Weight loss and eating behavior following vertical banded gastroplasty

Background Bariatric surgery is the treatment of choice for patients with morbid obesity. In addition to surgery, postoperative dietary behavior is an important mediator of weight loss and, therefore, critical in influencing outcome. Surgical treatment of obesity is not an alternative to dieting but a method to enforce dieting. Methods We evaluated early weight loss and postoperative eating behavior over time. Preoperatively as well as 6 months, 1 and 2 years after vertical banded gastroplasty (VBG), 91 patients were psychologically assessed using a semi-structured interview and a psychological questionnaire focusing on eating behavior. Results Over time, we found significant changes in weight, mostly in the 1st postoperative year (EWL= 52.0%); at 2 years, EWL was 61.5%. Patients reported substantial changes in feelings of hunger, appetite, satiety, and eating behavior; however, most improvements waned over time. In addition, there was a wide variability in changes within our patient group, and changes in weight loss appeared to be related to changes in restrained eating. Conclusion VBG not only leads to considerable weight loss, but also to significant improvements in eating behavior, at least within 2 years. However, most improvements wane over time and not all patients profit in the same way.     

Fasting glycemia: A good predictor of weight loss after RYGB

BackgroundPreoperative prediction of weight loss after Roux-en-Y gastric bypass (RYGB) could help surgeons in managing surgical lists and patients’ expectations. The objective of this study was to understand if preoperative metabolic control might improve surgical results.MethodsProspective cohort of 163 consecutive patients who underwent RYGB with at least 1 year of follow-up.ResultsMost patients were female (90.2%), with a mean age of 38 (19–60) and a BMI of 46.0 (34.3–59.9) kg/m². After 12 months, the mean body mass index (BMI) was 29.7 kg/m² (21.5–39.9) with a corresponding percentage of excess weight lost (%EWL) of 78.8% and a percentage of weight loss (%WL) of 35.1%.Patients with the highest preoperative fasting blood glucose (FBG) were older (42 versus 36; P<.001); were more likely to have type 2 diabetes (T2 DM, 40% versus 6.8%; P<.001) and metabolic syndrome (89% versus 25%; P<.001), had a slightly higher BMI (30.8 versus 29.3 kg/m²; P = .03), and had achieved a significantly lower %EWL and %WL at 12 months (72.5% versus 81.2%; P = .004; 33.2 versus 35.9%; P = .03, respectively). We observed a dose-response effect with increasing FBG (<85 mg/dL, 85–100 mg/dL, and≥100 mg/dL, respectively), with 83.5%, 80.0%, and 72.5% (P = .009) of %EWL at 12 months. By multivariate logistic regression, initial BMI and FBG>100, were the only variables related (inversely) with the probability of achieving a %EWL>80 or %WL>35. This effect was not detected in patients receiving oral antidiabetic medications.ConclusionHigher preoperative FBG is independently related to a poorer weight loss 12 months after RYGB; this suggests the need to offer earlier surgical intervention for severely obese patients with impairment of glucose metabolism. The potential for less weight loss in patients with a higher FBG should not discourage RYGB, given the significant metabolic improvement after surgery.     

Feasibility of a Supervised Inpatient Low-Calorie Diet Program for Massive Weight Loss Prior to RYGB in Superobese Patients

Background  

This study was undertaken to determine the feasibility of an inpatient low-calorie program for a substantial decrease of preoperative weight (>10 points in BMI) in superobese patients.     

