Bakgrund: Fetma och övervikt ökar hos världens befolkning och är idag ett globalt hälsoproblem. Det finns ingen skillnad för prevalensen av fetma mellan de båda könen i Sverige, men globalt sett ses en skillnad. Fetma kan leda till följdsjukdomar, vilka kan ha en negativ fysisk och psykisk påverkan på individens hälsorelaterade livskvalitet. En allt vanligare behandlingsmetod av fetma är viktminskningskirurgi. Att välja fetmakirurgi som behandlingsmetod är idag vanligare för kvinnor än för män. Syftet med denna litteraturstudie är att belysa hur den hälsorelaterade livskvaliteten upplevs, minst sex månader efter en viktminskningsoperation. Metoden som valdes utgick från Goodmans sju steg. Vetenskapliga artiklar söktes i två databaser; PubMed och Cinahl. 36 artiklar granskades och slutligen valdes 10 artiklar till resultatet, varav samtliga kvantitativa. Resultaten visade att den hälsorelaterade livskvaliteten påverkas av medicinska förändringarna som sker efter operationen. Vidare framkommer det att viktkirurgi ger ökad fysisk rörelseförmåga samt ökad självkänsla, vilket ger en ökad hälsorelaterad livskvalitet. Slutsats: Sjuksköterskans stöd kan komma att spela en viktig roll för patienten i deras förändring efter en viktminskningsoperation. Det är viktigt att sjuksköterskan har kunskap om de olika aspekter som inverkar på dessa patienters hälsorelaterade livskvalitet för att kunna möta patienten i just den situation hon/han befinner sig i. / Background: Obesity and overweight is increasing among the world's population and is today a global health problem. There is no difference in the prevalence of obesity between the sexes in Sweden, but globally a difference is seen. Obesity can lead to co-morbidities which may have an adverse physical and psychological impact on an individuals’ health-related quality of life. An increasingly common method of treatment of obesity is weight loss surgery. Choosing obesity surgery as a treatment method is today more common for women than for men. Surgery as treatment is increasingly common for people with obesity. There are more women than men undergoing weight loss surgery. The purpose of this study is to find out how the health-related quality of life is perceived, at least six months after a weight loss surgery. The method chosen was based on Goodman's seven steps. Scientific articles were searched in two databases, PubMed and Cinahl. 36 articles were reviewed, and finally 10 articles were selected for the result, of which all were quantitative. The results showed that the health-related quality of life is affected by medical changes that occur after surgery. Furthermore, it appears that weight loss surgery provides increased physical mobility and self-esteem, which will increase health-related quality of life. Conclusions: Nurses support could play an important role for the patient in their change after weight loss surgery. It is important that the nurse has knowledge about the different aspects that affect these patients' health-related quality of life in order to meet the patient in exactly the situation he/she is in.

Background. Roux-en-Y gastric bypass (RYGB) is an effective treatment for obesity, where gut peptides such as ghrelin, glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) play an instrumental role in reduced appetite after RYGB. This systematic review and meta-analysis aimed to establish the magnitude of change of ghrelin, GLP-1, PYY and appetite sensation following RYGB. Methods. A systematic search was conducted in Medline Ovid, Embase, Scopus, and Cochrane Central Register of Controlled Trials up until March 2021. Two independent reviewers screened articles for studies that evaluated ghrelin, GLP-1, PYY or appetite sensation via visual analogue scales (VAS) before and after RYGB in adults. Risk of bias was assessed with the quality assessment tool for before-after studies with no control group from the National Heart, Lung and Blood Institute (NHLBI). A multilevel model with random effects for study and follow-up time points nested in study was fit to the data. The model included kilocalorie consumption as a covariate and time points as moderators. Results. Among the 2,559 articles identified, 47 met the inclusion criteria, among which k=19 evaluated ghrelin, k=40 GLP-1, k=22 PYY and k=8 appetite sensation via VAS. Our results indicate that fasting ghrelin levels are decreased 2 weeks post-RYGB (p = .005) but do not differ from baseline from 6 weeks to 1-year post-RYGB. Postprandial ghrelin levels at 6 months and 1-year post-RYGB were not different from pre-surgical values (p = .51). Fasting GLP-1 levels were not different from pre-surgical levels up to 2 years post-RYGB. Postprandial levels of GLP-1 increased significantly from 1 week (p < .001) to 2 years post-RYGB (p < .01) compared to before surgery. Compared to pre-RYGB levels, fasting PYY increased at 6 months (p = .034) and 1 year (p = .0299) post-surgery and postprandial levels were increased up to 1 year (p < .01). Heterogeneity was significant in most analyses. Insufficient data on appetite sensation was available to be meta-analyzed. Conclusion. Our analyses illustrate the magnitude of change of ghrelin, GLP-1 and PYY before and after RYGB surgery. Importantly, between study heterogeneity within the current literature warrants more standardized protocols and studies with longer follow-up periods for better comprehension of changes in gut peptides following RYGB surgery.

