No description available.

At the 2nd Diabetes Surgical Summit in 2015, the world’s leading researchers and professionals in the field of diabetes, surgery, and public health gathered to develop new surgical treatment guidelines for diabetes. This summit led to the recommendation of bariatric surgery as an official treatment for type II diabetes, outlining that the surgery be considered for diabetic patients with a Body Mass Index (BMI) of 30, a much lower threshold BMI than that of typical bariatric surgery patients. Despite incontrovertible evidence that bariatric surgery can reverse the progression of diabetes and even cause remission, the physiological mechanisms chiefly responsible for these effects remain controversial. Peer-reviewed published literature was collected to examine the evidence for mechanisms responsible for metabolic improvements following bariatric surgery, especially Roux-en-Y gastric bypass. This review considered the effects of calorie restriction, appetite modulators, incretins, intestinal adaptations, adipose tissue, gut microbiota, bile acid circulation and composition, and psychosocial and behavioral changes on surgery-induced metabolic improvements and sustained type II diabetes remission. Clinical considerations, such as the surgical risks and improved indicators for bariatric surgery were also explored to contextualize the physiological mechanisms under study. The “hind gut hypothesis” emerged as an important overarching mechanism potentially responsible for many of the observed improvements. The more rapid delivery of food to the distal intestine, as well as the delayed mixing of pancreatic, gastric and bile secretions with food, likely contributes to increased nutrient-stimulation of enteroendocrine cells and greater binding of bile acids with their receptors, farnesoid X receptor and TGR5. These changes in food and secretion delivery also appear to positively affect the gut microbiota to support a non-obese microbiota profile. Calorie restriction may be responsible for the early effects of bariatric surgery, including not just a reduction in fat mass but also epigenetic changes to induce β-cell proliferation and increased insulin secretion. However, long-term benefits of bariatric surgery appear to be more closely correlated to enteroendocrine changes, including the surgery-induced changes to levels of appetite modulators that, unlike pure calorie restriction, promote feelings of satiation and reduce rates of diet failure and weight regain. Fat distribution and adipocyte function are also important contributors to both the pathophysiology of obesity-related diabetes and improvements following bariatric surgery. While reductions in BMI and subcutaneous adipose tissue area were not correlated to diabetes remission, reductions in visceral adipose tissue area and enhanced adiponectin secretions were both independent factors associated with diabetes remission. The important role of adipocytes as endocrine organs has emerged as an important field of inquiry. Adipokines, adipocyte hormones, may either promote a pro-inflammatory profile or an anti-inflammatory profile, impacting the development of obesity-related diabetes or diabetes remission, respectively. The findings of this review support the 2nd Diabetes Surgical Summit’s recommendations of proactive bariatric surgery as a treatment for diabetes. The risks of complications and mortality following bariatric surgery are low, whereas the long-term survival after bariatric surgery is improved relative to non-surgical, matched controls. Single-nucleotide polymorphisms associated with obesity and diabetes may serve as early indicators for surgery, and inform both surgical method and follow-up protocols. Despite the benefits of bariatric surgery, only a small number of eligible candidates undergo treatment. In the United States, barriers such as physician and patient perceptions and cost may limit access to surgery. In places that experience a health workforce shortage, there may be no health care professionals or facilities available to perform bariatric surgery. Therefore, while the surgery amazingly causes diabetes remission, one of its greatest benefits may be to continue to inform the mechanisms responsible for metabolic improvements toward developing new pharmacological treatments. In the future, less invasive drug treatments that seek to replicate the effects of bariatric surgery may be more successful in tackling the global obesity and diabetes crisis.

No description available.

