RESUMEN
PURPOSE: Bariatric surgery (BS) promotes carotid intima-media thickness (C-IMT) regression as early as 6 months post-surgery. To verify whether C-IMT regression occurs even earlier, we aimed at the effect of Roux-en-Y gastric bypass (RYGBP) and biliopancreatic diversion (BPD) on C-IMT 1-2 months and 12 months post-surgery. SUBJECTS/METHODS: Prospective trial. BS was performed on 109 patients either with (RYGBP = 42; BDP = 40) or without type 2 diabetes (RYGBP = 27). Healthy volunteers served as control group. FOLLOW-UP: baseline, 1-2 months, 12 months post-surgery. ENDPOINTS: changes (∆) in C-IMT, weight, body mass index, fat mass, waist and neck circumferences, blood pressure, HbA1c, glucose, insulin, insulin sensitivity [HOMA-IR; OGIS, from meal tolerance test], lipids, C-reactive protein, leptin, adiponectin, MCP-1. RESULTS: All surgery subgroups had similar levels of ∆-C-IMT. C-IMT in the pooled surgery group reduced from [mean (95% confidence interval)] 0.81 (0.77-0.84) mm to 0.66 (0.63-0.69) mm, p < 0.001 [-17.1 (-20.4 to -13.8)%] at 1-2 months, and to 0.63 (0.59-0.66) mm, p < 0.001 [-21.8 (-25.3 to -18.4)%] at 12 months post-surgery. ∆-C-IMT 1-2 months and 12 months post-surgery correlated to baseline C-IMT, and with ∆-leptin at 1-2 months, but not at 12 months post-surgery. In linear regression analysis, ∆-leptin and baseline C-IMT were predictors of ∆-C-IMT 1-2 months post-surgery. CONCLUSIONS: A remarkable C-IMT regression occurred as early as 1-2 months after BS in obese patients either with or without type 2 diabetes, which was associated to the early reduction in leptin, (at least partially) independent of weight loss. Whether this is a causative or correlative association needs further investigation.
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Cirugía Bariátrica , Grosor Intima-Media Carotídeo , Diabetes Mellitus Tipo 2/cirugía , Leptina/sangre , Obesidad/cirugía , Adulto , Cirugía Bariátrica/rehabilitación , Índice de Masa Corporal , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/patología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Humanos , Resistencia a la Insulina/fisiología , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/complicaciones , Obesidad/fisiopatología , Obesidad Mórbida/sangre , Obesidad Mórbida/complicaciones , Obesidad Mórbida/fisiopatología , Obesidad Mórbida/cirugía , Factores de Tiempo , Túnica Íntima/diagnóstico por imagen , Túnica Íntima/patología , Pérdida de Peso/fisiología , Adulto JovenRESUMEN
Backgrounds/Objectives:The activity of brown/beige adipose tissue (B/BAT) is inversely proportional to body adiposity. Studies have shown that obese subjects submitted to distinct approaches aimed at reducing body mass present an increase of B/BAT activation. However, it is unknown if this beneficial effect of body mass reduction applies to patients with type 2 diabetes mellitus. In this study, we evaluated the impact of massive body mass reduction obtained as a consequence of bariatric surgery in the cold-induced activation of B/BAT in obese non-diabetic (OND) and obese diabetic (OD) subjects. SUBJECTS/METHODS: This is an observational study. Fourteen OND, 14 OD and 11 subjects were included in the study. All obese subjects were submitted to Roux-in-Y gastric bypass and measurements were performed before and 8 months after surgery. B/BAT was evaluated by (18F)-FDG-PET/CT scan and determination of signature transcript expression in specimens obtained in biopsies. RESULTS: Before surgery, mean B/BAT activity and the expression of signature transcripts were similar between OND and OD groups. Eight months after surgery, body mass reduction was similar between the obese groups. Nevertheless, the activity of B/BAT was increased in OND and unchanged in OD subjects. This effect was correlated with a more pronounced improvement of insulin resistance, as evaluated by the hyperinsulinemic, euglycemic clamp, in OND subjects as compared with OD subjects. CONCLUSIONS: Body mass reduction has a more efficient effect to induce the activation of B/BAT in non-diabetic than in diabetic subjects. This effect is accompanied by more pronounced insulin sensitivity and serine 473 phosphorylation of Akt in B/BAT of non-diabetic than in diabetic subjects.
