|
1
|
Avdeeva VA, Suplotova LA, Rozhinskaya LY. Effects of bariatric surgery on bone metabolism: focusing on vitamin D. OBESITY AND METABOLISM 2022; 19:116-122. [DOI: 10.14341/omet12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
The main goal of bariatric surgery is weight loss due to fundamental differential changes in the anatomical and physiological characteristics of the gastrointestinal tract. At the same time, one of the most frequent complications of obesity surgery, especially operations associated with malabsorption, is vitamin D deficiency. Patients with obesity initially have a wide range of predisposing factors for metabolic diseases of the skeleton due to lifestyle problems. Nutrient deficiencies with high-calorie diets and a sedentary lifestyle with a tendency to wear clothing that covers most of the skin — reduces serum 25 (OH) D levels. In addition, the situation is aggravated by a decrease in the bioavailability of 25 (OH) D due to its sequestration in adipose tissue and its complete inaccessibility to the central blood flow. The consequences of bariatric surgery — a decrease in the amount of skin and malabsorption can aggravate the existing deficiency. As a result of a decrease in the level of 25 (OH) D and subsequent hypocalcemia and secondary hyperparathyroidism, negatively affect the state of bone health. The presented literature review is devoted to the problems of obesity surgery and vitamin D deficiency. The main focus is on bone metabolism associated with bariatric surgery, the causes of pre and postoperative vitamin D deficiency are discussed, and recommendations for its treatment after obesity surgery are given.
Collapse
|
|
2
|
Surgery in the Obese Pregnant Patient. Clin Obstet Gynecol 2021; 63:416-428. [PMID: 32224705 DOI: 10.1097/grf.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This chapter reviews issues which complicate surgery in obese pregnant patients. Maternal obesity is prevalent in the United States and is associated with numerous adverse health outcomes. When surgery is indicated during pregnancy, the presence of maternal obesity increases surgical risks for both the fetus and mother. Specific risks are identified and strategies to avoid them are evaluated. The prognosis and management of pregnant women who have undergone bariatric surgery is also discussed, and practical guidelines for obstetric management of these patients are presented.
Collapse
|
|
3
|
Furlan SF, Drager LF, Santos RN, Damiani LP, Bersch-Ferreira AC, Miranda TA, Machado RHV, Santucci EV, Bortolotto LA, Lorenzi-Filho G, Berwanger O, Cavalcanti AB, Schiavon CA. Three-year effects of bariatric surgery on obstructive sleep apnea in patients with obesity grade 1 and 2: a sub-analysis of the GATEWAY trial. Int J Obes (Lond) 2021; 45:914-917. [PMID: 33589771 DOI: 10.1038/s41366-021-00752-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Most of the evidence on bariatric surgery on obstructive sleep apnea (OSA) is based on observational studies and/or short-term follow-up in patients with obesity grade 3. SUBJECTS/METHODS This randomized study compared the effects of roux-en-Y gastric bypass (RYGB) or usual care (UC) on OSA severity in patients with obesity grade 1-2. Mild, moderate, and severe OSA was defined by the apnea-hypopnoea index (AHI): 5-14.9; 15-29.9, and ≥30 events/h, respectively. OSA remission was defined by converting any form of OSA into normal AHI (<5 events/h). RESULTS After 3-year of follow-up, the body-mass index increased in the UC while decreased in the RYGB group: +1.7 (-1.9; 2.7) versus -10.6 (-12.7; -9.2) kg/m2, respectively. The AHI increased by 5 (-4.2; 12.7) in the UC group while reduced in the RYGB group to -13.2 (-22.7; -7) events/h. UC significantly increase the frequency of moderate OSA (from 15.4 to 46.2%). In contrast, RYGB had a huge impact on reaching no OSA status (from 4.2 to 70.8%) in parallel to a decrease of moderate (from 41.7 to 8.3%) and severe OSA (from 20.8 to 0%). CONCLUSIONS RYGB is an attractive strategy for mid-term OSA remission or decrease moderate-to-severe forms of OSA in patients with obesity grade 1-2.
