Syndrome In Obese Patients Research Articles

FEATURES OF MANIFESTATION OF NONALCOHOLIC STEATOHEPATITIS IN OBESE PATIENTS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY

The state of energy starvation is the main phenomenon of the early postoperative period of bariatric surgery. All organs and systems of the body undergo such changes. Under normal physiological conditions, with the development of energy hunger, there is an excitation of metabolic centres in the hypothalamic-pituitary system of the brain. Transmitted impulses from chemoreceptor cells increase lipolysis, which ultimately leads to the mobilisation of large amounts of fatty acids from the fat depot to the liver. Excessively high concentrations of ketone bodies due to rapid weight loss are accompanied by the development of ketonemia, the severity of which depends not only on the compensatory capabilities of the body but also on the condition of the liver. Ketonemia is one of the common side effects reported by patients after bariatric surgery. Despite this, the evidence for the incidence of ketonemia after various bariatric surgeries and the mechanism of the development of this phenomenon is very limited. In this regard, this scientific article is devoted to the features of the manifestation of ketonemic syndrome in obese patients after the most popular type of bariatric surgery - laparoscopic longitudinal resection of the stomach.

Retracted: Clinical Evaluation of the Medium-Term Efficacy of Laparoscopic Sleeve Gastrectomy against Obstructive Sleep Apnea-Hypopnea Syndrome in Obese Patients.

[This retracts the article DOI: 10.1155/2022/7682706.].

Clinical Evaluation of the Medium-Term Efficacy of Laparoscopic Sleeve Gastrectomy against Obstructive Sleep Apnea-Hypopnea Syndrome in Obese Patients.

Objective This study was designed to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) for obstructive sleep apnea-hypopnea syndrome (OSAHS) in obese individuals and identify the related factors affecting its efficacy. Methods The clinical and follow-up data of 37 obese patients with OSAHS who underwent LSG in the Laparoscopic Surgery Department of Zibo Central Hospital from January 2017 to July 2018 were analyzed retrospectively. The effect of this operation on patients' weight and OSAHS was studied, and the factors affecting weight and OSAHS were examined through univariate and multivariate logistic regression analysis. Results Over 12 months of regular postoperative follow-up with the 37 patients, their body mass index (BMI) decreased, and the percentage of excess weight loss (EWL%) reached 73.2%. Additionally, the rate of successful OSAHS treatment reached 91.89%, and the apnea-hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO2) increased significantly. Univariate logistic regression analysis showed that gender, weight, EWL%, and smoking affected the efficacy of LSG against OSAHS (P < 0.05). EWL% and smoking were independent factors that helped determine the efficacy of LSG against morbid obesity (P < 0.05). Conclusion LSG can effectively help obese patients lose weight and show medium-term efficacy against OSAHS in obese people. Smoking and EWL% were found to be the factors determining the efficacy of LSG.

Joint detection of miR-149-3p and hepcidin predicts the onset of obstructive sleep apnea syndrome in obese patients.

BackgroundObstructive sleep apnea syndrome (OSAS) is a potentially fatal sleep respiratory disorder, and hepcidin has been found to be related with OSAS onset and severity. This study aimed to examine the serum expression of microRNA‐149‐3p (miR‐149‐3p) and hepcidin in OSAS patients, and evaluate the predictive value of miR‐149‐3p and hepcidin for OSAS occurrence in obese population.MethodsThis study analyzed the data from 212 OSAS patients and 120 control individuals. OSAS severity was evaluated by apnea hypopnea index (AHI) from polysomnography. Serum miR‐149‐3p was examined using reverse transcription quantitative PCR, and hepcidin and inflammatory cytokines were measured using ELISA kits. Logistic regression analysis was used to evaluate the predictive value of miR‐142‐3p and hepcidin for OSAS in obese population, and ROC curve was plotted to assess the predictive accuracy.ResultsSerum miR‐149‐3p and hepcidin were increased in OSAS patients, especially in the severe cases, and had diagnostic potential to distinguish OSAS. High miR‐149‐3p and hepcidin were positively correlated with OSAS patients' inflammatory cytokines. Obese OSAS patients had the highest miR‐149‐3p and hepcidin levels, and the two molecules had predictive value of OSAS present in obese population, and the combination of miR‐149‐3p and hepcidin showed the highest predictive accuracy.ConclusionSerum miR‐149‐3p and hepcidin levels were elevated in OSAS patients and correlated with disease severity and systemic inflammation. miR‐149‐3p and hepcidin levels have diagnostic value to distinguish OSAS, exhibited predictive value for OSAS in obese population, and the joint detection of the two molecules showed the highest predictive accuracy.

