This thesis examines the effect of surgical weight loss on gut and adipose tissue peptides involved in appetite regulation and energy homeostasis in morbidly obese humans. Roux-en-Y gastric bypass (RYGBP) is the gold standard operation used for effective long-term weight loss and improved health. The exact mechanisms for this outcome are under investigation. We measured ghrelin, a recently discovered hunger hormone, insulin, adiponectin and leptin along with anthropometry measures in 66 morbidly obese patients prior to and 6 and 12 months after RYGBP. Impressive weight loss occurred postoperatively as did alterations in the peptides. Consistent correlations were found between weight, leptin, ghrelin and insulin. The main findings were low ghrelin concentrations in obesity and an increase after RYGBP. We explored inflammatory proteins C-reactive protein (CRP), serum amyloid A and interleukin-6 before and during massive weight loss 6 and 12 months after RYGBP in morbidly obese subjects. The studied proteins declined after surgery and a correlation between CRP and homeostatic model of assessment for insulin resistance, independent of BMI, strongly linked insulin resistance and inflammation. CRP declined most in insulin-sensitive subjects. We examined the excluded stomach mucosa and vagus nerve by measuring gastrin, pepsinogen I (PGI), pancreatic polypeptide (PP) and ghrelin levels during week 1 and year after RYGBP. Ghrelin levels rose with weight loss but declined 24-hours after surgery, like PP, indicating transient vagal nerve damage. Low levels of gastrin and PGI suggest a resting mucosa. We evaluated gut peptides: peptide YY (PYY), glucaogon like peptide-1 (GLP-1), pro-neurotensin (pro-NT) and PP, in lean (young and middle-aged), obese and postoperative RYGBP subjects pre- and postprandially. RYGBP subjects had exaggerated levels of PYY and GLP-1 postprandially and higher basal proNT levels, implying a ‘satiety peptide tone’ that may contribute to the maintenance of weight loss. In summary, RYGBP results in marked weight loss and alterations in gut and adipose tissue peptides involved in appetite regulation and energy homeostasis. These postoperative peptide changes may contribute to impressive weight loss observed after RYGBP.

Η παχυσαρκία και οι σχετιζόμενες με αυτήν παθολογικές καταστάσεις συνιστούν μία από τις κυριότερες αιτίες θανάτου παγκοσμίως, με τα επίπεδά της να αυξάνονται σε ανησυχητικό βαθμό. Επιδημιολογικές έρευνες σε ασθενείς με μεταβολικό σύνδρομο έδειξαν ευθεία συσχέτιση μεταξύ παχυσαρκίας και χαμηλών επιπέδων HDL χοληστερόλης πλάσματος, ενώ μελέτες σε πειραματικά μοντέλα ποντικών αποδεικνύουν πως η συσχέτιση αυτή είναι αιτιολογική. Η HDL είναι ένα μίγμα λιποπρωτεϊνικών σωματιδίων που, ανάλογα με τη σύστασή τους σε λιπίδια, μπορούν να είναι δισκοειδή ή σφαιρικά. Η σημαντικότερη αθηροπροστατευτική δράση της HDL οφείλεται στο γεγονός ότι η συγκεκριμένη λιποπρωτεΐνη συλλέγει την περίσσεια χοληστερόλης από τους περιφερικούς ιστούς και τη μεταφέρει στο ήπαρ, όπου καταβολίζεται, μια διαδικασία γνωστή και ως ανάστροφη μεταφορά χοληστερόλης. Κύρια πρωτεΐνη της HDL είναι η απολιποπρωτεΐνη Α-Ι (apoA-I), η οποία αλληλεπιδρώντας με τον μεταφορέα λιπιδίων ABCA1 προάγει την de novo σύνθεση δισκοειδών HDL