K Schindler

Medical University of Vienna, Wien, Vienna, Austria

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Publications (18)61.13 Total impact

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    ABSTRACT: To determine the feasibility and efficacy of a high-protein diet compared with a standard diet aiming for weight maintenance in insulin treated type-2 diabetic patients on insulin requirement, body weight and metabolic parameters over 12 weeks.In a randomized controlled trial we assigned 44 type-2 diabetic patients on insulin therapy either to high-protein or standard diet over 12 weeks. Parameters were evaluated at baseline and monthly.After 12 weeks, the high protein diet significantly decreased insulin requirement (9.4±16.3 vs. +0.8±4.8 IU, mean±SD; p=0.007), fasting plasma glucose (41.7±62.5 vs. 2.1±39.0 mg dl- 1; p=0.02), body mass index (1.1±0.8 vs. 0.3±0.7 kg m- 2; p=0.003), fat-free (0.8±0.5 vs. 0.2±0.5kg; p=0.001), fat mass (2.6±1.7 vs. 0.8±1.6kg; p=0.001) and increased serum folate (4.2±8.3 vs. - 0.8±5.5 nmol l-1; p=0.04) compared to the standard diet. These beneficial metabolic effects are most likely related to the achieved weight loss. No significant differences between groups in renal function were observed.In this study we demonstrate that a high protein diet with emphasis on plant source protein vs. a standard diet is feasible in insulin-treated type-2 diabetic patients and reduces insulin requirement and body weight and improves metabolic parameters up to 12 weeks. A high protein diet can thus be considered as an appropriate diet choice for type-2 diabetic patients.
    Experimental and Clinical Endocrinology & Diabetes 05/2013; 121(5):286-294. · 1.56 Impact Factor
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    ABSTRACT: BACKGROUND: Weight regain (WR) occurs in some patients after laparoscopic Roux-en-Y gastric bypass (LRYGBP). Loss of restriction due to dilation of the gastrojejunostomy (GJS) or the gastric pouch might be the main cause for WR. With different techniques available for the establishment of the GJS, the surgical technique might influence long-term success. METHODS: We present a 5-year follow-up for weight loss and WR of a matched-pair study comparing circular stapled (CSA) to linear stapled (LSA) GJS in a series of 150 patients who underwent primary antecolic antegastric LRYGBP. Complete 5-year follow-up was obtained for 79 % of the patients. RESULTS: Excess BMI loss (EBL) at 3 months was better with the CSA (p = 0.02) and comparable thereafter. The 5-year %EBL was 67.3 ± 23.2 vs. 73.3 ± 24.3 % (CSA vs. LSA, p = 0.19) WR of > 10 kg from nadir was found in 24 patients (16 %) with higher incidence in CSA than in LSA patients (20 % vs. 12 %). The %WR was comparable for both groups, 16 ± 13 vs. 15 ± 19 % (CSA vs. LSA, p = 0.345). Eleven patients underwent surgical re-intervention for WR by placement of a non-adjustable band (n = 2), adjustable band (n = 7) and conversion to distal gastric bypass (n = 2). CONCLUSIONS: CSA and LSA lead to comparable weight loss in this 5-year follow-up. More patients in the CSA group had WR. Weight regain of more than 10 kg was found in one out of seven patients within 5 years postoperatively.
