Muscle strength and body composition in severe obesity

OBJECTIVE: The aim of our study was to evaluate associations between maximum voluntary contraction torques of the lower limbs and body composition for subjects with severe obesity. METHODS: Body composition was evaluated by bioelectrical impedance analysis, and maximum voluntary contraction torques of the lower limbs were measured using an isokinetic dynamometer. One hundred thirty-two patients were enrolled (100 females and 32 males). Eighty-seven patients had a body mass index between 40 and 49.9 kg/m2 (the A group), and 45 patients had a body mass index between 50 and 59.9 kg/m2 (the B group). RESULTS: Absolute extension and flexion torques had weak associations with fat-free mass but a moderate association with absolute extension torque and fat-free mass of the lower limbs. There were no significant differences between the A and B groups with respect to absolute extension and flexion torques. For the A group, absolute extension and flexion torques were moderately associated with fat-free mass and with fat-free mass of the lower limbs. For the B group, there were only moderate associations between absolute extension and flexion torques with fat-free mass of the lower limbs. CONCLUSIONS: Our findings demonstrate that both groups exhibited similar absolute torque values. There were weak to moderate associations between absolute extension and flexion torques and fat-free mass but a moderate association with fat-free mass of the lower limbs. Individuals with severe obesity should strive for greater absolute torques, fat-free mass and especially fat-free mass of the lower limbs to prevent functional limitations and physical incapacity

Metabolic effects of an entero-omentectomy in mildly obese type 2 diabetes mellitus patients after three years

BACKGROUND: Various digestive tract procedures effectively improve metabolic syndrome, especially the control of type 2 diabetes mellitus. Very good metabolic results have been shown with vertical gastrectomy and entero-omentectomy; however, the metabolic effects of an isolated entero-omentectomy have not been previously studied. METHODS: Nine patients with type 2 diabetes mellitus and a body mass index ranging from 29 to 34.8 kg/m² underwent an entero-omentectomy procedure that consisted of an enterectomy of the middle jejunum and exeresis of the major part of the omentum performed through a mini-laparotomy. Glucagon-like peptide-1 and peptide YY were measured preoperatively and three months following the operation. Fasting and postprandial variations in glycemia, insulinemia, triglyceridemia, hemoglobin A1c, and body mass index were determined in the preoperative period and 3, 18 and, 36 months after the operation. RESULTS: All patients significantly improved the control of their type 2 diabetes mellitus. Postprandial secretion of peptide YY and Glucagon-like peptide-1 were enhanced, whereas hemoglobin A1c, fasting and postprandial glucose, insulin, and triglyceride levels were significantly reduced. Mean body mass index was reduced from 31.1 to 27.3 kg/m². No major surgical or nutritional complications occurred. CONCLUSIONS: Entero-omentectomy is easy and safe to perform. A simple reduction in jejunal extension and visceral fat causes important improvements in the metabolic profile

Postoperative evolution of insulin sensitivity in diabetic patients: leeve gastrectomy vs Roux-en-Y gastric bypass

The purpose of this study was to compare postoperative evolution of insulin sensibility in diabetic patients after the two most relevant bariatric surgeries nowadays, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). A retrospective cohort study was conducted with type 2 diabetic patients, who underwent RYGB or SG from 2013 to 2018. The laboratory and anthropometric data was analyzed pre-surgery and during a 2-year follow-up. The tool chosen for this comparison was the HOMA2 nonlinear equations, calculated from fasting glycemia and blood insulin. The two surgical procedures were compared. There was significant difference between both evolutions in the first 6-months follow-up (p=0.029), but no difference was presented at the 1-year (p=0.053) or at the 2-year follow-up (p>0.05). Therefore, there was no long-term difference between surgeries, which fuels discussions about their mechanisms of action and their relevance in the treatment of insulin resistance

Changes in the intestinal microbiota of superobese patients after bariatric surgery

OBJECTIVES: The gut microbiota is associated with obesity and weight loss after bariatric surgery and has been related to its changing pattern. Exactly how the bacterial population affects weight loss and the results of surgery remain controversial. This study aimed to evaluate the intestinal microbiota of superobese patients before and after gastric bypass surgery (RYGB). METHOD: DNA fragments for the microbiota obtained from stool samples collected from nine superobese patients before and after bariatric surgery were sequenced using Ion Torrent. RESULTS: We observed that with a mean follow-up of 15 months, patients achieved 55.9% excess weight loss (EWL). A significant population reduction in the Proteobacteria phylum (11 to 2%, p=0.0025) was observed after surgery, while no difference was seen in Firmicutes and Bacteroidetes. Further analyses performed with two specific individuals with divergent clinical outcomes showed a change in the pattern between them, with a significant increase in Firmicutes and a decrease in Bacteroidetes in the patient with less weight loss (%EWL 50.79 vs. 61.85). CONCLUSIONS: RYGB affects the microbiota of superobese patients, with a significant reduction in Proteobacteria in patients with different weight loss, showing that different bacteria may contribute to the process

Efeitos da Redução da Gordura Epicárdica na Duração da Onda P de Obesos Mórbidos Submetidos à Cirurgia Bariátrica