σωματιδίων, τα οποία μετατρέπονται σε σφαιρικά με τη δράση του ενζύμου LCAT. Μία πρόσφατη μελέτη έδειξε ότι οι απολιποπρωτεΐνες E (apoE) και CIII (apoCIII) είναι ικανές να προάγουν την de novo βιογένεση HDL σωματιδίων ανεξάρτητα από την apoA-I. Η παρατήρηση αυτή ενίσχυσε την ιδέα ότι ο πληθυσμός της HDL είναι ένας συνδυασμός διαφορετικών σωματιδίων που έχουν διακριτή απολιποπρωτεϊνική σύνθεση. Επιπλέον, μεταβολές στις αναλογίες των απολιποπρωτεϊνών της HDL φαίνεται να καθορίζουν την κατανομή και τη λειτουργικότητα των υποπληθυσμών της. Στην παρούσα μελέτη στόχος ήταν ο δομικός και λειτουργικός χαρακτηρισμός της HDL σε ασθενείς με υπερνοσογόνο παχυσαρκία που υποβλήθηκαν σε χολοπαγκρεατική εκτροπή με γαστρική παράκαμψη κατά Roux en Y. Μελετήθηκαν 20 ασθενείς με υπερνοσογόνο παχυσαρκία, πριν και μετά την χειρουργική επέμβαση, και 7 υγιή άτομα ελέγχου. Απομονώθηκε πλάσμα από την ομάδα ελέγχου και από τους 20 ασθενείς πριν την επέμβαση καθώς και έξι μήνες μετά. Ακολούθησε κλασματοποίηση λιποπρωτεινών του πλάσματος με υπερφυγοκέντρηση σε βαθμίδωση πυκνότητας KBr και ανάλυση των κλασμάτων με Western Blot για ανίχνευση και ποσοτικοποίηση των επιπέδων των απολιποπρωτεινών apoA-I, apoE και apoCIII. Ακολούθησαν περαιτέρω βιοχημικές αναλύσεις των κλασμάτων, δομικές αναλύσεις με μη αποδιατακτική ηλεκτροφόρηση δύο διαστάσεων (2D-PAGE) και ηλεκτρονική μικροσκοπία, προκειμένου να υπάρξει μία πιο ξεκάθαρη εικόνα για τα σωματίδια που απαρτίζουν την HDL ενώ μετρήθηκε και η αντιοξειδωτική ικανότητα της HDL και στις τρεις ομάδες. Τέλος, μετρήθηκε η δραστικότητα του ενζύμου LCAT και συσχετίστηκε με την ηπατική εναπόθεση τριγλυκεριδίων των ασθενών. Η σειρά αναλύσεων των λιποπρωτεϊνικών κλασμάτων με Western Blot έδειξε ότι, έξι μήνες μετά την επέμβαση, υπάρχει μείωση των απολιποπρωτεϊνών A-I, E και CIII των ασθενών. Τα αποτελέσματα από την δισδιάστατη ηλεκτροφόρηση και την ηλεκτρονική μικροσκοπία αποδεικνύουν την ύπαρξη διαφορετικών σωματιδίων της HDL με διακριτή απολιποπρωτεϊνική σύνθεση, ενώ η μέτρηση του αντιοξειδωτικού δυναμικού της HDL φανερώνει τη ύπαρξη πιο λειτουργικής HDL μετά την επέμβαση. Η αυξημένη δραστικότητα της LCAT στους ασθενείς σε σχέση με την ομάδα ελέγχου και η μείωσή της μετά την επέμβαση υποδηλώνει ένα πιθανό αντιρροπιστικό μηχανισμό για την αναστολη της συσσώρευσης δισκοειδούς HDL. Έτσι προάγεται ο σχηματισμός περισσότερης ώριμης σφαιρικής HDL, ενώ αποτρέπεται και η εναπόθεση ηπατικών τριγλυκεριδίων που παρατηρείται στο ήπαρ των ασθενών αυτών. Η παρατήρηση ότι η δομή και η λειτουργικότητα της HDL βελτιώνονται στους ασθενείς έξι μήνες μετά την επέμβαση, οδηγεί στο συμπέρασμα ότι η χειρουργική επέμβαση στην οποία υποβάλλονται οι ασθενείς επιδρά θετικά στην ποιότητα της HDL. / Obesity and its related pathologies are one of the leading causes of death worldwide, with levels increasing to an alarming extent. Epidemiological studies in patients with metabolic syndrome showed a direct correlation between obesity and low levels plasma of HDL cholesterol and experimental studies in mice show that this correlation is causative. HDL is a mixture of lipoprotein particles, which, depending on their composition in lipids, may be discoidal or spherical. The most important atheroprotective action of HDL is due to the fact