Undergoing Gastric Bypass Surgery Research Articles

Impact of Weight Loss on Inflammation State and Endothelial Markers Among Individuals with Extreme Obesity After Gastric Bypass Surgery: a 2-Year Follow-up Study.

The medium-term impact of gastric bypass (GB) surgery on the inflammatory state and endothelial function of patients has yet to be confirmed. This study aims to elucidate the inflammatory profile and endothelial dysfunction response of adults with obesity 6 and 24months after undergoing GB surgery. The anthropometric and biochemical markers of 32 adults with obesity (two men and 30 females) were collected preoperatively, and 6 and 24months postoperatively. Body mass index (BMI) and excess weight had decreased by 15.79 ± 1.21kg/m2 (p < 0.01) and 83.80 ± 24.50% respectively at 24months. Leptin, C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1) levels, and the leptin/adiponectin ratio decreased significantly at both postoperative follow-up points compared with preoperative values (p < 0.01). IL-6 and ICAM-1 levels decreased between 6 and 24months post-GB (p < 0.01). IL-6 and ICAM-1 levels decreased between 6- and 24-months post-GB (p < 0.01). Resistin levels were significantly decreased (p < 0.01) at 6-month follow-up. The levels of the anti-inflammatory biomarkers IL-10, adiponectin, and the adiponectin/leptin ratio significantly increased postoperatively. There was an improvement in metabolic disorders after surgery. Our results demonstrated that after GB there was an improvement in the inflammatory profile, identified by a reduction in pro-inflammatory markers (CRP, IL-6, leptin) and an increase in anti-inflammatory markers (adiponectin, IL-10). The decrease in PAI-1 and ICAM-1 levels may suggest improvement in endothelial function. These findings provide clear evidence of the medium-term impact of GB on inflammation state and a number of endothelial markers, and a consequent reduction in the risk of cardiovascular diseases.

Oral Health\u2013Related Quality of Life After Gastric Bypass Surgery

ObjectiveThe aim was to examine how individuals treated for obesity with gastric bypass (GBP) surgery perceived their oral health and oral health–related quality of life (OHRQoL).MethodAll individuals in one Swedish region who had undergone GBP surgery (n = 1182) were sent a postal questionnaire 2 years after surgery. The questionnaire comprised items on sociodemographics, oral symptoms and the Oral Health Impact Profile-49 to assess the OHRQoL.ResultsThe mean age was 47.6 years with 75% females, response rate 55.3%. The self-perceived oral health was rated low by 45% of the respondents. Gender differences were seen, for instance, regarding hypersensitive teeth (men 18.8%, women 30.8%, p = 0.003). Nine out of ten reported at least one oral impact experienced sometimes, fairly or very often, according to the Oral Health Impact Profile-49 (OHIP-49). The mean additive OHIP-49 score was 30.3 (SD 36.1). The associations between self-reported oral health and OHRQoL were consistent throughout. Tooth hypersensitivity generated an OR of 2.28 (95% CI 2.28–8.46) of having ≥ 2 impacts on OHRQoL.ConclusionA large proportion of individuals having undergone GBP surgery reported problems with their oral health and impacts on their OHRQoL, indicating a need for medical and dental staff—surgeons and general practitioners as well as other health professionals—to offer oral health promotion and prevention measures.

The Effect of a Muscle Weight-Bearing and Aerobic Exercise Program on the Body Composition, Muscular Strength, Biochemical Markers, and Bone Mass of Obese Patients Who Have Undergone Gastric Bypass Surgery.

The effect of an exercise program on the body composition, muscular strength (MS), biochemical markers, and bone mineral density (BMD) of individuals undergoing gastric bypass is unclear. We assessed lean mass (LM), MS, bone remodeling markers, and BMD before and after supervised weight-bearing and aerobic exercise training in obese patients who underwent Roux-en-Y gastric bypass (RYGB). This study included 37 obese patients (81.1% women, mean age 38.2years, mean body mass index 42.4±0.5kg/m2). Whole body densitometry was used to evaluate pre- and postoperative BMD, total body fat, and LM. Serum calcium, parathyroid hormone, 25-hydroxyvitamin D, and bone remodeling markers were measured. MS was determined through the concentric 10 repetition maximum test. Postoperatively, participants were divided into two groups: the training group, who followed an exercise program (TG, n=18), and the control group, who did not (CG, n=19). After 1year, the TG showed a lower decrease in total BMD and at the lumbar spine and right hip compared with the CG (p<0.001). The TG had lower mass reduction and an increase in upper limb LM compared with the CG (both p<0.05). There was no significant difference between groups in bone markers or calcium metabolism. MS was higher in the TG than the CG (p<0.05). The supervised exercise program attenuated lumbar spine and right hip BMD loss and improved LM in the arms and overall MS but did not affect bone remodeling.