大鼠脊髓横断性损伤后细胞周期蛋白D3的表达变化

目的 探讨细胞周期蛋白D3（Cyclin D3）在横断性脊髓损伤（tSCI）后的表达变化以及定位情况。方法 将48只成年SD大鼠随机分为8组：正常对照组，T9横断伤2、8h、1、3、5、7和14d组，每组6只。采用Western blot测定损伤后各时间段Cyclin D3蛋白水平在脊髓中的表达变化。采用免疫组织化学方法检测Cyclin D3在正常以及损伤后脊髓中的分布和定位。结果 West—emblot显示，Cyclin D3蛋白水平在tSCI后头、尾段均呈现先升高后下降的趋势，尾段明显：Cyclin D3的表达于损伤后8h开始逐渐升高，3d达到高峰，一直持续到第5天，之后逐渐下降。免疫组织化学表明Cyclin D3在正常脊髓中均匀分布，损伤后3d，Cyclin D3在脊髓白质和灰质中表达明显增强；免疫荧光双标记表明Cyclin D3与神经元的标记物neuronal nucleus（NeuN）、少突胶质细胞标记物cyclic nucleotide 3’phosphohydrolase（CNPase）有明显共定位，与星形胶质细胞标记物gtial fibrillary acidic protein（GFAP）和小胶质细胞标记物OX-42也存在部分共定位。结论脊髓损伤后Cyc—lin D3蛋白水平呈现明显的时相变化，并且与神经元、少突胶质细胞、星形胶质细胞和小胶质细胞存在共定位，提示Cyclin D3参与了脊髓损伤后的病理生理过程。     

Weight loss following bariatric surgery decreases pericardial fat thickness lowering the risk of developing coronary artery disease

BackgroundPericardial fat has a local atherosclerotic effect and is associated with both metabolic syndrome (MetS) and coronary artery disease (CAD).ObjectivesThe aim of this study is to report changes in pericardial fat thickness (PFT) after bariatric surgery, and to investigate its significance on the risk of developing coronary artery disease (CAD).SettingAcademic institution.MethodsWe retrospectively measured the linear pericardial thickness from patients’ computed tomography (CT) scans within 5 years preoperatively and compared to any available CT scan within 5 years postoperatively. The PFT was measured at the right ventricular wall, perpendicular to the myocardium, at the level of the sternum. The risk of developing CAD was estimated by calculating the Framingham risk score (FRS). We divided the patients into 2 groups: laparoscopic sleeve gastrectomy (SG, Group 1), and laparoscopic gastric Roux-en-Y gastric bypass (LRYGB, Group 2). Common demographic characteristics and co-morbidities were collected along with the preoperative and postoperative lipid profiles.ResultsA total of 113 patients met the inclusion criteria, with 64 (56.6%) patients in group 1 and 49 (43.3%) patients in group 2. Group 1 consisted of 83.6% (n = 53) female patients versus 75.5% (n = 37) in group 2. The percent excess body mass index loss (%EBMIL) at 12 months was 74.4 ± 35.8% for group 1 versus 67 ± 30.1% for group 2 (P = .292). Pericardial thickness before surgery was 5.6 ± 1.9 mm and 4.6 ± 1.6 mm after surgery (P = .0001). The risk of CAD in females was 9.1% before and 6.6% after surgery. We found statistically significant linear association between pericardial thickness after surgery and a lower risk of CAD (P = .001).ConclusionBariatric surgery decreases the PFT lowering risk of developing CAD. Further studies may be needed to better assess these findings.     

Weight loss and asthma: a systematic review

Epidemiological studies first demonstrated the association between obesity and asthma and they have begun to provide additional evidence to support causality: a dose-effect relationship, consistency across studies (especially among women) and the correct temporal order (ie, obesity before asthma). To date, relatively few studies have addressed reversibility, an important but less frequently demonstrated epidemiological criterion of causality. Reversibility suggests that if excessive weight is a risk factor for asthma, then reducing body weight should decrease the prevalence of asthma, or at least decrease asthma related symptoms or health care utilisation. We performed a systematic review on weight loss and asthma, based on searches between January 1966 and January 2007 of both PubMed and the Cochrane Clinical Trial Database. Of the 15 relevant studies, asthma was the primary outcome in only five. Only one study was conducted in children. Regardless of the type of intervention (surgical vs medical), all 15 studies noted an improvement in at least one asthma outcome after weight loss. The improvement was noted across studies that differed in sample age, gender or country of origin. The heterogeneity of the interventions and outcomes precluded quantitative synthesis. We briefly review the role of specific factors (eg, gastro-oesophageal reflux) in the weight loss-asthma association, and potential directions for future research.     