Προσχεδιασμένη συγκριτική διπλή τυφλή μελέτη της αποτελεσματικότητας της επιμήκους γαστρεκτομής (LSG) και της μερικής γαστρικής παράκαμψης Roux-en-Y (LRYGB) σε ασθενείς με κλινικά σοβαρή παχυσαρκία (BMI 35-49,9) Η λαπαροσκοπική γαστρική παράκαμψη (LRYGB) αποτελεί στις μέρες μας το χρυσό κανόνα για τη χειρουργική αντιμετώπιση της κλινικά σοβαρής παχυσαρκίας. Η λαπαροσκοπική επιμήκης γαστρεκτομή (LSG) είναι μία σχετικώς νέα επέμβαση περιοριστικού τύπου η οποία τελευταία έχει αρχίσει να εφαρμόζεται ως μοναδική επέμβαση για την κλινικά σοβαρή παχυσαρκία. Η παρούσα προοπτική διπλή τυφλή μελέτη έχει σκοπό να διερευνήσει την ασφάλεια των παραπάνω επεμβάσεων καθώς και την αποτελεσματικότητα τους σε χρονικό ορίζοντα τριών χρόνων. Μέθοδος: Εξήντα ασθενείς με δείκτη σωματικής μάζας <50 Kg/m2 μετά από τυχαιοποίηση υπεβλήθησαν τριάντα σε LSG και τριάντα σε LRYGB. Οι ασθενείς παρακολουθήθηκαν μετεγχειρητικά για τρία χρόνια. Στο διάστημα αυτό καταγράφηκε η απώλεια βάρους, η πρώιμη και όψιμη νοσηρότητα και θνητότητα, η ίαση των συνοδών της παχυσαρκίας νόσων και η ανάπτυξη μικροθρεπτικών ανεπαρκειών μετά τους δύο τύπους χειρουργείων. Αποτελέσματα: Η θνητότητα ήταν μηδενική και στους δύο τύπους επεμβάσεων. Δεν καταγράφηκε σημαντική διαφορά στην πρώιμη (10% μετά από LRYGBP και 13.3% μετά από LSG, P>0.05) και όψιμη νοσηρότητα (10% σε κάθε ομάδα) μετά και τους δύο τύπους χειρουργείων. Η απώλεια βάρους ήταν στατιστικώς μεγαλύτερη μετά από LSG καθόλη τη διάρκεια της μελέτης. Τον τρίτο μετεγχειρητικό χρόνο η επί τις εκατό απώλεια του υπερβάλλοντος βάρους κυμαίνονταν στο 62.09% μετά από LRYGBP και στο 68.46% μετά από LSG (p=0.02). Δεν παρατηρήθηκε σημαντική διαφορά ως προς την ίαση των συνοδών της παχυσαρκίας νόσων, εκτός από τη δυσλιπιδαιμία η οποία βελτιώθηκε σε σημαντικότερο βαθμό μετά από LRYGB και την υπέρταση η οποία βελτιώθηκε σε σημαντικότερο βαθμό μετά από LSG. Ανεπάρκεια μικροθρεπτικών συστατικών παρατηρήθηκε σε ανάλογο βαθμό μετά τις δύο επεμβάσεις εκτός από την έλλειψη βιταμίνης Β12 η οποία παρατηρήθηκε σε μεγαλύτερο βαθμό μετά από LRYGB (P<0.001). Συμπεράσματα: Και οι δύο επεμβάσεις είναι ασφαλείς και αποτελεσματικές ως προς την απώλεια βάρους και την ίαση των συνοδών της παχυσαρκίας νόσων. Η LSG συνοδεύεται από λιγότερες μεταβολικές ανεπάρκειες και δεν απαιτεί τη χορήγηση συμπληρωμάτων εφ’ όρου ζωής. Η LSG φαίνεται ότι είναι μία υποσχόμενη επέμβαση για την κλινικά σοβαρή παχυσαρκία η οποία στα τρία χρόνια μετεγχειρητικής παρακολούθησης επιτυγχάνει μεγαλύτερη απώλεια βάρους από την LRYGB. / The efficacy of sleeve gastrectomy (LSG) and Roux en Y gastric bypass (LRYGB) in patients with morbid obesity (BMI 35-49,9). A comparative double-blind randomized trial Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently the gold standard bariatric procedure for the treatment of morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is an innovative restrictive procedure which has been increasingly applied as a sole bariatric procedure. A randomized trial was conducted to evaluate perioperative safety (30-day) and 3-years results. Methods: Sixty patients with body mass index (BMI) ≤ 50 Kg/m2 were randomized to LRYGB or LSG. Patients were monitored for 3 years after operation and throughout the study period weight loss, early and late complications, improvement of obesity related comorbidities and nutritional deficiencies were compared between studied groups. Results: There was no death in either group and no significant difference in early (10% after LRYGBP and 13.3% after LSG, P>0.05) and late morbidity (10% in each group). Weight loss was significantly better after LSG throughout the study period. At 3 years %EWL reached 62.09% after LRYGBP and 68.46% after LSG (p=0.02). There was no significant difference in the overall improvement of comorbidities but dyslipidemia improved more after LRYGB, whereas hypertension resolved more after LSG. Nutritional deficiencies occurred at same rate in the two groups except to vitamin B12 deficiency which was more common after LRYGB (P<0.001). Conclusion: In conclusion, LSG and LRYGBP are equally safe and effective in the amelioration of comorbidities, while LSG is associated with fewer postoperative metabolic deficiencies, without the need of supplementation. Furthermore, LSG is a promising bariatric procedure, since it seems to be superior to LRYGB at 3 years follow up on weight reduction.