    Obesity Surgery 03/2013; · 3.10 Impact Factor
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    ABSTRACT: Chronic adipose tissue inflammation is a hallmark of obesity, triggering the development of associated pathologies, particularly type 2 diabetes. Long-chain n-3 PUFAs reduce cardiovascular events and exert well-established antiinflammatory effects, but their effects on human adipose tissue inflammation are unknown. We investigated whether n-3 PUFAs reduce adipose tissue inflammation in severely obese nondiabetic patients. We treated 55 severely obese nondiabetic patients, scheduled to undergo elective bariatric surgery, with 3.36 g long-chain n-3 PUFAs/d (EPA, DHA) or an equivalent amount of butterfat as control, for 8 wk, in a randomized open-label controlled clinical trial. The primary efficacy measure was inflammatory gene expression in visceral and subcutaneous adipose tissue samples (subcutaneous adipose tissue and visceral adipose tissue), collected during surgery after the intervention. Secondary efficacy variables were adipose tissue production of antiinflammatory n-3 PUFA-derived eicosanoids, plasma concentrations of inflammatory markers, metabolic control, and the effect of the Pro12Ala PPARG polymorphism on the treatment response. Treatment with n-3 PUFAs, which was well tolerated, decreased the gene expression of most analyzed inflammatory genes in subcutaneous adipose tissue (P < 0.05) and increased production of antiinflammatory eicosanoids in visceral adipose tissue and subcutaneous adipose tissue (P < 0.05). In comparison with control subjects who received butterfat, circulating interleukin-6 and triglyceride concentrations decreased significantly in the n-3 PUFA group (P = 0.04 and P = 0.03, respectively). The Pro12Ala polymorphism affected the serum cholesterol response to n-3 PUFA treatment. Treatment with long-chain n-3 PUFAs favorably modulated adipose tissue and systemic inflammation in severely obese nondiabetic patients and improved lipid metabolism. These effects may be beneficial in the long-term treatment of obesity. This trial was registered at clinicaltrials.gov as NCT00760760.
    American Journal of Clinical Nutrition 10/2012; 96(5):1137-49. · 6.50 Impact Factor
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    ABSTRACT: The association between phase II of the motor migratory complex (MMC) and hunger remains poorly understood, which may be important in non-diabetic and diabetic obese subjects where gastric inter-digestive motility has been often reported as impaired. We characterize phase II of the MMC and its predictive power on food intake, weight loss, and glycemia in non-diabetic (OB) and diabetic (DM) obese subjects treated with gastric stimulation for 6 months. Twelve OB and 12 DM subjects were implanted with bipolar electrodes connected to a gastric stimulator capable of recording antrum electromechanical activity. The phase II mean interval size and duration increased from 156 ± 121 to 230 ± 228 s and from 98 ± 33 to 130 ± 35 min (p < 0.05) in OB and from 158 ± 158 to 180 ± 112 s and from 77 ± 26 to 109 ± 18 min (p < 0.05) in DM after 6 months. There was a significant trend of meals to interrupt the late rather than the early phase II. Nonlinear regression analysis demonstrated that weight loss in OB was significantly associated with the change in interval size of the late phase II and with phase II duration. In the DM group, weight loss and glycemia were also significantly associated with the change in the interval size of the early phase II. Gastric stimulation delivered in the digestive period can modify the length of the MMC and the contractility in its longest component, phase II. The duration and contractility of the MMC can determine to some extent future intake and, thus, influence energy balance.
    Obesity Surgery 07/2012; 22(9):1465-72. · 3.10 Impact Factor
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    ABSTRACT: BACKGROUND: "Fast-track" rehabilitation can accelerate recovery, reduce general morbidity and decrease hospital stay after elective colorectal surgery. Despite this evidence, there is no information on the acceptance and utilization of these concepts amongst Austrian anaesthesiologist. In addition to that differences between colonic and rectal resections have not been addressed yet. METHODS: A questionnaire concerning perioperative routines in elective, open colonic and rectal resection was sent to the senior anaesthesiologist in 120 Austrian digestive surgical centres. RESULTS: The response rate was 63% (76 centres). Prophylactic measures for postoperative nausea and vomiting (PONV) were administered in 32% of clinics. Epidural analgesia is in use in three-quarters both of the institutions, regardless of the procedure. Short-acting anaesthetics were used for colonic as well as rectal resections. Normothermia is provided by the majority of anaesthetists. CONCLUSIONS: In Austria the anaesthesiological routine after elective colonic and rectal surgery adheres broadly to the evidence-based recommendations for fast-track concepts. GRUNDLAGEN: Die "Fast-Track"-Rehabilitation im Rahmen elektiver kolorektaler Resektionen ist ein multimodales, perioperatives Behandlungskonzept, das chirurgische und anästhesiologische Aspekte kombiniert. Dadurch wird die Rate allgemeiner Komplikationen vermindert und eine rasche Rekonvaleszenz ermöglicht. Die hier vorgestellte Umfrage untersucht die Verbreitung und die Anwendung dieses Konzeptes in Österreich. METHODIK: 120 anästhesiologische Abteilungen erhielten einen Fragebogen, in dem das übliche anästhesiologische Vorgehen am Beispiel einer elektiven, offenen Sigma- und Rektumresektion beschrieben werden sollte. ERGEBNISSE: Die Rücklaufrate betrug 76 (63 %). Eine Prophylaxe gegen postoperative Übelkeit und Erbrechen ("postoperative nausea and vomiting", PONV) führen 32% der Befragten durch. Es nutzen 75 % der anästhesiologischen Abteilungen epidurale Analgesien. Kurzwirksame Analgetika sind weit verbreitet. Maßnahmen zum Erhalt der Normothermie haben sich fest etabliert. SCHLUSSFOLGERUNGEN: In Österreich orientiert sich die anästhesiologische Versorgung im Rahmen elektiver kolorektaler Resektionen in weiten Teilen an den evidenzbasierten Empfehlungen zur "Fast-Track"-Chirurgie. KeywordsAustria-Fast-track surgery-Anaesthesia-Colorectal surgery-Evidence-based medicine SchlüsselwörterÖsterreich-"Fast-Track"-Chirurgie-Anästhesiologisches Vorgehen-Kolorektale Chirurgie-Evidenzbasierte Medizin
    European Surgery 01/2010; 42(2):83-90. · 0.15 Impact Factor
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    ABSTRACT: Highly active antiretroviral therapy (HAART) leads to lipodystrophy and is associated with detrimental changes in glucose and lipid metabolism. This study investigated the impact of rosiglitazone on insulin sensitivity, beta cell function, bone mineral density, and body composition in HIV+ nondiabetic subjects under HAART. In this randomized, double blind, placebo controlled parallel group study, 40 HIV+ subjects were treated with rosiglitazone 4 mg/day (R, n=23) or placebo (P, n=17) for 6 months. Glucose, insulin and C peptide concentrations were analyzed for assessing insulin sensitivity and secretion. Adiponectin and leptin were evaluated. Body fluid compartments were measured with bioelectrical impedance spectroscopy, and bone mineral density and body composition with Dual X Ray absorptiometry. Rosiglitazone improved peripheral insulin sensitivity (+36.7+/-15.7 ml/min/m (2), p=0.03, means+/-SEM), while no change was observed in P (+4.5+/-19.5 ml/min/m (2), p=0.55). Liver insulin resistance, beta cell activity, and hepatic insulin clearance did not change. Plasma adiponectin increased (R: +2.47+/-0.86 microg/ml, p=0.01 vs. P: +0.45+/-0.60, p=0.28). Rosiglitazone had no influence on body composition, fat distribution and bone mineral density but expanded extra-cellular fluid volume in HIV infected persons (R: +0.50+/-0.21 l, p=0.02 vs. P: 0.10+/-0.25 l, p=0.32). Lipid metabolism in P remained unchanged, in R total cholesterol and LDL cholesterol levels increased significantly (p<0.05). Rosiglitazone treatment resulted in improved peripheral insulin sensitivity with increased circulating adiponectin in HIV patients under HAART. No effect was seen on body fat distribution, bone mineral density, and weight. These side effects and their potential for cardiac risk must be weighed against the beneficial effects on glucose metabolism.
    Hormone and Metabolic Research 04/2009; 41(7):573-9. · 2.15 Impact Factor
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    ABSTRACT: 'Fast-track' rehabilitation has been shown to accelerate recovery, reduce general morbidity and decrease hospital stay after elective colonic surgery. Despite this evidence, there is no information on the acceptance and utilization of these concepts among the entirety of Austrian and German surgeons. In 2006, a questionnaire concerning perioperative routines in elective, open colonic resection was sent to the chief surgeons of 1270 German and 120 Austrian surgical centres. The response rate was 63% in Austria (76 centres) and 30% in Germany (385 centres). Mechanical bowel preparation is used by the majority (Austria, 91%; Germany, 94%); the vertical incision is the standard method of approach to the abdomen in Austria (79%) and Germany (83%), nasogastric decompression tubes are rarely used, one-third of the questioned surgeons in both countries use intra-abdominal drains. Half of the surgical centres allow the intake of clear fluids on the day of surgery and one-fifth offer solid food on that day. Epidural analgesia is used in three-fourths of the institutions. Although there is an evident benefit of fast-track management, the survey shows that they are not yet widely used as a routine in Austria and Germany.