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Tejido Adiposo Beige/fisiología , Tejido Adiposo Pardo/fisiología , Diabetes Mellitus Tipo 2/cirugía , Derivación Gástrica , Resistencia a la Insulina/fisiología , Obesidad Mórbida/cirugía , Pérdida de Peso/fisiología , Adaptación Fisiológica , Adulto , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Fluorodesoxiglucosa F18 , Humanos , Obesidad Mórbida/diagnóstico por imagen , Obesidad Mórbida/metabolismo , Obesidad Mórbida/fisiopatología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND/OBJECTIVES: The identification of brown/beige adipose tissue in adult humans has motivated the search for methods aimed at increasing its thermogenic activity as an approach to treat obesity. In rodents, the brown adipose tissue is under the control of sympathetic signals originating in the hypothalamus. However, the putative connection between the depots of brown/beige adipocytes and the hypothalamus in humans has never been explored. The objective of this study was to evaluate the response of the hypothalamus and brown/beige adipose tissue to cold stimulus in obese subjects undergoing body mass reduction following gastric bypass. SUBJECTS/METHODS: We evaluated twelve obese, non-diabetic subjects undergoing Roux-in-Y gastric bypass and 12 lean controls. Obese subjects were evaluated before and approximately 8 months after gastric bypass. Lean subjects were evaluated only at admission. Subjects were evaluated for hypothalamic activity in response to cold by functional magnetic resonance, whereas brown/beige adipose tissue activity was evaluated using a (F 18) fluorodeoxyglucose positron emisson tomography/computed tomography scan and real-time PCR measurement of signature genes. RESULTS: Body mass reduction resulted in a significant increase in brown/beige adipose tissue activity in response to cold; however, no change in cold-induced hypothalamic activity was observed after body mass reduction. No correlation was found between brown/beige adipose tissue activation and hypothalamus activity in obese subjects or in lean controls. CONCLUSIONS: In humans, the increase in brown/beige adipose tissue activity related to body mass reduction occurs independently of changes in hypothalamic activity as determined by functional magnetic resonance.
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Tejido Adiposo Pardo/metabolismo , Derivación Gástrica , Hipotálamo/patología , Obesidad/metabolismo , Tomografía de Emisión de Positrones , Delgadez/metabolismo , Adaptación Fisiológica , Adulto , Brasil/epidemiología , Frío , Femenino , Fluorodesoxiglucosa F18/administración & dosificación , Regulación de la Expresión Génica , Humanos , Proteínas Mitocondriales/metabolismo , Obesidad/fisiopatología , Obesidad/cirugía , Radiofármacos/administración & dosificación , Reacción en Cadena en Tiempo Real de la Polimerasa , Transducción de Señal , Termogénesis , Delgadez/fisiopatologíaRESUMEN
BACKGROUND: This study aims to assess the clinical and physiological effects of Roux-en-Y gastric bypass (RYGBP) on type 2 diabetes associated with mild obesity (body mass index [BMI] 30-34.9 kg/m(2)) over 24 months postsurgery. METHODS: In this prospective trial, 36 mildly obese subjects (19 males) with type 2 diabetes using oral antidiabetic drugs with (n = 24) or without insulin (n = 12) underwent RYGBP. Follow-up was conducted at baseline and 3, 6, 12, and 24 months postsurgery. The following endpoints were considered: changes in HbA1c, fasting glucose and insulin, antidiabetic therapy, BMI, oral glucose insulin sensitivity [OGIS, from meal tolerance test (MTT)], beta-cell secretory function [ΔCP(0-30)/ΔGlu(0-30) (ΔC-peptide/Δglucose ratio, MTT 0-30 min), disposition index (DI = OGIS [Symbol: see text] ΔCP(0-30)/ΔGlu(0-30)], glucagon-like peptide (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) [incremental area under the curve (AUCi)], adiponectin, C-reactive protein, and lipids. RESULTS: All subjects achieved normal-to-overweight BMI after 3 months. Over 24 months, 31/36 (86 %) subjects presented HbA1c <7 % [complete and partial remission of diabetes in 9/36 (22 %) and 1/36 (3 %), respectively]. Since 3 months postsurgery, improvements were observed in OGIS [290 (174) to 373 (77) ml/min/m(2), P = 0.009], ΔCP(0-30)/ΔGlu(0-30) [0.24 (0.19) to 0.52 (0.34) ng/mg, P = 0.001], DI [7.16 (8.53) to 19.8 (15.4) (ng/mg) (ml/min/m(2)), P = 0.001], GLP-1 AUCi [0.56 (0.64) to 3.97 (3.86) ng/dl [Symbol: see text] 10 min [Symbol: see text] 103, P = 0.000], and GIP AUCi [30.2 (12.6) to 27.0 (20.2) ng/dl [Symbol: see text] 10 min [Symbol: see text] 103, P = 0.004]. At baseline and after 12 months, subjects with diabetes nonremission had longer diabetes duration, higher HbA1c, lower beta-cell secretory function, and higher first 30-min GIP AUCi, compared with those with remission. CONCLUSIONS: RYGBP improves the glucose metabolism in subjects with type 2 diabetes and mild obesity. This effect is associated with improvement of insulin sensitivity, beta-cell secretory function, and incretin secretion.
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Diabetes Mellitus Tipo 2/cirugía , Derivación Gástrica , Obesidad/cirugía , Adulto , Glucemia/metabolismo , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Péptido 1 Similar al Glucagón/metabolismo , Prueba de Tolerancia a la Glucosa , Humanos , Insulina/metabolismo , Resistencia a la Insulina/fisiología , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/metabolismo , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: Autophagy is a highly regulated process that has an important role in the control of a wide range of cellular functions, such as organelle recycling, nutrient availability and tissue differentiation. A recent study has shown an increased autophagic activity in the adipose tissue of obese subjects, and a role for autophagy in obesity-associated insulin resistance was proposed. Body mass reduction is the most efficient approach to tackle insulin resistance in over-weight subjects; however, the impact of weight loss in adipose tissue autophagy is unknown. SUBJECTS: Adipose tissue autophagy was evaluated in mice and humans. RESULTS: First, a mouse model of diet-induced obesity and diabetes was maintained on a 15-day, 40% caloric restriction. At baseline, markers of autophagy were increased in obese mice as compared with lean controls. Upon caloric restriction, autophagy increased in the lean mice, whereas it decreased in the obese mice. The reintroduction of ad libitum feeding was sufficient to rapidly reduce autophagy in the lean mice and increase autophagy in the obese mice. In the second part of the study, autophagy was evaluated in the subcutaneous adipose tissue of nine obese-non-diabetic and six obese-diabetic subjects undergoing bariatric surgery for body mass reduction. Specimens were collected during the surgery and approximately 1 year later. Markers of systemic inflammation, such as tumor necrosis factor-1α, interleukin (IL)-6 and IL-1ß were evaluated. As in the mouse model, human obesity was associated with increased autophagy, and body mass reduction led to an attenuation of autophagy in the adipose tissue. CONCLUSION: Obesity and caloric overfeeding are associated with the defective regulation of autophagy in the adipose tissue. The studies in obese-diabetic subjects undergoing improved metabolic control following calorie restriction suggest that autophagy and inflammation are regulated independently.
