Severe Obese Patients Research Articles

Serial vs. parallel approach to screen sleep disorders: an exploratory study

Aiming to verify which is the most effective screening approach for sleep disorders between the serial (first step: sleep self-report measure; second step only in case of positive outcome at the first: objective tool) and parallel (unique step, with the concurrent use of sleep self-report measure and objective tool), a first secondary analysis of previously collected data (study 1) was carried out examining primary insomniacs (PI) and healthy controls (HC). Aiming to verify the implementation of such approaches in clinical populations presenting high comorbidity with sleep disorder, an additional secondary analysis (study 2) was carried out, investigating hypertensive patients (HP) and severe obese patients (SOP). 84 HC and 47 PI were examined in study 1, while 36 SOP, and 30 HP in study 2. All participants originally underwent actigraphic recordings for seven consecutive days, using the Actiwatch device (objective tool). At the end of the recording week, participants filled the Mini Sleep Questionnaire (sleep self-report measure). As regards the study 1, the parallel and serial approaches allowed to correctly identify the 97.87% and 55.32% of PI, respectively. With reference to the study 2, the 36.11% and 80.56% of SOP were identified as positive at the serial and parallel approaches, respectively, while the corresponding percentages of HP were 30% and 70%. Study 1 showed that parallel screening approach is the most effective in PI, allowing to correctly identifying almost the entirety of these patients. Study 2 highlighted that serial screening approach is more useful in SOP and HP, identifying a percentage of positive patients overall in line with the documented comorbidity with sleep disorder in these clinical populations.

Intervención integral de ocho meses disminuye el peso y mejora los niveles de depresión y ansiedad en obesos severos y mórbidos

Introducción. La obesidad mórbida genera una disminución considerable de la expectativa y calidad de vida, según lo cual existen niveles aumentados de depresión y ansiedad.Objetivo. Determinar los efectos de un programa de tratamiento integral en la pérdida de peso y los niveles de ansiedad y depresión de obesos severos y mórbidos.Materiales y métodos. Se estudiaron 4 hombres y 12 mujeres de un promedio de 34 26 años, candidatos a cirugía bariátrica. 6 obesos severos y 10 pacientes con obesidad mórbida participaron en una intervención de tratamiento integral de 8 meses. Se evaluaron en preintervención y post intervención: peso, índice de masa corporal (IMC), contorno de la cintura, capacidad cardiorrespiratoria, ansiedad y depresión.Resultados. El peso y el IMC posterior a la intervención disminuyeron de forma significativa (p<0.001) en un 12.28% y 12.30%, respectivamente, el contorno cintura presentó una disminución de un 11.67% (p< 0.001). Además, la capacidad respiratoria mejoró bastante (p<0.001). Los síntomas ansiosos y depresivos disminuyeron de manera significativa (p<0.001).Conclusión. La intervención integral de 8 meses presenta beneficios significativos en la pérdida de peso de los participantes y en la mejora de los niveles de ansiedad y depresión. Por tal motivo, la intervención realizada puede recomendarse para el tratamiento de esta condición.

Advantages of Minimal Access versus Conventional Aortic Valve Replacement in Elderly or Severely Obese Patients

Objective: the aim of the study to evaluate the benefits of minimal access versus conventional surgery in elderly obese patients undergoing aortic valve replacement (AVR). Materials and Methods: this is a retrospective, observational, cohort study of prospectively collected data on 45 elderly and obese patients undergoing isolated primary AVR between July 2012 and March 2014 in our Cardiac Surgery Unit. Of these, 31 were performed with conventional surgery and 14 were performed with an upper ministernotomy. With propensity score matching, 14 patients (minimally invasive group) were compared with 14 patients in conventional sternotomy (control group). Results: After propensity matching score the two groups were comparable in terms of preoperative characteristics. Median age was 76±7 years in minimally invasive group and 76.7± 10 years in control group, the BMI was respectively 32.2 ± 6.8 and 30.5± 5.6. Cardiopulmonary bypass time was longer in minimally invasive group than in control group (107.7± 22.9 vs 92.4± 19.1 min, p= 0.065) , no significant difference in aortic cross clamp time (76.9± 19.4 vs 72± 16.5 min, p= 0.48) but shorter ventilation time (13±8 vs 23± 13 hours, p=0.029), intensive care unit stay (1±1 vs 2±2 days, p=0.026) and hospital stay (8.5± 4 vs 13.5± 7 days, p=0.037). No difference in the incidence of major and minor postoperative complications and related morbidity was observed. Conclusions: Our limited experience shows that mini-access isolated AVR is a reproducible, safe and effective surgical option in elderly obese patients. Because shorter ventilation time and faster recovery we therefore advocate minimal approach as the procedure of choice for primary isolated AVR in these cohort of patients.