that this lipoprotein collects excess cholesterol from peripheral tissues and transports it to the liver where it is catabolized. The main protein of the HDL is apolipoprotein A-I (apoA-I), which interacts with the lipid carrier ABCA1 and promotes de novo synthesis of discoidal HDL particles, which are converted to spherical with the LCAT enzyme. A recent study showed that apolipoprotein E (apoE) and CIII (apoCIII) areable to promote de novo biogenesis of HDL particles regardless of apoA-I. This observation supported the idea that the population of HDL is a combination of different particles with distinct apolipoprotein composition. Moreover, changes in the apolipoprotein ratiosof HDL appear to determine the distribution and function of its subpopulations. Although HDL cholesterol (HDL-C) has been traditionally associated to atheroprotection, recently it became clear that HDL particle functionality is also a key in reducing cardiovascular mortality. To this date the effects of obesity on HDL structure and functionality remain unclear. In this study, the objective was the structural and functional characterization of HDL frommorbidly obese patients undergoing biliopancreatic diversion by Roux en Y before and six months after the operation, and in lean control subjects. We studied 20 morbidly obese patients before and after surgery, and 7 control healthy individuals. Plasma was isolated from the control group and 20 patients before surgery and six months. Plasma was fractionated by KBr density gradient ultracentrifugation and lipoprotein fractions were isolated and analyzed, by Western Blot, for detection and quantification of the levels of apolipoproteins apoA-I, apoE and apoCIII. Further biochemical analysis of fractions, structural analysis with non denaturing two-dimensional electrophoresis (2D-PAGE) and electron microscopy, in order to have a more clear picture of the particles that compose HDL. In order to determine whether or how the efficiency of HDL is affected by the operation, we performed an assay measuring the antioxidant capacity of HDL in all three groups. Finally, the activity of the LCAT enzyme was measured and was correlated with the triglyceride deposition observed in the liver of these patients. The sequence analyzes of lipoprotein fractions by Western Blot showed that six months after surgery, there was a decrease in the levels of apolipoproteins AI, E and CIII. The results from the two-dimensional electrophoresis and electron microscopy showed the existence of different particles with distinct HDL apolipoprotein composition while the increased antioxidant potential of HDL indicates the existence of a more functional HDL after surgery. The increased activity of LCAT in patients plasma compared with the control group and its reduction after surgery, suggests that perhaps there may be a saving grace that tries to overcome the accumulation of discoidal HDL and promotes the formation of more mature, spherical HDL, so as to prevent the triglyceride deposition observed in the liver of these patients. The observation that the structure and function of HDL improved six months after surgery, leads to the conclusion that the surgery undergone by patients has a positive effect on the quality of HDL.

