Preoperative Predictive Factors of Successful Weight Loss and Glycaemic Control 1 Year After Gastric Bypass for Morbid Obesity

BACKGROUND: Gastric bypass (GBP) is one of the most effective surgical procedures to treat morbid obesity and the related comorbidities. This study aimed at identifying preoperative predictors of successful weight loss and type 2 diabetes mellitus (T2DM) remission 1 year after GBP. METHODS: Prospective longitudinal study of 771 patients who underwent GBP was performed at four Italian centres between November 2011 and May 2013 with 1-year follow-up. Preoperative anthropometric, metabolic and social parameters, the surgical technique and the previous failed bariatric procedures were analyzed. Weight, the body mass index (BMI), the percentage of excess weight lost (% EWL), the percentage of excess BMI lost (% BMIL) and glycated haemoglobin (HbA1c) were recorded at follow-up. RESULTS: Univariate and multivariate analysis showed that BMI <50 kg/m2 (p\u2009=\u20090.006) and dyslipidaemia (p\u2009=\u20090.05) were predictive factors of successful weight loss. Multivariate analysis of surgical technique showed significant weight loss in patients with a small gastric pouch (p\u2009<\u20090.001); the lengths of alimentary and biliary loops showed no statistical significance. All diabetic patients had a significant reduction of HbA1c (p\u2009<\u20090.001) after surgery. BMI\u2009 65\u200950 kg/m2 (p\u2009=\u20090.02) and low level of preoperative HbA1c (p\u2009<\u20090.01) were independent risk factors of T2DM remission after surgery. CONCLUSIONS: This study provides a useful tool for making more accurate predictions of best results in terms of weight loss and metabolic improvement

Colorectal cancer after bariatric surgery (Cric-Abs 2020): Sicob (Italian society of obesity surgery) endorsed national survey

Background The published colorectal cancer (CRC) outcomes after bariatric surgery (BS) are conflicting, with some anecdotal studies reporting increased risks. The present nationwide survey CRIC-ABS 2020 (Colo-Rectal Cancer Incidence-After Bariatric Surgery-2020), endorsed by the Italian Society of Obesity Surgery (SICOB), aims to report its incidence in Italy after BS, comparing the two commonest laparoscopic procedures-Sleeve Gastrectomy (SG) and Roux-en-Y gastric bypass (GBP). Methods Two online questionnaires-first having 11 questions on SG/GBP frequency with a follow-up of 5-10 years, and the second containing 15 questions on CRC incidence and management, were administered to 53 referral bariatric, high volume centers. A standardized incidence ratio (SIR-a ratio of the observed number of cases to the expected number) with 95% confidence intervals (CI) was calculated along with CRC incidence risk computation for baseline characteristics. Results Data for 20,571 patients from 34 (63%) centers between 2010 and 2015 were collected, of which 14,431 had SG (70%) and 6140 GBP (30%). 22 patients (0.10%, mean age = 53 +/- 12 years, 13 males), SG: 12 and GBP: 10, developed CRC after 4.3 +/- 2.3 years. Overall incidence was higher among males for both groups (SG: 0.15% vs 0.05%; GBP: 0.35% vs 0.09%) and the GBP cohort having slightly older patients. The right colon was most affected (n = 13) and SIR categorized/sex had fewer values &lt; 1, except for GBP males (SIR = 1.07). Conclusion Low CRC incidence after BS at 10 years (0.10%), and no difference between procedures was seen, suggesting that BS does not trigger the neoplasm development

Natureza admirada, natureza devastada: História e Historiografia da colonização de Santa Catarina Nature admired, nature devastated: History and Historiography of the colonization of Santa Catarina

De um modo geral, a história da "imigraçãopor -colonização" no século XIX, objeto histórico presente na historiografia brasileira e nas histórias regionais, é predominantemente narrada de acordo com as coordenadas ideológicas hegemônicas da sociedade moderna: civilização, progresso, evolução e trabalho. Dentro deste quadro conceitual, a natureza é vista e representada como um mero recurso natural que deve ser "naturalmente" explorado e manipulado pela sociedade humana. Este artigo aborda a história e o conhecimento histórico sobre a experiência da colonização em Santa Catarina, principalmente em relação às principais colônias fundadas na segunda metade do século XIX. Problematiza-se a relação culturapor -natureza instituída no processo colonizador e a concepção de natureza contida no conhecimento histórico da colonização; observam-se fontes documentais (Relatórios da Província, Relatórios das Colônias) e historiográficas na perspectiva da História Ambiental; e procura-se demonstrar que o modo de ver e explicar a "evolução histórica" da colonização estimula e legitima a destruição e a domesticação do mundo natural tanto quanto dos povos indígenas, em particular a Mata Atlântica e os índios Xokleng.<br>Generally speaking, the 19th century history of "immigration-colonization", object of the Brazilian historiography and the local historical studies, is mainly narrated from the perspective of the modern society ideological, hegemonic coordinates: civilization, progress, evolution, and work. From this conceptual viewpoint, nature is represented as a mere natural resource that must be exploited and handled by the human society. This paper deals with history and the historical knowledge about the colonization process in Santa Catarina state, mainly in relation to the first colonies settled in the second half of the 19th century. It questions the relationship between culture and nature instituted in the colonization process and the concept of nature present in the historical accounts of the colonies; documental and historiographic sources are observed (Province Reports and Colonies Reports) from the perspective of environmental history. The paper also demonstrates that as the historical evolution of the colonization is traditionally seen and explained it stimulates and legitimates the destruction and domestication of the natural world as well as the native people, particularly the Atlantic Forest and the Xokleng people