Steatorrhea and Hyperoxaluria in Severely Obese Patients Before and After Roux-en-Y Gastric Bypass

Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) is generally attributed to fat malabsorption. If hyperoxaluria is indeed caused by fat malabsorption, magnitudes of hyperoxaluria and steatorrhea should correlate. Severely obese patients, prior to bypass, ingest excess dietary fat that can produce hyperphagic steatorrhea. The primary objective of the study was to determine whether urine oxalate excretion correlates with elements of fat balance in severely obese patients before and after RYGB. Fat balance and urine oxalate excretion were measured simultaneously in 26 severely obese patients before and 1 year after RYGB, while patients consumed their usual diet. At these time points, stool and urine samples were collected. Steatorrhea and hyperoxaluria were defined as fecal fat >7 g/day and urine oxalate >40 mg/day. Differences were evaluated using paired 2-tailed t tests. Prior to RYGB, 12 of 26 patients had mild to moderate steatorrhea. Average urine oxalate excretion was 61 mg/day; there was no correlation between fecal fat and urine oxalate excretion. After RYGB, 24 of 26 patients had steatorrhea and urine oxalate excretion averaged 69 mg/day, with a positive correlation between fecal fat and urine oxalate excretions (r= 0.71, P < .001). For each 10 g/day increase in fecal fat output, fecal water excretion increased only 46 mL/day. Steatorrhea and hyperoxaluria were common in obese patients before bypass, but hyperoxaluria was not caused by excess unabsorbed fatty acids. Hyperphagia, obesity, or metabolic syndrome could have produced this previously unrecognized hyperoxaluric state by stimulating absorption or endogenous synthesis of oxalate. Hyperoxaluria after RYGB correlated with steatorrhea and was presumably caused by excess fatty acids in the intestinal lumen. Because post-bypass steatorrhea caused little increase in fecal water excretion, most patients with steatorrhea did not consider themselves to have diarrhea. Before and after RYGB, high oxalate intake contributed to the severity of hyperoxaluria.

Changes in zinc-α2-glycoprotein (ZAG) plasma concentrations pre and post Roux-En-Y gastric bypass surgery (RYGB) or a very low calorie (VLCD) diet in clinically severe obese patients: Preliminary Study.

The purpose of this preliminary study was to investigate changes in plasma concentrations of zinc-α2-glycoprotein (ZAG), a lipid mobilizing hormone, in obese subjects following Roux-En-Y Gastric Bypass (RYGB) surgery or a very low calorie diet (VLCD). Fasting blood concentrations and anthropometric measurements were measured pre and 12 weeks post intervention. 14 healthy, obese individuals underwent either RYGB (N=6) surgery or a VLCD (N=8). Body composition and fasting plasma ZAG concentrations were measured at baseline (pre) and 12 weeks post intervention (post). At pre-intervention baseline, there was no difference in plasma ZAG between the two intervention groups. Post-intervention, there was a significant overall reduction (F(1,11) = 32.8, p<0.001) in plasma ZAG, which was significant only within the RYGB group from pre to post intervention (33.2 ± 5.7 μg/ml to 26.7 ± 4.8 μg/ml (p<0.015)) and significantly greater than the change within the VLCD group. The change in ZAG was inversely correlated across groups with BMI reduction (r= -0.60, p<0.05), % body fat reduction (r= -0.68, p<0.015), reduction in weight (r= -0.58, p<0.05), and % weight loss (r= -0.70, p<0.05). Overall, subjects who underwent RYGB or VLCD had a significant reduction in plasma ZAG. This reduction was significant within the RYGB group alone, who lost a larger amount of weight than the VLCD group, which suggests that ZAG may have a protective effect during marked weight loss.