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Tejido Adiposo/metabolismo , Autofagia , Diabetes Mellitus Tipo 2/fisiopatología , Inflamación/metabolismo , Obesidad/fisiopatología , Pérdida de Peso , Proteínas Adaptadoras Transductoras de Señales/metabolismo , Tejido Adiposo/inmunología , Adolescente , Adulto , Animales , Proteínas Reguladoras de la Apoptosis/metabolismo , Autofagia/inmunología , Beclina-1 , Índice de Masa Corporal , Restricción Calórica , Citocinas/metabolismo , Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 2/inmunología , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Derivación Gástrica , Humanos , Inflamación/inmunología , Resistencia a la Insulina , Masculino , Proteínas de la Membrana/metabolismo , Ratones , Persona de Mediana Edad , Obesidad/inmunología , Obesidad/metabolismo , Proteína Sequestosoma-1 , Serina-Treonina Quinasas TOR/metabolismo , Factor de Transcripción TFIIH , Factores de Transcripción/metabolismoRESUMEN
CONTEXT: Recent studies have shown that xenin can act in the hypothalamus, reducing food intake through a leptin- and melanocortin system-independent mechanism. OBJECTIVE: To evaluate the impact of body mass reduction on the blood and cerebrospinal fluid (CSF) levels of xenin. DESIGN AND SETTING: Thirteen obese patients (11 women) selected for roux-in-Y gastric bypass surgery were evaluated before and approximately 8 months after surgery. Xenin was determined in serum and CSF by radioimmunoassay. RESULTS: As compared with lean subjects, obese patients have increased blood levels of xenin, which reduce after surgery. There are significant correlations between blood xenin and blood leptin and insulin levels. CSF concentration of xenin is â¼10-fold lower than blood levels, and is significantly higher in obese subjects as compared with lean ones, returning to normal levels after body mass reduction. There is a significant linear correlation between CSF and blood levels of xenin. CONCLUSION: Xenin is present in the human CSF in a concentration â¼10-fold lower than the blood. Both blood and CSF xenin are correlated with blood levels of important markers of adiposity, leptin and insulin. The levels of CSF xenin are linearly correlated with blood xenin, independently of patient body mass, suggesting that either its transport across the blood-brain barrier is not saturated in the concentration range detected in this study or that there is a coordinated release of xenin from the periphery and the CNS.
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Barrera Hematoencefálica/metabolismo , Ayuno/líquido cefalorraquídeo , Derivación Gástrica , Leptina/líquido cefalorraquídeo , Neurotensina/líquido cefalorraquídeo , Obesidad Mórbida/líquido cefalorraquídeo , Adolescente , Adulto , Transporte Biológico , Biomarcadores , Índice de Masa Corporal , Ayuno/sangre , Femenino , Humanos , Leptina/sangre , Masculino , Persona de Mediana Edad , Neurotensina/sangre , Obesidad Mórbida/sangre , Obesidad Mórbida/cirugía , Radioinmunoensayo , Pérdida de PesoRESUMEN
AIMS/HYPOTHESIS: Bariatric surgery is currently employed as an effective approach to treat class III obesity and class II obesity with co-morbidities. Unfortunately, the general anthropometric and metabolic outcomes of the surgery are not homogeneous, and defining the eligibility criteria that allow for a more precise prediction of the outcomes of this invasive procedure will refine the selection of patients. Here we tested the hypothesis that the Gly482Ser polymorphism of the ppargc1a gene would predict different outcomes following bariatric surgery. METHODS: Fifty-five patients (26 Gly/Gly and 29 Gly/Ser+Ser/Ser) selected for the Roux-en-Y gastric bypass according to the National Institutes of Health Consensus Statement criteria were followed up for 1 year, monitoring their anthropometric, metabolic and inflammatory parameters. RESULTS: Patients with the Gly482Ser polymorphism had significantly improved reductions in the waist/hip ratio, fasting blood glucose, C-reactive protein, blood leukocyte count, serum interleukin-6 and intima-media thickness of the carotid artery, as compared with Gly/Gly patients. CONCLUSIONS/INTERPRETATION: Thus, the Gly482Ser polymorphism may predict a more favorable metabolic and inflammatory outcome for obese patients submitted to bariatric surgery, leading to a reduced atherosclerotic risk.