Collapse
Affiliation(s)
- Sofia F Furlan
- Program in Cardiology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Hypertension Unit, University of São Paulo Medical School, São Paulo, Brazil
| | - Luciano F Drager
- Hypertension Unit, University of São Paulo Medical School, São Paulo, Brazil. .,Renal Division, University of São Paulo Medical School, São Paulo, Brazil.
| | | | - Lucas P Damiani
- Research Institute, Heart Hospital (HCor), São Paulo, Brazil
| | | | | | | | | | - Luiz A Bortolotto
- Hypertension Unit, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
|
4
|
Voils CI, Shaw R, Adler R, Jeanes E, Lewis MA, Sharp W, Cronin KA, Hetzel S, Mao L, Johnson HM, Elwert F, Pabich S, Gavin KL, Yancy WS, Porter LS. Protocol for Partner2Lose: A randomized controlled trial to evaluate partner involvement on long-term weight loss. Contemp Clin Trials 2020; 96:106092. [PMID: 32750431 PMCID: PMC7395658 DOI: 10.1016/j.cct.2020.106092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022]
Abstract
Background Behavioral interventions produce clinically significant weight reduction, with many participants regaining weight subsequently. Most interventions focus on an individual, but dietary and physical activity behaviors occur with, or are influenced by, domestic partners. According to interdependence theory, couples who approach behavior change as a problem to be tackled together versus independently are more likely to utilize communal coping processes to promote behavior change. We utilized interdependence theory to develop a partner-assisted intervention to increase long-term weight loss. Methods Community-dwelling individuals (index participants) cohabitating with a partner with 1) overweight and at least one obesity-related comorbidity or 2) obesity are randomized to participate in a standard weight management program alone or with their partner. The weight management program involves biweekly, in-person, group sessions focusing on weight loss for six months, followed by three group sessions and nine telephone calls focusing on weight loss maintenance for twelve months. In the partner-assisted arm, partners participate in half of the group sessions and telephone calls. Couples receive training in principles of cognitive behavioral therapy for couples, including sharing thoughts and feelings and joint problem solving, to increase communal coping. The primary outcome is participant weight loss at 24 months, with caloric intake and moderate-intensity physical activity as secondary outcomes. Partner weight and caloric intake will also be analyzed. Mediation analyses will examine the role of interdependence variables and social support. Discussion This trial will provide knowledge about effective ways to promote long-term weight loss and the role of interdependence constructs in weight loss. Clinical trials identifier: NCT 03801174.
Collapse
Affiliation(s)
- Corrine I Voils
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA; William S Middleton Memorial Veterans Hospital, 2500 Overlook Terrace (151), Madison, WI 53705, USA.
| | - Ryan Shaw
- Duke University School of Nursing, 307 Trent Dr., 1055 Clipp, Durham, NC 27710, USA
| | - Rachel Adler
- Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street Suite 2-016, Boston, MA 02120, USA
| | - Elizabeth Jeanes
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA
| | - Megan A Lewis
- RTI International, 119 S. Main St., Union Trust Bldg., Suite 220, Seattle, WA 98104, USA
| | - Whitney Sharp
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA
| | - Kate A Cronin
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA
| | - Scott Hetzel
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Biostatistics and Bioinformatics, 610 Walnut St, WARF 201, Madison, WI 53726, USA
| | - Lu Mao
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Biostatistics and Bioinformatics, 610 Walnut St, WARF 201, Madison, WI 53726, USA
| | - Heather M Johnson
- Boca Raton Regional Hospital, Christine E. Lynn Women's Health & Wellness Institute, 690 Meadows Road, Boca Raton, FL 33486, USA
| | - Felix Elwert
- University of Wisconsin-Madison Department of Sociology, 11800 Observatory Dr, Madison, WI 53706, USA
| | - Samantha Pabich
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Medicine, 1685 Highland Ave Madison, WI 53705-2281, USA
| | - Kara L Gavin
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA
| | - William S Yancy
- Duke University School of Medicine, Department of Medicine, 501 Douglas St., Durham, NC 27705, USA
| | - Laura S Porter
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Box 90399, Durham, NC 27708, USA
| |
Collapse
|
|
5
|
Yancy WS, Crowley MJ, Dar MS, Coffman CJ, Jeffreys AS, Maciejewski ML, Voils CI, Bradley AB, Edelman D. Comparison of Group Medical Visits Combined With Intensive Weight Management vs Group Medical Visits Alone for Glycemia in Patients With Type 2 Diabetes: A Noninferiority Randomized Clinical Trial. JAMA Intern Med 2020; 180:70-79. [PMID: 31682682 PMCID: PMC6830502 DOI: 10.1001/jamainternmed.2019.4802] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Traditionally, group medical visits (GMVs) for persons with diabetes improved glycemia by intensifying medications, which infrequently led to weight loss. Incorporating GMVs with intensive dietary change could enable weight loss and improve glycemia while decreasing medication intensity. OBJECTIVE To examine whether a program of GMVs combined with intensive weight management (WM) is noninferior to GMVs alone for change in glycated hemoglobin (HbA1c) level at 48 weeks (prespecified margin of 0.5%) and superior to GMVs alone for hypoglycemic events, diabetes medication intensity, and weight loss. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial identified via the electronic medical record 2814 outpatients with type 2 diabetes, uncontrolled HbA1c, and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 27 or higher from Veterans Affairs Medical Center clinics in Durham and Greenville, North Carolina. Between January 12, 2015, and May 30, 2017, 263 outpatients started the intervention. INTERVENTIONS Participants randomized to the GMV group (n = 136) received counseling about diabetes-related topics with medication optimization every 4 weeks for 16 weeks, then every 8 weeks (9 visits). Participants randomized to the WM/GMV group (n = 127) received low-carbohydrate diet counseling with baseline medication reduction and subsequent medication optimization every 2 weeks for 16 weeks followed by an abbreviated GMV intervention every 8 weeks (13 visits). MAIN OUTCOMES AND MEASURES Outcomes included HbA1c level, hypoglycemic events, diabetes medication effect score, and weight at 48 weeks analyzed using hierarchical generalized mixed models to account for clustering within group sessions. RESULTS Among 263 participants (mean [SD] age, 60.7 [8.2] years; 235 [89.4%] men; 143 [54.4%] black), baseline HbA1c level was 9.1% (1.3%) and BMI was 35.3 (5.1). At 48 weeks, HbA1c level was improved in both study arms (8.2% in the WM/GMV arm and 8.3% in the GMV arm; mean difference, -0.1%; 95% CI, -0.5% to 0.2%; upper 95% CI, <0.5% threshold; P = .44). The WM/GMV arm had lower diabetes medication use (mean difference in medication effect score, -0.5; 95% CI, -0.6 to -0.3; P < .001) and greater weight loss (mean difference, -3.7 kg; 95% CI, -5.5 to -1.9 kg; P < .001) than did the GMV arm at 48 weeks and approximately 50% fewer hypoglycemic events (incidence rate ratio, 0.49; 95% CI, 0.27 to 0.71; P < .001) during the 48-week period. CONCLUSIONS AND RELEVANCE In GMVs for diabetes, addition of WM using a low-carbohydrate diet was noninferior for lowering HbA1c levels compared with conventional medication management and showed advantages in other clinically important outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01973972.
Collapse
Affiliation(s)
- William S Yancy
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Diet and Fitness Center, Durham, North Carolina
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Moahad S Dar
- Greenville Health Care Center, Department of Veterans Affairs, Greenville, North Carolina.,Brody School of Medicine, Greenville, North Carolina
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Surgery, University of Wisconsin, Madison
| | | | - David Edelman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
|
6
|
Cox N, Gibas S, Salisbury M, Gomer J, Gibas K. Ketogenic diets potentially reverse Type II diabetes and ameliorate clinical depression: A case study. Diabetes Metab Syndr 2019; 13:1475-1479. [PMID: 31336509 DOI: 10.1016/j.dsx.2019.01.055] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/28/2019] [Indexed: 01/22/2023]
Abstract
Efficacious adherence to treatment protocol predicts metabolic control among Type 2 diabetics (T2DM) [1-4]; however, few healthcare systems employ individualized strategies to mediate the comorbidity of T2DM with other chronic disease states. A clinically prescribed ketogenic diet, patient-centered nutritional education and high intensity interval training (HIIT), girded by solution-focused psychotherapy, modulate significant improvements in the clinical biomarkers associated with concurring T2DM and clinical depression [5-15]. Relevant metabolic change was noted in the following measures: HOMA-IR, triglyceride/HDL ratio, HgA1c, fasting insulin, fasting glucose, fasting triglycerides, LDL, VLDL, HDL, total cholesterol and C-reactive protein. The Patient Health Questionnaire 9 (PHQ-9) along with clinical interview and the mental status exam showed notable change in the patient's depressive symptoms; likewise, her self-efficacy score normalized, as measured by the General Self-Efficacy Questionnaire (GSE) and the Metabolic Syndrome Compliance Questionnaire (MSC). The case study highlights a 65-year old female who presented with a 26-year history of dually-diagnosed Type 2 diabetes (T2DM) and major depressive disorder (MDD). The patient was prescribed a ketogenic diet (KD), clinically formulated from her resting metabolic rate, body fat percentage and lean body mass, together with weekly nutrition education, high intensity interval training (matched to her cardiovascular conditioning), and eight 45-minute solution-focused psychotherapy sessions. Intervention goals included improved insulin sensitivity evaluated by the HOMA-IR, sustained glycemic control measured via HgA1c, reduced cardiovascular risk via the triglyceride/HDL ratio, and improved depressive symptoms with increased self-efficacy monitored by the PHQ-9 and GSE/MSC. The results of the 12-week intervention were statistically significant. The patient's HgA1c dropped out of diabetic range (8.0%) and normalized at 5.4%. Her average daily glucose measurements declined from 216 mg/dL to 96 mg/dL; the HOMA-IR and triglyceride/HDL ratios improved by 75%. Her marker for clinical depression and measurement of self-efficacy normalized. The 12-week individualized treatment intervention served to functionally reverse 26 years of T2DM, ameliorate two and half decades of chronic depressive disorder and empower/equip the patient with a new experience of hope and success.