Impact of weight loss on the cardiovascular system after bariatric surgery

Introduction. Obesity is a chronic disease with a great impact on the cardiovascular system through its association with type II diabetes, hypertension, dyslipidemia, metabolic syndrome (MetS) and also through direct alterations in cardiac performance and morphology. Recent long term studies prove that substantial weight loss obtained via bariatric surgery is capable of improving cardiac risk factors associated with severe obesity, decreasing the mortality rates.Aim: to assess the long-term changes in cardiovascular risk and cardiac structure in obese patients who had lost weight after laparoscopic sleeve gastrectomy (LSG).Methods. Fifty-two severe obese patients (44±9 years, 57.7% women, BMI=45±8 kg/m2) underwent clinical and biochemical examination and Doppler echocardiograms before and 5 years after LSG.Results. Pre-operatively, 78.4% of patients were hypertensive, 46.2% had diabetes, 73.1% MetS and 44.2% presented left ventricle hypertrophy (LVH), reflecting high cardio-metabolic risk. The patients reassessment was made 61.7±10.5 months after LSG, when a decrease in BMI of 21.9±10% was achieved (p&lt;0.001). The prevalence of hypertension (64.7%), diabetes (32.7%) and MetS (28.8%) decreased compared to the pre-operative examination (p=0.019, p&lt;0.001, p=0.036). An increase in left ventricle mass and left ventricle mass index (LVMI) (p&lt;0.001) and in the prevalence of LVH (57.7%-p=0.001) was recorded. Patients were divided into two groups based on the decrease in LVMI (positive response-38.5%) or increase in LVMI post-surgery (negative response-61.5%), compared with pre-operative values. The group of patients with negative response had lost less weight (p=0.006), had a poor glycemic control (p=0.022), and higher systolic (p=0.004) and diastolic (p=0.030) pressure values compared to the first evaluation.Conclusion. The increase of LVMI after LSG indicates that this study should continue, including a larger number of patients. It is important to identify the factors that can predict an inappropriate response to surgery, in order to prevent and treat them.

Physiological correlates to spontaneous physical activity variability in obese patients with already treated sleep apnea syndrome.

Physical activity is promoted in patients with sleep disorders and obesity. The aim of the present study was to assess physiological factors influencing objectively measured spontaneous physical activity in already treated patients for obstructive sleep apnea (OSA) by nocturnal continuous positive airway pressure (CPAP). Fifty-five patients (age=53±3years; body mass index (BMI)=38±3kg/m2; compliance with CPAP >4h/night) were prospectively included. Measurements were 5-day actigraphy with metabolic equivalent of task (METs) assessment, body composition, pulmonary function, quadriceps and respiratory muscle strength, exercise capacity (6-min walking distance and maximal aerobic capacity), as well as sleep parameters (sleepiness, duration, oxygen saturation, and micro-arousals during sleep) and quality of life (SF-36 questionnaire). As expected, the number of steps per day (6879±2511) and mean intensity of physical activity (1.38±0.15 METs) were below the recommendations for obese population. In age-adjusted stepwise regression models, peak oxygen consumption (VO2 peak) and peak dyspnea perception during incremental exercise test were independent predictors of the number of steps per day (r=0.49, p=0.001) although VO2 peak and peak minute ventilation were independent predictors of intensity of physical activity (in METs/day; r=0.49, p=0.001). In severe obese patients with OSA, exercise capacity, ventilatory requirement, and dyspnea perception were main physiological components of physical activity. These results emphasize the need to consider specific training interventions that increase ability to perform intense physical activity in obese OSA.

