Serum Leptin and Adiponectin Concentration in Type 2 Diabetes Patients in the Short and Long Term Following Biliopancreatic Diversion.

A deranged adipokine system is implicated in obesity and in type 2 diabetes mellitus (T2DM), and the lack of remission of T2DM after bariatric surgery could be also accounted for by the postoperative persistence of this condition. METHODS: Thirty T2DM patients undergoing biliopancreatic diversion (BPD) with a wide range of baseline body mass index (BMI) were evaluated prior to and at 1 and 5 years following BPD. Besides the usual clinical evaluations, acute insulin response (AIR) to intravenous glucose load as a parameter of insulin secretion and the serum leptin and adiponectin concentration were measured throughout the follow-up period in all patients. RESULTS: A long-term T2DM remission was observed in 21 patients (70 %). Serum leptin level reduced at the first year and remained substantially unchanged at a long term in both the remitter and non-remitter patients, while following the operation, a progressive significant increase of serum adiponectin level was observed only in remitter patients (from 9.2 to 12.3 \u3bcg/mL at 1 year and to 15.18 \u3bcg/mL at 5 years in the remitters and from 8.8 to 8.75 \u3bcg/mL at 1 year and to 11.8 \u3bcg/mL at 5 years in the non-remitters). Serum leptin mean values were positively associated with the BMI ones both prior to and following BPD (p\u2009<\u20090.005), while serum adiponectin values were positively related (p\u2009<\u20090.04) to the postoperative AIR data. CONCLUSIONS: The improvement of the pattern of cytokine production, as evidenced by postoperative rise in serum adiponectin concentration, might play a role in T2DM remission after bariatric surgery

The Real-Life Use of a Protein-Sparing Modified Fast Diet by Nasogastric Tube (ProMoFasT) in Adults with Obesity: An Open-Label Randomized Controlled Trial

Background: Protein-sparing modified fast (PSMF) diet is a very-low-carbohydrate ketogenic diet administered to patients with obesity, which preserves lean mass and suppresses appetite as well as continuous enteral feeding. Thus, we aim to evaluate the effect of the PSMF diet administered continuously by nasogastric tube (NGT) or orally. Methods: Patients with a body mass index (BMI) &gt; 34.9 kg/m2 were randomly assigned to receive a whey protein PSMF formula through NGT (ProMoFasT) or orally. Data were collected at baseline and after 150 days. The endpoints were assessed in the intention-to-treat population. Results: We enrolled 20 patients in the ProMoFasT group and 24 in the oral group. No differences in body weight, BMI or waist circumference between the two groups were found after 150 days. At follow-up, FFM (%) and MM (%) results were higher in the ProMoFasT group than the oral group (63.1% vs. 52.9%, p = 0.012 and 45.0% vs. 36.1%, p = 0.009, respectively) and FM (kg) and FM (%) were significantly lower in the ProMoFasT group (36.9 kg vs. 44.0 kg, p = 0.033 and 37.4% vs. 44.9%, p = 0.012, respectively). Insulin levels were lower in the ProMoFasT group than the oral group at follow-up (11.8 mU/L vs. 28.0 mU/L, p = 0.001, respectively). Conclusion: The ProMoFasT is more effective in improving body composition and glucometabolic markers than the same diet administered orally

Disordered eating and weight loss after bariatric surgery

PURPOSES: Aberrant eating patterns are frequently observed in bariatric patients. Since bariatric operations produce alterations in food transit and in appetite/satiety balance, postoperative eating behavior changes are not surprising. METHODS: 88 consecutive obese patients undergoing Roux-en-Y gastric bypass (RYGBP, 50 cases) and Sleeve Gastrectomy (SG, 38 cases) were retrospectively evaluated. Beside anthropometric data measurement, eating behavior was assessed by direct interview prior to the operation and at the first and second postoperative years: patients were considered as eating disordered (ED) when referred habitual occurrence of binge eating and nibbling/grazing. Weight loss was assessed by percent of BMI loss (% \u394 BMI). Together with standard follow-up, patients received additional behavioral/dietetic support upon request. RESULTS: Postoperative ED patients showed lower % \u394 BMI than the not ED ones at one (30.7%\u2009\ub1\u20098,5 vs. 26.8%\u2009\ub1\u200910, p\u2009&lt;\u20090.02) and two (32%\u2009\ub1\u200910.3 vs. 27.4%\u2009\ub1\u200912.9, p\u2009&lt;\u20090.05) years after operation, the follow-up rate being 82% and 76%, respectively, without differences between RYGBP and SG group. After RYGBP, an improvement of eating behavior was observed (ED patients from 75 to 28% at 1 year and to 27% at 2 years), while no changes were observed after SG. In SG patients, the number of additional behavioral/dietetic support sessions throughout the follow-up was positively associated with % \u394 BMI. DISCUSSION: The postoperative normalization of eating pattern has a role in weight loss after bariatric surgery. Behavioral/dietetic support is indicated in all SG patient, while after RYGBP is useful only when weight loss is unsatisfactory