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Darbo tikslas Įvertinti antro tipo cukrinio diabeto (2 tipo CD) chirurginio gydymo klinikinį ir ekonominį efektyvumą. Uždaviniai : 1. Ištirti visus pacientus operuotus dėl nutukimo ir 2 tipo CD LSMUL KK Chirurgijos klinikoje 2005-2010 metais. 2. Palyginti šių pacientų klinikinę būseną ir gyvenimo kokybę prieš ir praėjus daugiau kaip 1 metams po operacijos. 3. Palyginti 2 tipo CD gydymo išlaidas operuojant ir neoperuojant bei įvertinti skrandžio apylankos operacijos ekonominį efektyvumą. Tyrimo metodika Tyrimui atlikti buvo išduotas Kauno regioninio bioetikos komiteto leidimas Nr. BE-2-59. Atlikta pacientų, kuriems dėl nutukimo ir 2 tipo CD 2005-2010m. Kauno Klinikose buvo atlikta skrandžio apylankos operacija, duomenų retrospektyvinė analizė. Praėjus daugiau kaip 1 metams po operacijos detaliai ištirta pacientų klinikinė būsena. Gyvenimo kokybės ir operacinio gydymo naudingumo įvertinimui taikyti SF-36 klausimynas ir SF-6D konversijos modelis. Ekonominio naudingumo analizės modelis naudotas apskaičiuojant ir lyginant operacinio ir konservatyvaus 2 tipo CD tiesiogines gydymo išlaidas. Duomenys apdoroti ir analizuoti naudojant statistinį duomenų analizės paketą SPSS 15. Rezultatai 2005-2010 metais Kauno klinikų chirurginiame skyriuje dėl nutukimo ir 2 tipo CD operuoti 76 pacientai (52 moterys ir 24 vyrai). 67 pacientams buvo atlikta skrandžio apylankos operacija, 8 skrandžio apjuosimo reguliuojama juosta operacija ir 1 pacientui marginalinė skrandžio rezekcija (sleeve... [toliau žr. visą tekstą] / Aim To evaluate the clinical and cost-effectiveness of the laparoscopic Roux-en-Y gastric-bypass (LRYGB) in obese patients with type 2 diabetes. Tasks: 1. To investigate all the patients underwent the LRYGB on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010. 2. To compare the clinical outcomes and quality of life (QoL) in operated patients before and 1 year or later after the surgery. 3. To evaluate the cost-effectiveness of LRYGB and to compare it with the conventional treatment cost. Methodology of the research The retrospective study of 51 patient underwent LRYGB on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010. The clinical evaluation of operated patients 1 year or later after the laparoscopic gastric-bypass. SF-36 questionnaire and SF-6D conversion model were used to evaluate the QoL and health benefits after the surgery. To evaluate and to compare the surgical and conventional treatment costs in obese type 2 diabetes patients, the cost utility analysis model was used. Kaunas regional committee of bioethics approved the project (permission Nr BE-2-59). The data was processed and analysed using the package SPSS 15,0 of statistical data analysis. Results 76 patients (52 women and 24 men) were operated on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010. 67 patients underwent LRYGB, in 8 patients the laparoscopic adjustable gastric banding and sleeve resection in 1 patient were performed. One year or later after the... [to full text]

Ο στόχος της παρούσας μελέτης ήταν η σύγκριση των αποτελεσμάτων και των μεταβολικών επιπλοκών της γαστρικής παράκαμψης Roux-en-Y και μιας εκδοχής της χολοπαγκρεατικής εκτροπής σε έναν αποκλειστικά non-superobese πληθυσμό. Τα κύρια χαρακτηριστικά της χολοπαγκρεατικής εκτροπής ήταν: γαστρικός θύλακος 15 ± 5 pml, χολοπαγκρεατική έλικα 200 cm, κοινό κανάλι 100 cm και διατροφική έλικα το λοιπό λεπτό έντερο. Τα κύρια χαρακτηριστικά της RYGBP ήταν: γαστρικός θύλακος 15 ± 5 ml, χολοπαγκρεατική έλικα 60 cm, Roux έλικα 100 cm και κοινό κανάλι το υπόλοιπο μήκος του λεπτού εντέρου. Από 130 ασθενείς με BMI 35-50 kg/m2, οι 65 υποβλήθηκαν σε RYGBP και οι 65 σε BPD. ΄Ολοι οι ασθενείς ολοκλήρωσαν το δεύτερο μετεγχειρητικό έτος. Η μέση απώλεια υπερβάλλοντος βάρους (excess weight loss, %EWL) ήταν καλύτερη μετά από BPD καθόλη τη διάρκεια του follow-up, ενώ στα 2 χρόνια η EWL ήταν > 50% στο 100% των ασθενών της BPD σε σύγκριση με το 88.7% της RYGBP. Η παθολογική ανοχή γλυκόζης, η υπερχοληστερολαιμία, η υπερτριγλυκεριδαιμία και η υπνική άπνοια παρουσίασαν πλήρη ύφεση και στις δύο ομάδες, αλλά τα μέσα επίπεδα ολικής χοληστερόλης ήταν σημαντικά