Collapse
Affiliation(s)
- Nate Cox
- Bethel University, United States
| | | | | | | | | |
Collapse
|
|
7
|
Broström A, Pakpour AH, Ulander M, Nilsen P. Development and psychometric evaluation of the Swedish propensity to achieve healthy lifestyle scale in patients with hypertension. J Clin Nurs 2018; 27:4040-4049. [PMID: 29776007 DOI: 10.1111/jocn.14535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop and validate a Swedish questionnaire to measure propensity for behaviour change regarding food habits, physical activity and weight reduction in patients with hypertension. DESIGN Cross-sectional design. METHODS A total of 270 consecutive patients with hypertension diagnosed at four primary care centres in Sweden were included. The 6-item Swedish version of the Propensity to Achieve Healthy Lifestyle Scale (PAHLS) was developed to measure propensity for behaviour change regarding food habits, physical activity and weight reduction. The PAHLS (i.e., including three items for preparedness and three items for capacity) was developed by three multiprofessional researchers inspired by the transtheoretical model of behaviour change in collaboration with clinically active nurses. Data were collected by questionnaires on food habits (i.e., the Food Frequency Questionnaire), physical activity (the International Physical Activity Questionnaire), propensity for a healthy lifestyle (the PHLQ), as well as during a clinical examination. Exploratory (EFA) and confirmatory factor analyses (CFA), as well as Rasch analysis, were used. RESULTS Of the 270 patients (50% women), 27% scored low levels of physical activity on the International Physical Activity Questionnaire, and 34% of the patients were obese (body mass index ≥30 kg/m2 ). The EFA (explaining 54% of the variance) showed unidimensionality for the PAHLS that was supported by both CFA and Rasch analyses. No floor and 1.9% ceiling effects were found. Multiple group CFA (an extension of structural equation modelling) showed that the PAHLS operated equivalently across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good. CONCLUSION The initial testing of PAHLS provided good validity and reliability scores to measure propensity for behaviour change in patients with hypertension. RELEVANCE TO CLINICAL PRACTICE The PAHLS can be used by nurses as a tool to simplify shared decision-making in relation to behavioural changes.
Collapse
Affiliation(s)
- Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Martin Ulander
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Division of Clinical Neurophysiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Division of Social Medicine and Public Health Science, Department of Health and Society, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
|
8
|
Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes 2017; 8:464-474. [PMID: 29204255 PMCID: PMC5700383 DOI: 10.4239/wjd.v8.i11.464] [Citation(s) in RCA: 231] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/11/2017] [Accepted: 09/04/2017] [Indexed: 02/05/2023] Open
Abstract
Bariatric surgery is recognized as a highly effective therapy for obesity since it accomplishes sustained weight loss, reduction of obesity-related comorbidities and mortality, and improvement of quality of life. Overall, bariatric surgery is associated with a 42% reduction of the cardiovascular risk and 30% reduction of all-cause mortality. This review focuses on some nutritional consequences that can occur in bariatric patients that could potentially hinder the clinical benefits of this therapeutic option. All bariatric procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract; this alteration makes these patients more susceptible to developing nutritional complications, namely, deficiencies of macro- and micro-nutrients, which could lead to disabling diseases such as anemia, osteoporosis, protein malnutrition. Of note is the evidence that most obese patients present a number of nutritional deficits already prior to surgery, the most important being vitamin D and iron deficiencies. This finding prompts the need for a complete nutritional assessment and, eventually, an adequate correction of pre-existing deficits before surgery. Another critical issue that follows bariatric surgery is post-operative weight regain, which is commonly associated with the relapse of obesity-related co-morbidities. Nu-tritional complications associated with bariatric surgery can be prevented by life-long nutritional monitoring with the administration of multi-vitamins and mineral supplements according to the patient's needs.
