Journal Watch—September 2015

| September 1, 2015

A quick look at the noteworthy articles in bariatric and metabolic research

Autologous reconstruction and visceral transplantation for management of patients with gut failure after bariatric surgery: 20 Years of Experience.
Abu-Elmagd KM, Costa G, McMichael D, et al. Ann Surg. 2015;262(4):586–601.
Synopsis: Bariatric surgery (BS) is currently the most effective treatment for severe obesity. However, these weight loss procedures may result in the development of gut failure (GF) with the need for total parenteral nutrition (TPN). This retrospective study is the first to address the anatomic and functional spectrum of BS-associated GF with innovative surgical modalities to restore gut function. Methods: Over two decades, 1,500 adults with GF were referred with history of BS in 142 (9%). Of these, 131 (92%) were evaluated and received multidisciplinary care. GF was due to catastrophic gut loss (Type-I, 42%), technical complications (Type-II, 33%), and dysfunctional syndromes (Type-III, 25%). Primary bariatric procedures were malabsorptive (5%), restrictive (19%), and combined (76%). TPN duration ranged from 2 to 252 months. Results: Restorative surgery was performed in 116 (89%) patients with utilization of visceral transplantation as a rescue therapy in 23 (20%). With a total of 317 surgical procedures, 198 (62%) were autologous reconstructions; 88 (44%) foregut, 100 (51%) midgut, and 10 (5%) hindgut. An interposition alimentary conduit was used in 7 (6%) patients. Reversal of BS was indicated in 84 (72%) and intestinal lengthening was required in 10 (9%). Cumulative patient survival was 96% at 1 year, 84% at 5 years, and 72% at 15 years. Nutritional autonomy was restored in 83% of current survivors with persistence or relapse of obesity in 23%. Conclusions: GF is a rare but serious life-threatening complication after BS. Successful outcome is achievable with comprehensive management, including reconstructive surgery and visceral transplantation.
PMID: 26366538

Multiple factors related to the secretion of glucagon-like peptide-1.
Wang X, Liu H, Chen J, Li Y, Qu S. Int J Endocrinol. 2015;2015:651757.
Synopsis: The glucagon-like peptide-1 is secreted by intestinal L cells in response to nutrient ingestion. It regulates the secretion and sensitivity of insulin while suppressing glucagon secretion and decreasing postprandial glucose levels. It also improves beta-cell proliferation and prevents beta-cell apoptosis induced by cytotoxic agents. Additionally, glucagon-like peptide-1 delays gastric emptying and suppresses appetite. The impaired secretion of glucagon-like peptide-1 has negative influence on diabetes, hyperlipidemia, and insulin resistance related diseases. Thus, glucagon-like peptide-1-based therapies (glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors) are now well accepted in the management of type 2 diabetes. The levels of glucagon-like peptide-1 are influenced by multiple factors including a variety of nutrients. The component of a meal acts as potent stimulants of glucagon-like peptide-1 secretion. The levels of its secretion change with the intake of different nutrients. Some drugs also have influence on GLP-1 secretion. Bariatric surgery may improve metabolism through the action on GLP-1 levels. In recent years, there has been a great interest in developing effective methods to regulate glucagon-like peptide-1 secretion. This review summarizes the literature on glucagon-like peptide-1 and related factors affecting its levels.
PMID: 26366173

Psychometric properties of the Montgomery-Åsberg Depression Rating Scale in severely obese patients.
Paiva-Medeiros PF, Duarte-Guerra LS, Santo MA, Lotufo-Neto F, Wang YP. Span J Psychol. 2015 Sep 14;18:E69.
Synopsis: Obesity is a chronic condition worldwide and has frequent association with major depression. The Montgomery-Åsberg Depression Rating Scale (MADRS) was applied to obese patients in order to detect briefly and systematically depressive symptoms. The objectives were: to estimate the reliability of the MADRS and to investigate the criterion validity of MADRS. The best cut-off point to detect depressive symptoms was determined in comparison with the Structured Clinical Interview for DSM-IV Axis I Diagnosis (SCID-I). The sample was recruited consecutively from the waiting list of a bariatric surgery service of the university clinic. Trained clinical psychologists applied the assessment instruments. The final sample was comprised of 374 class III obese adults (women 79.9%, mean age 43.3 years [SD 11.6], mean body mass index 47.0kg/m2 [SD 7.1]). The mean total score of the MADRS was 7.73 (SD 11.33) for the total sample, with a Cronbach’s alpha coefficient of .93. Women presented higher mean score than men (8.08 versus 6.33; p= .23). The best cut-off point was 13/14 in accordance with the Receiver Operating Characteristics (ROC) curve analysis, yielding a sensitivity of .81 and specificity of .85. The overall ability to discriminate depression according to area under the curve was .87. The results showed that the MADRS is a reliable and valid scale to detect depressive symptoms among patients seeking treatment in preoperative period, displaying adequate psychometric properties.
PMID: 26364907