Timing of food intake is associated with weight loss evolution in severe obese patients after bariatric surgery

Recent research has demonstrated a relationship between the timing of food intake and weight loss in humans. However, whether the meal timing can be associated with weight loss in patients treated with bariatric surgery is unknown. To evaluate the role of food-timing in the evolution of weight loss in a sample of 270 patients that underwent bariatric surgery with a follow-up of 6 years. Participants (79% women; age [mean±SD]: 52±11 years; BMI: 46.5±6.0kg/m2) were classified according their weight loss response patterns after bariatric surgery: good weight-loss-responders (67.8%), primarily poor weight-loss-responders (10.8%) or secondarily poor weight-loss-responders (21.4%). Then, they were grouped in early-eaters and late-eaters, according to the timing of the main meal (before or after 15:00h). Obesity and biochemical parameters, energy and macronutrients intake, energy expenditure, sleep duration, and chronotype were studied. The percentage of late eaters (after 15:00h) was significantly higher in the primarily poor weight-loss-responders (∼70%) than in both secondarily poor weight-loss-responders (∼42%) and good weight-loss-responders (∼37%) (p=0.011). Consistently, primarily poor weight-loss-responders had lunch later as compared to good and secondarily poor weight-loss-responders (p=0.034). Age, gender and type of surgery were not determining. Surprisingly, obesity-related variables, biochemical parameters, pre-surgical total energy expenditure, sleep duration, chronotype, calorie intake and macronutrients distribution, were similar among groups. Weight loss effectiveness after bariatric surgery is related to the timing of the main meal. Our preliminary results suggest that the timing of food intake is important for weight regulation and that eating at the right time may be a relevant factor to consider in weight loss therapy even after bariatric surgery.

閉塞性睡眠時無呼吸症候群に対する口腔内装置治療の有用性に関する検討

A clinical study was performed in patients with obstructive sleep apnea syndrome (OSAS) to clarify the effectiveness of an oral appliance (OA). In 40 patients, the mean apnea hypopnea index (AHI) was 24.7 ±19.3 /h at baseline, and they were classified into 13 mild (AHI 5 to <15), 18 moderate (AHI 15 to <30) and 9 severe (AHI ≥30) cases of OSAS. The AHI on OA therapy decreased significantly (P<0.0001) to a mean AHI of 5.9±5.1/h, and the improvement rate was 71.0±28.0%. Twenty-one patients (52.5%) had a successful response (AHI <5). There was no significant difference in the AHI on OA therapy among the mild, moderate, and severe groups. The AHI improvement rate was low (51.7%) in patients with a body mass index (BMI) of ≥25 kg/m2; however, there was no significant difference in the AHI improvement rate on covariance analysis assuming that BMI was a covariate. Therefore, the effect of OA did not depend on the BMI. There was no significant difference in the reduction in AHI among groups classified according to age or Epworth sleepiness scale (ESS). These results suggested that OA therapy was effective for mild and moderate OSAS cases and that improvement in AHI can be expected in severe OSAS or obese patients.

LBP502 - Applicability, Reliability and Diagnostic Performance of Fibroscan for Liver Evaluation in Severe Obese Patients Candidate to Bariatric Surgery

LBP502 - Applicability, Reliability and Diagnostic Performance of Fibroscan for Liver Evaluation in Severe Obese Patients Candidate to Bariatric Surgery

The DSM-5 effect: psychological characteristics of new patients affected by Binge Eating Disorder following the criteria of the DSM-5 in a sample of severe obese patients.

The current study evaluated whether or not there were significant differences in psychopathological traits between three groups of individuals. The first was a group of patients seeking bariatric surgery diagnosed as being affected by Binge Eating Disorder (BED), according to the new criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This group (NEW BED group) did not meet BED diagnosis following the previous criteria listed in the DSM-IV-TR. The second group of individuals was composed of severely obese patients seeking bariatric surgery not affected by an eating disorder, according to the diagnostic criteria of the DSM-5 (OB group). The third group was composed of individuals within a healthy weight range (Control group). 94 severely obese patients (33 in the NEW BED group and 61 in the OB group) were compared to the Control group including 41 participants on depression, anxiety and eating habits. The NEW BED scored significantly higher than the OB group on the Beck Depression Inventory, both the subscales of the State Trait Anxiety Inventory, on disinhibition and hunger subscales of the Three-Factor Eating Questionnaire and on many subscales of the Eating Disorders Inventory. The new, less restrictive diagnostic criteria for BED of the DSM-5 are useful in identifying obese patients affected by severe psychopathology and dysfunctional eating habits.