Studies have shown that following bariatric surgery, there is an almost immediate reversal of type 2 diabetes. However, there still remains questions as to why this occurs and what possible explanations there may be. This paper aims to focus on several studies that have found a reversal of diabetes in obese patients who have undergone bariatric surgery. Furthermore, it explores several possibilities for the reasons behind this reversal including the role of AMP-activated protein kinase, the incretins gastric inhibitory peptide and glucagon-like peptide-1, and also looks at genetics. Bariatric surgery and a description of certain mechanisms are first described for an understanding. Following is a literature review of published studies on bariatric surgery, the reversal of diabetes following the procedure, and roles of AMPK and incretins. Because of the possibility that reduced caloric intake may not be the major factor in the diabetic reversal, it is suggested that further research be done on obese and normal weight patients and observe the levels of the mentioned mechanisms and also various genes to see if they offer a more thorough explanation.

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No description available.

Le DT2 est caractérise par un défaut combiné de la sécrétion et de l’action de l’insuline. Depuis près d’un demi siècle la chirurgie bariatrique et notamment le Roux-en-Y Gastric Bypass (RYGB) ont montré des effets spectaculaires sur le contrôle glycémique remettant en question le paradigme de la prise en charge médicale du DT2. L’exclusion gastro duodénale induite par le RYGB améliore le métabolisme glucidique indépendemment de la perte de poids. Ainsi les modifications du flux biliaire semblent jouer un rôle, cependant les mécanismes sous-jacents ne sont pas clairs. Nous avons réalisés des RYGB chez le miniporc et nous avons montré que l'absorption intestinale du glucose est diminuée dans l’anse alimentaire (AL) dépourvue de bile. L'absorption du glucose dans l’AL était restaurée par l'ajout de la bile, et cet effet était inhibé lorsque le co transport actif sodium glucose 1 (SGLT1) était bloquée par la phlorizine. SGLT1 restait exprimée dans la AL, cependant la teneur dans la lumière de l’intestin en sodium était nettement diminuée. L’ajout de sodium dans l'AL provoquait le même effet que la bile sur l'absorption du glucose et augmentait également l’excursion glycémique post prandiale chez le miniporc au cours d’un repas test vigil. La diminution de l'absorption intestinale du glucose après RYGB a ensuite été confirmée chez l'homme. Nos résultats démontrent que la l’exclusion biliaire affecte le métabolisme post prandiale du glucose par modulation des co transporteurs intestinaux sodium-glucose. / Type 2 diabetes (T2D) is characterized primarily as a combined defect of insulin secretion and insulin action. For nearly a decade, the somewhat mysterious but spectacular benefit of metabolic surgery, and more specifically of Roux-en-Y gastric bypass (RYGB), on glucose control has been caused a questioning the current paradigm of T2D management. Gastro-intestinal exclusion by RYGB improves glucose metabolism, independent of weight loss. Although changes in intestinal bile trafficking have been shown to play a role, the underlying mechanisms are unclear. We performed RYGB in minipigs and showed that the intestinal uptake of ingested glucose is blunted in the bile deprived alimentary limb (AL). Glucose uptake in the AL was restored by the addition of bile, and this effect was abolished when active glucose intestinal transport was blocked with phlorizin. Sodium-glucose cotransporter 1 remained expressed in the AL, while intraluminal sodium content was markedly decreased. Adding sodium to the AL had the same effect as bile on glucose uptake. It also increased postprandial blood glucose response in conscious minipigs following RYGB. The decrease in intestinal uptake of glucose after RYGB was confirmed in humans. Our results demonstrate that bile diversion affects postprandial glucose metabolism by modulating sodium-glucose intestinal cotransport.

