Month Weight Outcomes of Women Evaluated for Reoperative Bariatric Surgery. Obes Surg 2023:10.1007/s11695-023-06583-6. [PMID: 37061626 DOI: 10.1007/s11695-023-06583-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The use of psychological screening instruments prior to bariatric surgery has been well established. However, there is currently no specific literature on psychological screening of candidates for reoperative bariatric surgery. METHODS This study evaluated archival data for 40 women who were candidates for reoperative bariatric surgery and completed the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Profile analysis examined differences between patient groups who did and did not undergo reoperative surgery. MMPI-2-RF profiles for reoperative patients then were compared to previous samples of preoperative and postoperative patients. Hierarchical linear modeling was used to predict BMI following reoperative surgery over a 12-month period based on MMPI-2-RF scales while controlling for age and initial BMI. RESULTS Profile analysis results showed no significant differences on MMPI-2-RF scale scores between reoperative candidates who did and did not undergo a second surgery. With some minor differences attributed to minimization of symptoms, there were no systematic differences in MMPI-2-RF scale scores for reoperative surgery patients compared to preoperative and postoperative patient groups. BMI outcomes over a 12-month period showed that age and initial BMI were significantly better predictors than MMPI-2-RF scores. CONCLUSIONS Administration of MMPI-2-RF for reoperative bariatric surgery patients likely is equivalent to its typical use in preoperative screening. Only the MMPI-2-RF Disconstraint scale showed any relationship to BMI outcomes over time following reoperative surgery.
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Affiliation(s)
- Tim Hoyt
- Madigan Army Medical Center, 9040 Fitzsimmons Dr, Tacoma, WA, 98431, USA.
- Office of Force Resiliency, 4000 Defense Pentagon, Washington, DC, 20301-4000, USA.
| | - Fawn A Walter
- Madigan Army Medical Center, 9040 Fitzsimmons Dr, Tacoma, WA, 98431, USA
| | - Tegan M Michl
- Madigan Army Medical Center, 9040 Fitzsimmons Dr, Tacoma, WA, 98431, USA
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Low resilience in severe obesity: marker of adverse childhood experiences and current psychological disorders. Eat Weight Disord 2022; 27:3507-3519. [PMID: 36209466 DOI: 10.1007/s40519-022-01488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/25/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Psychological disorders, early-age psychological traumas and eating disorders may contribute to the development of severe obesity in vulnerable individuals. Resilience may serve a protective role against binge eating disorder or depression. The current study aimed to investigate the relationship between adverse childhood experiences (ACE), resilience, and current psychological disorders. It also examined whether resilience plays a protective role in this pathway in a cohort of patients seeking bariatric surgery. METHODS Two hundred patients (153 women, 47 men) with severe obesity scheduled for bariatric surgery at the CHRU Nancy were included between September 2016 and April 2017. Participants completed the Resilience Scale for Adults (RSA) questionnaire and underwent a structured interview on ACE and current psychological disorders. RESULTS Mean total RSA score was 5.16 ± 0.87. The most frequent ACE were emotional neglect (90.5%) and emotional abuse (61%); 96% reported at least one ACE; 67% presented at least one current psychological disorder, the most frequent being anxiety (36%) and BED (35%). The number of psychological disorders, cumulative ACE and age explained 19.5% of the variance in total RSA score (p < 0.0001; adjusted R2 = 0.19). The association of cumulative ACE and number of psychological disorders was mediated by resilience. CONCLUSION Our findings suggest that resilience is a relevant component of the psychosocial phenotype of severe obesity in bariatric surgery candidates. Resilience seems to play a partly mediation role in the relationship between ACE and psychological disorders. Low resilience becomes a marker that underscores the necessity to examine in greater depth ACE and psychological disorders. LEVEL OF EVIDENCE Level III, cohort analytic study.
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Bulajic M, Vadalà di Prampero SF, Boškoski I, Costamagna G. Endoscopic therapy of weight regain after bariatric surgery. World J Gastrointest Surg 2021; 13:1584-1596. [PMID: 35070065 PMCID: PMC8727177 DOI: 10.4240/wjgs.v13.i12.1584] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/14/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective, safe, less invasive and even reproducible treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery. Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.
