Biological effects of bariatric surgery on obesity-related comorbidities.

The Department of Surgery, Division of General and Minimally Invasive Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Canadian journal of surgery. Journal canadien de chirurgie (Impact Factor: 1.27). 02/2013; 56(1):47-57. DOI: 10.1503/cjs.036111
Source: PubMed

ABSTRACT The prevalence of obesity has increased so rapidly over the last few decades that it is now considered a global epidemic. Obesity, defined as a body mass index (BMI) of 30 or more, is associated with several comorbid conditions that decrease life expectancy and increase health care costs. Diet therapies have been reported to be ineffective in the long-term treatment of obesity, and guidelines for the surgical therapy of morbid obesity (BMI ≥ 40 or BMI ≥ 35 in the presence of substantial comorbidities) have since been established. Considering the number of bariatric surgical procedures has dramatically increased since these guidelines were established, we review the types of bariatric surgical procedures and their impact on diabetes, sleep apnea, dyslipidemia and hypertension - 4 major obesity-related comorbidities.

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    ABSTRACT: Background Even though internal hernia (IH) after a laparoscopic Roux-en-Y gastric bypass (LRYGB) is a well-known entity for bariatric surgeons and radiologists, accurate diagnosis remains difficult. The aim of this study was to evaluate the sensitivity and specificity of ten different CT findings in patients with a proven internal hernia after a LRYGB. Methods A retrospective analysis of all LRYGB patients who underwent an explorative laparoscopy for abdominal pain has been performed. Preoperative CT scans were individually reviewed by two radiologists specialized in abdominal CT imaging in a randomized blind way. These results were compared with the operative reports. Results Between 2004 and 2013, 7,328 patients underwent a LRYGB. One hundred sixty nine of these patients underwent an explorative laparoscopy for abdominal pain after a LRYGB, 131 of which had a preoperative CT scan. Of these 131 patients, 72 suffered from an IH. Fifty-nine patients had no IH and served as control group. Mesenteric swirl was the best predictor with for reader 1 a sensitivity of 68 % and specificity of 86 % and for reader 2 a sensitivity of 89 % and specificity of 63 %. Other signs had an even larger interobserver variability. Conclusions A CT scan can help in confirming the diagnosis of an IH, especially if a mesenteric swirl is present. However, since the presented sensitivities are variable and do not reach 100 %, IH might be missed, implicating that a high index of suspicion with a low threshold for explorative laparoscopy/-tomy remains the cornerstone of appropriate treatment.
    Obesity Surgery 09/2014; 25(4). DOI:10.1007/s11695-014-1433-5 · 3.74 Impact Factor
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    ABSTRACT: It is increasingly appreciated that perinatal events can set an organism on a life-long trajectory for either health or disease, resilience or risk. One early life variable that has proven critical for optimal development is the nutritional environment in which the organism develops. Extensive research has documented the effects of both undernutrition and overnutrition, with strong links evident for an increased risk for obesity and metabolic disorders, as well as adverse mental health outcomes. Recent work has highlighted a critical role of the immune system, in linking diet with long term health and behavioral outcomes. The present review will summarize the recent literature regarding the interactions of diet, immunity, and behavior.KeywordsDietNutritionImmuneInflammationMicrogliaCytokineIL-18ObesityCalorie restrictionLipopolysaccharideAbbreviationsACTH, adrenocorticotropic hormoneARC, arcuate nucleusBDNF, brain derived neurotropic factorBMI, body mass indexCR, calorie restrictionCRH, corticotropin-releasing hormoneGR, glucocorticoid receptorHPA axis, hypothalamic-pituitary-adrenal axisIF, intermittent fastingIκB, inhibitory factor κBIL, interleukinIba1, ionized calcium-binding adapter moleculeLPS, lipopolysaccharideNHP, non-human primateNFκB, nuclear factor κBPVN, paraventricular nucleus of the hypothalamuspoly I:C, polyinosinic:polycytidylic acidPOMC, pro-opiomelanocortinTLR, toll-like receptorWT, wild type
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    ABSTRACT: Background: Surgically induced weight loss is a treatment option for the management of obe-sity and the related common disorders. This study evaluated the beneficial effects of bariatric surgery on metabolic profile and the prevalence of metabolic syndrome (MetS) among Iranian patients. Materials and Methods: A prospective observational study was performed on 26 morbidly obese patients scheduled for bariatric surgery, using laparoscopic Roux-en-Y gastric bypass (LRYGB). The parameters of hypertension, type 2 diabetes mellitus (T2DM), hyperlip-idemia, MetS prevalence, and anthropometric measurements of Iranian patients, were recorded, at the preoperative visit and in follow-ups. The follow-up was performed for a median of 12 months, and the change in MetS prevalence and its componnts were assesed. Results: LRYGB induced a mean weight loss of 69.0±21.2%, after 12 months. Preoperative MetS was diagnosed in 21 patients (84%) and decreased to 6 patients (24%) after LRYGB (P=0.001). Likewise, the prevalence of hypertension was significantly decreased from 76% (pre-LRYGB values) to 20% (post-LRYGB values) (P=0.001). The prevalence of T2DM was also decreased from 20% to 8% (P=0.5).Conclusion: According to our results, RYGB produced a rapid and significant weight loss and improvement in hypertension and MetS within one year but there was a cont roversy about