Collapse
Affiliation(s)
- Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Erminia Lembo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Gennaro Saldalamacchia
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Claudia Kesia Avola
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Luigi Angrisani
- Department of Public Health, Federico II University, 80131 Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| |
Collapse
|
|
9
|
Wolfe BM, Kvach E, Eckel RH. Treatment of Obesity: Weight Loss and Bariatric Surgery. Circ Res 2017; 118:1844-55. [PMID: 27230645 DOI: 10.1161/circresaha.116.307591] [Citation(s) in RCA: 439] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/29/2016] [Indexed: 12/11/2022]
Abstract
This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD), as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health, which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by nonsurgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the comorbidities, quality of life, and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes mellitus, inflammation, obstructive sleep apnea, and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors after weight loss, it is reasonable to expect a reduction of CVD events and related mortality after weight loss in populations with obesity. The quality of the current evidence is reviewed, and future research opportunities and summaries are stated.
Collapse
Affiliation(s)
- Bruce M Wolfe
- From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.).
| | - Elizaveta Kvach
- From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.)
| | - Robert H Eckel
- From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.)
| |
Collapse
|
|
10
|
Impact of dose-response calorie reduction or supplementation of a covertly manipulated lunchtime meal on energy compensation. Physiol Behav 2016; 165:15-21. [DOI: 10.1016/j.physbeh.2016.06.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/22/2016] [Accepted: 06/25/2016] [Indexed: 11/20/2022]
|
|
11
|
Leidy HJ, Clifton PM, Astrup A, Wycherley TP, Westerterp-Plantenga MS, Luscombe-Marsh ND, Woods SC, Mattes RD. The role of protein in weight loss and maintenance. Am J Clin Nutr 2015; 101:1320S-1329S. [PMID: 25926512 DOI: 10.3945/ajcn.114.084038] [Citation(s) in RCA: 284] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Over the past 20 y, higher-protein diets have been touted as a successful strategy to prevent or treat obesity through improvements in body weight management. These improvements are thought to be due, in part, to modulations in energy metabolism, appetite, and energy intake. Recent evidence also supports higher-protein diets for improvements in cardiometabolic risk factors. This article provides an overview of the literature that explores the mechanisms of action after acute protein consumption and the clinical health outcomes after consumption of long-term, higher-protein diets. Several meta-analyses of shorter-term, tightly controlled feeding studies showed greater weight loss, fat mass loss, and preservation of lean mass after higher-protein energy-restriction diets than after lower-protein energy-restriction diets. Reductions in triglycerides, blood pressure, and waist circumference were also reported. In addition, a review of the acute feeding trials confirms a modest satiety effect, including greater perceived fullness and elevated satiety hormones after higher-protein meals but does not support an effect on energy intake at the next eating occasion. Although shorter-term, tightly controlled feeding studies consistently identified benefits with increased protein consumption, longer-term studies produced limited and conflicting findings; nevertheless, a recent meta-analysis showed persistent benefits of a higher-protein weight-loss diet on body weight and fat mass. Dietary compliance appears to be the primary contributor to the discrepant findings because improvements in weight management were detected in those who adhered to the prescribed higher-protein regimen, whereas those who did not adhere to the diet had no marked improvements. Collectively, these data suggest that higher-protein diets that contain between 1.2 and 1.6 g protein · kg-1 · d-1 and potentially include meal-specific protein quantities of at least ∼25-30 g protein/meal provide improvements in appetite, body weight management, cardiometabolic risk factors, or all of these health outcomes; however, further strategies to increase dietary compliance with long-term dietary interventions are warranted.