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Affiliation(s)
- Milutin Bulajic
- Department of Gastroenterology and Digestive Endoscopy, Mater Olbia Hospital, Olbia 07026, Italy
| | | | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
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Pacheco D, Izaola O, Primo D, de Luis D. Allele a of the rs16147 variant of neuropeptide Y predicts early metabolic improvements after bariatric surgery with biliopancreatic diversion in morbid obese subjects. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Yeo D, Toh A, Yeo C, Low G, Yeo JZ, Aung MO, Rao J, Kaushal S. The impact of impulsivity on weight loss after bariatric surgery: a systematic review. Eat Weight Disord 2021; 26:425-438. [PMID: 32232777 DOI: 10.1007/s40519-020-00890-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Impulsivity has been shown to be associated with obesity through links to pathological eating behavior such as binge eating. The recent literature suggests that impulsivity is linked to poorer outcomes post-bariatric surgery. Impulsivity can be measured in various ways and comprises of three broad domains: impulsive choice, impulsive action, and impulsive personality traits. The aim of this systematic review is to synthesize the current evidence on the impact of impulsivity on post-bariatric surgery weight loss. METHODS A literature review was performed in February 2020. Original studies investigating the relationship between impulsivity and weight loss post-bariatric surgery were evaluated. RESULTS Ten studies with a total of 1246 patients were analyzed. There were four case-control, four prospective observational and two retrospective observational studies. The postoperative follow-up ranged from 0.5 to 12 years. Eight studies measuring trait impulsivity did not show any association with weight loss post-bariatric surgery, although two studies reported an indirect effect of impulsivity on weight loss mediated via pathological eating behavior. Assessment of impulsive action by two studies showed that post-bariatric surgery weight loss is affected by impulsive action. CONCLUSION Impulsivity may adversely affect postoperative outcomes after bariatric surgery. However, this may be specific to state impulsivity or impulsive action rather than trait impulsivity. Patients with a higher state impulsivity may benefit from closer follow-up post-bariatric surgery, as well as cognitive behavioral therapies targeting cognitive control over food. LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- D Yeo
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - A Toh
- Department of Psychology, Tan Tock Seng Hospital, Singapore, Singapore
| | - C Yeo
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - G Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J Z Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - M O Aung
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - J Rao
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - S Kaushal
- Department of General Surgery, Tan Tock Seng Hospital, Jalan Tan Tock Seng, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Konings G, Drukker M, Mulkens S, Severeijns R, van Os J, Ponds R. Postsurgical Compliance and Eating Behavior 5 Years After Surgery. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gerdy Konings
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Sandra Mulkens
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
- Department of Clinical Psychological Science, Section on Eating Disorders and Obesity, Maastricht University, Maastricht, The Netherlands
| | - Ruud Severeijns
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
- Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, United Kingdom
| | - Rudolf Ponds
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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Peterhänsel C, Nagl M, Wagner B, Dietrich A, Kersting A. Childhood maltreatment in bariatric patients and its association with postoperative weight, depressive, and eating disorder symptoms. Eat Weight Disord 2020; 25:999-1010. [PMID: 31154633 DOI: 10.1007/s40519-019-00720-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/23/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The present study aimed to compare prevalence rates of childhood maltreatment between patients with severe obesity undergoing bariatric surgery and patients without a surgical procedure. Second purpose was to calculate the association between childhood maltreatment and outcomes 6 and 12 months after a bariatric procedure. METHODS Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ) and compared between 120 bariatric surgery patients and 346 non-surgery patients with severe obesity. For the bariatric surgery subgroup, linear mixed models with repeated measures were used to analyze the predictive value of childhood maltreatment on weight outcomes and psychopathology. Additionally, between- and within-group comparisons were calculated to compare patients with and without childhood maltreatment regarding BMI and weight loss (%TWL, %EWL), depression severity (BDI-II), eating disorder psychopathology (EDE-Q), and suicidal ideation (BSS), at baseline, 6- and 12-month assessment. RESULTS Prevalence rates for childhood maltreatment, depression and suicidal ideation were significantly higher in non-surgery compared to bariatric surgery patients. Within the surgery group, no significant interaction effect between childhood maltreatment and time was found. Hence, childhood maltreatment did not impact the course of body weight, depression and eating disorder psychopathology from pre- to post-surgery. CONCLUSIONS Significantly higher rates of childhood maltreatment were found within non-surgery patients with obesity in comparison to bariatric surgery patients. Childhood maltreatment did not predict poorer outcomes after surgery. Since history of childhood maltreatment may increase the risk for psychological disturbances, regular screening and, if necessary, psychological support should be offered to both groups. LEVEL OF EVIDENCE Evidence obtained from well-designed cohort or case-control analytic studies, Level III. CLINICAL TRIAL REGISTRATION Deutsches Register Klinischer Studien-German Clinical Trials Register: DRKS00003976.