Microbiome as mediator of diet on colorectal cancer risk: The role of Vitamin D, markers of inflammation and adipokines

Obesity and diet are associated with colorectal cancer (CRC) risk, and microbiome could mediate this risk factor. To investigate this interaction, we performed a case-control study (34 CRC cases and 32 controls) and analyzed fecal microbiota composition using 16S rRNA metabarcoding and sub-sequential shotgun analyses of genomic bacterial DNA to evaluate the role of microbiome and diet in CRC etiology, taking into account vitamin D and other risk biomarkers. Dietary habits were evaluated using a short questionnaire. Multivariate methods for data integration and mediation analysis models were used to investigate causal relationships. CRC cases were significantly more often deficient in vitamin D than controls (p = 0.04); FokI and CYP24A1 polymorphism frequency were different between cases and controls (p = 0.03 and p = 0.02, respectively). A diet poor in fatty fish and rich in carbohydrates was found to be significantly associated with CRC risk (p = 0.011). The mediation analysis confirmed the significant role of the microbiome in mediating CRC risk-increasing levels of Bifidobacteria/Escherichia genera ratio, an indicator of “healthy” intestinal microbiome, can overcome the effect of diet on CRC risk (p = 0.03). This study suggests that microbiome mediates the diet effect on CRC risk, and that vitamin D, markers of inflammation, and adipokines are other factors to consider in order to achieve a better knowledge of the whole carcinogenic process.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Outcome of laparoscopic gastric bypass in obese and diabetic patients: when surgery fails.

BACKGROUND: The beneficial effects of bariatric surgery on diabetes and obesity have been widely demonstrated in literature. The aim of our study was to evaluate the rate of failure of laparoscopic gastric bypass both in terms of weight loss and metabolic remission after one follow-up year. METHODS: A longitudinal, multicentric prospective study was carried out on 771 patients affected by pathological obesity. The following parameters were recorded for each patient before surgery: anthropometric, metabolic, social, smoking habits and previous failure of other bariatric procedures. After 1 follow-up year, final weight, final BMI, final percentage of lost excess body weight and percentage of lost BMI were evaluated. RESULTS: Statistical analysis showed a correlation between BMI > 50 Kg/m2 , presence of metabolic syndrome, presence of diabetes, gastric pouch volume greater than 60 ml and failure of weight loss outcome. Statistical analysis of metabolic failure has recognized a high preoperative HbA1c % value as a statistically significant negative predictive factor. CONCLUSIONS: Bariatric Surgery is the most effective treatment for weight loss and metabolic improvement. However, in our study, surgery did not achieve the expected outcome in patients with specific metabolic, anthropometric and surgical characteristics (BMI > 50 Kg/m2, presence of metabolic syndrome, presence of T2DM with high preoperative HbA1c % level and gastric pouch volume greater than 60 ml

SICOB-endorsed national Delphi consensus on obesity treatment optimization: focus on diagnosis, pre-operative management, and weight regain/insufficient weight loss approach

PurposeOverweight and obesity affects 60% of adults causing more than 1.2 million deaths across world every year. Fight against involved different specialist figures and multiple are the approved weapons. Aim of the present survey endorsed by the Italian Society of Bariatric Surgery (SICOB) is to reach a national consensus on obesity treatment optimization through a Delphi process.MethodsEleven key opinion leaders (KOLs) identified 22 statements with a major need of clarification and debate. The explored pathways were: (1) Management of patient candidate to bariatric/metabolic surgery (BMS); (2) Management of patient not eligible for BMS; (3) Management of patient with short-term (2 years) weight regain (WR) or insufficient weight loss (IWL); (4) Management of the patient with medium-term (5 years) WR; and (5) Association between drugs and BMS as WR prevention. The questionnaire was distributed to 65 national experts via an online platform with anonymized results.Results54 out of 65 invited panelists (83%) respond. Positive consensus was reached for 18/22 statements (82%); while, negative consensus (s20.4; s21.5) and no consensus (s11.5, s17) were reached for 2 statements, respectively (9%).ConclusionThe Delphi results underline the importance of first-line interdisciplinary management, with large pre-treatment examination, and establish a common opinion on how to properly manage post-operative IWL/WR