Bakgrund: Fetma är ett allvarligt folkhälsoproblem då fetma ökar risken att drabbas av följdsjukdomar, samt att patienter med fetma visat sig ha lägre genomsnittlig hälsorelaterad livskvalitet (HRQoL) jämfört med befolkningen i allmänhet. Syfte: med denna litteraturöversikt var att beskriva hälsorelaterad livskvalitet bland personer som genomgått fetmakirurgi. Metod: Litteraturöversikt baserad på 8 kvantitativa interventionsstudier med uppföljningar mellan 9 månader - 10 år efter genomförd behandling. Litteratursökning skedde i databaserna PubMed och Cinahl. Analys av studierna skedde genom att studierna sammanställdes baserat på redovisning av frågeformulär SF-36 för index fysisk och mental hälsa och dess åtta dimensioner. Resultat: Samtliga studier indikerar att den fysiska hälsan i genomsnitt ökar efter fetmakirurgi. Samtliga utom en studie indikerar att hälsoindex för mental hälsa i genomsnitt ökar efter fetmakirurgi. Studier som sträcker sig över flera uppföljningsperioder visar att den initiala ökningen av hälsoindex minskar med tiden och effekten är som högst 1–2 år efter fetmakirurgi. Konklusion: Resultaten pekar på att fetmakirurgi initialt leder till en förbättring av fysisk och mental HRQoL med en tydlig topp efter 1–2 år. Studier med högt deltagande och uppföljning över tid är för få för att dra slutsatser kring effekten av fetmakirurgi på HRQoL på längre sikt. Utbildning av vårdpersonal och uppföljningsprogram kan bidra till ökat uppföljningsdeltagande, och minska risken för bortfall till följd av brister i vårdpersonalens bemötande. / Background: Obesity is a serious public health problem as it increases the risk of secondary diseases. Patients with obesity have been shown to have lower average health-related quality of life (HRQoL) compared to the general population. Aim: of this literature review was to describe health-related quality of life among people who have undergone bariatric surgery. Methods: Literature review of eight quantitative intervention studies with follow-ups between 9 months to 10 years. Literature search took place in the databases PuBMed and Cinahl. Analysis of the studies was done by summarizing the studies based on the reported result of the SF-36 questionnaire for physical and mental health and its eight dimensions. Results: All studies indicate that physical health increases on average after bariatric surgery. All but one study indicate that the mental health index increases, on average, after bariatric surgery. Studies that extend over several follow-up periods show that the initial increase in mental health decreases over time and the effect is highest 1–2 years after bariatric surgery. Conclusion: The results indicate that bariatric surgery initially leads to an improvement in physical and mental HRQoL with a clear peak after 1–2 years. Studies with high participation and follow-up over time are too few to draw conclusions about the effect of bariatric surgery on HRQoL in the longer term. Training of healthcare professionals and follow-up programs can contribute to increased follow-up participation, and reduce the risk of non-response.