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Affiliation(s)
- C Peterhänsel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany.
| | - M Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - B Wagner
- MSB Medical School Berlin, Calandrellistraße 1 - 9, 12247, Berlin, Germany
| | - A Dietrich
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
- Department of Surgery, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - A Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Leipzig University Medical Center, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
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de Luis DA, Calvo SG, Pacheco D, Ovalle HF, Aller R. Adiponectin gene variant RS rs266729: Relation to lipid profile changes and circulating adiponectin after bariatric surgery. Surg Obes Relat Dis 2018; 14:1402-1408. [PMID: 30037702 DOI: 10.1016/j.soard.2018.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND ADIPOQ rs266729 have been associated with body mass index and metabolic parameters. OBJECTIVES Our aim was to assess the contribution of this genetic variant on lipid profile and serum adiponectin levels after biliopancreatic diversion surgery in morbidly obese patients in a 3-year prospective study. SETTING Tertiary Hospital. METHODS A prospective cohort study (sample) of 149 patients with morbid obesity was evaluated. Biochemical and anthropometric parameters were studied at baseline and every year for a 3-year-follow-up period. RESULTS Percentage of excess weight loss (65.9% versus 66.0%:ns), body mass index, weight, waist circumference, fat mass, blood pressure, fasting glucose, low-density lipoprotein cholesterol, total cholesterol, insulin, homeostasis model assessment of insulin resistance, and triglyceride levels improved in both genotype groups. A decrease in fasting insulin levels, homeostasis model assessment of insulin resistance, total cholesterol, low-density lipoprotein cholesterol, and triglycerides was higher in non-G-allele carriers than G-allele carriers. The increase of adiponectin levels (at 1 yr) found after 1 (delta: 16.2 ± 3.1 ng/mL versus 2.1 ± 1.0 ng/mL; P = .02), 2 (delta: 24.2 ± 3.1 ng/mL versus 3.1 ± 1.1 ng/mL; P = .02), and 3 years (delta: 33.2 ± 3.9 ng/mL versus 4.7 ± 1.8 ng/mL; P = .01) was higher in non-G-allele carriers than G carriers. At all times, adiponectin levels were higher in patients with genotype CC. CONCLUSIONS Non-G allele of ADIPOQ gene variant (rs266729) is associated with increases in adiponectin levels and better improvement of low-density lipoprotein cholesterol, triglycerides, insulin, and homeostasis model assessment of insulin resistance after biliopancreatic diversion massive weight loss than G-allele carriers.
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Affiliation(s)
- Daniel Antonio de Luis
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Department Surgery Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Susana García Calvo
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Department Surgery Hospital Universitario Rio Hortega, Valladolid, Spain
| | - David Pacheco
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Department Surgery Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Hilda Fernandez Ovalle
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Department Surgery Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Rocio Aller
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Department Surgery Hospital Universitario Rio Hortega, Valladolid, Spain.
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Changes in Outcomes, Satiety and Adverse Upper Gastrointestinal Symptoms Following Laparoscopic Adjustable Gastric Banding. Obes Surg 2017; 27:1240-1249. [PMID: 27822766 DOI: 10.1007/s11695-016-2434-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patient-reported outcomes and perceptions are critical to the overall efficacy and acceptability of a surgical procedure. Outcomes, such as patient satisfaction and perceived success of the surgery and adverse symptoms, have not been described in detail following bariatric surgery. The associations and predictors of patient satisfaction have not been defined. This study aimed to examine long-term outcomes and perceptions after laparoscopic adjustable gastric banding (LAGB). METHODS We conducted a prospective study of outcomes, satiety and adverse upper gastrointestinal symptoms, as well as quality of life and subjective patient satisfaction in LAGB patients. Data were collected at 3 years (T1) and 8 years post-operatively (T2). RESULTS One-hundred and sixty patients completed follow-up at T1 and T2. The average age was 44.0 ± 11.2 years. At T2, the total body weight loss was 17.8 ± 11.9 %. Satisfaction decreased significantly between time points (8.6 ± 1.8 vs 7.2 ± 2.9, p < 0.01), and quality of life reduced slightly across all domains. Hunger scores remained low (3.8 ± 1.8 vs 3.9 ± 1.8, p = 0.61). The dysphagia score did not change significantly (p = 0.54). There was minimal change in frequency of regurgitation, although there was significant increase in patient assessment of how bothered they were by regurgitation. Multivariate analysis identified increased awareness of regurgitation as a principal driver of reduced satisfaction. CONCLUSIONS Weight loss, satiety and adverse symptoms demonstrated only slight changes between 3 and 8 years post-operatively. Despite this, overall satisfaction and perception of success of the procedure reduced markedly. This appeared mediated by reduced tolerance of adverse symptoms. These data inform follow-up practises aimed at optimizing outcomes.