    Colorectal Disease 06/2008; 11(2):162-7. · 2.08 Impact Factor
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    ABSTRACT: BACKGROUND: Bariatric procedures like gastric banding, vertically banded gastroplasty and Roux-en-Y gastric bypass have impacted on the postoperative eating behavior. Since laparoscopic sleeve gastrectomy (LSG) leads to decreased plasma ghrelin levels, a reduced sensation of hunger following surgery is expected. The aim of this study was to assess the impact of LSG on the eating behavior in correlation with plasma ghrelin levels. METHODS: This prospective study was carried out in 15 morbidly obese patients who underwent LSG. The German version of the self-report Three-Factor Eating Questionnaire (TFEQ) was applied preoperatively and at six months following surgery to assess the impact of LSG on the three dimensions of eating behavior: restraint, disinhibition and hunger. The correlation between plasma ghrelin levels and the sensation of hunger was assessed in a subset of seven patients. RESULTS: Following LSG, increased cognitive restraint and decreased disinhibition of eating were found. Furthermore, a significant decrease in hunger was observed with a significant correlation (r = 0.834, p = 0.01) between circulating plasma ghrelin levels and hunger scores. CONCLUSIONS: Following LSG, a high correlation between decreased ghrelin levels and the reduced sensation of hunger was found. This may contribute to the excellent weight loss observed following laparoscopic sleeve gastrectomy. GRUNDLAGEN: Bariatrische Operationsverfahren wie das Magenband, VGB und Magenbypass haben nachgewiesenermaßen Einfluss auf das postoperative Essverhalten. Nachdem die laparoskopische "Sleeve gastrectomy" (LSG) zu verringerten Ghrelin-Spiegeln führt, ist eine Reduktion im Hungerempfinden zu erwarten. Ziel dieser Studie war es, den Einfluss der LSG auf das Essverhalten in Korrelation Plasma-Ghrelin-Spiegeln zu bestimmen. METHODIK: In dieser prospektiven Studie von 15 morbid adipösen LSG-Patienten wurde die deutsche Version des "Self-report Three-Factor Eating Questionnaire" (TFEQ) vor der Operation und 6 Monate postoperativ angewandt, um den Einfluss der LSG auf die drei Dimensionen des Essverhaltens: Kontrolle, Irritierbarkeit und Hungerempfinden zu bestimmen. In einer Untergruppe von 7 Patienten wurde die Korrelation zwischen Plasma-Ghrelin-Spiegeln und dem Hungerempfinden untersucht. ERGEBNISSE: LSG führte zu einer Zunahme in der kognitiven Einschränkung und zu einer reduzierten Kontrolle, Irritierbarkeit. Weiters wurde eine signifikante Reduktion im Hungerempfinden nachgewiesen, welche ebenfalls mit den Ghrelin-Spiegeln korrelierte (r = 0.834, p = 0.01). SCHLUSSFOLGERUNGEN: LSG führt zu einem reduzierten Hungerempfinden, welches mit den ebenfalls verringerten Plasma-Ghrelin-Spiegeln korreliert. Diese Effekte können zu dem exzellenten Gewichtsverlust nach LSG beitragen.
    European Surgery 05/2008; 40(3):120-124. · 0.15 Impact Factor
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    ABSTRACT: Plasma adipocyte fatty acid binding protein (A-FABP) and epidermal fatty acid binding protein (E-FABP) concentrations have been linked to obesity and the metabolic syndrome. In this study, we investigated whether plasma A-FABP and E-FABP concentrations are altered by weight loss in obese patients. In a prospective study, fasting plasma A-FABP and E-FABP concentrations were measured before and 6 months after gastric banding in 33 morbidly obese patients, with a body mass index (BMI) of 46 +/- 5 kg/m(2). Eleven healthy subjects with a BMI < 25 kg/m(2) served as controls. A-FABP and E-FABP plasma concentrations were higher in obese subjects (36.7 +/- 6.7 and 3.7 +/- 0.7 ng/ml, respectively) than in controls (18.1 +/- 0.6 and 2.6 +/- 0.5, respectively, p < 0.01). Gastric banding reduced BMI to 40 +/- 5 kg/m(2), A-FABP to 32.6 +/- 5.4 ng/ml and E-FABP to 1.9 +/- 0.7 ng/ml (all p < 0.05) after 6 months. Insulin sensitivity as estimated by the Homeostasis Model Assessment insulin resistance index was unchanged. A-FABP concentrations were significantly associated with BMI before and 6 months after surgery (p < 0.05, r = 0.42 and r = 0.37 respectively). Elevated plasma A-FABP and E-FABP concentrations in morbidly obese subjects are reduced after gastric banding-induced weight loss. This suggests that FABP may be associated with improvement of metabolic conditions over time.