Introdução: A gordura epicárdica (GE) é biologicamente ativa e, por meio de seu efeito parácrino, interage com o miocárdio atrial e pode estar envolvida no remodelamento atrial observado em obesos. A duração da onda P (DOP) é um marcador não invasivo do tempo de condução atrial e reflete alterações relacionadas ao remodelamento atrial. Os efeitos da redução da GE induzida pela cirurgia bariátrica sobre a DOP ainda não foram definidos. Métodos: Recrutamos prospectivamente 22 obesos mórbidos sem outras comorbidades na Unidade de Cirurgia Bariátrica do Hospital das Clínicas da Universidade de São Paulo. Os pacientes foram submetidos a avaliações clínica e laboratorial, além de eletrocardiograma (ECG) de 12 derivações, ecocardiograma bidimensional e Holter de 24 h. A mesma avaliação foi realizada 12 meses após a cirurgia bariátrica. A fim de que as variáveis contínuas fossem comparadas, foram utilizados os testes T pareado e de Wilcoxon. Já para avaliar a associação entre variáveis independentes foi utilizado um modelo de regressão para medidas repetidas. Resultados: Ao todo, 20 pacientes completaram o protocolo (idade: 36,35 ± 10,26 anos, 18 mulheres). Houve uma redução significativa da DOP, do índice de massa corporal (IMC) e da GE após cirurgia bariátrica (p<0,05). Houve também redução média de 11,55 ± 8,49 ms na DOP. Na análise de regressão múltipla, foi observada associação entre a redução da DOP e a redução da GE e do IMC. Conclusões: Em obesos mórbidos sem outras comorbidades, a redução da GE após cirurgia bariátrica foi associada a melhora do remodelamento atrial, indicada por uma redução significativa da DOP

Constraints of Weight Loss as a Marker of Bariatric Surgery Success: An Exploratory Study

PurposeThe aim of this exploratory study was to investigate whether the degree of weight loss properly reflects improvements in cardiometabolic health among patients who underwent Roux-en-Y gastric bypass.MethodsIn this ancillary analysis from a clinical trial, patients were clustered into tertiles according to the magnitude of the percentage weight loss (1st tertile: “higher weight loss”: −37.1 ± 5.8%; 2nd tertile: “moderate weight loss”: −29.7 ± 1.4%; 3rd tertile: “lower weight loss”: −24.2 ± 2.3%). Delta changes (9 months after surgery-baseline) in clustered cardiometabolic risk (i.e., blood pressure index, fasting glucose, high-density lipoprotein [HDL] and triglycerides [TG]), glycated hemoglobin (HbA1c), homeostasis model assessment (HOMA-IR), and C-reactive protein (CRP) were calculated.ResultsA total of 42 patients who had complete bodyweight data (age = 40 ± 8 year; BMI = 47.8 ± 7.1 kg/m2) were included. Surgery led to substantial weight loss (−37.9 ± 11.3 kg, P &lt; 0,001), and clinically significant improvements in blood pressure index (−17.7 ± 8.2 mmHg, P &lt; 0.001), fasting glucose (−36.6 ± 52.5 mg/dL, P &lt; 0.001), HDL (9.4 ± 7.1 mg/dL, P &lt; 0.001), TG (−35.8 ± 44.1 mg/dL P &lt; 0,001), HbA1c (−1.2 ± 1.6%, P &lt; 0.001), HOMA-IR (−4.7 ± 3.9 mg/dL, P &lt; 0.001) and CRP (−8.5 ± 6.7 μg/mL P &lt; 0.001). Comparisons across tertiles revealed no differences for cardiometabolic risk score, fasting glucose, HbAc1, HOMA-IR, blood pressure index, CRP, HDL, and TG (P &gt; 0.05 for all). Individual variable analysis confirmed cardiometabolic improvements across the spectrum on weight-loss. There were no associations between weight loss and any dependent variable.ConclusionWeight loss following bariatric surgery does not correlate with improvements in cardiovascular risk factors. These findings suggest that weight loss alone may be insufficient to assess the cardiometabolic success of bariatric surgery, and the search for alternate proxies that better predict surgery success are needed

Inter-relação entre o perfil dos lábios superiores e a posição da maxila e dos incisivos superiores em pacientes adultos

Introduction: Professional evaluations and lay person evaluations as well do not show a clear relationship between hard tissue and soft tissue profiles in orthodontic patients. However, there are concrete evidences that the orthodontist can change the facial profile of the patients. aim: This research project aimed to measure the contribution of the bone structure of the maxilla and the upper incisors inclination to the upper lip profile. Methods: A sample of 147 adult patients, 58 male and 89 female, aged from 15 to 49 years, the most of them Caucasians, was retrospectively selected from the private practice of one of the authors. It was assumed that the esthetic facial profile depends of the hard tissues that support it besides its own features as thickness, strength and composition. The present research model was not set to control the intrinsic features of the soft tissue. To compose the Ricketts and Burstone esthetic lines, the main cephalometric variables were SNA and U1PP, when concomitantly considered. Results: The regression coefficients, although statistically significant, did not contributed expressively to explain the regard variables, the pre-defined esthetic lines. Furthermore, the results suggested a negative correlation between the maxillary position (SNA) and the anteroposterior inclination of the upper incisors (U1PP), possibly due to the compensatory action of the lips and the tongue. Conclusion: The results did not presented conclusive scientific evidences about the contribution of the hard tissues for the soft tissue facial profiles