Relationships between Emotional Well-Being, Patient Activation and Social Support among Adults with Severe Obesity Who Have Undergone Gastric Bypass Surgery

Objective: To examine the relationship between emotional well-being, patient activation and social support in a cohort of adults with severe obesity who underwent gastric bypass surgery from January to December 2012. Design: Cross-sectional survey. Subjects: Of a total population of 129 people, aged 18 - 68 years, at a local hospital in central Norway, 64 (50%) responding to the questionnaire, 52 (81%) being women. Main Outcome Measures: The World Health Organization—Five Well-Being Index (WHO-5), the 13-item Patient Activation Measure (PAM-13), a 16-item instrument on the frequency and content of social support, and demographic and clinical data. Results: A significant positive association was found between higher level of patient activation and better emotional well-being (P = 0.02) in linear regression analysis. A higher level of family support was significantly associated with better emotional well-being (practical social support from the family (P = 0.04), emotional social support from family (P = 0.01) and from friends (P = 0.005)). Conclusion: Screening tools for emotional well-being should be used systematically in postoperative consultations to recognize those who need a more individually tailored post-surgery follow-up care after gastric bypass surgery. In addition, health care providers in both specialist and primary health care settings should consider assessing the level of social support as part of regular follow-up routines.

Omental Gene Expression of Adiponectin Correlates with Degree of Insulin Sensitivity Before and After Gastric Bypass Surgery

Circulating adiponectin is known to correlate negatively with insulin resistance in patients with obesity and diabetes. The aim of this study was to assess the effect of gastric bypass (GB) surgery on adiponectin gene expression in subcutaneous and omental adipose tissues. Adipose tissues and plasma were obtained from 25 subjects undergoing GB surgery, 15 non-obese subjects, and 12 subjects after GB surgery. Real-time quantitative reverse transcription polymerase chain reaction was used for analysis of the adipose tissues. Adiponectin expression was normalized for glyceraldehyde 3-phosphate dehydrogenase and expressed as percentage of subject-matched subcutaneous expression which was given an arbitrary value of 100%. Insulin resistance was assessed by the homeostatic model assessment (HOMA). Circulating adiponectin was assayed by ELISA. Omental adiponectin gene expression was fivefold higher in subjects after GB when compared with age-matched morbidly obese subjects before GB (P < 0.01). There were no statistical differences in omental adiponectin gene expression observed in subjects after GB and age-matched non-obese subjects. For the entire cohort of subjects, there was a significant negative correlation between omental adiponectin expression and insulin resistance expressed by HOMA values (r = -0.62, P < 0.001). Circulating adiponectin was significantly lower (P < 0.05) in the obese group than in the non-obese and post-GB groups. Omental adiponectin gene expression significantly increases after GB surgery reaching levels equal to age-matched non-obese subjects. Omental adiponectin expression has a significant negative correlation with the insulin resistance status.

Gastric bypass alters the dynamics and metabolic effects of insulin and proinsulin secretion