Do severe obese patients with stress urinary incontinence benefit from transobturator tape procedure? 3-year surgical outcome.

We evaluate the impact of severe obesity on surgical outcomes of the transobturator tape (TOT) procedure in patients with stress urinary incontinence (SUI). In total, 32 women with severe obesity (body mass index [BMI] >35 kg/m(2)) were included in the study. All patients were preoperatively evaluated with history, pelvic examination, ultrasonography, and cough stress test. All patients completed the International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) preoperatively and at the postoperative follow-up. Cure of incontinence was defined as being completely dry after surgery. Cure was assessed subjectively and objectively. Subjective improvement defined as an International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) score ≤12 and satisfaction with surgery. Failure was defined as having no change or worsening of urinary incontinence after surgery. Postoperative patient satisfaction was assessed using a visual analog scale. The mean follow-up time and mean BMI were 40.9 ± 20.9 months and 38 ± 3 kg/m(2), respectively. According to preoperative ICIQ-SF questionnaire scores, 20 patients (62.5%) had severe and 12 patients (37.5 %) had very severe urinary incontinence symptoms. No patient had slight or moderate symptoms. None of the patients experienced worsening symptoms after surgery. Objective cure, subjective cure, subjective improvement and patient satisfaction rates were 81.2%, 46.8%, 37.5%, and 84.3% respectively. Our overall complication rate was 9.3%. None of the patients experienced intraoperative complications. In experienced hands, TOT is an effective and safe procedure to treat SUI, with minimal complications in severe obese women.

Smoking Habit in Severe Obese after bariatric procedures.

BackgroundBariatric procedures provide an effective means of short term weight loss and sustained weight control for the morbidly obese. The effect of bariatric procedures on smoking habit in obese subjects is not well known. Therefore, we examined the short term effect of bariatric surgery on smoking habit of severe obese patients up to 12 months from the intervention.Patients and MethodsSmoking habit was assessed in a cohort of 78 morbid smoking obese patients followed at our clinic for bariatric procedures. They underwent non surgical intra-gastric balloon (IB) or surgical procedures such as lap–band laparoscopic surgery (LAGB) or sleeve gastrectomy/gastric by-pass (SPG). Subjects were administered a written questionnaire about their smoking habit before and 3, 6 and 12 months after the procedures.ResultsNo differences were found among the three groups at 6 and 12 months after the procedures (IB 21 %, LAGB 6 %, SPG 5 %; and IB 14 %, LAGB 3 %, SPG 5 %). Only after 3 months, the rate of quitting of the IB group was higher than LAGB and SPG groups (36 %, 6 % and 5 %, respectively; p = 0.02).ConclusionsBariatric procedures have no effects on smoking habit of moderate-to-heavy smoker severe obese patients. The use of other traditional smoking cessation methods in patients undergone to bariatric procedures should be implemented.

Eating behaviour in treatment-seeking obese subjects – Influence of sex and BMI classes

Obese subjects frequently show an adversely altered eating behaviour. However, little is known on differences in eating behaviour across different degree of obesity. We analysed data on the three factor eating questionnaire assessing cognitive restraint, disinhibition, and hunger that were filled in by 664 obese patients (469 women) who seeked treatment in our Interdisciplinary Obesity Center. Patients were divided in five BMI classes (30 – <35 kg/m2, 35 – <40 kg/m2, 40 – <50 kg/m2, and >50 kg/m2). Multivariate regression analyses revealed that sex was significantly related to all three eating behaviour traits (all P < 0.042) but no significant relation to BMI (as a continuous variable) was observed. Women in comparison to men showed significantly higher cognitive restraint (9.7 ± 4.3 vs. 7.7 ± 4.4; P < 0.001) and disinhibition (9.0 ± 3.5 vs. 7.7 ± 3.5; P < 0.001) scores and also showed higher hunger scores (6.9 ± 3.7 vs. 6.3 ± 3.5; P = 0.042). Analyses on different BMI classes revealed that cognitive restraint decreased (P = 0.016) while disinhibition (P = 0.010) and hunger (P = 0.044) increased independently of sex with increasing BMI classes. However, above the obesity grade I class (i.e. BMI 30 – < 35 kg/m2) there were no differences in eating behaviour variables between the remaining BMI classes. Data indicate profound differences in eating behaviour between women and men that persist across a wide range of obesity. Furthermore, data suggest that while grade I obese patients show higher cognitive restraint and less disinhibition and hunger scores than more severe obese patients these dimensions of eating behaviour do not systematically vary across higher BMI classes.