Η γαστρική παράκαμψη κατά Roux en Y αποτελεί την πλέον δημοφιλή επέμβαση αντιμετώπισης της νοσογόνου παχυσαρκίας. Στη σύγχρονη εποχή, πάνω από τις μισές επεμβάσεις γαστρικής παράκαμψης διενεργούνται λαπαροσκοπικά. Σκοπός της παρούσας μελέτης είναι η σύγκριση μεταξύ της ανοικτής και της λαπαροσκοπικής τεχνικής, σε χρονικό ορίζοντα παρακολούθησης 5 ετών από την επέμβαση. Μέθοδος: Οι πρώτοι 60 ασθενείς, που υποβλήθηκαν σε ανοικτή γαστρική παράκαμψη και οι αντίστοιχοι 60 ασθενείς, που υποβλήθηκαν σε λαπαροσκοπική επέμβαση, μελετήθηκαν για 5 χρόνια μετεγχειρητικά. Οι παράμετροι, που καταγράφηκαν περιελάμβαναν την απώλεια βάρους και τη διατήρηση αυτής, τη βελτίωση ή πλήρη ίαση των συνοδών της παχυσαρκίας νόσων, τις πρώιμες και όψιμες μετεγχειρητικές επιπλοκές, τη διάρκεια επέμβασης και το χρόνο νοσηλείας των ασθενών. Αποτελέσματα: Όλοι οι ασθενείς παρουσίασαν απώλεια βάρους, χωρίς να παρατηρούνται στατιστικά σημαντικές διαφορές μεταξύ των δύο ομάδων, που διατηρήθηκε σε όλη τη διάρκεια του follow-up. Μικρή επανάκτηση του απολεσθέντος βάρους παρατηρήθηκε μετά τον 3ο χρόνο μετεγχειρητικά. Η ίαση ή βελτίωση των συνοδών νοσημάτων δεν παρουσίασε στατιστικά σημαντική διαφορά μεταξύ των δύο ομάδων. Ισοδύναμες παρουσιάζονται και οι δύο τεχνικές, όσον αφορά στην εμφάνιση μετεγχειρητικών επιπλοκών. Η διάρκεια της λαπαροσκοπικής επέμβασης παρουσιάζεται μεγαλύτερη, γεγονός που μπορεί να ερμηνευθεί βάσει της καμπύλης εκμάθησης. Η διάρκεια νοσηλείας δεν παρουσιάζει διαφορά μεταξύ των δύο ομάδων. Συμπεράσματα: Η λαπαροσκοπική γαστρική παράκαμψη, συγκρινόμενη με την ανοικτή επέμβαση, αποτελεί μία εξίσου ασφαλή και αποτελεσματική τεχνική για την αντιμετώπιση της κλινικά σοβαρής παχυσαρκίας. / Roux en Y gastric bypass (RYGBP) is the most popular operation between patients, undergoing bariatric operation. In modern times, over half of the gastric bypass operations are performed by the laparoscopic way. The aim of the present study is the comparison between open and laparoscopic technique, in a follow-up period of 5 years post surgically.`Methods: The first 60 patients, who underwent open gastric bypass and the respective 60 patients, who underwent the laparoscopic approach, were studied for 5 years post surgically. The parameters recorded, included the excess weight loss and the following maintenance of the loss, the improvement or healing of the obesity related comorbidities, early and late complications, the duration of the operation and the duration of the patients’ hospitalization. Results: All patients exhibited excess weight loss, without statistically significant differences between the two groups, which maintained throughout the follow-up period. A small proportion of regaining the lost weight was observed after the 3rd year post surgically. Healing or improvement of the obesity related comorbidities didn’t appear statistically significant difference between the two groups. There were no differences between the two groups regarding the post surgically complications. The duration of the laparoscopic approach was longer, which can be attributed to the learning curve. The duration of the patients’ hospitalization didn’t differ between the two groups. Conclusion: Laparoscopic gastric bypass, compared to the open procedure, is an equally safe and effective technique for the confrontation of clinically severe obesity.