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Enfermedad de la Arteria Coronaria/prevención & control , Derivación Gástrica , Obesidad Mórbida/genética , Obesidad Mórbida/cirugía , Polimorfismo de Nucleótido Simple , Adolescente , Adulto , Brasil/epidemiología , Proteína C-Reactiva/genética , Grosor Intima-Media Carotídeo , Comorbilidad , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/genética , Enfermedad de la Arteria Coronaria/patología , Femenino , Derivación Gástrica/métodos , Glicina , Humanos , Interleucina-6/genética , Masculino , Persona de Mediana Edad , Obesidad Mórbida/epidemiología , Reacción en Cadena de la Polimerasa , Serina , Resultado del Tratamiento , Pérdida de Peso , Adulto JovenRESUMEN
OBJECTIVE: To examine the impact of important weight loss on insulin inhibition of its own secretion during experimentally induced hyperinsulinemia under euglycemic conditions. DESIGN: Longitudinal, clinical intervention study--bariatric surgery (vertical banded gastroplasty--gastric bypass--Capella technique), re-evaluation after 4 and 14 months. SUBJECTS: Nine obese patients class III (BMI=54.6+/-2.6 kg/m2) and nine lean subjects (BMI=22.7+/-0.7 kg/m2). MEASUREMENTS: Euglycemic hyperinsulinemic clamp (insulin infusion: 40 mU/min m2), C-peptide plasma levels, electrical bioimpedance methodology, and oral glucose tolerance test (OGTT). RESULTS: BMI was reduced in the follow-up: 44.5+/-2.2 and 33.9+/-1.5 kg/m2 at 4 and 14 months. Insulin-induced glucose uptake was markedly reduced in obese patients (19.5+/-1.9 micromol/min kg FFM) and improved with weight loss, but in the third study, it was still lower than that observed in controls (35.9+/-4.0 vs 52.9+/-2.2 micromol/min kg FFM). Insulin-induced inhibition of its own secretion was blunted in obese patients (19.9+/-5.7%, relative to fasting values), and completely reversed to values similar to that of lean ones in the second and third studies (-60.8+/-4.2 and -54.0+/-6.1%, respectively). CONCLUSION: Weight loss in severe obesity improved insulin-induced glucose uptake, and completely normalized the insulin inhibition on its own secretion.
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Gastroplastia , Hiperinsulinismo/metabolismo , Insulina/fisiología , Obesidad Mórbida/metabolismo , Adulto , Análisis de Varianza , Glucemia/metabolismo , Péptido C/sangre , Ayuno/sangre , Femenino , Gastroplastia/métodos , Prueba de Tolerancia a la Glucosa , Humanos , Hiperinsulinismo/etiología , Insulina/metabolismo , Secreción de Insulina , Estudios Longitudinales , Masculino , Obesidad Mórbida/cirugía , Pérdida de PesoRESUMEN
OBJECTIVE: To assess the effect of massive weight loss in relation to insulin resistance and its correlation to changes in glycemic homeostasis and lipid profile in severely obese patients. RESEARCH METHODS AND PROCEDURES: A prospective clinical intervention study was carried out with 31 morbidly obese women (body mass index: 54.2 +/- 8.8 kg/m(2)) divided into three groups according to their glucose tolerance test: 14 normal, 8 impaired glucose tolerance, and 9 type 2 diabetes. All subjects underwent an insulin tolerance test with intravenous bolus of 0.1 U insulin/kg body weight before silastic ring vertical gastroplasty Roux-en-Y gastric bypass surgery, and again at 2, 4, 6, and 12 months postoperatively. Fasting plasma glucose, hemoglobin A1c, and lipid profile were also evaluated. RESULTS: A reduction of 68 +/- 15% in initial excess body weight was evident within 1 year. Along with weight loss, the following statistically significant changes were found: an increase in the insulin-sensitivity index (Kitt) and a decrease in fasting plasma glucose and hemoglobin A1c, most notably in the type 2 diabetes group. An overall improvement in lipid profile was observed in all three groups. DISCUSSION: Bariatric surgery was an effective therapeutic approach for these obese patients because it reduced both weight and insulin resistance, along with improving metabolic parameters. Significant correlations were found between insulin resistance and metabolic improvements. Weight loss after bariatric surgery induced an improvement in metabolic fitness, related to the reduction in insulin resistance over a range of glucose tolerance statuses from normal to diabetic.
