Conditions In Obese Patients Research Articles

Sleeve Gastrectomy in Metabolic Syndrome for Nonmorbid Obese Patients: Is this the Future for Diabetes Treatment?

During the development of surgical treatments, there have been so many improvements and challenging task that have lead surgeons to treat patients with new procedures and new indications. Gastrectomy surgery initially was performed for cancer surgery. Now it is a worldwide performed procedure for complete healthy stomachs, but the main indication its weight loss, and all the physiological improvements that this procedure will bring to the patients’ health. During the bariatric surgery development, there have been different choices for different indications and different patients, depending on a variety of conditions and data that take evidence based medicine, to approve that this procedures can be accepted in the surgical field. All the studies that have been showing improvement of medical conditions in obese patients, and had compared different type of procedures (Gastric Bypass, Duodenal Switch, Biliopancreatic Divertion, Sleeve Gastrectomy), led surgeon in different part of the world to take indications of surgery beyond weight loss. Being proved by previous analysis, that most of the patients get remission or cure, of comorbidities before an statistically significant weight loss, this study was led to perform vertical sleeve gastrectomy in patients with overweight, nonobese, that where diagnosed with metabolic syndrome (MS). Ten patients where operated (f = 6 m = 4), all of them met at least three criteria for MS (National Cholesterol Education Program Adult Treatment Panel III Citeria), 100% had diabetes mellitus (DM) as a criteria. After surgery the patients where followed up to 12 months and the mean body mass index (BMI) achieved overall was 22.58 kg/m 2 being the minimum 18.8 kg/m 2 (f = 22.28 m = 22.44). The total mean weight loss overall was 64.95 ± 12.6 kg, and the mean percentage of weightloss was 35% of initial weight with no clinical significance in the patients and 70% had remission of DM.

Implementation of a Very Low Calorie Diet in Patients Undergoing Urologic Surgery: Room for Improvement?

Introduction Several urologic surgeries, such as adrenalectomy, radical nephrectomy, thrombectomy, and partial nephrectomy—whether open, laparoscopic, or robotic—often require liver retraction and mobilization to achieve adequate exposure of critical structures. However, performing these procedures in morbidly obese patients (defined as having a body mass index of > 30 kg/m) is technically challenging and represents an increasing problem given alarming increasing rates in the US population. Aside from the comorbidities that increase perioperative risks in this patient population, additional technical difficulties are often encountered when performing intraabdominal urologic procedures. In particular, hepatomegaly, a common condition in obese patients, often limits the intraabdominal space available for performing right-sided procedures, and even the use of robotic technology does not necessarily overcome this technical challenge. Furthermore, traction of a fatty liver may increase the risk for liver trauma or bleeding. We present a thorough discussion of the implementation of a very low calorie diet (VLCD) to decrease hepatomegaly before anticipated urologic surgery.

Laparoscopic pectopexy versus sacropexy for apical prolapse correction: The first randomized prospective controlled clinical trial

Introduction: Sacral colpopexy is a well established method of apical prolapse correction. Although this technique allows restoring the physiological axis of the vagina, it also bares some potential risks: An injury to the presacral venous plexus, a long term risk of de novo constipation, difficult surgical conditions in obese patients. We developed pectopexy, an alternative method to avoid the presacral preparation: The vagina or cervix is fixed in a hammock-like manner to both iliopectineal ligaments by the use of a synthetic mesh.

The effect of body weight on the choice of material for the bearing couple in artificial hip joints

Abstract The effect of body weight on the success of arthroplasty replacement of the hip joint is a controversial issue, particularly the question of whether the choice of bearing couple used should be adapted to individual patient characteristics. As part of this study, we carried out a literature-based meta-analysis of clinical results that referred to patient weight. The friction of various material combinations under different joint forces was also experimentally determined. Clinically, there are reports of unfavorable implant positioning, increased rate of dislocations, and increased noise developments for obese patients. The results of the friction measurements do not suggest a material choice adapted to body weight. For obese patients, therefore, the same argument applies as for patients with normal weight; provided a correct implantation situation can be ensured, ceramic-on-ceramic bearing couples should be favored from a tribological point of view. If the correct implant position—for example, based on the more complicated implant conditions in obese patients—cannot be achieved, a hard–soft bearing couple with a ceramic head appears to be preferable to a hard–hard bearing couple.

Obesity hypoventilation syndrome in obstructive sleep apnea patients in the United Arab Emirates: a retrospective cross-sectional study

ObjectivesTo estimate the frequency of symptoms of obesity hypoventilation syndrome (OHS) in patients with obstructive sleep apnoea (OSA) and to evaluate comorbidities associated with OHS.DesignRetrospective study based on patients' medical records and on further sleep tests performed in the study centre during the inclusion visit.SettingRespiratory Care Unit and Sleep Disorder Centre of the Zayed Military Hospital United Arab Emirates.ParticipantsAll patients referred to the study centre for a suspicion of sleep-disordered breathing.Main outcome measuresPrevalence of OSA and OSA + OHS and comorbidities in patients with OSA and OHS.ResultsA total of 212 adult patients participated in the study. Of these, 107 patients (50.5% [43.8–57.1% CI 95%]) fulfilled diagnostic criteria for OSA, and the majority were men (79.4%). Among patients with OSA, 18 patients (16.8% [10.8–25.1% CI 95%]) fulfilled diagnostic criteria for OHS. In this group, women were more frequently affected than men (31.8% [7/22] vs. 12.9% [11/85], respectively; p = 0.03) and tended to be older than affected men, with a mean age of 55 ± 10.6 years versus 46 ± 13 for men. After adjustment for gender, OHS was significantly associated with hypertension (OR = 3.5; p = 0.03), diabetes mellitus (OR = 4.6; p = 0.02), ischaemic heart disease (OR = 5.1; p = 0.04) and pulmonary hypertension (OR = 16.1; p = 0.001).ConclusionOHS is a common condition in obese patients in the UAE and is associated with an increased risk of cardiovascular comorbidities and diabetes.

Retracted: Quercetin Decreases Liver Damage in Mice with Non‐Alcoholic Steatohepatitis

Non-alcoholic steatohepatitis (NASH) is a frequent condition in obese patients that may progress to end-stage liver disease. This study was designed to evaluate the modulation of this condition by use of quercetin (Q), a flavonoid largely found in vegetable foods, with known anti-inflammatory and antioxidant properties, in the experimental model of non-alcoholic steatohepatitis (NASH) using a diet deficient in methionine and choline (MCD). Male C57BL6 mice were divided into four groups (n=16): (i) Control plus vehicle (control ration plus carboxymethylcellulose 1% used as vehicle, CO+V); (ii) Control ration plus Q 50mg/kg (CO+Q); (iii) MCD diet plus vehicle (NASH+V); and (iv) MCD diet plus Q (NASH+Q). Diets were administered for 4weeks. At the end of the experimental period, liver alterations, bioindicators of oxidative stress and DNA damage were assessed. NASH was diagnosed in 100% of the mice that were fed the MCD diet. In addition, a significant increase in DNA damage in liver tissue from NASH+V group was observed in comparison with CO+V. The group NASH+Q showed a significant decrease in hepatic damage enzymes, lipoperoxidation, DNA damage and a lower degree of macrovesicular steatosis, ballooning and inflammatory process. These findings suggest that Q may have protective effects by improving liver integrity in NASH.

A review of obesity and orthopaedic surgery: The critical issues

Obesity is a growing concern in the health community because of the morbidities associated with it. There is a higher occurrence of many orthopaedic conditions among obese individuals than their non-obese counter parts. Obesity also worsens the progression of many of these orthopaedic conditions. Studies have shown that obesity may have negative impact on bone metabolism and may be implicated in the pathophysiology of some orthopaedic conditions like osteoporosis, fractures, osteoarthritis and many soft tissue ailments by both reduction in bone mass and elaboration of proinflammatory cytokines. These contribute to preponderance of musculoskeletal co-morbidities among obese patients. Critical peri-operative issues which include increased cardiopulmonary risks, issues of special equipment, instrumentation, surgical approach, patients' positioning and adjustments in medication should be acknowledged and meticulously addressed in operative management of orthopaedic conditions in obese patients. Surgeries in obese patients are fraught with operative challenges and post-operative complications than in the non-obese and a good knowledge of the critical issues in surgical management of obese patients is necessary to facilitate decision making as well as rendering of effective and efficient orthopaedic care.