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Vitolo E, Santini E, Seghieri M, Giannini L, Coppedè F, Rossi C, Dardano A, Solini A. Heterozygosity for the rs696217 SNP in the Preproghrelin Gene Predicts Weight Loss After Bariatric Surgery in Severely Obese Individuals. Obes Surg 2017; 27:961-967. [PMID: 27681093 DOI: 10.1007/s11695-016-2387-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several patients encompass a scarce weight loss after Roux-en-Y gastric bypass (RYGB). As such event is not related to surgical complications, finding markers able to identify "well responders" and to predict weight loss outcome is clinically relevant. Ghrelin regulates appetite and energy balance. Common single nucleotide polymorphisms (SNPs) in its encoding genes have been associated with body weight regulation. Other peptides involved in satiety modulation, like the CD40/CD40L complex, are less explored. METHODS One hundred, otherwise healthy, obese subjects (aged 45 ± 11 years, 65 females, BMI 48.0 ± 0.7 kg/m2) were sequentially enrolled in years 2014-2015. SNPs rs2241766 for adiponectin gene, rs490683 for ghrelin receptor, rs696217 and rs27647 for the preproghrelin/ghrelin gene, and rs1126535 for the CD40L gene were determined on DNA extracted from circulating lymphomonocytes. Patients were reevaluated at 6 (n = 100), 26 (n = 91), and 52 weeks (n = 79) after RYGB. RESULTS Subjects carrying the rs696217 T allele encompassed a significantly greater reduction in BMI 52 weeks after surgery (GG vs GT 30.5 ± 1.1 vs 38.1 ± 2.1 %; p < 0.001). Carrying the rs1126535 C allele in the CD40L gene was associated with a significantly lower BMI reduction at week 52 (TT vs CT 33.2 ± 1.1 vs 28.1 ± 2.3 %, p = 0.049). rs490683 and rs27647 SNPs of ghrelin and rs2241766 for adiponectin gene did not show any difference between carriers and non-carriers of the mutant allele. CONCLUSION Carrying a G to T substitution in rs696217 (preproghrelin gene) seems to mark a successful weight loss outcome; we also report for the first time that the rs1126535 C allele (CD40L gene) may predict a worse response to bariatric surgery.
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Affiliation(s)
- Edoardo Vitolo
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy
| | - Eleonora Santini
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy
| | - Marta Seghieri
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy
| | - Livia Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy
| | - Fabio Coppedè
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Medical Genetics, University of Pisa, Pisa, Italy
| | - Chiara Rossi
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy
| | - Angela Dardano
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy
| | - Anna Solini
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy.
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Mazidi M, Rezaie P, Jangjoo A, Tavassoli A, Rajabi MT, Kengne AP, Nematy M. Effect of bariatric surgery on adiposity and metabolic profiles: A prospective cohort study in Middle-Eastern patients. World J Diabetes 2017; 8:374-380. [PMID: 28751961 PMCID: PMC5507835 DOI: 10.4239/wjd.v8.i7.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/05/2017] [Accepted: 06/06/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate changes in adiposity and cardio-metabolic risk profile following Roux-en-Y gastric bypass in patients of Middle Eastern ethnicity with severe obesity. METHODS This prospective cohort study involved 92 patients who met the indications of bariatric surgery. Post-procedure markers of obesity and cardiometabolic profile were monitored regularly for a year. RESULTS Mean body mass index decreased by 29.5% from 41.9 to 29.5 kg/m2 between baseline and 12-mo follow-up, while mean fat mass decreased by 45.9% from 64.2 kg to 34.7 kg. An improvement was also observed in the gluco-metabolic profile with both fasting glucose and HbA1c substantially decreasing (P < 0.001). CONCLUSION The present study shows the short to medium term (1 year) health benefits of bariatric surgery for patients of Middle Eastern ethnicity.