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Resistencia a la Insulina , Insulina , Obesidad Mórbida/sangre , Obesidad Mórbida/cirugía , Adulto , Glucemia/análisis , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Diabetes Mellitus Tipo 2/sangre , Ayuno , Femenino , Derivación Gástrica , Intolerancia a la Glucosa/sangre , Prueba de Tolerancia a la Glucosa , Hemoglobina Glucada/análisis , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Triglicéridos/sangre , Pérdida de PesoRESUMEN
OBJECTIVE: Insulin inhibition of insulin secretion has been described in normal lean subjects. In this study, we examined whether this phenomenon also occurs in the morbidly obese who often have severe peripheral insulin resistance. SUBJECTS: Twelve obese patients, normotolerant to glucose (8 F/4 M, body mass index (BMI)=54.8+/-2.5 kg/m(2), 39 y) and 16 lean control subjects (10 F/6 M, BMI=22.0+/-0.5 kg/m(2), 31 y). DESIGN AND MEASUREMENTS: An experimental study using various parameters, including an euglycemic hyperinsulinemic clamp (280 pmol/min/m(2) of body surface), an oral glucose tolerance test (OGTT), electrical bioimpedance and indirect calorimetry. RESULTS: The obese subjects were insulin resistant (M=19.8+/-1.6 vs 48.7+/-2.6 micromol/min kg FFM, P<0.0001) and hyperinsulinemic in the fasted state and after glucose ingestion. Fasting plasma C-peptide levels (obese 1425+/-131 pmol/l vs lean 550+/-63 pmol/l; P<0.0001) decreased less during the clamp in the obese groups (-16.9+/-6.9% vs -43.0+/-5.6% relative to fasting values; P=0.007). In the lean group, the C-peptide decrease during the clamp (percentage variation) was related to insulin sensitivity, M/FFM (r=0.56, P=0.03), even after adjustment for the clamp glucose variation. CONCLUSION: We conclude that, in lean subjects, insulin inhibits its own secretion, and this may be related to insulin sensibility. This response is blunted in morbidly obese patients and may have a role in the pathogenesis of fasting hyperinsulinemia in these patients.
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Péptido C/sangre , Hiperinsulinismo/etiología , Resistencia a la Insulina/fisiología , Insulina/sangre , Obesidad Mórbida/sangre , Adulto , Composición Corporal , Índice de Masa Corporal , Calorimetría Indirecta , Estudios de Casos y Controles , Impedancia Eléctrica , Femenino , Técnica de Clampeo de la Glucosa , Prueba de Tolerancia a la Glucosa , Humanos , Hiperinsulinismo/sangre , Masculino , Obesidad Mórbida/fisiopatologíaRESUMEN
BACKGROUND: A longitudinal, clinical intervention study with bariatric surgery was done to investigate the relationship between leptin levels, BMI, and insulin during weight loss across a range of glucose tolerance from normal to diabetes. METHODS: 43 morbidly obese patients (BMI: 42-75 kg/m2) undergoing vertical banded gastroplasty Roux-en-Y gastric bypass (VBG-RGB), were divided into 3 groups: 21 normal (NGT), 12 impaired glucose tolerance (IGT) and 10 type 2 diabetes (DM). Leptin, insulin, glucose, lipids and uric acid were measured at baseline and 2, 4, 6, and 12 months following surgery. RESULTS: BMI fell from 54.1 +/- 9.1 to 34.6 +/- 6.3 kg/m2, similarly in all groups. Leptin decreased from 73.9 +/- 8.7 to 16.9 +/- 10.2 ng/ml and was strongly correlated with BMI during 1-year follow-up (r = 0.78; p < 0.001). Linear univariate analysis for repeated evaluation showed a positive correlation between leptin and glucose, triglycerides, uric acid, and insulin. Multivariate regression analysis indicated that BMI was independently correlated with the decrease in leptin (p < 0.001), accounting for 66% of the variance in leptin levels during weight loss. These results were found in the NGT and IGT groups. In the DM group, a small additional influence in leptin levels was attributed to glucose decrease. CONCLUSIONS: A strong link between leptin and BMI was found after surgery. BMI was the main determinant of the decrease of leptin. In these patients submitted to bariatric surgery, ranging from normal glucose tolerance to diabetes, changes in insulin levels and metabolic parameters, except for glucose in the DM group, did not appear to be correlated with changes in leptin levels.
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Insulina/metabolismo , Leptina/sangre , Obesidad Mórbida/metabolismo , Adulto , Glucemia/metabolismo , Índice de Masa Corporal , Diabetes Mellitus/metabolismo , Femenino , Derivación Gástrica , Intolerancia a la Glucosa/metabolismo , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad Mórbida/sangre , Obesidad Mórbida/cirugía , Análisis de Regresión , Pérdida de Peso/fisiologíaAsunto(s)
Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Carcinoma de Células Escamosas , Neoplasias Esofágicas , Biopsia , Técnicas CitológicasRESUMEN
The authors present the results of a clinical and endoscopic controlled trial of outpatients with duodenal ulcer treated with carbenoxolone (CBX) and carbenoxolone plus antacids (CBX + AA). They observed complete healing of the duodenal ulcer in 77%-83,3% in both groups of patients. They concluded that CBX is important in the treatment of duodenal ulcer been equally effective alone or in association with antacids.
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Antiácidos/uso terapéutico , Carbenoxolona/uso terapéutico , Úlcera Duodenal/tratamiento farmacológico , Ácido Glicirretínico/análogos & derivados , Evaluación de Medicamentos , Quimioterapia Combinada , Úlcera Duodenal/diagnóstico , Endoscopía , Tecnología de Fibra Óptica , Humanos , ComprimidosAsunto(s)
Acalasia del Esófago/cirugía , Adolescente , Adulto , Anciano , Cardias/cirugía , Enfermedad de Chagas/complicaciones , Niño , Acalasia del Esófago/etiología , Esofagoplastia/métodos , Esófago/cirugía , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones PosoperatoriasAsunto(s)
Fístula Esofágica/terapia , Fístula Intestinal/terapia , Fístula Pancreática/terapia , Nutrición Parenteral Total , Nutrición Parenteral , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nutrición Parenteral/efectos adversos , Nutrición Parenteral Total/efectos adversos , Nutrición Parenteral Total/métodosRESUMEN
The authors present the results of a study of the amount of water and potassium in small samples of skeletal muscle and of the intestinal wall of albino rats. Five groups of 10 animals were separated according to the following conditions: peritonitis, pyloric obstruction, intestinal obstruction, mesenteric ischemia and a control group. The results suggest that skeletal muscle is capable of buffering the increased amount of potassium liberated by the tissues which undergo acute trauma, until a critical concentration is reached. Further studies are needed to clarify some of the conflicting results obtained.