    Diabetes Obesity and Metabolism 09/2007; 9(5):761-3. · 5.18 Impact Factor
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    ABSTRACT: Thiazolidinediones (TZD) may improve insulin resistance in patients with diabetes and HIV. The novel adipocytokines visfatin and retinol-binding protein-4 (RBP-4) have been proposed to influence the development of impaired glucose tolerance. The impact of TZD on these cytokines is yet unknown. In this randomized, double-blind, placebo-controlled parallel group study, 37 lean HIV-positive subjects aged 19-50 years were treated with 8 mg/day rosiglitazone (n=20) or placebo (n=17) for 6 months. Insulin sensitivity was estimated from the homeostasis model assessment (HOMA) index. Fasting visfatin, RBP-4, leptin, and adiponectin plasma concentrations were analyzed by immunoassays. Rosiglitazone had no effect on impaired insulin sensitivity, but increased median plasma visfatin from 6.2 ng/ml (95% CI: 5.9; 6.5) to 13.7 ng/ml (12.6; 19.1) (P<0.001) and adiponectin from 3.2 ng/ml (2.2; 4.0) to 4.0 ng/ml (3.3; 8.5; P<0.001). RBP-4 was lowered from 21.0 ng/ml (19.6; 23.1) to 16.3 ng/ml (15.2; 17.0; P<0.001), and leptin concentrations were unchanged. Adipocytokine concentrations were stable in subjects receiving placebo, where a deterioration in insulin sensitivity was detectable (P<0.05). Changes in visfatin and RBP-4 were correlated in subjects receiving rosiglitazone (r=-0.64, P<0.01) but not placebo (r=0.12, P=0.15). TZD treatment affects circulating adipocytokine concentrations in subjects with HIV. Reductions in RBP-4 and increases in visfatin may contribute to the pharmacodynamic action of TZD on glucose homeostasis. Quantification of adipocytokines might be useful to assess TZD treatment effectiveness in insulin-resistant subjects with HIV.
    Clinical Pharmacology &#38 Therapeutics 05/2007; 81(4):580-5. · 6.85 Impact Factor
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    ABSTRACT: To determine circulating levels of adipocytokines, especially the recently characterized visfatin, and the fat-derived factor retinol-binding protein-4 (RBP-4) in HIV-infected subjects and their respective changes following treatment with highly active antiretroviral therapy (HAART). Fourteen HIV-positive, HAART-naïve subjects were compared with 10 HIV-negative healthy controls and reassessed after a 1-year treatment with HAART. Plasma visfatin and RBP-4 were determined by ELISA, whereas leptin and adiponectin by RIA. Body composition was measured with dual X-ray absorptiometry (DXA). Homeostasis model assessment (HOMA-IR) was assessed using insulin and glucose levels. Visfatin and RBP-4 levels in HIV-positive subjects were comparable with those of HIV-negative controls before treatment with HAART. Treatment with HAART for 12 months resulted in a 6.9-fold and 7.1-fold increase of visfatin and RBP-4 levels (+54.0 +/- 9.7 ng mL(-1), P < 0.0001 and +95.3 +/- 31.7 ng mL(-1), P < 0.01), respectively. Leptin (-2.7 +/- 1.6 ng mL(-1), P = 0.054) was unchanged and adiponectin (-2.8 +/- 0.7 microg mL(-1), P < 0.01) decreased. Changes of visfatin concentrations correlated significantly with the increases of RBP-4 (r = 0.78, P = 0.001), fat-free mass (FFM, r = 0.75, P < 0.05) and change of HOMA-IR (r = 0.64, P < 0.05). Parameters of glucose metabolism and body fat mass were unchanged during the observation period. Treatment with HAART induced a pronounced increase of plasma visfatin and RBP-4 as well as a decrease of adiponectin in HIV-infected patients on HAART. Although body weight, fat mass and parameters of glucose metabolism remained stable, the changes in the adipocytokines might herald subsequent alterations of these parameters.