Effects of the Postoepartive Dietetic/Behavioral Counseling on the Weight Loss After Bariatric Surgery

OBJECTIVE: Weight outcomes after bariatric surgery are due to an adequate adjustment of eating behavior to the new gastrointestinal conditions created by operation. The efficacy of dietary/behavior counseling for promoting weight loss and maintenance in a growing number of bariatric patients was investigated. MATERIAL AND METHODS: One hundred seventy-six non-diabetic obese patients undergoing Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) were investigated. The first group (CO, 88 subjects, 16 male) attended a standard surgical follow-up, while in the second (DIET, 88 subjects, 15 male) the surgeon was supported by a dietitian, and patients received behavioral-dietary sessions on individual request. Data prior to the operation and at 2 years were considered, the weight outcome being regarded as successful when postoperative body mass index (BMI) value was lower than 30 kg/m2. RESULTS: Weight results were better (p\u2009&lt;\u20090.01) in the RYGBP than in the SG patients. In comparison to CO, in the DIET group a greater adherence to the bariatric program was observed (76% vs. 41%, &lt;\u20090.01), while body weight data and prevalence of successful cases at 2 years (87\u2009\ub1\u200923 vs. 83\u2009\ub1\u200916 kg and 27% vs.33%, respectively) were similar. CONCLUSIONS: After RYSG and SG, postoperative dietetic/behavioral sessions delivered on patient's request does not influence weight results. The dietetic intervention promotes the adherence to bariatric program and prevents postoperative follow-up loss. In a dietitian/behavioral strategy after RYGBP and SG, a cognitive reinforcement of the compliance to bariatric program and a strengthening of the motivation to changes could promote better weight results

The predictive dysphagia score (PreDyScore) in the short- and medium-term post-stroke: a putative tool in PEG indication

PURPOSE: We performed an evaluation of dysphagia in an unselected series of strokes to identify factors causing persisting dysphagia at 1 month after onset and to formulate a predictive score. METHODS: We evaluated the association between dysphagia and clinical aspects (univariate analysis) at the 7th and 30th days after admission. We performed a multivariate logistic regression at the 30th day on the factors that were significant. We computed a simple score for predicting persistent dysphagia. RESULTS: We recruited 249 patients. At the 7th day, 94 patients were dysphagic (37.75%). Factors associated with dysphagia included TACI (OR 3.85), mRS ≥ 3 (OR 4.45), malnutrition (OR 2.69), and BMI ≥ 20 (OR 0.52). At the 30th day, 217 patients remained in the study, and dysphagia persisted in 75 (36.76%). The factors that were associated with dysphagia were age > 74 years (OR 1.99), TACI (OR 5.82), mRS score ≥ 3 (OR 4.31), malnutrition (OR 3.27), and BMI ≥ 20 (OR 0.45). The multivariate analysis indicated that mRS ≥ 3 (OR 1.80) and BMI ≥ 20 (OR 0.45) remained significantly associated with dysphagia. The best correlation with dysphagia was the sum of mRS and the reciprocal of the BMI multiplied by 100 ((mRS + 1 ∕ BMI) × 100). We named this score PreDyScore that ranged between 3.7 and 10.47. Using < 6 and > 8 as cutoffs, the sensitivity was 67.03%, and the specificity 95.65%. CONCLUSION: BMI < 20 and mRS ≥ 3 are easily measurable bedside predictive factors of persistent dysphagia. PreDyScore showed good sensitivity and very good specificity and enables the prediction of persistent dysphagia with great accuracy in any clinical settin

Immunonutrition in major oncologic head and neck surgery: Analysis of complications, plasmatic equilibrium, and costs

BackgroundMalnutrition, in patients with solid tumors, is associated with a worse clinical outcome and about 40% of patients affected by head and neck cancers (HNC) are malnourished at the time of cancer diagnosis. We investigated the potential benefit of a standardized immunonutritional protocol (INP) to patients with HNC receiving major ablative surgery. MethodsAn observational study was conducted enrolling 199 patients: 50 treated with the INP and 149 with standard enteral nutrition. Complication rates, need for medications, and costs were considered as outcomes. ResultsINP played a protective role in development of major surgical complications (OR 0.23, p = 0.023), albumin administration (RR 0.38, p = 0.018), and antibiotic duration (p < 0.001) and is cost-effective in patients with moderate or severe malnutrition (-6083euro and -11 988euro, p < 0.05). ConclusionsOur study supports the utility of INP, and accurate nutritional screening can help to identify malnourished patients who would receive the most benefits from this protocol