O presente estudo avaliou o efeito do exercício aeróbio em mulheres obesas, pós gastroplastia Bypass Y de Roux. Dentre os objetivos específicos, comparou o percentual de gordura por dobras cutâneas, antes e após o programa de treinamento e o peso corporal em Kg pré e pós intervenção. A amostra foi composta por 11 mulheres com média de 31,45 anos (± 8,27) e a altura de 1,63 metros (± 0,03), durante 12 semanas, realizaram 60 minutos de exercício físico aeróbio (caminhada/corrida), 5 vezes na semana, com FC controlada. A média da prescrição da FCM foi entre 142,18 bpm (± 2,63) e 157,90 bpm (± 3,41), correspondendo a 55 e 70% da FCM. Antes do início e após o término do programa de treinamento, foi avaliado o método duplamente indireto de composição corporal. Dentre as medidas antropométricas foram coletadas a estatura; o peso; as circunferências e as dobras cutâneas. A análise dos dados foi realizada pelo programa estatístico SPSS versão 16.0. Os resultados da estatística descritiva foram expressos como média e desvio padrão (± dp) e, em todas as análises, foi adotado como nível de significância p<0,05. A adesão ao programa de exercício físico aeróbio durante 12 semanas foi um procedimento eficaz e significante para a redução do peso corporal, para o IMC, as circunferências de cintura e quadril, o RCQ e para o percentual de gordura corporal. Foi possível obter um efeito significativo na composição corporal, apesar de não se ter controlado outros tratamentos convencionais, tais como hábitos nutricionais, medicamentosos e terapias comportamentais / This study has evaluated the effect that aerobic exercise has in obese women after the gastric bypass Y de Roux Amongst the specific objectives, it compared the fat percentage by skinfold thickness before and after the training program and the body weight in kilograms before and after intervention The sample was built of 11 women of 31,45 years old (± 8,27) on average and heights of 1,63 (± 0,03) on average on a 12 Week period they performed 60 minutes of aerobic exercise (walking, running) 5 times a week with heart rate controlled. The average of the FCM prescription was between 142,18 bpm (± 2,63) and 157,90 bpm (± 3,41) equivalent to 55 and 70% of FCM Before the beginning and after the end of the training program they assessed the double indirect method of body composition. Amongs the anthropometric measures they collected data as tallness, weight, circumference, and skinfolds. The data analysis was accomplished by the statistics program SSPS version 16.0 The results from the descriptive statistics were expressed as average and standard deviation (± SD) and for all the analysis the significance level used was p<0,05 he adhesion to the aerobic exercise program. The adhesion on a 12-week period was an efficient and significant procedure to body weight loss to the IMC to waist and hip circumference the RCQ and to the percentage of body fat It was possible to obtain a significant effect on the body composition, despite not having checked other conventional treatments such as nutritional habits, drugs and behavioral therapies

BACKGROUND: Bariatric surgery is an effective weight loss treatment modality for people with morbid obesity, however, there may be a negative impact on postoperative bone health. This review summarizes changes of different bone mineral density dual-energy x-ray absorptiometry measurements, with specific attention to the laparoscopic sleeve gastrectomy and the roux-en-y gastric bypass. METHODS: PubMed and the Cochrane Library searches yielded 156 articles published before November 2017. The articles were evaluated based on the following inclusion criteria: focus on laparoscopic sleeve gastrectomy or roux-en-y gastric bypass and bone health, written in English, full-length article, studied participants for one-to-two years, and included statistical measurements. RESULTS: Of the 156 studies that were initially screened, 16 full-length articles were included in the final analysis. The articles described a lower loss of bone density at the lumbar spine, femoral neck, forearm, and total hip after laparoscopic sleeve gastrectomy when compared to roux-en-y gastric bypass, however, these studies lack statistical power due to the small sample sizes of less than 10 participants. CONCLUSION: The number of bariatric surgeries continues to increase worldwide, however, the literature provides limited studies that evaluate the effects of bariatric surgery on bone health, more than two-years postoperative. Further study is necessary to determine the mechanisms of bone loss after bariatric surgery, with great attention to differences in bone health between sexes.