PREVALENCE AND CHARACTERISTICS OF THE POLYCYSTIC OVARIAN SYNDROME IN OVERWEIGHT AND OBESE PREMENOPAUSAL WOMEN.

Polycystic ovarian syndrome (PCOS) is commonly associated with obesity, but the prevalence of the syndrome in obese patients is not well established. The present study aims to investigate the prevalence of PCOS among overweight and obese premenopausal women and to evaluate the possible associations between the syndrome and metabolic disturbances in obese patients. Medical records of all women referred to a single endocrine center because of obesity and/or metabolic disturbances during a three-year period were analyzed. A total of 262 overweight and obese patients of reproductive age were included in the retrospective study. The overall prevalence of PCOS using the Rotterdam criteria in the group of overweight and obese women was 26%. The degree of obesity did not influence the PCOS prevalence. Women with PCOS had higher blood glucose and insulin levels after glucose load in comparison to other obese patients despite the younger age. PCOS is a common finding among obese women seeking endocrine help. The oral glucose tolerance test is an important tool for the early detection of carbohydrate disorders in women with the syndrome. Furthermore, screening for PCOS components might be justified in young obese women with pronounced insulin resistance or dysglycemia.

Bariatrik cerrahi öncesi Cushing sendromu için kapsamlı tarama programları gerekli mi?

Purpose: Recent studies have shown a higher prevalence of Cushing's syndrome in obese patients with type 2 diabetes, but its prevalence in overweight and obese populations is not clear. The aim of this study was to evaluate the need for screening tests for Cushing's syndrome in morbidly obese individuals before bariatric surgery. Materials and methods: Between January 2015 and December 2019, 300 patients with Body Mass Index (BMI) ≥35 kg/m 2 that admitted to our endocrine outpatient clinic for evaluation before bariatric surgery were included in this study. Overnight low dose 1 mg dexamethasone suppression test was applied to all patients. Next day 8 am serum cortisol concentration less than 1.8 μg/dL was defined as normal suppression. Results: Three hundred patients undergoing bariatric surgery were screened for Cushing's syndrome. The mean ± standard deviation age of the patients was 39.4±11.7 years and 236 (77.3%) were women. The mean BMI of the patients was 45.9±5.5 kg/m 2 before bariatric surgery. Forty-seven (15.7%) patients in type 2 diabetes mellitus, 28 (9.3%) patients with hypertension and 3 (1%) patients who had achived euthyroidism after levothyroxine treatment. The mean one year BMI after bariatric surgery was 28±4.6 kg/m 2 . Serum cortisol concentration was <1.8 μg/dL after 1 mg overnight dexamethasone suppression test in all patients. Conclusion: The results of the evaluated data revealed that the routine screening of morbidly obese individuals for Cushing's syndrome before bariatric surgery is not necessary.

Визначення ефективності програми фізичної терапії пацієнтів з ожирінням за динамікою параметрів метаболічного синдрому

Mariia AravitskaPurpose: to determine the effectiveness of the physical therapy program for obese patients by the dynamics of the components of the metabolic syndrome. Material & Methods: 214 people of the second adulthood with obesity I and II degree were examined. In terms of compliance, they were divided into a comparison group (low level) and a main group (high level). The control group consisted of 63 people without signs of obesity. The components of the metabolic syndrome were evaluated by anthropometric indicators (body mass index, waist and hip circumference, their ratio) and biochemical parameters (blood glucose, cholesterol, triglycerides, high density lipoproteins, leptin), and the visceral obesity index was calculated. The examination was carried out before and after the introduction of the annual program of physical therapy, which included maintaining a high level of compliance, increasing physical activity, changing the diet, reflexology, massage, and psychocorrection. Results: in all obese individuals were determined by abdominal obesity, fasting hyperglycemia and impaired glucose tolerance, high levels of total cholesterol, triglycerides, leptin, low levels of low-density lipoproteins. The visceral obesity index exceeded those of people with normal body weight (р<0,05). Compliance with the principles of the developed program made it possible to achieve a statistically significant (p<0,05) improvement relative to the initial indicators of all the studied parameters of the persons of the main group. Patients in the comparison group showed an increase in body mass index, a tendency to deteriorate atherogenic dyslipidemia and glucose uptake, a high content of leptin. Conclusions: as a result of the implementation of the developed program of physical therapy, a statistically significant improvement in the studied parameters of the metabolic syndrome in obese patients was compared with the initial result and the comparison group.

