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: 1.51). 02/2013; 56(1):47-57. DOI: 10.1503/cjs.036111
Source: PubMed


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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    • "Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the most favored bariatric procedure in the USA [1], despite the fact that it ranks as 1 of the most difficult laparoscopic procedures [3]. Various reviews and metaanalyses have been conducted to trace the most effective and safe bariatric procedure among the most popular ones : LAGB, LRYGB, and LSG [3] [4]. "
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    ABSTRACT: Background: Laparoscopic mini-gastric bypass (LMGB) is a relatively new bariatric procedure; published studies are accumulating in various settings. The objective of this study was to summarize the available evidence about the efficacy and safety of LMGB. Methods: A systematic search in the literature was performed , and PubMed and reference lists were scrutinized (end-of-search date: July 15, 2013). For the assessment of the eligible articles, the Newcastle-Ottawa quality assessment scale was used. Results: Ten eligible studies were included in this study, reporting data on 4,899 patients. According to all included studies, LMGB induced substantial weight and body mass index reduction, as well as substantial excess weight loss. Moreover, resolution or improvement in all major associated medical illnesses and improvement in overall Gastrointestinal Quality of Life Index score were recorded. Major bleeding and anastomotic ulcer were the most commonly reported complications. Readmission rate ranged from 0%- 11%, whereas the rate of revision operations ranged from .3%- 6%. The latter were conducted due to a variety of medical reasons such as inadequate or excessive weight loss, malnutrition, and upper gastrointestinal bleeding. Finally, the mortality rate ranged between 0% and .5% among primary LMGB procedures. Conclusion: LMGB represents an effective bariatric procedure; its safety and minimal postoperative morbidity seem remarkable. Randomized comparative studies seem mandatory for the further evaluation of LMGB.
    No preview · Article · Sep 2014 · Surgery for Obesity and Related Diseases
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    • "Today, available treatments include combination of diet, physical exercise, and pharmaceutical regimens where monoagent therapy is not as effective as combination ones. Bariatric surgery is considered the most efficient treatment in severely obese patients (BMI ≥ 40 kg/m2) [138, 139]. Adiponectin, showing antihyperglycemic, antiatherogenic, and anti-inflammatory properties, could have important clinical benefits such us enabling the development of therapies for the prevention and/or for treatment of obesity and its obesity-related diseases. "
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    ABSTRACT: Obesity is a major health problem strongly increasing the risk for various severe related complications such as metabolic syndrome, cardiovascular diseases, respiratory disorders, diabetic retinopathy, and cancer. Adipose tissue is an endocrine organ that produces biologically active molecules defined "adipocytokines," protein hormones with pleiotropic functions involved in the regulation of energy metabolism as well as in appetite, insulin sensitivity, inflammation, atherosclerosis, cell proliferation, and so forth. In obesity, fat accumulation causes dysregulation of adipokine production that strongly contributes to the onset of obesity-related diseases. Several advances have been made in the treatment and prevention of obesity but current medical therapies are often unsuccessful even in compliant patients. Among the adipokines, adiponectin shows protective activity in various processes such as energy metabolism, inflammation, and cell proliferation. In this review, we will focus on the current knowledge regarding the protective properties of adiponectin and its receptors, AdipoRs ("adiponectin system"), on metabolic complications in obesity and obesity-related diseases. Adiponectin, exhibiting antihyperglycemic, antiatherogenic, and anti-inflammatory properties, could have important clinical benefits in terms of development of therapies for the prevention and/or for the treatment of obesity and obesity-related diseases.
    Full-text · Article · Jul 2014 · BioMed Research International
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    • "It is emphasized that obesity was a complex , multifactorial condition, and many endogenous genetic, endocrine and inflammatory pathways and environmental factors are involved in the development of obesity and obesity related diseases (de Mutsert et al. 2013). The World Health Organization defines overweight as a body mass index (BMI) of 25 or more and obesity as a BMI of 30 or more (Noria et al. 2013). "
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    ABSTRACT: Obesity results in a proinflammatory state starting within the metabolic cells as adipocyte, monocyte. The bioactive system, including cytokines as IL-4 and IL-6, contributes to the pathogenesis of conditions associated with obesity and favors inflammation. This study aimed to investigate the role of IL-4 gene intron 3 VNTR and IL-6 gene -597G/A polymorphisms in the pathogenesis of obesity. The study included 127 patients with obesity (BMI>30kg/m 2) and 110 healthy controls. Genomic DNA was isolated and genotyped using polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) analysis for IL-4 gene and IL-6 gene polymorphisms. There was no statistical significant difference in the allele and genotype frequencies of both genes polymorphism in obesity patients and control groups (p>0.05). Additionally, there was no statistical significant difference in the combine genotype analysis of IL-4 gene intron 3 VNTR and IL-6 gene -597G/A polymorphism (p>0.05). These findings showed that there are not any associations of IL-4 gene intron 3 VNTR and IL-6 gene -597G/A polymorphisms with susceptibility of a person for development of obesity. This is the first report that investigates the relationships between susceptibility of obesity and IL-4 gene intron 3 VNTR, IL-6 gene -597G/A polymorphisms.
    Full-text · Article · Jan 2013 · International Journal of Human Genetics
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