Impact of bariatric surgery on life expectancy in severely obese patients with diabetes: a decision analysis.

To create a decision analytic model to estimate the balance between treatment risks and benefits for severely obese patients with diabetes. Bariatric surgery leads to many desirable metabolic changes, but long-term impact of bariatric surgery on life expectancy in patients with diabetes has not yet been quantified. We developed a Markov state transition model with multiple Cox proportional hazards models and logistic regression models as inputs to compare bariatric surgery versus no surgical treatment for severely obese diabetic patients. The model is informed by data from 3 large cohorts: (1) 159,000 severely obese diabetic patients (4185 had bariatric surgery) from 3 HMO Research Network sites; (2) 23,000 subjects from the Nationwide Inpatient Sample; and (3) 18,000 subjects from the National Health Interview Survey linked to the National Death Index. In our main analyses, we found that a 45-year-old woman with diabetes and a body mass index (BMI) of 45 kg/m gained an additional 6.7 years of life expectancy with bariatric surgery (38.4 years with surgery vs 31.7 years without surgery). Sensitivity analyses revealed that the gain in life expectancy decreased with increasing BMI, until a BMI of 62 kg/m is reached, at which point nonsurgical treatment was associated with greater life expectancy. Similar results were seen for both men and women in all age groups. For most severely obese patients with diabetes, bariatric surgery seems to improve life expectancy; however, surgery may reduce life expectancy for the super obese with BMIs over 62 kg/m.

Figure-of-Eight Wire Sternal Closure Technique Can Reduce Post-Open Cardiovascular Surgery Chest Re-Exploration and Pain Scores in Diabetic Patients with Severe Obesity (Body Mass Index: 35-40)

Background. Postoperative sternal instability can be associated with the density of bone and type of wire closure. Sternal instability is a serious complication, especially in diabetic obese patients. This category of patients is susceptible to activation of inflammation and inflammatory and/or infective involvement of the sternum after sternotomy. This study was designed to evaluate the comparison of safety and efficacy of figure-of-eight with simple wire sternal closure technique in high-risk diabetic severe obese patients [Body mass index (BMI): 35-40]. Methods and materials. This study, conducted on 80 diabetic patients with severe obesity (BMI: 35-40) undergoing elective off-pump coronary artery bypass graft (CABG) surgery in duration from the first day to two weeks after surgery. Sternal wire closure techniques are divided into two groups, group A (n=40), patients undergoing simple wire closure and group B (n=40), patients undergoing figure-of-eight wire closure. Results. The average age of patients was 64.7±13.2 years. According to the patient self-rated numeric pain intensity scale, the pain of sternum related to existing of wire closure was classified to mild [(group A: n=14), (group B: n=17)], moderate [(group A: n=14), (group B: 19)], and severe [(group A: n=12), (group B: 4)]. Postoperative pain scores had significant higher difference in simple closure than figure-of-eight technique. From all patients, three cases with figure-of-eight and seven cases with simple wire closure had chest re-exploration after surgery. Chest re-exploration in group of figure-of-eight was lower than group of simple closure significantly (p=0.03). Postoperative utilization of inotropic agents, mediastinitis, cerebrovascular accident (CVA) and atrial fibrillation (AF) had not significant differences between both techniques. Conclusion. These findings show that figure-of-eight sternal wire closure technique can reduce postoperative pain scores and chest re-exploration significantly in diabetic patients with severe obesity.