Collapse
Affiliation(s)
- Heather J Leidy
- From the Department of Nutrition and Exercise Physiology, School of Medicine, University of Missouri; Columbia, MO (HJL); the Sansom Institute for Health Research, School of Pharmacy and Medical Sciences (PMC) and School of Population Health (TPW), University of South Australia, Adelaide, Australia; the Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark (AA); the Department of Human Biology, NUTRIM, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands (MSW-P); the Centre of Clinical Research Excellence in Nutritional Physiology, Interventions, and Outcomes, University of Adelaide, Adelaide, Australia (NDL-M and PMC); Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organization (CSIRO)-Animal, Food, and Health Sciences, Adelaide, Australia (NDL-M); the Department of Psychiatry and Behavioral Neuroscience; UC College of Medicine, University of Cincinnati, Cincinnati, OH (SCW); and the Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN (RDM)
| | - Peter M Clifton
- From the Department of Nutrition and Exercise Physiology, School of Medicine, University of Missouri; Columbia, MO (HJL); the Sansom Institute for Health Research, School of Pharmacy and Medical Sciences (PMC) and School of Population Health (TPW), University of South Australia, Adelaide, Australia; the Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark (AA); the Department of Human Biology, NUTRIM, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands (MSW-P); the Centre of Clinical Research Excellence in Nutritional Physiology, Interventions, and Outcomes, University of Adelaide, Adelaide, Australia (NDL-M and PMC); Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organization (CSIRO)-Animal, Food, and Health Sciences, Adelaide, Australia (NDL-M); the Department of Psychiatry and Behavioral Neuroscience; UC College of Medicine, University of Cincinnati, Cincinnati, OH (SCW); and the Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN (RDM)
| | - Arne Astrup
- From the Department of Nutrition and Exercise Physiology, School of Medicine, University of Missouri; Columbia, MO (HJL); the Sansom Institute for Health Research, School of Pharmacy and Medical Sciences (PMC) and School of Population Health (TPW), University of South Australia, Adelaide, Australia; the Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark (AA); the Department of Human Biology, NUTRIM, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands (MSW-P); the Centre of Clinical Research Excellence in Nutritional Physiology, Interventions, and Outcomes, University of Adelaide, Adelaide, Australia (NDL-M and PMC); Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organization (CSIRO)-Animal, Food, and Health Sciences, Adelaide, Australia (NDL-M); the Department of Psychiatry and Behavioral Neuroscience; UC College of Medicine, University of Cincinnati, Cincinnati, OH (SCW); and the Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN (RDM)
| | - Thomas P Wycherley
- From the Department of Nutrition and Exercise Physiology, School of Medicine, University of Missouri; Columbia, MO (HJL); the Sansom Institute for Health Research, School of Pharmacy and Medical Sciences (PMC) and School of Population Health (TPW), University of South Australia, Adelaide, Australia; the Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark (AA); the Department of Human Biology, NUTRIM, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands (MSW-P); the Centre of Clinical Research Excellence in Nutritional Physiology, Interventions, and Outcomes, University of Adelaide, Adelaide, Australia (NDL-M and PMC); Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organization (CSIRO)-Animal, Food, and Health Sciences, Adelaide, Australia (NDL-M); the Department of Psychiatry and Behavioral Neuroscience; UC College of Medicine, University of Cincinnati, Cincinnati, OH (SCW); and the Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN (RDM)
| | - Margriet S Westerterp-Plantenga
- From the Department of Nutrition and Exercise Physiology, School of Medicine, University of Missouri; Columbia, MO (HJL); the Sansom Institute for Health Research, School of Pharmacy and Medical Sciences (PMC) and School of Population Health (TPW), University of South Australia, Adelaide, Australia; the Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark (AA); the Department of Human Biology, NUTRIM, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands (MSW-P); the Centre of Clinical Research Excellence in Nutritional Physiology, Interventions, and Outcomes, University of Adelaide, Adelaide, Australia (NDL-M and PMC); Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organization (CSIRO)-Animal, Food, and Health Sciences, Adelaide, Australia (NDL-M); the Department of Psychiatry and Behavioral Neuroscience; UC College of Medicine, University of Cincinnati, Cincinnati, OH (SCW); and the Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN (RDM)
| | - Natalie D Luscombe-Marsh
- From the Department of Nutrition and Exercise Physiology, School of Medicine, University of Missouri; Columbia, MO (HJL); the Sansom Institute for Health Research, School of Pharmacy and Medical Sciences (PMC) and School of Population Health (TPW), University of South Australia, Adelaide, Australia; the Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark (AA); the Department of Human Biology, NUTRIM, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands (MSW-P); the Centre of Clinical Research Excellence in Nutritional Physiology, Interventions, and Outcomes, University of Adelaide, Adelaide, Australia (NDL-M and PMC); Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organization (CSIRO)-Animal, Food, and Health Sciences, Adelaide, Australia (NDL-M); the Department of Psychiatry and Behavioral Neuroscience; UC College of Medicine, University of Cincinnati, Cincinnati, OH (SCW); and the Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN (RDM)
| | - Stephen C Woods
- From the Department of Nutrition and Exercise Physiology, School of Medicine, University of Missouri; Columbia, MO (HJL); the Sansom Institute for Health Research, School of Pharmacy and Medical Sciences (PMC) and School of Population Health (TPW), University of South Australia, Adelaide, Australia; the Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark (AA); the Department of Human Biology, NUTRIM, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands (MSW-P); the Centre of Clinical Research Excellence in Nutritional Physiology, Interventions, and Outcomes, University of Adelaide, Adelaide, Australia (NDL-M and PMC); Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organization (CSIRO)-Animal, Food, and Health Sciences, Adelaide, Australia (NDL-M); the Department of Psychiatry and Behavioral Neuroscience; UC College of Medicine, University of Cincinnati, Cincinnati, OH (SCW); and the Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN (RDM)
| | - Richard D Mattes
- From the Department of Nutrition and Exercise Physiology, School of Medicine, University of Missouri; Columbia, MO (HJL); the Sansom Institute for Health Research, School of Pharmacy and Medical Sciences (PMC) and School of Population Health (TPW), University of South Australia, Adelaide, Australia; the Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark (AA); the Department of Human Biology, NUTRIM, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands (MSW-P); the Centre of Clinical Research Excellence in Nutritional Physiology, Interventions, and Outcomes, University of Adelaide, Adelaide, Australia (NDL-M and PMC); Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organization (CSIRO)-Animal, Food, and Health Sciences, Adelaide, Australia (NDL-M); the Department of Psychiatry and Behavioral Neuroscience; UC College of Medicine, University of Cincinnati, Cincinnati, OH (SCW); and the Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN (RDM)
| |
Collapse
|
|
12
|
Higher breakfast glycaemic load is associated with increased metabolic syndrome risk, including lower HDL-cholesterol concentrations and increased TAG concentrations, in adolescent girls. Br J Nutr 2014; 112:1974-83. [DOI: 10.1017/s0007114514003092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Almost all previous studies examining the associations between glycaemic load (GL) and metabolic syndrome risk have used a daily GL value. The daily value does not distinguish between peaks of GL intake over the day, which may be more closely associated with the risk of the metabolic syndrome. The aim of the present study was to investigate the cross-sectional associations between daily and mealtime measures of GL and metabolic syndrome risk, including metabolic syndrome components, in adolescents. Adolescents participating in the 14-year follow-up of the Western Australian Pregnancy Cohort (Raine) Study completed 3 d food records and metabolic assessments. Breakfast GL, lunch GL, dinner GL and a score representing meal GL peaks over the day were determined in 516 adolescents. Logistic regression models were used to investigate whether GL variables were independent predictors of the metabolic syndrome in this population-based cohort (3·5 % prevalence of the metabolic syndrome). Breakfast GL was found to be predictive of the metabolic syndrome in girls (OR 1·15, 95 % CI 1·04, 1·27; P <0·01), but not in boys. Other meal GL values and daily GL were found to be not significant predictors of the metabolic syndrome. When breakfast GL was examined in relation to each of the components of the metabolic syndrome in girls, it was found to be negatively associated with fasting HDL-cholesterol concentrations (P= 0·037; β = − 0·004; 95 % CI − 0·008, − 0·002) and positively associated with fasting TAG concentrations (P= 0·008; exp(β) = 1·002; 95 % CI 1·001, 1·004). The results of the present study suggest that there may be an association between breakfast composition and metabolic syndrome components in adolescent girls. These findings support further investigation into including lower-GL foods as part of a healthy breakfast in adolescence, particularly for girls.
Collapse
|
|
13
|
Tapsell LC, Dunning A, Warensjo E, Lyons-Wall P, Dehlsen K. Effects of Vegetable Consumption on Weight Loss: A Review of the Evidence with Implications for Design of Randomized Controlled Trials. Crit Rev Food Sci Nutr 2014; 54:1529-38. [DOI: 10.1080/10408398.2011.642029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
|
14
|
Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O'Shea JE, Thorne RL, Zhang Q, Louie JCY. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health 2013; 13:1231. [PMID: 24369765 PMCID: PMC3890608 DOI: 10.1186/1471-2458-13-1231] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 12/12/2013] [Indexed: 11/17/2022] Open
Abstract
Background There is some evidence in the literature that emphasising fish consumption may assist with weight loss. The aim was to assess the effects of advice to consume 2 fish meals per week in a weight loss diet. Methods A parallel randomised placebo-controlled trial was conducted in 118 obese Australian adults (mean BMI ± SD 31.3 ± 3.5 kg/m2; mean age ± SD 45 ± 10 y; 28% male). Participants received low calorie dietary advice + placebo (1 g olive oil; Control), low calorie dietary advice emphasising fish + placebo (Fish), or low calorie dietary advice emphasising fish diet + LCn3PUFA supplements (Fish + S). Individualised advice targeted 2 MJ energy deficit (30%E fat, 45%E carbohydrate and 25%E protein) with or without two servings (180 g) fatty fish/wk. Results All groups lost weight at 12 months (Control −4.5 kg vs. Fish −4.3 kg vs. Fish + S −3.3 kg; p < 0.001) and percentage body fat (Control: -1.5% vs. Fish: -1.4% vs. Fish + S: -0.7%; p < 0.001) but there were no significant differences between groups. Cardiovascular disease risk factors changed as expected from weight loss. Conclusions Advice to consume 2 fish meals per week did not enhance the effects on weight loss of a healthy low calorie diet. Trial registration ACTRN12608000425392.