Food choices, physical activity and metabolic health in obese patients

The aim of the current study was to analyse the food choices and physical activity of obese adult Estonian persons, and associations with the prevalence of metabolic syndrome. The study was carried out on 76 patients aged over 35 years whose body mass index was ≥30 kg/m2. The subjects were recruited through family physicians. The subjects’ consumption of three food groups (fruit, vegetables, whole-grain products) and physical activity based on the IPAQ questionnaire was compared with the prevalence of metabolic syndrome based on five indicators (waist circumference, triglycerides, HDL- cholesterol and fasting plasma glucose, blood pressure). The prevalence of metabolic syndrome was found to be 50%. The results of the study did not show statistically significant correlations between prevalence of metabolic syndrome and age or gender. Neither were there any significant age or gender differences in the subjects’ nutritional and activity behaviour. Comparison of the nutritional behaviour of persons with and without the metabolic syndrome showed that daily consumers of fruit had a 4.48 times lower risk of metabolic syndrome than those who ate fruit more seldom. No statistically significant correlation was found between physical activity and prevalence of metabolic syndrome. Based on the current study, the daily consumption of fruit can be an essential protective factor against metabolic syndrome in obese patients and provides a simple recommendation physicians can give their patients to follow.

Pathophysiology and Management of Acute Respiratory Distress Syndrome in Obese Patients.

A rising prevalence of obesity is reported over time and throughout the world. At the same time, the acute respiratory distress syndrome (ARDS) remains an important public health problem, accounting for approximately 10% of intensive care unit admissions and leading to significant hospital mortality. Even in the absence of acute illnesses, obesity affects respiratory mechanics and gas exchange in the setting of a restrictive disease. In the presence of ARDS, obesity adds various challenges to a safe and effective management of respiratory support. Difficult airway management, altered lung and chest wall physiology, and positional gas trapping are routinely encountered. The management of such difficult cases is generally empiric, as it is based on small-sized, physiologic studies or on suggestions from the general anesthesia literature. The present review focuses on those cases in which ARDS is coincident with obesity, with the aim of presenting treatment options based on the current evidence. The first part summarizes the epidemiology of obesity and ARDS. Then the diagnostic challenges due to obesity-related artifacts of the different imaging techniques will be presented. A subsequent, detailed description of the altered respiratory anatomy and physiology of obesity will provide help in selecting an optimal, individually tailored strategy of support. Furthermore, we will discuss how esophageal manometry should be used to adjust the settings of positive end-expiratory pressure and tidal volume; the challenges of prone positioning and extracorporeal support; and the optimal strategies for weaning from mechanical ventilation, including when and how to perform a tracheostomy.

Obstructive Sleep Apnea syndrome in obese patients: Effects on metabolic and cardiovascular profile and impact of 6 months of behavioural therapy

Aim: Obesity and Obstructive Sleep Apnea (OSA) are known cardiovascular risk factors however their individual contribution remains unclear. We evaluated the impact of OSA on metabolic profile, in a cohort of obese subjects, and the effect of behavioural therapy (BT) in obese subjects with (OSA+) and without OSA (OSA-).

Intrahepatic Fat, Not Obesity, Is a Main Driver of the Metabolic Syndrome in Obese Patients and Is Significantly Reduced by Weight Loss Surgery

Khoraki, Jad MD; Wiens, Curtis N. PhD; McMillan, Alan B. PhD; Artz, Nathan S. PhD; Haufe, William; Campo, Camilo A.; Schlein, Alexandria MD; Sirlin, Claude B. MD; Reeder, Scott B. MD, PhD; Campos, Guilherme M. MD, FACS Author Information

Evaluation of adipose tissue distribution by ultrasonography and it's relationship to metabolic disturbances in obese patients

Purpose: The aim of the study is to find out the relation between ultrasonographic measurements of abdominal adipose tissue and metabolic syndrome in obese patients.

Cushing’s syndrome in obese patients with type 2 diabetes: A single center screening study

The frequency of Cushing’s syndrome (CS) in obese patients was not properly determined and the studies focused on the frequency of occult CS and the possible improvement of diabetes and obesity with treatment of CS are needed. In this study, we aimed to investigate the frequency of CS in obese patients with type 2 diabetes. The study enrolled with 200 obese (body mass index (BMI) >30 kg/m2), type 2 diabetes patients between 2009 and 2011 in Sisli Etfal Training and Research Hospital, Turkey. Twenty-eight males and 172 females were recruited to the study. Mean age of the study group was 51.7 ± 8.5. Nineteen patients (9.5 %) failed to suppress cortisol levels less than 1.8 μg/dL after a 1-mg overnight dexamethasone suppression test (ODST) and these patients proceeded to have a 2-day 2-mg low-dose dexamethasone suppression test. After further screening, three (%1.5) patients were diagnosed with CS in our study. Among the three patients diagnosed with CS, the tumor was located in the pituitary gland in two patients. The present study revealed that the frequency of Cushing’s syndrome in obese and diabetic patients were 1.5 %, which was much higher than the general population. Occult CS should take into account as an exacerbating factor for diabetes and screening for CS should be considered in poorly controlled diabetic patients.

Low serum 25(OH)D levels are assocıated to hıgher BMI and metabolic syndrome parameters in adult subjects in Turkey.

The aim of this study was to investigate the association of 25(OH)D levels with biochemical, anthropometric, and metabolic data obtained from normal and obese people. This study was carried out on 90 individuals between the ages of 18 to 63 that had various body mass indexes. Blood samples and anthropometric measurements were taken. Waist circumferences, fat mass, LDL cholesterol levels, HDL cholesterol levels, 25(OH)D levels, and triglyceride levels were significantly different according to the body mass index groups of the participants (p<0.05). When compared to the normal body mass index group, both other groups (overweight and obese) had higher waist circumferences, triglyceride levels, LDL cholesterol levels, fasting insulin levels, HOMA-IR ratios, parathyroid hormone levels, and fat mass, and had lower 25(OH)D levels (p<0.05). The overweight group participants had higher 25(OH)D levels than the obese group, and had lower waist circumferences, fat mass, fasting insulin level, HOMA-IR ratios, and HbA1C and PTH levels than those in the obese group (p<0.05). In conclusion, the mean level of 25(OH)D is very low in overweight and obese individuals and low serum 25(OH)D levels appear to be associated with obesity, visceral obesity, hypertriglyceridemia, insulin resistance, and metabolic syndrome in obese patients.

Red wine polyphenols modulate fecal microbiota and reduce markers of the metabolic syndrome in obese patients.

This study evaluated the possible prebiotic effect of a moderate intake of red wine polyphenols on the modulation of the gut microbiota composition and the improvement in the risk factors for the metabolic syndrome in obese patients. Ten metabolic syndrome patients and ten healthy subjects were included in a randomized, crossover, controlled intervention study. After a washout period, the subjects consumed red wine and de-alcoholized red wine over a 30 day period for each. The dominant bacterial composition did not differ significantly between the study groups after the two red wine intake periods. In the metabolic syndrome patients, red wine polyphenols significantly increased the number of fecal bifidobacteria and Lactobacillus (intestinal barrier protectors) and butyrate-producing bacteria (Faecalibacterium prausnitzii and Roseburia) at the expense of less desirable groups of bacteria such as LPS producers (Escherichia coli and Enterobacter cloacae). The changes in gut microbiota in these patients could be responsible for the improvement in the metabolic syndrome markers. Modulation of the gut microbiota by using red wine could be an effective strategy for managing metabolic diseases associated with obesity.

Massive Deep Vein Thrombosis Underlying Unexpected Iliac Vein Compression Syndrome (May-Thurner Syndrome) Complicated by Invasive Electrophysiologic Procedure

A 44-year-old woman, who was obese and on oral contraceptive medication, presented with recurrent palpitation to the emergency department. A 12-lead electrocardiography showed narrow QRS complex tachycardia with a short RP interval. On electrophysiology study, typical atrioventricular nodal reentrant tachycardia was confirmed by differential pacing maneuvers, and a radiofrequency slow pathway modification was demonstrated without complication. A week later, the patient complained of pelvic pain and leg swelling. Emergent computer tomography revealed massive deep vein thrombosis (DVT) underlying external iliac vein compression (May-Thurner Syndrome). The case suggests that electrophysiologic procedure with catheterization via the femoro-iliac vein may lead to DVT underlying May-Thurner Syndrome in obese patients on oral contraceptive medication.