Obesity in pregnancy problems and potential solutions

Recent years have witnessed an increase in the prevalence of maternal obesity during pregnancy in the United States and worldwide. Obese women have increased risks for gestational problems, such as diabetes, hypertension, and pre-eclampsia. Further, gestational obesity can adversely impact fetal growth and result in macrosomia, congenital abnormalities, and even fetal death. Measures must be taken to reduce maternal adiposity, as even a modest weight loss during pregnancy is beneficial for the health of mothers and fetus. Calorie restriction and moderate exercise are proven safe methods of stopping weight gain and/or inducing white-fat loss in these subjects. Additionally, therapeutic drugs that activate the AMP-activated protein kinase signaling pathway may be effective in ameliorating pathological conditions in obese patients. Finally, dietary supplementation with L-arginine or its effective precursor (L-citrulline) may be beneficial for managing overweight or obese gestating women by reducing white-fat accretion. Because of ethical concerns over human studies, animal models (e.g., sheep, pigs, baboons, rats, and mice) are warranted to test novel hypotheses with enormous biological significance and clinical applications.

Metabolic acuity score: effect on major complications after bariatric surgery

Co-morbid conditions in obese patients contribute to the incidence and severity of major complications after bariatric surgery and significantly increase the cost of the procedure. Previous publications have validated the patient factors that increase the risk of mortality; however, it is currently a rare event. The development of a metabolic acuity score (MAS) to augment the body mass index might allow for accurate preoperative assessment and optimal treatment of patients. The present study has proposed a MAS for decreasing major complications. Prospectively collected outcomes of 2416 patients undergoing Roux-en-Y gastric bypass (n = 1821) or laparoscopic adjustable gastric banding (n = 595) in a community hospital were evaluated for the incidence of major complications, readmissions, and reoperations. Beginning in August of 2006, 1072 patients were divided into MAS groups of 1-4 according to age, body mass index, weight, history of deep vein thrombosis/pulmonary embolism, sleep apnea, diabetes, hypertension, immobility, heart disease, and psychological classification. The acuity groups were compared with each other and with 1344 patients who underwent treatment before the MAS was implemented. A significant decrease occurred in the readmission rates within 30 days after the MAS was put into practice (8.5% before MAS versus 1.7% after MAS, P <.001) for the Roux-en-Y gastric bypass patients. The postoperative infection rates were lower after implementing the MAS (3.5% before MAS, .7% after MAS, P <.001). After adjusting for random and fixed effects of covariates, the implementation of the MAS significantly reduced the incidence of postoperative internal hernias, infections, deep vein thrombosis, readmissions, and reoperations. Recognition of specific patient acuity characteristics through the implementation of MAS and aggressive preoperative and perioperative management led to lower major complication rates and decreased the incidence of readmissions and reoperations after bariatric surgery.

PL-309: Metabolic acuity score: Impact on major complications following bariatric surgery

Co-morbid conditions in obese patients contribute to the incidence and severity of major complications following bariatric surgery and significantly increase the cost of the procedure. Previous publications validate patient factors that increase risk of mortality, however it is currently a rare event. Development of a Metabolic Acuity Score (MAS) to augment Body Mass Index (BMI) may allow accurate preoperative assessment and optimum management of patients. This study proposes a MAS for decreasing major complications.

Insulin, Insulin-like Growth Factor-I, Endogenous Estradiol, and Risk of Colorectal Cancer in Postmenopausal Women