A program of telementoring in laparoscopic bariatric surgery.
Fuertes-Guiró F, Vitali-Erion E, Rodriguez-Franco A. Minim Invasive Ther Allied Technol. 2015 Sep 11:1-7. [Epub ahead of print]
Synopsis: Background: This study proposes a system for teaching and surgical support with the benefits of online Information and Communications Technology (ITC)-based telementoring for laparoscopic bariatric surgery (LBS). Material and Methods: A system of telementoring was established between a university center and two community hospitals. Telementoring was performed via internet protocol using a direct point-to-point connection, ASDL 1.2 Mbps, time delay 150 ms, 256-bit advanced encryption standard (AES). In the period of time selected, all interventions for LBS in both hospitals were included. When patients agree with telementoring, data outcomes (operating time, hospital stay, conversion to open surgery and complications) were collected. The rest of these interventions were recorded. Results: Thirty-six patients underwent elective LBS, 20 of whom were referred and accepted for telementoring. Patients selected without telementoring took longer: 200 (46) min vs 139 (33) min, p < 0.01. There were two conversions in non-mentored groups. The hospital stay was 4.6 (0.5) days for telementored interventions and 6.7 (0.5) days without mentoring (p<0.01). Four patients (12.5%) in non-mentored groups suffered minor complications. Conclusions: This program supports the safety and feasibility of telementoring in LBS. Telementoring is an alternative in community hospitals because it can improve the quality of advanced procedures of laparoscopic surgery.
PMID: 26360307

Postoperative marijuana use and disordered eating among bariatric surgery patients.
Vidot DC, Prado G, De La Cruz-Munoz N, et al. Surg Obes Relat Dis. 2015 Jun 15. pii: S1550-7289(15)00206-3.
Synopsis: Current literature is scarce in documenting marijuana use after bariatric weight loss surgery (WLS). The objective of this study was to explore the association among marijuana use patterns, disordered eating, and food addiction behaviors in patients 2 years after WLS. The setting was a university hospital in the United States. Participants (N =50, mean age 28 y, standard deviation =5.8) were administered a structured assessment that included the Addiction Severity Index, Yale Food Addiction Scale, Eating Disorder Examination Questionnaire, and Disordered Eating Questionnaire. Marijuana use was defined based on the Addiction Severity Index as current use (within 30 d), recent use (use in last year), and increased use (increased use since surgery). Data were analyzed using Fisher’s exact tests and linear regression methods adjusting for age, gender, race/ethnicity, time since surgery, and change in body mass index.
The majority of the sample was female (76%) and underwent Roux-en-Y gastric bypass (62%). Eighteen percent (18%) of the sample reported current marijuana use; 38% reported recent use; and 21.4% reported increased use post-WLS. A loss of controlled food intake was associated with current (P= .02) and increased post-WLS use (P= .01). Increased use and/or regular marijuana use predicted higher scores on eating disorder subscales compared with respective counterparts (P<.05). Current use did not significantly predict higher scores on the Yale Food Addiction Scale. Findings indicated marijuana use in post-WLS patients despite recommendations against use. A subgroup of WLS patients may be at risk for disordered eating post-WLS, particularly those who used marijuana before surgery, and should be closely monitored for several years post-WLS.
PMID: 26363714

The early origins of obesity and insulin resistance: timing, programming and mechanisms.
Nicholas LM, Morrison JL, Rattanatray L, et al. Int J Obes (Lond). 2015 Sep 14. [Epub ahead of print]
Synopsis: Maternal obesity is associated with an increased risk of developing gestational diabetes mellitus (GDM) and it also results in an increased risk of giving birth to a large baby with increased fat mass. Furthermore, it is also contributes to an increased risk of obesity and insulin resistance in the offspring in childhood, adolescence and adult life. It has been proposed that exposure to maternal obesity may therefore result in an ‘intergenerational cycle of obesity and insulin resistance. There is significant interest in whether exposure to maternal obesity around the time of conception alone contributes directly to poor metabolic outcomes in the offspring and whether dieting in the obese mother before pregnancy or around the time of conception has metabolic benefits for the offspring. This review focusses on experimental and clinical studies that have investigated the specific impact of exposure to maternal obesity during the periconceptional period alone or extending beyond conception on adipogenesis, lipogenesis and on insulin signalling pathways in the fat, liver and muscle of the offspring. Findings from these studies highlight the need for a better evidence base for the development of dietary interventions in obese women before pregnancy and around the time of conception to maximize the metabolic benefits and minimize the metabolic costs for the next generation.
PMID: 26367335

Daily exposure to sucrose impairs subsequent learning about food cues: a role for alterations in ghrelin signalling and dopamine D2 receptors.
Sharpe MJ, Clemens KJ, Morris MJ, Westbrook RF. Neuropsychopharmacology. 2015 Sep 14. [Epub ahead of print]
Synopsis: The prevalence of hedonic foods and associated advertising slogans has contributed to the rise of the obesity epidemic in the modern world. Research has shown that intake of these foods disrupt dopaminergic systems. It may be that a disruption of these circuits produces aberrant learning about food-cue relationships. We found that rodents given 28 days of intermittent access to sucrose exhibited a deficit in the ability to block learning about a stimulus when it is paired in compound with food and another stimulus that has already been established as predictive of the food outcome. This deficit was characterised by an approach to a cue signalling food delivery that is usually blocked by prior learning, an effect dependent on dopaminergic prediction-error signalling in the midbrain. Administering the D2 agonist quinpirole during learning restored blocking in animals with a prior history of sucrose exposure. Further, repeated central infusions of ghrelin produced a deficit in blocking in the same manner as sucrose exposure. We argue that changes in dopaminergic systems resulting from sucrose exposure are mediated by a disruption of ghrelin signalling as rodents come to anticipate delivery of the highly palatable sucrose outside of normal feeding schedules. This suggestion is supported by our finding that both sucrose and ghrelin treatments resulted in increases in amphetamine-induced locomotor responding. Thus, for the first time we have provided evidence of a potential link between alterations in D2 receptors caused by the intake of hedonic foods and aberrant learning about cue-food relationships capable of promoting inappropriate feeding habits. Additionally, we have found preliminary evidence to suggest that this is mediated by changes in ghrelin signalling, a finding that should stimulate further research into modulation of ghrelin activity to treat obesity.
PMID: 26365954

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Category: Journal Watch, Past Articles

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