The effect of oral glutamine on Treg cells (CD4+/FOXP3+/CD25+) and C-Reactive Protein in the perioperative period in severe obese patients undergoing Laparoscopic Gastric ByPass

Event Abstract Back to Event The effect of oral glutamine on Treg cells (CD4+/FOXP3+/CD25+) and C-Reactive Protein in the perioperative period in severe obese patients undergoing Laparoscopic Gastric ByPass Roberto U. Cruz1*, Saul Ocampo2, Trinidad G. Iglesias3 and Manuel R. Prieto2 1 General Surgery Resident at Hospital Civil Fray Antonio Alcalde, General Surgery, Mexico 2 Hospital Civil Fray Antonio Alcalde, General Surgery, Mexico 3 Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Inmunology, Mexico INTRODUCTION Obesity is associated with low-grade systemic inflammation, also called metabolic inflammation. The use of metabolic agents, such as Glutamine, in preoperative period, can help in postoperative recovery; because the impact on intestinal perfusion and immune response. Until now, there are not previous researches with this population in the proposed scenario. The objective is to evaluate modulation from the immune response with enteral glutamine. METHODS Comparative randomized blind clinical trial with 13 patients undergoing Laparoscopic Gastric Bypass from April 2014 to December 2014, in the Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico. Body Mass Index in both groups was >35 and <45 kg/m2. Study group received enteral Glutamine 40g/day and Control Group Calcium Caseinate 40g/day; 5 days previous surgical intervention. Blood samples were obtained before oral intake, 1-hour previous surgical intervention and 48 hours after Laparoscopic Gastric ByPass to be evaluated with monoclonal antibodies for CD3+, CD4+, CD25+ and FOXP3+ in flow cytometry. C-Reactive Protein was also evaluated in the different visits made during the study. RESULTS Increase T CD3+ preoperative marker was observed for both groups, with no significant statistical difference (p=0.8 CI95% -3.3 – 4.12). 48-Hours after Laparoscopic Gastric ByPass, C-Reactive Protein was lower in Study Group with 75.7±12.44 mg/dl compared with Control Group 131.47±40 mg/dl, p=0.009 CI95% (-93–-17). In addition, CD4+ and CD25+ showed increased levels in glutamine group compared with control (42.57±5.62 vs 40.5±5.92 and 1.44±1.04 vs 1.2±0.55), with statistically significant p value (0.6 and 0.5 respectively) CONCLUSIONS Nutritional supplementation given previous surgery can activate Treg cells, with possible participation in immunomodulation reducing post surgical hyper inflammatory response; given by lower C-Reactive Protein levels, according to our study model. Therefore, more studies are needed to confirm the results. Acknowledgements General Surgery Department Hospital Civil Fray Antonio Alcalde Inmunology Department Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara Keywords: Laparoscopic gastric bypass, Glutamine, Treg cells, severe obese, C-Reactive Protein Conference: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología, Medellin, Colombia, 13 Oct - 16 Oct, 2015. Presentation Type: Poster Presentation Topic: Immunotherapy Citation: Cruz RU, Ocampo S, Iglesias TG and Prieto MR (2015). The effect of oral glutamine on Treg cells (CD4+/FOXP3+/CD25+) and C-Reactive Protein in the perioperative period in severe obese patients undergoing Laparoscopic Gastric ByPass. Front. Immunol. Conference Abstract: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología. doi: 10.3389/conf.fimmu.2015.05.00365 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 07 Mar 2015; Published Online: 15 Sep 2015. * Correspondence: Mr. Roberto U Cruz, General Surgery Resident at Hospital Civil Fray Antonio Alcalde, General Surgery, Guadalajara, Jalisco, 44280, Mexico, robertocruzneri@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Roberto U Cruz Saul Ocampo Trinidad G Iglesias Manuel R Prieto Google Roberto U Cruz Saul Ocampo Trinidad G Iglesias Manuel R Prieto Google Scholar Roberto U Cruz Saul Ocampo Trinidad G Iglesias Manuel R Prieto PubMed Roberto U Cruz Saul Ocampo Trinidad G Iglesias Manuel R Prieto Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Psychopathological characteristics of patients seeking for bariatric surgery, either affected or not by binge eating disorder following the criteria of the DSM IV TR and of the DSM 5