<p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p>

INTRODUÇÃO: O diabetes mellitus tipo 2 (DM2) é uma doença correlacionada com a obesidade mórbida. O paciente obeso apresenta efeito incretínico suprimido e consequente desbalanço da homeostase glicêmica. Diversos estudos evidenciam a melhora do DM2 após a confecção da Gastroplastia com derivação intestinal em Y de Roux (GDYR). Os mecanismos de controle da glicemia podem ser de longo e curto prazo. Os mecanismos de ação precoce estão ligados à restrição calorica, melhora da resistência insulínica, da função da célula beta pancreática e retorno do efeito incretínico pelo aumento do GLP1 e GIP, porém os dados são conflitantes. MÉTODOS: Onze pacientes obesos graves diabéticos foram submetidos à GDYR com confecção de gastrostomia no remanescente gástrico após perda de peso inicial de 10%. Os pacientes foram submetidos à coleta de entero-hormônios, perfil glicêmico e Teste de Tolerância Oral à glicose (TTOG) no pré-operatório em curva temporal que foi comparado ao pós-operatório por Via Oral e por Via da Gastrostomia em até 7 dias após o procedimento. RESULTADOS: A média da idade foi 46,09±7,08 anos. No pré-operatorio, o peso médio foi 120,97±17,02 quilogramas, altura 1,67±0,11 metros, IMC médio 44,06±6,59 kg/m2, glicemia de jejum média 194,55±62,45 mg/dl e hemoglobina glicada 8,74±1,64%. Em 77,7% dos pacientes, houve remissão precoce do DM2 no pós-operatório avaliado pelo TTOG. Também foi observada queda significante da glicemia, insulinemia e do HOMA-IR independente da via administrada. Ocorreu aumento significativo do GLP1 e redução do GIP pela Via Oral pós-operatória. A Grelina não apresentou alterações. CONCLUSÃO: Evidenciou-se redução da glicemia e da resistência periférica nos primeiros dias de pós-operatório da GDYR, independente da via de passagem do alimento. A alteração no efeito incretínico (aumento do GLP1 e redução do GIP) só foi observada na Via Oral pós-operatória / INTRODUCTION: Type 2 diabetes mellitus (DM2) is a disease correlated with morbidly obesity. The obese patient has a suppressed incretin effect and consequent inbalance of glycemic homeostasis. Several studies have shown an improvement in DM2 after Gastroplasty with Roux-en-Y gastric bypass (RYGB). The mechanisms of glycemic control may be long-term and shortterm. The mechanisms of early action are linked to caloric restriction, improvement of insulin resistance, pancreatic beta cell function and return of the incretin effect through the increase of GLP1 and GIP, but the data are conflicting. METHODS: Eleven diabetic obese patients underwent RYGB with gastrostomy in gastric remnant after initial 10% weight loss. Patients were submitted to assessment of enterohormones, glycemic profile and Oral Glucose Tolerance Test (OGTT) in the preoperative period in a time curve that was compared to the postoperative period by Oral Via and Gastrostomy Via up to 7 days after the procedure .RESULTS: The mean age of the group was 46.09 ± 7.08 years. In the preoperative the mean weight was 120.97 ± 17.02 kilograms, height of 1.67 ± 0.11 meters, mean BMI of 44.06 ± 6, 59 kg/m2, mean fasting blood glucose of 194.55 ± 62.45 mg/dl and glycated hemoglobin 8.74 ± 1.64%. In 77.7% of the patients there was remission of DM2 in postoperative evaluated by the OGTT. Significant decrease in glycemia, insulinemia and HOMA-IR was also observed, regardless of the route of administration. There was a significant increase in GLP1 and reduction of GIP by the postoperative oral route. Ghrelin did not change. CONCLUSION: A reduction in glycemia and peripheral insulinal resistance was observed in early postoperative days of RYGB, independent of the food route. The change in incretin effect (increase of GLP1 and reduction of GIP) was only observed in the postoperative oral route