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Mazidi M, Gao HK, Hui H, Li L, Ferns GA. Changes in adiposity and other cardiometabolic risk factors following Roux-en-Y gastric bypass: A 12-month prospective cohort study in Chinese patients. Indian J Gastroenterol 2017; 36:258-262. [PMID: 28779276 DOI: 10.1007/s12664-017-0774-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 07/07/2017] [Indexed: 02/04/2023]
Abstract
AIM We aimed to investigate the changes in adiposity and other cardiometabolic risk factors in the year following Roux-en-Y gastric bypass (RYGB) in patients of Chinese ethnicity. METHODS The study recruited 209 patients who met the indications for bariatric surgery. Adiposity and cardiometabolic risk factors were assessed at baseline and over the 12 months following surgery in all participants. SPSS® software was used for statistical analysis. RESULTS The mean body mass index (BMI) was 29.98 kg/m2 at baseline and steadily decreased to 25.32 kg/m2 at 12 months, giving a relative change of -15.5% (p < 0.001). All of the lipid profile fractions except high-density lipoprotein (HDL) declined during the first 12 months of follow up; serum HDL increased during this time (all ANOVA p < 0.001). The mean fasting plasma glucose was 9.49 mmol/L at baseline and gradually decreased to 5.69 mmol/L at 12 months, giving a relative change of -40.0% (p < 0.001). CONCLUSION Following the RYGB procedure, changes in measures of adiposity were paralleled by a significant improvement in cardiometabolic factors for 12 months after surgery.
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Affiliation(s)
- Mohsen Mazidi
- Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang, Beijing, China. .,Institute of Genetics and Developmental Biology, International College, University of Chinese Academy of Science (IC-UCAS), West Beichen Road, Chaoyang, China.
| | - Hong-Kai Gao
- Department of General Surgery, The General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Han Hui
- Department of General Surgery, The General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Liang Li
- Department of General Surgery, The General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Gordon A Ferns
- Division of Medical Education, Brighton and Sussex Medical School, University of Brighton, Rm 342, Mayfield House, Brighton, BN1 9PH, UK
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Velázquez-Fernández D, Mercado-Celis G, Flores-Morales J, Clavellina-Gaytán D, Vidrio R, Vidrio E, Mosti M, Sánchez-Aguilar H, Rodriguez D, León P, Herrera MF. Analysis of Gene Candidate SNP and Ancestral Origin Associated to Obesity and Postoperative Weight Loss in a Cohort of Obese Patients Undergoing RYGB. Obes Surg 2016; 27:1481-1492. [DOI: 10.1007/s11695-016-2501-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Yildiz B, Katar K, Hamamci O. Efficacy of laparoscopic sleeve gastrectomy for the treatment of obesity in a non-Western society. Eat Weight Disord 2016; 21:695-699. [PMID: 27142665 DOI: 10.1007/s40519-016-0287-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The objective of this study was to analyze the mid-term outcomes of sleeve gastrectomy in a cohort of obese patients. METHODS We analyzed the outcomes of 159 adult patients who had laparoscopic sleeve gastrectomy between January 2011 and January 2015 in our center. Data collected included patient demographics, presence of comorbid diseases, preoperative body mass index, percent excess weight loss, resolution of comorbid diseases, morbidity and in-hospital mortality. RESULTS We achieved a 24th month percent excess weight loss of 75.1 ± 10.5. Remission of diabetes mellitus, hypertension, hyperlipidemia and obstructive sleep apnea syndrome after sleeve gastrectomy was as high as 84, 63.9, 75.8 and 93 %, respectively, in different studies. Our results in diabetes mellitus, hypertension and hyperlipidemia are comparable with other data on the improvement of comorbidites after sleeve gastrectomy. We found less improvement in obstructive sleep apnea syndrome in our cohort when compared to other reports. CONCLUSIONS Sleeve gastrectomy is an efficient, durable technique for the treatment of obesity and associated comorbidities in all body mass index subgroups of obese population. For better outcomes, strategies for proper education and certification are needed.