How Does Bariatric Surgery Improve Type II Diabetes? The Neglected Importance of the Liver in Clearing Glucose and Insulin from the Portal Blood

The pandemic of obesity due to food “addiction” has led to a dramatic increase in rates of Type II Diabetes Mellitus (T2DM). T2DM is characterized by increased glucose and insulin (but not of the C-peptide) serum levels. Increase of insulin serum level without increase of insulin synthesis is supposed to be due to insulin resistance. Reduction of body weight (BW) through reduction of calories uptake is the most effective measure to treat T2DM and metabolic syndrome in obese patients. Appetite suppressant drugs which potentially reduce BW have several side effects, and as lifestyle modifiers are not approved of as potential antidiabetic drugs. In addition to the treatment of extreme (BMI ≥ 40) obesity, surgeons have expanded the offer of bariatric surgery as therapeutic option for diabetic, non-morbid (BMI ≤ 35) obesity. As a collateral effect of this surgical intervention, acute and long-term improvement of T2DM has been observed. Although several hypotheses to explain this improvement have been reported, the exact mechanism underlying the reduced hyperglycemia and hyperinsulinemia immediately after surgery is unclear. Though long-term effects of the different operations have not yet been studied thoroughly. Besides weight-loss, bariatric surgery may also reduce lipid accumulation in the liver. Reverse of the hepatic lipid deposition may improve clearance of glucose and insulin from the liver and consequently lead to reduction their concentrations in the peripheral blood. This mechanism has not, however, been considered when effects of bariatric surgery on glucose metabolism have been reported. In fact, a few reports on limited patients number already published have given information about changes of liver size and/or liver lipid content at different time points postoperation. Future prospective studies should focus on the changes in glucose and lipid metabolism induced in the liver by the various types of surgical interventions.

Prevalence of Risk Factors for Obesity Hypoventilation Syndrome in Obese Patients Diagnosed With Obstructive Sleep Apnea

Prevalence of Risk Factors for Obesity Hypoventilation Syndrome in Obese Patients Diagnosed With Obstructive Sleep Apnea

Screening for Cushing's syndrome in obese patients; is it really necessary?

to be more frequent among patients with metabolic syndrome. Previous studies have suggested to perform a routine screening for CS in obese patients; however, more recent reports only recommend a case-finding approach in patients with uncontrolled diabetes and hypertension, despite appropriate treatment. Objective: The aim of this study was to evaluate the prevalence of unsuspected CS in morbidly obese patients in an outpatient’s clinic. Patients and methods: Retrospective case-note study. We reviewed the medical records of morbidly obese patients referred to our clinic prior to bariatric surgery between january 2001 and december 2011. All patients had a complete medical history including physical examination, and 399 underwent screening for CS as part of our pre-surgical protocol. As screening for autonomous cortisol secretion, we performed an overnight 1 mg Dexamethasone Suppression Test (DST). Serum cortisol < 1.8 μg/dl was the cut-off point for normal suppression. Results: 399 patients (308 female; mean age 41.9 ± 10.5 years; mean BMI 51.5 ± 8.4 kg/m2). In the retrospective analysis, prediabetes and diabetes mellitus were observed in 10.3% and 27.8% respectively. In 21 of 399 patients, screening was considered to be abnormal. Eight of these 21 patients had subsequent normal 24h Urinary Free Cortisol (UFC) levels (150 μg/24h). In 13 of 20 patients, we repeated an overnight 1mg DST, on suspicion of failing to take the dexamethasone correctly. Three patients failed to suppress their cortisol levels, two of them were on carbamazepine, which was considered to be a false positive result. The other patient with abnormal UFC levels was diagnosed with CS (0.26%), whose cause was a pituitary microadenoma. Conclusion: A low proportion of patients with morbid obesity were found to have CS. Our findings suggest that morbidly obese patients should not be routinely screened for CS.

Relationships between Site-specific Sarcopenia and Metabolic Syndrome in Obese Patients

Relationships between Site-specific Sarcopenia and Metabolic Syndrome in Obese Patients