INTRODUÇÃO: O diabetes mellitus tipo 2 (DM2) é uma doença correlacionada com a obesidade mórbida. O paciente obeso apresenta efeito incretínico suprimido e consequente desbalanço da homeostase glicêmica. Diversos estudos evidenciam a melhora do DM2 após a confecção da Gastroplastia com derivação intestinal em Y de Roux (GDYR). Os mecanismos de controle da glicemia podem ser de longo e curto prazo. Os mecanismos de ação precoce estão ligados à restrição calorica, melhora da resistência insulínica, da função da célula beta pancreática e retorno do efeito incretínico pelo aumento do GLP1 e GIP, porém os dados são conflitantes. MÉTODOS: Onze pacientes obesos graves diabéticos foram submetidos à GDYR com confecção de gastrostomia no remanescente gástrico após perda de peso inicial de 10%. Os pacientes foram submetidos à coleta de entero-hormônios, perfil glicêmico e Teste de Tolerância Oral à glicose (TTOG) no pré-operatório em curva temporal que foi comparado ao pós-operatório por Via Oral e por Via da Gastrostomia em até 7 dias após o procedimento. RESULTADOS: A média da idade foi 46,09±7,08 anos. No pré-operatorio, o peso médio foi 120,97±17,02 quilogramas, altura 1,67±0,11 metros, IMC médio 44,06±6,59 kg/m2, glicemia de jejum média 194,55±62,45 mg/dl e hemoglobina glicada 8,74±1,64%. Em 77,7% dos pacientes, houve remissão precoce do DM2 no pós-operatório avaliado pelo TTOG. Também foi observada queda significante da glicemia, insulinemia e do HOMA-IR independente da via administrada. Ocorreu aumento significativo do GLP1 e redução do GIP pela Via Oral pós-operatória. A Grelina não apresentou alterações. CONCLUSÃO: Evidenciou-se redução da glicemia e da resistência periférica nos primeiros dias de pós-operatório da GDYR, independente da via de passagem do alimento. A alteração no efeito incretínico (aumento do GLP1 e redução do GIP) só foi observada na Via Oral pós-operatória / INTRODUCTION: Type 2 diabetes mellitus (DM2) is a disease correlated with morbidly obesity. The obese patient has a suppressed incretin effect and consequent inbalance of glycemic homeostasis. Several studies have shown an improvement in DM2 after Gastroplasty with Roux-en-Y gastric bypass (RYGB). The mechanisms of glycemic control may be long-term and shortterm. The mechanisms of early action are linked to caloric restriction, improvement of insulin resistance, pancreatic beta cell function and return of the incretin effect through the increase of GLP1 and GIP, but the data are conflicting. METHODS: Eleven diabetic obese patients underwent RYGB with gastrostomy in gastric remnant after initial 10% weight loss. Patients were submitted to assessment of enterohormones, glycemic profile and Oral Glucose Tolerance Test (OGTT) in the preoperative period in a time curve that was compared to the postoperative period by Oral Via and Gastrostomy Via up to 7 days after the procedure .RESULTS: The mean age of the group was 46.09 ± 7.08 years. In the preoperative the mean weight was 120.97 ± 17.02 kilograms, height of 1.67 ± 0.11 meters, mean BMI of 44.06 ± 6, 59 kg/m2, mean fasting blood glucose of 194.55 ± 62.45 mg/dl and glycated hemoglobin 8.74 ± 1.64%. In 77.7% of the patients there was remission of DM2 in postoperative evaluated by the OGTT. Significant decrease in glycemia, insulinemia and HOMA-IR was also observed, regardless of the route of administration. There was a significant increase in GLP1 and reduction of GIP by the postoperative oral route. Ghrelin did not change. CONCLUSION: A reduction in glycemia and peripheral insulinal resistance was observed in early postoperative days of RYGB, independent of the food route. The change in incretin effect (increase of GLP1 and reduction of GIP) was only observed in the postoperative oral route