χαμηλότερα μετά από BPD στα 2 χρόνια. Ο διαβήτης υποχώρησε πλήρως σε όλους τους ασθενείς της BPD και σε 7 στους 10 ασθενείς της RYGBP. Δεν παρατηρήθηκαν στατιστικά σημαντικές διαφορές στις πρώιμες και όψιμες μη μεταβολικές επιπλοκές. Υποαλβουμιναιμία παρατηρήθηκε σε 1 ασθενή της RYGBP (1.5%) και σε 6 ασθενείς της BPD (9.2%). Μόνο ένας ασθενής από κάθε ομάδα χρειάστηκε νοσηλεία και ολική παρεντερική διατροφή. Συμπεραίνουμε πως οι μεταβολικές επιπλοκές μετά από BPD δεν ήταν σοβαρές και δεν παρουσίαζαν στατιστικά σημαντική διαφορά ανάμεσα στις δύο ομάδες, οπότε και οι δύο επεμβάσεις είναι ασφαλείς και αποτελεσματικές σε non-superobese πληθυσμούς, αλλά η BPD είναι πιο αποτελεσματική στην απώλεια βάρους και στην επίλυση του διαβήτη και της υπερχοληστερολαιμίας. / The aim of the present study was the comparison of the effectiveness and the metabolic complications of Roux-en-Y gastric bypass (RYGBP) versus a variant of biliopancreatic diversion (BPD) in an exclusively non-superobese population. The main characteristics of the BPD were: gastric pouch 15 ± 5 ml, biliopancreatic limb 200 cm, common channel 100 cm and alimentary limb the remainder of the small intestine. The main characteristics of the RYGBP were: gastric pouch 15 ± 5 ml, biliopancreatic limb 60 cm, Roux limb 100 cm and common channel the remainder of the small intestine. Of 130 patients with BMI 35-50 kg/m2, 65 underwent RYGBP and 65 underwent BPD. All patients completed their second postoperative year. Mean excess weight loss (EWL) was better after BPD at all time periods, and the %EWL was > 50% in all BPD patients compared to 88.7% of RYGBP patients. Glucose intolerance, hypercholesterolemia, hypertriglyceridemia and sleep apnea completely resolved in all patients in both groups, although mean total cholesterol level was significantly lower in BPD patients at second year. Diabetes completely resolved in all BPD patients and in 7 of the 10 RYGBP patients. No statistically significant differences were observed between the two groups in early and late non-metabolic complications. Hypoalbuminemia occured in only 1 patient after RYGBP (1.5%) and in 6 patients after BPD (9.2%). Only 1 patient from each group was hospitalized and received total parenteral nutrition. We conclude that the metabolic complications that occured following this type of BPD were not severe nor significantly different between the two groups, therefore both operations can be considered safe and effective for non-superobese patients, but BPD is more effective in weight loss as well as the resolution of diabetes and hypercholesterolemia.

Made available in DSpace on 2014-06-11T19:32:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-11Bitstream added on 2014-06-13T21:05:19Z : No. of bitstreams: 1 fogaca_kcp_dr_arafcf.pdf: 1112291 bytes, checksum: f3c51513471a3c93b2a06295152462f4 (MD5) / Unimep / A cirurgia bariátrica é apontada como um dos mais efetivos, se não o único recurso terapêutico para obesidade mórbida. Entretanto, a recuperação de peso vem sendo foco de atenção nesses pacientes, especialmente após um ou mais anos de cirurgia; sendo que seus efeitos, magnitude e causas necessitam ser estudados. Esta pesquisa teve como objetivo avaliar a relação de fatores ligados ao consumo e gasto energético com a variação do peso corporal de mulheres em pós-cirúrgico tardio de Derivação Gástrica em Y-de-Roux (DGYR). Foi realizado um estudo transversal do qual participaram 45 mulheres, com idades entre 26 e 61 anos, operadas por derivação gástrica em Y-de-Roux há mais de 24 meses, assistidas na Clínica Bariátrica do Hospital Fornecedores de Cana, Piracicaba – SP. Foi avaliado o consumo alimentar e o gasto energético com atividades físicas a partir do recordatório de 3 dias, a taxa de metabolismo em repouso (TMR) por calorimetria indireta e as concentrações séricas de glicose, insulina e leptina. Para efeito de análise, as mulheres foram agrupadas quanto à recuperação de peso corporal (NR = não recuperação; R = recuperação > 10% do menor peso após a cirurgia), ao índice de massa corporal (IMC) em Não Obesas (NO - IMC < 30 kg/m²) e Obesas (O - IMC > 30 kg/m²) e pela percentagem da Perda do Excesso de Peso (PPEP) Baixa (PPEP < 50%), Moderada (PPEP entre 50% e 75%) e Alta (PPEP > 75%). Para a comparação dos resultados entre os grupos foram utilizados os testes de Mann-Whitney e Kruskal-Wallis, seguido do teste de Dunn. As correlações entre as variáveis foram testadas pelo coeficiente de Spearman. As análises foram realizadas considerando um nível de significância de 5%. Não foi encontrada relação dos indicadores de perda e manutenção de peso (recuperação de peso, IMC e PPEP) e o consumo de nutrientes. O perfil geral de consumo... / Bariatric surgery is pointed out as one of the most effective, if not the only therapeutic resource to treat morbid obesity. However, there has been growing attention to the weight regain seen in bariatric surgery patients, especially one or more years after surgery. The objective of this study was to assess the factors associated with energy consumption and expenditure and body weight variation in the late postoperative period of women who had undergone Roux-en-Y gastric bypass (RYGB). A cross-sectional study was done with 45 women aged 26 to 61 years who had undergone Roux-en-Y gastric bypass at least 24 months earlier, being treated at the Bariatric Clinic of the Hospital Fornecedores de Cana, Piracicaba, SP. The following were investigated: food intake and energy expenditure with physical activities (3-day recall), resting energy expenditure - REE (indirect calorimetry) and serum concentrations of glucose, insulin and leptin. The women were grouped according to the following for analysis: amount of weight regained (NR = no regain; R = regained >10% of the lowest weight achieved after surgery); body mass index (BMI) into non-obese (NO-BMI < 30kg/m2) and Obese (O – BMI > 30 kg/m2); and percentage of excess weight lost (PEWL) into Low (PEWL < 50%), Moderate (50% < PEWL < 75%) and High (PEWL > 75%). The results of the groups were compared with the Mann-Whitney and Kruskal-Wallis tests, followed by the Dunn test. The correlations between the variables were tested with the Spearman’s coefficient. The level of significance was set at 5%. There was no relationship between weight loss and maintenance indicators (weight regain, BMI and PEWL) and nutrient intake. The general food intake profile did not vary among the volunteers but there was a positive correlation between carbohydrate intake... (Complete abstract click electronic access below)

Orientador: Maria Rita Marques de Oliveira / Banca: Maria Rita Marques de Oliveira / Banca: Vânia Aparecida Leandro Merhi / Banca: Aureluce Demonte / Banca: Celso Vieira de Souza Leite / Banca: José Ernesto dos Santos / Resumo: A cirurgia bariátrica é apontada como um dos mais efetivos, se não o único recurso terapêutico para obesidade mórbida. Entretanto, a recuperação de peso vem sendo foco de atenção nesses pacientes, especialmente após um ou mais anos de cirurgia; sendo que seus efeitos, magnitude e causas necessitam ser estudados. Esta pesquisa teve como objetivo avaliar a relação de fatores ligados ao consumo e gasto energético com a variação do peso corporal de mulheres em pós-cirúrgico tardio de Derivação Gástrica em Y-de-Roux (DGYR). Foi realizado um estudo transversal do qual participaram 45 mulheres, com idades entre 26 e 61 anos, operadas por derivação gástrica em Y-de-Roux há mais de 24 meses, assistidas na Clínica Bariátrica do Hospital Fornecedores de Cana, Piracicaba - SP. Foi avaliado o consumo alimentar e o gasto energético com atividades físicas a partir do recordatório de 3 dias, a taxa de metabolismo em repouso (TMR) por calorimetria indireta e as concentrações séricas de glicose, insulina e leptina. Para efeito de análise, as mulheres foram agrupadas quanto à recuperação de peso corporal (NR = não recuperação; R = recuperação > 10% do menor peso após a cirurgia), ao índice de massa corporal (IMC) em Não Obesas (NO - IMC < 30 kg/m²) e Obesas (O - IMC > 30 kg/m²) e pela percentagem da Perda do Excesso de Peso (PPEP) Baixa (PPEP < 50%), Moderada (PPEP entre 50% e 75%) e Alta (PPEP > 75%). Para a comparação dos resultados entre os grupos foram utilizados os testes de Mann-Whitney e Kruskal-Wallis, seguido do teste de Dunn. As correlações entre as variáveis foram testadas pelo coeficiente de Spearman. As análises foram realizadas considerando um nível de significância de 5%. Não foi encontrada relação dos indicadores de perda e manutenção de peso (recuperação de peso, IMC e PPEP) e o consumo de nutrientes. O perfil geral de consumo... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Bariatric surgery is pointed out as one of the most effective, if not the only therapeutic resource to treat morbid obesity. However, there has been growing attention to the weight regain seen in bariatric surgery patients, especially one or more years after surgery. The objective of this study was to assess the factors associated with energy consumption and expenditure and body weight variation in the late postoperative period of women who had undergone Roux-en-Y gastric bypass (RYGB). A cross-sectional study was done with 45 women aged 26 to 61 years who had undergone Roux-en-Y gastric bypass at least 24 months earlier, being treated at the Bariatric Clinic of the Hospital Fornecedores de Cana, Piracicaba, SP. The following were investigated: food intake and energy expenditure with physical activities (3-day recall), resting energy expenditure - REE (indirect calorimetry) and serum concentrations of glucose, insulin and leptin. The women were grouped according to the following for analysis: amount of weight regained (NR = no regain; R = regained >10% of the lowest weight achieved after surgery); body mass index (BMI) into non-obese (NO-BMI < 30kg/m2) and Obese (O - BMI > 30 kg/m2); and percentage of excess weight lost (PEWL) into Low (PEWL < 50%), Moderate (50% < PEWL < 75%) and High (PEWL > 75%). The results of the groups were compared with the Mann-Whitney and Kruskal-Wallis tests, followed by the Dunn test. The correlations between the variables were tested with the Spearman's coefficient. The level of significance was set at 5%. There was no relationship between weight loss and maintenance indicators (weight regain, BMI and PEWL) and nutrient intake. The general food intake profile did not vary among the volunteers but there was a positive correlation between carbohydrate intake... (Complete abstract click electronic access below) / Doutor

Orientador: Bruno Geloneze Neto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T04:57:20Z (GMT). No. of bitstreams: 1 Lima_MarceloMirandadeOliveira_M.pdf: 5830772 bytes, checksum: 60a5a321b7a0db75dbf4b6b163df924a (MD5) Previous issue date: 2010 / Resumo: A obesidade visceral está associada à resistência à insulina (RI), à presença de síndrome metabólica (SMet), à presença do diabetes tipo 2 (DM2) e a risco cardiovascular e mortalidade elevados. Entretanto, não está claro se existe uma relação causal. A ressecção cirúrgica da gordura visceral (lipectomia visceral) é um modelo experimental excelente para esclarecer esta questão. Em modelos animais, a lipectomia visceral melhora a sensibilidade à insulina (SI), a tolerância à glicose e o perfil de adipocinas. A omentectomia combinada com a cirurgia bariátrica em humanos tem efeitos controversos sobre a SI no longo prazo, e não há dados sobre o curto prazo, no qual o efeito da perda de peso poderia ser minimizado. Para investigar o papel da gordura visceral no metabolismo, este estudo prospectivo randomizado analisou, como objetivo primário, os efeitos aditivos da omentectomia combinada ao bypass gástrico em Y de Roux na SI corporal total (valor de M), mensurada pelo clamp euglicêmicohiperinsulinêmico (método padrão-ouro) no curto prazo (1 mês pós-cirurgia). Também foram analisados o HOMA-IR (marcador substitutivo de SI), as adipocinas, outros parâmetros bioquímicos e cardiovasculares, medidas antropométricas, composição corporal e as medidas ecográficas da gordura abdominal, subcutânea e visceral. Vinte mulheres em menacme com obesidade grau III e SMet foram randomizadas para bypass gástrico isolado (grupo-controle) ou combinado à omentectomia total e estudadas précirurgia e 1 mês pós-cirurgia. Na análise do conjunto dos dois grupos, não houve melhora na SI medida pelo clamp (valor de M) no primeiro mês pós-cirurgia apesar de haver redução de peso (pequena mas significativa). Ao contrário, observou-se