Collapse
Affiliation(s)
- Linda C Tapsell
- Smart Foods Centre, University of Wollongong, Northfields Avenue, Wollongong NSW 2522, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
15
|
Experience and acceptability of diets of varying protein content and glycemic index in an obese cohort: results from the Diogenes trial. Eur J Clin Nutr 2013; 67:990-5. [DOI: 10.1038/ejcn.2013.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/11/2013] [Accepted: 03/13/2013] [Indexed: 02/01/2023]
|
|
16
|
McClain AD, Otten JJ, Hekler EB, Gardner CD. Adherence to a low-fat vs. low-carbohydrate diet differs by insulin resistance status. Diabetes Obes Metab 2013; 15:87-90. [PMID: 22831182 PMCID: PMC3504183 DOI: 10.1111/j.1463-1326.2012.01668.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/28/2012] [Accepted: 07/06/2012] [Indexed: 12/01/2022]
Abstract
Previous research shows diminished weight loss success in insulin-resistant (IR) women assigned to a low-fat (LF) diet compared to those assigned to a low-carbohydrate (LC) diet. These secondary analyses examined the relationship between insulin-resistance status and dietary adherence to either a LF-diet or LC-diet among 81 free-living, overweight/obese women [age = 41.9 ± 5.7 years; body mass index (BMI) = 32.6 ± 3.6 kg/m(2)]. This study found differential adherence by insulin-resistance status only to a LF-diet, not a LC-diet. IR participants were less likely to adhere and lose weight on a LF-diet compared to insulin-sensitive (IS) participants assigned to the same diet. There were no significant differences between IR and IS participants assigned to LC-diet in relative adherence or weight loss. These results suggest that insulin resistance status may affect dietary adherence to weight loss diets, resulting in higher recidivism and diminished weight loss success of IR participants advised to follow LF-diets for weight loss.
Collapse
Affiliation(s)
- Arianna D. McClain
- Stanford Prevention Research Center, Stanford University School of Medicine
| | - Jennifer J. Otten
- Stanford Prevention Research Center, Stanford University School of Medicine
| | - Eric B. Hekler
- School of Nutrition and Health Promotion, Arizona State University
| | | |
Collapse
|
|
17
|
Rubio-Aliaga I, Marvin-Guy LF, Wang P, Wagniere S, Mansourian R, Fuerholz A, Saris WHM, Astrup A, Mariman ECM, Kussmann M. Mechanisms of weight maintenance under high- and low-protein, low-glycaemic index diets. Mol Nutr Food Res 2011; 55:1603-12. [PMID: 21957032 DOI: 10.1002/mnfr.201100081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 07/06/2011] [Accepted: 07/09/2011] [Indexed: 01/19/2023]
Abstract
SCOPE Weight maintenance after intended weight loss is a challenge in an obesogenic environment. In a large multicentre dietary intervention study (DiOGenes), it has recently been demonstrated that a high-protein/low-glycaemic index (HP/LGI) diet was slightly more efficient in maintaining weight loss than low-protein/LGI or high-GI (LP/LGI or HGI) diets. Here, we use a proteomic approach to assess the molecular mechanisms behind this positive effect. METHODS AND RESULTS A subset of the most successful (weight loser, n=12) and unsuccessful (weight re-gainer, n=12) individuals consuming the LGI diets with either high- or low-protein content (HP or LP/LGI), following an initial calorie deficit run-in weight loss phase, were analyzed at the plasma protein level. Proteomic analysis revealed 18 proteins regulated after 6 months of the dietary weight maintenance phase. Furthermore, 12 proteins were significantly regulated as a function of success rate under an HP diet, arising as candidate biomarkers of mechanisms of successful weight maintenance under an HP/LGI diet. Pregnancy-zone protein (PZP) and protein S (PROS1) were revealed as novel biomarkers of weight maintenance showing opposite effects. CONCLUSION Semantic network analysis of the 12 regulated proteins revealed that under an HP/LGI an anti-atherogenic effect and alterations of fat metabolism were associated with the success of maintaining the initial weight loss.
Collapse
Affiliation(s)
- Isabel Rubio-Aliaga
- Functional Genomics Group, Department of Bioanalytical Sciences, Nestlé Research Center, Lausanne, Switzerland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|