We evaluate whether there are any significant differences in psychopathology between severe obese patients affected by Binge Eating Disorder diagnosed following both the DSM IV TR and the DSM5 criteria, and severe obese patients not having an eating disorder. Method118 severe obese patients seeking treatment at a center for bariatric surgery in northern Italy were asked to take part in the current study for a period of six months. Average participant age was 44.27years, SD 12.42. Age ranged from 18 to 67years. Average patient BMI was 45.03, SD 7.11, ranging from 32.14 to 66.16kg/m2. Seventy seven of the patients (65.3%) were females and 41 (34.7%) were males. BED diagnosis was determined following the diagnostic criteria of both the DSM IV TR and the DSM 5. The presence of other eating disorders was excluded through a clinical screening using the Eating Disorder Inventory (EDI). Patient eating habits and the presence of emotional eating were appraised using the Three-Factor Eating Questionnaire. Levels of depression and anxiety were evaluated using the Beck Depression Inventory and the State Trait Anxiety Inventory. Results57 out of 118 patients were found to be affected by BED following the DSM 5 criteria; among them 24 followed those of the DSM IV TR. BED patients scored higher on four subscales of the Eating Disorders Inventory: Drive for thinness (DT), Bulimia (B), Body dissatisfaction (BD) and Interoceptive awareness (IA) on the STAI and on the Disinhibition and Hunger subscales of the TFEQ. DiscussionThe results confirm the presence of high levels of psychopathology among patients diagnosed with BED, even if they have been diagnosed following the criteria of the DSM 5. There is a great overlap in psychopathology between BED patients diagnosed following the DSM IV TR and the DSM 5 criteria.

Effects of a very low calorie diet in the preoperative stage of bariatric surgery: a randomized trial

BackgroundPreoperative bariatric patients can follow very low calorie diets (VLCD), reducing surgical risks. However, possible advantages of a liquid diet over one of normal consistency are controversial. This study investigated the effect of a liquid VLCD compared with one of normal consistency considering visceral fat (VF) loss and metabolic profile in preoperative clinically severe obese patients. MethodsThis was a randomized, open-labeled, controlled clinical trial. Patients were divided into 2 groups: liquid diet and normal diet. Data were collected at baseline and 7 and 14 days after intervention. Information gathered was analyzed for loss of weight and VF, biochemical data, anthropometric data, and energy intake. ResultsFifty-seven patients consumed the liquid diet and 47 consumed the normal consistency diet. The liquid diet group lost significantly more weight (P<.0290) and VF (P<.0410) than the normal diet group. An inverse correlation occurred between VF loss and surgical time among the liquid diet group (r2 = -.1302, P = .001). Additionally, there was a positive correlation between the percentage of excess weight loss and ketonuria (P = .0070). No between-group difference occurred regarding calorie intake. ConclusionPatients that consumed a liquid diet presented a positive effect on reducing VF and greater weight loss than the normal diet group. Both VLCDs presented benefits offering a protective effect during the preoperative stage.

Weight Loss Associated with Bariatric Surgery Does Not Restore Short Telomere Length of Severe Obese Patients After 1 Year

Telomere shortening is physiologically associated with ageing but it may be influenced by oxidative stress and chronic inflammation, linked to obesity. Thus, obesity might represent an additional cause of telomere attrition. We aim to study relative telomere length (RTL) in obese subjects with and without metabolic syndrome and to assess the effect of weight loss induced by bariatric surgery. We evaluated RTL in 107 obese subjects (62 with metabolic syndrome and 45 without metabolic syndrome), compared to 130 age-matched non-obese subjects. We also measured RTL in a subgroup of 93 obese patients prior to and 3, 6, 9 and 12 months after surgery. RTL of obese subjects was significantly shorter (p<0.0001) than non-obese subjects but without differences between patients with and without metabolic syndrome (p=0.19). RTL was significantly shorter than baseline at 3, 6, 9 and 12 months after bariatric surgery. These results confirm that obese subjects have shorter telomeres compared to non-obese subjects, but RTL is not influenced by the presence of metabolic syndrome. RTL shows an additional attrition during the immediate post-operative period, probably due to a catabolic state.