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Affiliation(s)
- Baris Yildiz
- Ankara Numune Teaching Hospital General Surgery, Selanik cad 29/2 Kizilay, Ankara, 06650, Turkey.
| | - Kagan Katar
- Elbistan State Hospital, Kahramanmaras, Turkey
| | - Okan Hamamci
- Ankara Numune Teaching Hospital General Surgery, Selanik cad 29/2 Kizilay, Ankara, 06650, Turkey
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Schag K, Mack I, Giel KE, Ölschläger S, Skoda EM, von Feilitzsch M, Zipfel S, Teufel M. The Impact of Impulsivity on Weight Loss Four Years after Bariatric Surgery. Nutrients 2016; 8:nu8110721. [PMID: 27854246 PMCID: PMC5133107 DOI: 10.3390/nu8110721] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/03/2016] [Accepted: 11/09/2016] [Indexed: 01/01/2023] Open
Abstract
Bariatric surgery has serious implications on metabolic health. The reasons for a failure of bariatric surgery, i.e., limited weight loss, are multifactorial and include psychological factors. We established a theoretical model of how impulsivity is related to weight loss outcome. We propose that depressive symptoms act as a mediator between impulsivity and pathological eating behavior, and that pathological eating behavior has a direct impact on weight loss outcome. We calculated excessive weight loss (%EWL) and assessed self-reported impulsivity (using the Baratt Impulsiveness Scale (BIS-15) total score), depressive symptoms (the Patient Health Questionnaire (PHQ-9) score), and pathological eating behavior (the Eating Disorder Inventory 2 (EDI-2) total score) in 65 patients four years after laparoscopic sleeve gastrectomy. Regression and mediation analyses were computed to validate the theoretical model. The BIS-15, PHQ-9, and EDI-2 have medium to high correlations between each other, and EDI-2 correlated with %EWL. The mediation analysis yielded that the PHQ-9 represents a significant mediator between BIS-15 and EDI-2. The regression model between EDI-2 and %EWL was also significant. These results support our theoretical model, i.e., suggest that impulsivity has an indirect impact on weight loss outcome after bariatric surgery, mediated by depression and transferred through pathological eating behavior. Thus, the underlying psychological factors should be addressed in post-operative care to optimize weight loss outcome.
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Affiliation(s)
- Kathrin Schag
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Isabelle Mack
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Katrin E Giel
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Sabrina Ölschläger
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Eva-Maria Skoda
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Maximilian von Feilitzsch
- Department of General, Visceral and Transplant Surgery, University of Tübingen, 72076 Tübingen, Germany.
| | - Stephan Zipfel
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Martin Teufel
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
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Health-related quality of life in two randomized controlled trials of phentermine/topiramate for obesity: What mediates improvement? Qual Life Res 2015; 25:1237-44. [PMID: 26446094 DOI: 10.1007/s11136-015-1153-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Phentermine/topiramate combination therapy resulted in significant weight loss and improvements in cardiometabolic risk factors in patients with obesity/overweight in two published 56-week randomized, placebo-controlled trials (EQUIP and CONQUER). The purpose of the current study was to examine whether phentermine/topiramate is also associated with greater improvements in health-related quality of life (HRQOL) and whether HRQOL improvements are solely attributable to weight reduction. METHODS Patients in EQUIP (n = 751) had a body mass index (BMI) ≥ 35 with no obesity-related comorbidity. Patients in CONQUER (n = 1623) had a BMI ≥ 27 and ≤ 45 and at least two obesity-related comorbid conditions. HRQOL was assessed with Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and Medical Outcomes Study Short Form (SF-36) (CONQUER only). RESULTS Significant improvements in both obesity-specific and physical HRQOL were observed at 56 weeks in both trials (p < .0001). In EQUIP, BMI reduction fully mediated improvements in IWQOL-Lite total score (p < .0001). In CONQUER, both BMI reduction (all p values < .0001) and change in depressive symptoms (all p values < .025) were significant mediators of improved IWQOL-Lite total score and SF-36 Physical Component Summary score. Gender, psychiatric history, and baseline triglycerides moderated these relationships. CONCLUSIONS Both trials demonstrated that treatment with phentermine/topiramate improved HRQOL compared with placebo. Although reduction in BMI accounted for the majority of improvements in obesity-specific and physical HRQOL, decrease in depressive symptoms was also a significant mediator. Results highlight the predominance of weight reduction as a key factor in improving HRQOL in obesity.
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