    European Journal of Clinical Investigation 09/2006; 36(9):640-6. · 3.37 Impact Factor
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    ABSTRACT: Nutritional support teams (NST) have been demonstrated to be an excellent mechanism for identifying patients in need of nutrition support, improving the efficacy of nutrition support in a variety of hospital environments. Focus of this study was the investigation of function, structure and organisation of NST in Germany (D), Austria (A) and Switzerland (CH). Prospective investigation of the function, structure and organisation of NST in D, A and CH, using standardised questionnaires. From a total of 3071 hospitals in D, A and CH, NST have been established at 98 hospitals (3.2%). Their main activities were creating nutritional regimes (100%), education (87%) and monitoring nutrition therapy (92%). In general, the NST are not independently operating units but are affiliated to a special discipline. Seventy-one per cent of the physicians, 40% of the nurses and 69% of the dieticians in the NST held a nutrition-specific additional qualification. A total of 12% of the physicians, 37% of the nurses and 46% of the dieticians are exclusively responsible for the NST. A reduction of complications (88%) and cost saving (98%) were indicated since their establishment. The NST received in 32% funding support. In D, A, CH neither a uniform nor comprehensive patient care by NST existed in 2004. Standards of practice, development of guidelines in clinical nutrition and better documentation in NSTs are necessary. Special efforts should be aimed at education of NST members and financing of teams.
    Clinical Nutrition 01/2006; 24(6):1005-13. · 3.30 Impact Factor
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    ABSTRACT: Different changes of plasma ghrelin levels have been reported following gastric banding, Roux-en-Y gastric bypass, and biliopancreatic diversion. This prospective study compares plasma ghrelin levels and weight loss following laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) in 20 patients. Patients who underwent LSG (n=10) showed a significant decrease of plasma ghrelin at day 1 compared to preoperative values (35.8 +/- 12.3 fmol/ml vs 109.6 +/- 32.6 fmol/ml, P=0.005). Plasma ghrelin remained low and stable at 1 and 6 months postoperatively. In contrast, no change of plasma ghrelin at day 1 (71.8 +/- 35.3 fmol/ml vs 73.7 +/- 24.8 fmol/ml, P=0.441) was found in patients after LAGB (n=10). Increased plasma ghrelin levels compared with the preoperative levels at 1 (101.9 +/- 30.3 fmol/ml vs 73.7 +/- 24.8 fmol/ml, P=0.028) and 6 months (104.9 +/- 51.1 fmol/ml vs 73.7 +/- 24.8 fmol/ml, P=0.012) after surgery were observed. Mean excess weight loss was higher in the LSG group at 1 (30 +/- 13% vs 17 +/- 7%, P=0.005) and 6 months (61 +/- 16% vs 29 +/- 11%, P=0.001) compared with the LAGB group. As a consequence of resection of the gastric fundus, the predominant area of human ghrelin production, ghrelin is significantly reduced after LSG but not after LAGB. This reduction remains stable at follow-up 6 months postoperatively, which may contribute to the superior weight loss when compared with LAGB.