melhora no HOMA-IR. A omentectomia não potencializou os efeitos do bypass gástrico na SI apesar de associar-se a maior perda de peso. Em conclusão, não se provou que a gordura visceral é um fator causal para a diminuição da SI. Um mês após a cirurgia, o metabolismo da glicose no jejum melhora independente de mudanças na SI periférica e a omentectomia não influenciou este resultado / Abstract: Visceral obesity is linked to insulin resistance, metabolic syndrome, diabetes, cardiovascular risk and mortality. Whether this relationship is causative or correlative is unclear. The surgical resection of visceral fat is an excellent experimental model to address this issue. It has been shown to improve insulin sensitivity (IS), glucose tolerance and adipokine profile in animal models. The omentectomy has been combined to bariatric surgery in humans in order to study its long-term metabolic effects with controversial results on IS. To approach the role of the visceral fat tissue in metabolism, the present prospective randomized trial assessed the additional effects of omentectomy combined to Roux-en-Y gastric bypass (RYGBP) on whole-body IS, measured by the "gold standard" method, i. e., the euglycemic-hyperinsulinemic clamp, a month post-surgery, as a primary objective. HOMA-IR (a surrogate marker of IS), adipokines, other basal blood and cardiovascular parameters, anthropometric measurements, body composition and ecographic measures of the subcutaneous and visceral fat thicknesses in the abdomen were also evaluated. Twenty grade-III obese premenopausal women with metabolic syndrome were randomized to either RYGBP alone (control group) or combined to a total greater omentectomy and were studied at baseline and shortly after surgery (first month). In the analysis of the pooled data from both groups, IS measured by the clamp (M-value) did not improve in the first post-surgery month despite of a decrease in body weight. This finding was discordant to the observation of an improvement in HOMA-IR. Omentectomy did not potentiate the effect of RYGBP on IS despite of being associated with greater weight loss. In conclusion, it has not been proven that the visceral fat is a causal factor on impaired IS. A month after RYGBP, fasting glucose metabolism improves independent of a change in peripheral insulin sensitivity and omentectomy did not influence this outcome / Mestrado / Clinica Medica / Mestre em Clinica Medica

Highly palatable and/or calorically dense foods, such as those rich in fat, engage the striatum to govern and set complex behaviors. Striatal dopamine signaling has been implicated in hedonic feeding and the development of obesity. Dieting and bariatric surgery have markedly different outcomes on weight loss, yet how these interventions affect central homeostatic and food reward processing remains poorly understood. Here, we propose that dieting and gastric bypass produce distinct changes in peripheral factors with known roles in regulating energy homeostasis, resulting in differential modulation of nigrostriatal and mesolimbic dopaminergic reward circuits. Enhancement of intestinal fat metabolism after gastric bypass may also modify striatal dopamine signaling contributing to its unique long-term effects on feeding behavior and body weight in obese individuals.

Highly palatable and/or calorically dense foods, such as those rich in fat, engage the striatum to govern and set complex behaviors. Striatal dopamine signaling has been implicated in hedonic feeding and the development of obesity. Dieting and bariatric surgery have markedly different outcomes on weight loss, yet how these interventions affect central homeostatic and food reward processing remains poorly understood. Here, we propose that dieting and gastric bypass produce distinct changes in peripheral factors with known roles in regulating energy homeostasis, resulting in differential modulation of nigrostriatal and mesolimbic dopaminergic reward circuits. Enhancement of intestinal fat metabolism after gastric bypass may also modify striatal dopamine signaling contributing to its unique long-term effects on feeding behavior and body weight in obese individuals.