Obesity is a risk factor for colorectal cancer, and hyperinsulinemia, a common condition in obese patients, may underlie this relationship. Insulin, in addition to its metabolic effects, has promitotic and antiapoptotic activity that may be tumorigenic. Insulin-like growth factor (IGF)-I, a related hormone, shares sequence homology with insulin, and has even stronger mitogenic effects. However, few prospective colorectal cancer studies directly measured fasting insulin, and none evaluated free IGF-I, or endogenous estradiol, a potential cofactor in postmenopausal women. Therefore, we conducted a case-cohort investigation of colorectal cancer among nondiabetic subjects enrolled in the Women's Health Initiative Observational Study, a prospective cohort of 93,676 postmenopausal women. Fasting baseline serum specimens from all incident colorectal cancer cases (n = 438) and a random subcohort (n = 816) of Women's Health Initiative Observational Study subjects were tested for insulin, glucose, total IGF-I, free IGF-I, IGF binding protein-3, and estradiol. Comparing extreme quartiles, insulin [hazard ratio (HR)(q4-q1), 1.73; 95% confidence interval (CI), 1.16-2.57; P(trend) = 0.005], waist circumference (HR(q4-q1), 1.82; 95% CI, 1.22-2.70; P(trend) = 0.001), and free IGF-I (HR(q4-q1), 1.35; 95% CI, 0.92-1.98; P(trend) = 0.05) were each associated with colorectal cancer incidence in multivariate models. However, these associations each became nonsignificant when adjusted for one another. Endogenous estradiol levels, in contrast, were positively associated with risk of colorectal cancer (HR comparing high versus low levels, 1.53; 95% CI, 1.05-2.22), even after control for insulin, free IGF-I, and waist circumference. These data suggest the existence of at least two independent biological pathways that are related to colorectal cancer: one that involves endogenous estradiol, and a second pathway broadly associated with obesity, hyperinsulinemia, and free IGF-I.

Obesity Research in Canada: Literature Overview of the Last 3 Decades

To identify research published on obesity in Canada, to explore the range of areas studied, and to identify gaps and areas that merit future research attention. Medline and International Pharmaceutical Abstracts databases were searched from 1970 onwards. Original articles were identified and categorized by areas of interest. A total of 1186 relevant articles were identified: 17, 136, 687, and 346 articles during the 1970s, 1980s, 1990s, and 2000 to 2003, respectively. Of the articles, 816 were considered original studies and accepted for this analysis. Twelve research areas were identified: basic science involving animal experiments (29%), human experiments (16%), populations surveys (14%), obesity-related comorbidities (13%), diagnostic/surgical issues (11%), nonpharmacological approaches (7%), drug-related issues (4%), anthropometrics (2%), impact of weight loss (2%), cost/healthcare use (1%), attitudes/perceptions (0.9%), and models/procedures (0.5%). Two-thirds of all research was conducted in Quebec (34%) and Ontario (33%). Given the multifactorial nature of obesity, Canadian obesity research covers a broad range of areas with a predominance of basic science but lesser emphasis on community and primary care studies. Furthermore, there was a paucity of research on either clinical management of medical conditions in obese patients or clinical aspects that go beyond weight loss. Thus, although Canada appears well represented in basic research, more attention to exploration of clinical issues and healthcare delivery for obese patients appears warranted.

Physical activity in the prevention and treatment of other morbid conditions and impairments associated with obesity: current evidence and research issues.

To evaluate the current status of knowledge concerning the effects of physical activity in the treatment and prevention of obesity- related problems, including cancers of the colon, breast, uterus, and prostate; gallstones; osteoarthritis; back pain; sleep apnea; reproductive abnormalities; and impaired health-related quality of life. A Medline literature search on the effects of physical activity in the above conditions was conducted. Only studies with some measure of weight and a description of the type of physical activity were included. No controlled randomized trials of exercise in the treatment of any of the studied conditions in obese patients were identified. Most of the epidemiologic studies reviewed were beset with severe methodological weaknesses. Most of the 18 studies on physical activity and colon cancer risk showed a protective effect that in some studies appeared to be greater than expected by weight loss alone. Some but not all studies of hormone-dependent cancers and gallstones showed a protective effect for physical activity. There were insufficient data on the role of exercise for the other morbid conditions studied. The scarce data available on the role of physical activity in the prevention of obesity-related chronic conditions listed above suggest a protective role that needs to be examined further in studies with improved methodologies. Well-designed intervention trials are needed to assess the role of physical activity in the treatment and long-term outcome of obese patients with these co-morbid conditions.

Über die Bedeutung depressiver Zustände bei Adipösen

This study concerns frequency and meaning of depressive conditions in obese patients. The examination was carried out with two groups of 39 obese subjects, 30 women and 9 men. The patients with depressive symptoms differed highly significantly from those without depressive symptoms in relation to the age of the beginning of their overweight. They became overweighted preponderantly as adults, striking frequently in correlation with the situations of emotional stress. This would support the hypothesis of this study, that depressive states as an organism variable in this group of patients has essential influence as well for the onset as for the maintenance of the overweight.