    Obesity Surgery 09/2005; 15(7):1024-9. · 3.10 Impact Factor
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    ABSTRACT: Plasma ghrelin, an orexigenic peptide derived from the stomach and duodenum, increases following weight loss and might contribute to weight regain. The aim of the present study was to evaluate the effect of laparoscopic adjustable gastric banding (LAGB) on body weight and body composition as well as plasma ghrelin in relation to eating behaviour in morbidly obese patients. This study was performed in 23 morbidly obese subjects who underwent standardized LAGB. Fasting plasma ghrelin was measured before and 6 months after surgery and was correlated with body weight, body composition, and eating behaviour. Six months after LAGB, body weight decreased significantly by -15.7 +/- 1.4 kg (mean +/- SEM, P = 0.0001) which was accompanied by an increased cognitive restraint of eating (P = 0.001), and by a decreased disinhibition of eating and susceptibility to hunger (P = 0.0001). Plasma ghrelin increased (P = 0.016) by 27.2% from 100.39 +/- 12.90 to 127.22 +/- 13.15 fmol mL(-1). The change in plasma ghrelin correlated with changes in body weight (r = -0.49, P = 0.02), BMI (r = -0.42, P = 0.048) and fat mass (r = -0.519, P = 0.013), but not with changes of fat-free mass and of the three dimensions of eating behaviour. Weight loss following LAGB leads to an increase in fasting plasma ghrelin and is accompanied by a decrease in hunger, disinhibition of eating and an increase in cognitive restraint. Thus, changes in eating behaviour, which promote reduction of food intake and not fasting ghrelin, determines weight loss achieved by LAGB.
    European Journal of Clinical Investigation 09/2004; 34(8):549-54. · 3.37 Impact Factor
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    ABSTRACT: Because female sex protects against dyslipidaemia and atherosclerosis in normal subjects, we aimed to reveal potential sex differences in metabolic side-effects of a newly initiated highly active antiretroviral therapy (HAART) regimen, and to relate these changes to endothelial cell activation as measured by levels of circulating E-selectin (cE-selectin). Prospective longitudinal cohort study. Tertiary care centre at a University Hospital. HIV-seropositive male (n = 27) and female patients (n = 13) with a plasma viral load of > or = 10 000 copies/ml and 35 healthy controls were enrolled in the study. All participants were weight stable, free of acute opportunistic infections, and had not taken any protease inhibitors before. Serum levels of lipids, insulin, leptin, and cE-selectin were measured before initiation of HAART, and at 3 and 6 months thereafter. HAART increased serum levels of triglycerides, leptin, and low-density lipoprotein (LDL) cholesterol; these effects were more distinct in women. Fasting insulin levels and the LDL : high density lipoprotein (HDL) ratio increased only in female HIV-infected patients (P < 0.02 versus men). In contrast, endothelial activation, as measured by cE-selectin, decreased more in men (P < 0.02) than in women. As a consequence, women had higher triglycerides and leptin levels after therapy than did men, and the LDL : HDL ratio and cE-selectin levels, which were initially higher in men, were no longer different between the sexes. Metabolic adverse effects during HAART are more pronounced in women than in men. Hence, female HIV-infected patients seem to loose part of their natural protection from atherosclerosis during antiretroviral therapy.
    AIDS 05/2001; 15(6):725-34. · 6.41 Impact Factor
  • Annals of the New York Academy of Sciences 06/2000; 904:603-6. · 4.38 Impact Factor
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    ABSTRACT: (i) To investigate whether protease inhibitor (PI) (nelfinavir)-containing highly active antiretroviral therapy (HAART) affects body composition differently in HIV-infected and AIDS patients without wasting syndrome. (ii) To delineate the changes in resting energy expenditure (REE) under PI therapy, and to determine whether sustained reductions in HIV RNA would decrease REE. Prospective longitudinal cohort study with individually matched healthy controls. Tertiary care centre at a University Hospital. HIV-seropositive (n = 20) and AIDS patients (n = 17) with a plasma viral load of at least 10000 copies/ml and 37 healthy volunteers were enrolled. All participants were weight stable, free of acute opportunistic infections, and naive to PI therapy. Patients underwent testing of bioelectrical impedance analysis (BIA), indirect calorimetry and food intake, shortly before the initiation of HAART and 24 weeks thereafter. Both patient groups gained weight, body mass index (BMI), and fat-free mass (FFM) (P < 0.05 versus baseline), whereas only AIDS patients gained fat mass. Increases were more pronounced in the AIDS group. REE was elevated compared with corresponding controls at baseline, and decreased similarly in HIV and in AIDS patients during PI therapy (P < 0.05). The reduction in the viral burden preceded the decrease in REE by several weeks. Body composition and metabolic parameters improved during PI therapy in HIV-infected and AIDS patients without wasting. Although an early reduction in viral load as a result of HAART does not seem to influence REE directly, sustained viral load suppression may promote a decrease in energy expenditure.
    AIDS 12/1999; 13(17):2389-96. · 6.41 Impact Factor