AimsHyperproinsulinaemia is associated with obesity and is a risk factor for Type 2 diabetes. We explored the dynamics of proinsulin and insulin and postprandial effects on glucose and lipids in subjects who had undergone gastric bypass (GBP) surgery compared with morbidly obese (MO) subjects and normal weight control subjects (NW).MethodsSubjects free from diabetes were recruited: 10 previously MO subjects [body mass index (BMI)±sd, 34.8±6.2kg/m2] who had undergone GBP surgery, 10 MO subjects (BMI 44±3.1kg/m2) and 12 NW control subjects (BMI 23.2±2.4kg/m2). After an overnight fast, a standard meal (2400 kJ) was ingested and glucose, proinsulin, insulin free fatty acids and triglycerides were determined up to 180 min.ResultsFasting proinsulin was similar in the GBP group and NW control subjects, but threefold increased in MO subjects (P < 0.05). Postprandial AUC for glucose was similar in the three groups and AUC for proinsulin was high in MO, intermediate in the GBP group and lowest in NW control subjects (P for trend = 0.020). Postprandial proinsulin at 60 min was similar in the GBP group and MO subjects and twofold higher than in NW control subjects. Postprandial proinsulin at 180 min was normal in the GBP group, but fivefold increased in MO subjects (P = 0.008). Insulin increased rapidly at 30 min in the GBP group and was normal at 90 min, whereas insulin was still increased at 90–180 min in the MO subjects (P < 0.001).ConclusionsMO subjects, free from diabetes, have elevated proinsulin concentrations in the fasting as well as the postprandial phase. After GBP surgery markedly lower fasting and postprandial proinsulin concentrations were observed, although BMI was higher compared with NW control subjects.

Pulmonary Embolus after Retrieval of a Temporary Inferior Vena Caval Filter in a Jehovah's Witness Undergoing Gastric Bypass Surgery

We present the case of pulmonary embolus after retrieval of a temporary inferior vena caval (IVC) filter in a Jehovah's Witness patient who underwent uneventful laparoscopic gastric bypass surgery. The 40-year-old female was admitted to the hospital 2 days after retrieval of the filter with bilateral pulmonary emboli for which she received anticoagulation therapy and consequently developed thoracic bleeding. We present this complicated case to highlight the risk of pulmonary emboli after IVC filter removal without anticoagulation, and to demonstrate the additional risk in managing a Jehovah's Witness patient.

Serum ghrelin levels in response to glucose load in obese subjects post-gastric bypass surgery.

We sought to elucidate further the mechanisms leading to weight loss after gastric bypass (GBP) surgery in morbidly obese individuals. Ghrelin is a gastroenteric appetite-stimulating peptide hormone, fasting levels of which decrease with increasing adiposity and increase with diet-induced weight loss. In addition, ghrelin levels rapidly decline postprandially. We measured serum ghrelin responses to a 75-g oral glucose tolerance test (OGTT) in 6 subjects who had undergone GBP surgery 1.5 +/- 0.7 years before testing and compared these responses with 6 obese subjects about to undergo GBP surgery, 6 obese nonsurgical subjects (matched for BMI to the post-GBP surgical group), and 5 lean subjects. Despite weight loss induced by the GBP surgery, fasting serum ghrelin levels were significantly lower in the post-GBP surgery group than in the lean subject (by 57%) or pre-GBP surgery (by 45%) group. Serum ghrelin levels during the OGTT were significantly lower in postoperative than in lean, obese pre-GBP surgical, or obese nonsurgical subjects. The magnitude of the decline in serum ghrelin levels between 0 and 120 minutes post-OGTT was significantly smaller in postoperative (by 62%), obese pre-GBP surgical (by 80%), or obese nonsurgical (by 69%) subjects in comparison with lean subjects. Serum ghrelin levels in response to OGTT are lower in subjects post-GBP surgery than in either lean or obese subjects. Tonically low serum ghrelin levels may be involved in the mechanisms inducing sustained weight loss after GBP surgery.

Preoperative and postoperative assessment of nutrient intakes in patients who have undergone gastric bypass surgery.

The study of 25 morbidly obese patients who had undergone gastric bypass surgery was undertaken to determine the fat, carbohydrate (CHO), protein, and total caloric intake before and at 1, 3, 6, and 12 months postoperatively. No postoperative complications occurred, and all patients lost weight appropriately. The nutrient intakes were estimated from dietary recall. Dramatic decreases occurred in average total caloric intake from a preoperative value of 3979.4 to 351.6 kcal at 1 month, 471.3 kcal at 3 months, 932.7 kcal at 6 months, and 1091 kcal at 12 months. Fat, CHO, and protein intake decreased equally until 12 months when fat intake had reached a plateau while CHO and protein intake continued to rise. Weight reduction after gastric bypass surgery is related to decreased caloric intake, predominantly in the fat component.