Weight loss of prostatic tissue during electroresection.

During electroresection the weight loss of prostatic tissue was demonstrated to vary between 15 and 42% with a mean value of 26%. Using a scalpel the mean weight loss was 12%.     

胃左动脉栓塞术后体质量变化

目的探讨胃左动脉栓塞术对患者体质量的影响。方法回顾性分析因上消化道出血而行介入诊疗的74例患者,术中造影明确或高度可疑出血患者34例(栓塞组),对其中17例单纯采用明胶海绵颗粒行胃左动脉栓塞(观察组1),另17例采用微弹簧圈及明胶海绵颗粒行胃左动脉栓塞(观察组2);术中造影未见明确出血,未进行胃左动脉栓塞的40例患者作为对照组,分析各组患者手术前后的体质量变化情况。结果观察组1、2与对照组患者的年龄、体质量指数、恶性肿瘤病史、手术史差异均无统计学意义(P均0.05)。与术前相比,术后3个月内观察组1患者体质量平均下降6.93%±3.98%,观察组2下降7.76%±5.37%,两组间差异无统计学意义(t=0.593,P=0.649);对照组下降2.88%±1.76%,观察组1、2与对照组比较差异均有统计学意义(t=0.254、3.179,P=0.010、0.002)。结论胃左动脉栓塞术可能导致体质量下降,有望应用于肥胖患者的治疗。     

Weight loss and distal forearm fractures in postmenopausal women

Summary  

Weight loss is a risk factor for hip fractures, but few studies have evaluated the effect of weight loss on distal forearm fracture risk. In this longitudinal study including 7,871 postmenopausal women, weight loss of 5% or more was associated with an increased risk of distal forearm fractures.     

Weight loss in obese women--exercise v. dietary education

It was postulated that a nutrition-education programme was as effective an adjunct to a diet-based weight-loss programme as an exercise regimen. Forty-five obese female volunteers were placed on the same 5,000 kJ diet and were then assigned to each of three therapy groups: (i) an exercise group, involving three 1-hour exercise sessions per week (15 women); (ii) a lecture group involving a weekly 1-hour group lecture session (15); and (iii) a control group (15) who received only the diet and no activity. Weight loss, body fat loss (%) and daily energy intake reductions were equally reduced in the subjects in all three groups who completed the programme. There was, however, a significantly higher dropout rate in the control group. Taking this into account, the weight loss in the two test groups was similar and greater than that of the control group. We conclude that, in the short term, dietary education was as effective as exercise in promoting dietary compliance and weight loss.     

Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure

BACKGROUND: Obesity and its related illness is a primary health concern today. METHODS: Five hundred morbidly obese patients (mean age 42 years; mean preoperative weight 123 kg) underwent laparoscopic adjustable gastric banding surgery in a private U.S. hospital setting within a comprehensive multidisciplinary bariatric program. Patients were followed up to 36 months. Comorbidity status was assessed for 163 patients who completed > or =18 months' follow-up by comparing medications (type and dosage) prescribed for each comorbid condition before surgery and at follow-up. RESULTS: At 36 months after surgery, mean body mass index (BMI) had decreased from 45.2 to 34.9 kg/m(2) and mean percent excess weight loss (%EWL) was 47%. Complications were as follows: gastric pouch dilatation (6.8%), slippage (2.8%), and stoma obstruction (0.6%). There was no mortality. Resolution or improvement of comorbidities were as follows: gastroesophageal reflux disease (GERD) (87%; usually immediately postsurgery), asthma (81.8%), diabetes (66%), dyslipidemia (65.5%), hypertension (48%), and sleep apnea (33%). CONCLUSIONS: Gastric banding provides good weight loss and significant reduction in comorbidities with few and minor complications.