Background: Roux-en-y gastric bypass (RYGB) surgery produces significant weight loss, however a number of patients experience some and/or complete recidivism of weight years after surgery. Limited research has investigated why patients are experiencing weight regain after surgical interventions. Our objective was to identify appetite-related measures associated with weight regain after RYGB surgery. Methods: Using a cross-sectional design, 29 participants (49.6 ± 9.1 years of age; 29-62 months post-RYGB) were divided into three weight categories; (weight maintainers, n = 9; low weight regainers, n = 10; and high weight regainers, n = 10). Appetite, smell function, eating behaviours and food reward were measured in response to a standardized meal. Results: Weight regain increased significantly in association with time after surgery (rs = 0.768, p = 0.016). High regainers gained on average 8.6 kg/year, compared to low regainers and maintainers, 3.8 ± 0.9 kg/year and 0.9 ± 0.9 kg/year, respectively (p < 0.001). Dietary restraint (using the Three Factor Eating Questionnaire) was significantly higher in weight maintainers and low regainers compared to high regainers using clinical subscales (p < 0.05). Weight regain was associated with higher “liking” of high-fat sweet foods (measured with the Leeds Food Preference Questionnaire) among high weight regainers. Conclusion: Weight regain after RYGB may be associated with higher preferences for high-fat sweet foods, whereas, higher dietary restraint may be associated with lower wanting of high-fat sweet foods among weight maintainers. Findings provide insight into why some patients after RYGB regain weight, while others maintain their weight. Future research is needed to further explore the relationships between appetite-related factors and weight regain after RYGB employing a longitudinal study design.

O presente estudo avaliou o efeito do exercício aeróbio em mulheres obesas, pós gastroplastia Bypass Y de Roux. Dentre os objetivos específicos, comparou o percentual de gordura por dobras cutâneas, antes e após o programa de treinamento e o peso corporal em Kg pré e pós intervenção. A amostra foi composta por 11 mulheres com média de 31,45 anos (± 8,27) e a altura de 1,63 metros (± 0,03), durante 12 semanas, realizaram 60 minutos de exercício físico aeróbio (caminhada/corrida), 5 vezes na semana, com FC controlada. A média da prescrição da FCM foi entre 142,18 bpm (± 2,63) e 157,90 bpm (± 3,41), correspondendo a 55 e 70% da FCM. Antes do início e após o término do programa de treinamento, foi avaliado o método duplamente indireto de composição corporal. Dentre as medidas antropométricas foram coletadas a estatura; o peso; as circunferências e as dobras cutâneas. A análise dos dados foi realizada pelo programa estatístico SPSS versão 16.0. Os resultados da estatística descritiva foram expressos como média e desvio padrão (± dp) e, em todas as análises, foi adotado como nível de significância p<0,05. A adesão ao programa de exercício físico aeróbio durante 12 semanas foi um procedimento eficaz e significante para a redução do peso corporal, para o IMC, as circunferências de cintura e quadril, o RCQ e para o percentual de gordura corporal. Foi possível obter um efeito significativo na composição corporal, apesar de não se ter controlado outros tratamentos convencionais, tais como hábitos nutricionais, medicamentosos e terapias comportamentais / This study has evaluated the effect that aerobic exercise has in obese women after the gastric bypass Y de Roux Amongst the specific objectives, it compared the fat percentage by skinfold thickness before and after the training program and the body weight in kilograms before and after intervention The sample was built of 11 women of 31,45 years old (± 8,27) on average and heights of 1,63 (± 0,03) on average on a 12 Week period they performed 60 minutes of aerobic exercise (walking, running) 5 times a week with heart rate controlled. The average of the FCM prescription was between 142,18 bpm (± 2,63) and 157,90 bpm (± 3,41) equivalent to 55 and 70% of FCM Before the beginning and after the end of the training program they assessed the double indirect method of body composition. Amongs the anthropometric measures they collected data as tallness, weight, circumference, and skinfolds. The data analysis was accomplished by the statistics program SSPS version 16.0 The results from the descriptive statistics were expressed as average and standard deviation (± SD) and for all the analysis the significance level used was p<0,05 he adhesion to the aerobic exercise program. The adhesion on a 12-week period was an efficient and significant procedure to body weight loss to the IMC to waist and hip circumference the RCQ and to the percentage of body fat It was possible to obtain a significant effect on the body composition, despite not having checked other conventional treatments such as nutritional habits, drugs and behavioral therapies

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13140号 / 論医博第2140号 / 新制||医||1026(附属図書館) / (主査)教授 小西 靖彦, 教授 羽賀 博典, 教授 万代 昌紀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM