Lifestyle changes followed by bariatric surgery lower inflammatory markers and the cardiovascular risk factors C3 and C4. Improved memory function two years after bariatric surgery. The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. The effects of supervised exercise training 12–24 months after bariatric surgery on physical function and body composition: a randomised controlled trial Inhibition of C-Reactive Protein in Morbidly Obese Patients After Laparoscopic Sleeve Gastrectomy Evaluation of Current Eligibility Criteria for Bariatric Surgery Determinants associated with the correction of glomerular hyper-filtration one year after bariatric surgery. Change in Predicted 10-Year Cardiovascular Risk Following Laparoscopic Roux-en-Y Gastric Bypass Surgery Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis. Preoperative lifestyle intervention in bariatric surgery: a randomized clinical trial. The Effect of Antioxidant Vitamin Supplementation on Traditional Cardiovascular Risk Factors Impact of C-reactive protein and fibrinogen on cardiovascular prognosis in patients with stable angina pectoris: the AtheroGene study.
BACKGROUND Morbidly obese patients are at risk of developing insulin resistance and cardiovascular disease . Low- grade systemic inflammation is an important factor for this development . We evaluated the effect of bariatric surgery on markers of inflammation , coagulation and glucose metabolism . METHODS Ninety-seven morbidly obese patients and 17 lean subjects ( control group ) participated .  Anthropometric measurements  as well as  fasting blood sample s  were obtained at first admission , prior to surgery , and 1 year after surgery . RESULTS At admission , the morbidly obese group had significantly elevated levels of the complement components C3 and C4 compared to the lean control group ( P<0.0001 ) . Levels of C3 and C4 dropped significantly in the morbidly obese group over time ( P<0.0001 ) , and , 1 year after the operation , levels were comparable to those of the control group . The same changes were seen for markers of inflammation ( high-sensitivity C-reactive protein , tumor necrosis factor-α , interferon-γ , interleukin-1 receptor antagonist , IL-6 , and IL-13 ) , coagulation ( fibrinogen and plasminogen activator inhibitor-1 ) , and glucose metabolism ( leptin and insulin ) . There was a positive correlation between changes in C3 and body mass index , weight , coagulation parameters , inflammatory parameters , and leptin , respectively . CONCLUSIONS Bariatric surgery in morbidly obese patients  reduced weight effectively . Even more importantly , the increased levels of several risk factors associated with diabetes and cardiovascular co-morbidity normalized 1 year after surgery OBJECTIVE Obesity is as an independent risk factor for poor neurocognitive outcomes , including Alzheimer 's disease .  Bariatric surgery has recently been shown to result in improved memory at 12-weeks postoperatively . However , the long-term effects of bariatric surgery on cognitive function remain unclear . DESIGN AND METHODS Eighty-six individuals ( 63 bariatric surgery patients , 23 obese controls ) were recruited from a prospect i ve study examining the neurocognitive effects of bariatric surgery .  All participants completed  self-report measurements and a computerized cognitive test battery  prior to surgery and at 12-week and 24-month follow-up ; obese controls completed measures at equivalent time points . RESULTS Bariatric surgery patients exhibited high rates of pre-operative cognitive impairments in attention , executive function , memory , and language . Relative to obese controls , repeated measures ANOVA showed improvements in memory from baseline to 12-weeks and 24-months postoperatively ( P < 0.05 ) . Regression analyses controlling for baseline factors revealed that a lower BMI at 24-months demonstrated a trend toward significance for improved memory ( β = -.30 , P = 0.075 ) . CONCLUSION These findings suggest that cognitive benefits of bariatric surgery may extend to 24-months postoperatively . Larger prospect i ve studies with extended follow-up periods are needed to eluci date whether bariatric surgery decreases risk for cognitive decline and possibly the development of dementia AIMS To evaluate the effect of weight loss after bariatric surgery ( BS )  on peripheral adipocytokines , renal parameters and other cardiovascular risk factors ( CVRFs ) . METHODS A total of 70 ( 41 women ) extremely obese adults were prospect ively studied before and 12 months after surgery . CONTROLS 24 ( 15 women ) normal-weight adults .  Anthropometric , biochemical and renal parameters were recorded . RESULTS Presurgery , adiponectin ( ADPN ) was lower , whereas leptin , insulin resistance , C-reactive protein , creatinine clearance and albuminuria were higher in patients than controls ( P<0.001 ) . All parameters improved postsurgery . Changes in ADPN correlated negatively with leptin , insulin resistance , albumin , C-reactive protein , and creatinine clearance . Multiple regression analysis : using changes in ADPN as the dependent variable , only changes in insulin resistance ( P=0.005 ) and albumin ( P=0.019 ) were significant independent determinants for changes in ADPN . No statistical differences were found in relation to the degree of obesity . CONCLUSION Patients changed to obesity type I after surgery . This implies a substantial improvement of CVRFs including ADPN , creatinine clearance and albuminuria . Changes in plasma ADPN correlated negatively with insulin resistance and with albuminemia but not with renal parameters . The lack of differences between different degrees of obesity suggests that the relationship between weight and CVRFs no longer exists when obesity becomes very extreme Background : Bariatric surgery is effective for the treatment of stage II and III obesity and its related diseases , although increasing evidence is showing weight regain ~12–24 months postsurgery . Weight regain increases the risk of physical function decline , which negatively affects an individual 's ability to undertake activities of daily living . The study assessed the effects of a 12-week supervised exercise intervention on physical function and body composition in patients between 12 and 24 months post bariatric surgery . Methods : Twenty-four inactive adult bariatric surgery patients whose body mass index remained ⩾30 kg m2 12 to 24 months post surgery were r and omised to an exercise intervention ( n=12 ) or control group ( n=12 ) . Supervised exercise consisted of three 60-min gym sessions per week of moderate intensity aerobic and resistance training for 12 weeks . Control participants received usual care .  The incremental shuttle walk test ( ISWT ) was used to assess functional walking performance after the 12-week exercise intervention , and at 24 weeks follow-up . Measures of anthropometric , physical activity , cardiovascular and psychological outcomes were also examined . Using an intention-to-treat protocol , independent t-tests were used to compare outcome measures between groups . Results : Significant improvements in the exercise group were observed for the ISWT , body composition , physical function , cardiovascular and self-efficacy measures from baseline to 12 weeks . A large baseline to 12-week change was observed for the ISWT ( exercise : 325.00±117.28 m ; control : 355.00±80.62 m , P<0.001 ) . The exercise group at 24 weeks recorded an overall mean improvement of 143.3±86.6 m and the control group recorded a reduction of −32.50±75.93 m. Findings show a 5.6 kg difference between groups in body mass change from baseline to 24 weeks favouring the exercise group . Conclusions : A 12-week supervised exercise intervention led to significant improvements in body mass and functional walking ability post intervention , with further improvements at the 24-week follow-up Background Obesity is considered a low- grade chronic inflammatory condition as reflected by increased C-reactive protein ( CRP ) levels . Inflammation is emerging as a predictor of cardiovascular disease and it may be a precursor of the metabolic syndrome . Bariatric surgery is commonly performed as a treatment for morbid obesity offering significant reductions in premature myocardial infa rct ion . Laparoscopic sleeve gastrectomy ( LSG ) is a relatively new bariatric procedure that is currently used as a definitive procedure for weight loss . The aim of this study is to assess the impact of sleeve gastrectomy on CRP levels . Methods This study is part of an ongoing , prospect i ve , cohort study to evaluate LSG impact on iron indices . CRP levels were compared preoperatively and 6 months after surgery . Similarly , demographics including body mass index and excess weight were also compared at these same study points . Data were analyzed using Student paired t test and Pearson product moment correlation analysis . Results Twenty-nine morbidly obese patients were included . There was significant decrease in body mass index ( BMI ) between the preoperative and 6-month period ( 50.9 ± 13.2 and 35.1 ± 6.85 , respectively ; P < 0.001 ) . Also CRP levels were statistically significantly lower at 6 months after surgery ( preoperative 12.3 ± 7.53 mg/L and postoperative 5.6 ± 4.2 mg/L. P < 0.0001 ) . The significant weight loss as reflected by change in BMI was correlated with the difference between preoperative and postoperative CRP levels . Conclusions Massive weight loss in morbidly obese patients induced by LSG causes a significant decrease in CRP levels , which could reduce the risk of cardiovascular diseases in these patients OBJECTIVE Patients with a BMI < 35 kg/m2 and patients with a BMI between 35 and 40 kg/m2 without comorbidities are noneligible by current eligibility criteria for bariatric surgery .  We used Swedish obese subjects ( SOS ) to explore long-term outcomes in noneligible versus eligible patients . RESEARCH DESIGN AND METHODS The SOS study involved 2,010 obese patients who underwent bariatric surgery ( 68 % vertical-b and ed gastroplasty , 19 % b and ing , and 13 % gastric bypass ) and 2,037 contemporaneously matched obese controls receiving usual care .  At inclusion , the participant age was 37–60 years and BMI was ≥34 kg/m2 in men and ≥38 kg/m2 in women . The effect of surgery was assessed in patients that do ( n = 3,814 ) and do not ( n = 233 ) meet current eligibility criteria . The date of analysis was 1 January 2012 . The follow-up time was up to 20 years , with a median of 10 years . RESULTS Cardiovascular risk factors were significantly improved both in noneligible and eligible individuals after 10 years of follow-up . Surgery reduced the diabetes incidence in both the noneligible ( adjusted hazard ratio 0.33 [ 95 % CI 0.13–0.82 ] , P = 0.017 ) and eligible ( 0.27 [ 0.22–0.33 ] , P < 0.001 ) groups . We could not detect a difference in the effect of surgery between the groups ( adjusted interaction P value = 0.713 ) . CONCLUSIONS Bariatric surgery drastically reduced the incidence of type 2 diabetes both in noneligible and eligible patients and improved cardiovascular risk factors in both groups . Our results show that strict BMI cutoffs are of limited use for bariatric surgery prioritization if the aim is to prevent diabetes and improve cardiovascular risk factors BACKGROUND Increased adipokine production and hyperfiltration may explain the links between obesity and chronic kidney disease . Indeed , hyperfiltration may precede a subsequent accelerated decline of kidney function in these patients . Glomerular filtration rate decreases after bariatric surgery in young obese patients with hyperfiltration . OBJECTIVE Our aim was to identify the factors associated with this decrease 1 year after bariatric surgery . SETTING We used data from a prospect i ve cohort of severely obese patients who underwent bariatric surgery in Nice University Hospital . METHODS We analyzed 175 patients before and 1 year after bariatric surgery .  Low- grade inflammation was evaluated by serum C-reactive protein levels . Lean body mass and fat body mass were estimated by bioelectric impedance analysis . Body surface area was assessed by the Du Bois formula . Serum creatinine levels were used to estimate glomerular filtration rate by the chronic kidney disease-epidemiology collaboration ( CKD-EPI ) equation . Glomerular filtration rate was de-adjusted from st and ard body surface area and then divided by lean body mass to calculate the decrease in hyperfiltration and to separate the patients into 2 groups : above or below the median decrease of hyperfiltration after bariatric surgery . RESULTS The factors associated with a large correction of hyperfiltration were baseline C-reactive protein levels ( 10.0 ± 5.8 mg/L versus 12.7 ± 7.4 mg/L , P = .01 ) and brachial circumference ( 41 ± 4 cm versus 44 ± 5 cm , P = .006 ) . A high fat mass reduction rate was significantly associated with a substantial hyperfiltration reduction after bariatric surgery ( P<.001 ) independently of sex and surgical procedure . CONCLUSIONS The correction of hyperfiltration is associated with a high reduction rate of fat mass after bariatric surgery but may be limited by low- grade inflammation Background Bariatric surgery is being conducted more often for morbid obesity , but little evidence exists about how it affects the risk of future cardiovascular events . The goal of this study was to quantify the change in predicted 10-year cardiovascular risk following  laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) .  Methods We conducted a prospect i ve clinical study of morbidly obese adults undergoing LRYGBP at a university hospital in the USA . Our primary outcome measure was mean change in 10-year cardiovascular risk at 12 months . We estimated cardiovascular risk by using the Framingham risk equation , which calculates the absolute risk of cardiovascular events for patients with no known history of heart disease , stroke , or peripheral vascular disease by using information on age , sex , blood pressure , total and high-density lipoprotein cholesterol levels , smoking status , and history of diabetes . Results Ninety-two participants underwent LRYGBP between December 2004 and October 2005 . Their predicted baseline 10-year cardiovascular risk was 6.7 % . At 6 and 12 months , their predicted risk had decreased to 5.2 % and 5.4 % , respectively . Assuming no change in risk among untreated patients , this represents an absolute risk reduction of 1.3 % ; which suggests that 77 morbidly obese patients would have to undergo LRYGBP  to avert one new case of cardiovascular disease over the ensuing 10 years ( number needed to treat = 77 ) . Conclusion Our findings indicate that LRYGBP is associated with improvements in cardiovascular risk factors and a corresponding decrease in predicted 10-year risk of cardiovascular disease BACKGROUND The risk of cardiovascular disease is reduced by bariatric surgery , but it is unknown if exercise after bariatric surgery reduces this risk even further . OBJECTIVE To investigate if Roux-en-Y-gastric bypass ( RYGB ) and supervised physical training after RYGB improve cardiovascular disease risk markers within coagulation activation , fibrin clot properties , and fibrinolysis . SETTING Bariatric center , Hospital of Southwest Jutl and , Denmark . METHODS Sixty obese patients underwent RYGB and 6 months after RYGB were r and omized to 26 weeks of physical training or  a control group .  Biomarkers within coagulation activation , fibrin clot properties , and fibrinolysis were measured presurgery , and 6 , 12 , and 24 months postsurgery . RESULTS Six months after RYGB , the endogenous thrombin potential decreased from 1744 ( 1603 - 2003 ) to 1416 ( 1276 - 1582 ) nM × min ( P<.001 ) . Alterations in fibrin clot properties result ed in an increased clot lysis from 23.8 % ( 16.1%-38.9 % ) to 40.3 % ( 28.5%-59.35 ; P<.0001 ) . Furthermore , fibrinogen was reduced from 12.6 ( 11.1 - 14.7 ) to 11.5 ( 9.90 - 13.3 ) µM ( P<.001 ) , and plasminogen activator inhibitor antigen was reduced from 40.5 ( 28.4 - 49.4 ) to 24.4 ( 15.4 - 32.7 ) ng/mL ( P<.0001 ) . Physical training after RYGB increased fibrinolytic activity from 58.0 ( 36.0 - 75.5 ) to 88.0 ( 66.0 - 132.0 ) IU/mL compared with 52.5 ( 30.0 - 80.0 ) to 64.0 ( 49.0 - 100.0 ) IU/mL in controls ( P<.01 ) and reduced plasminogen activator inhibitor antigen from 23.5 ( 16.7 - 35.4 ) to 18.1 ( 14.3 - 25.4 ) ng/mL compared with 24.4 ( 13.9 - 28.7 ) to 24.2 ( 14.1 - 29.6 ) ng/mL in controls ( P<.05 ) . No effects of physical training were observed on markers of coagulation activation and fibrin clot properties . CONCLUSION We observed favorable long-term reductions in markers of thrombin generation , improved fibrin clot properties , and increases in fibrinolysis after RYGB . Supervised physical training after RYGB further increased fibrinolysis BACKGROUND Studies on the impact of presurgery weight loss and lifestyle preparation on outcomes following bariatric surgery are needed . OBJECTIVE To evaluate whether a presurgery behavioral lifestyle intervention improves weight loss through a 24-month postsurgery period . SETTING Bariatric Center of Excellence at a large , urban medical center . METHODS C and i date s for bariatric surgery were r and omized to a 6-month behavioral lifestyle intervention or to 6 months of usual presurgical care . The lifestyle intervention consisted of 8 weekly face-to-face sessions , followed by 16 weeks of face-to-face and telephone sessions before surgery ; the intervention also included 3 monthly telephone contacts after surgery . Assessment s were conducted 6 , 12 , and 24 months after surgery . RESULTS Participants who underwent surgery ( n = 143 ) were 90.2 % female and 86.7 % White . Average age was 44.9 years , and average body mass index was 47.5 kg/m(2 ) at study enrollment . At follow-up , 131 ( 91.6 % ) , 126 ( 88.1 % ) , 117 ( 81.8 % ) patients participated in the 6- , 12- , and 24-month assessment s , respectively . Percent weight loss from study enrollment to 6 and 12 months after surgery was comparable for both groups , but at 24 months after surgery , the lifestyle group had significantly smaller percent weight loss compared with the usual care group ( 26.5 % versus 29.5 % , respectively , P = .02 ) . CONCLUSIONS Presurgery lifestyle intervention did not improve weight loss at 24 months after surgery . The findings from this study raise questions about the utility and timing of adjunctive lifestyle interventions for bariatric surgery patients Background Evidence from observational epidemiologic studies has indicated that antioxidants consumed through the diet or as dietary supplements lower the risk of developing atherosclerotic cardiovascular disease . Evidence suggesting that the major mechanism for the protective effect of antioxidants is mediated through decreased oxidation of lipids , particularly low-density lipoprotein ( LDL ) cholesterol is accumulating . Other evidence , however , suggests that antioxidants may influence traditional modifiable cardiovascular risk factors such as the blood pressure and serum lipids favorably . The purpose of this study was to determine the effect of antioxidant vitamin supplementation on modifiable risk factors for atherosclerotic cardiovascular disease . Design A r and omized , placebo-controlled , clinical trial of antioxidant vitamin supplementation , conducted at a single community-based clinical research center . Methods We assigned 297 retired teachers who were members of the Maryl and Retired Teachers Association r and omly to 2 - 4 months of dietary supplementation with placebo or combined antioxidant vitamin capsules providing 400 IU/day vitamin E , 500 mg/day vitamin C , and 6 mg/day β-carotene . The outcome measures were the blood pressure , fasting serum total cholesterol , high-density lipoprotein cholesterol , LDL cholesterol , and fasting glucose . Results After 2 - 4 months of supplementation the combined antioxidant supplement had had no significant effect on the systolic and diastolic blood pressures , fasting serum lipids ( total cholesterol , high-density lipoprotein cholesterol , and LDL cholesterol ) and fasting glucose , with unadjusted and adjusted analyses . Conclusion Data from this trial suggest that the protective effect from antioxidant vitamin supplementation , if there is one , likely results from mechanisms other than modification of traditionally modifiable cardiovascular risk factors AIMS C-reactive protein and fibrinogen have been extensively studied and shown to be predictive for a first cardiovascular event in healthy individuals . We evaluated the potential clinical use of C-reactive protein and fibrinogen in patients already suffering from coronary artery disease ( CAD ) . METHODS AND RESULTS In a sub study of the prospect i ve AtheroGene registry , we assessed in 1806 patients with documented CAD and stable angina pectoris , the risk of cardiovascular death and non-fatal myocardial infa rct ion ( n=183 ) over a median follow-up of 3.5 ( maximum 7.7 ) years according to baseline levels of C-reactive protein and fibrinogen . C-reactive protein and fibrinogen were associated with future cardiovascular events , such as an increment in one st and ard deviation of C-reactive protein is associated with a 1.15-fold ( 95 % CI 1.05 - 1.27 , P=0.002 ) increase , an increment of one st and ard deviation of fibrinogen with a 1.27-fold ( 95 % CI 1.12 - 1.43 , P<0.0005 ) increase in hazard risk in the models adjusted for age and sex . Adjustment for traditional risk factors and clinical confounders did not significantly attenuate this relationship . In a comparison of a basic model ( traditional risk factors ; AUC=0.68 ) with models additionally including either C-reactive protein ( AUC=0.69 ) or fibrinogen ( AUC=0.70 ) , only little additional predictive information over that obtained from assessment of traditional risk factors was obtained . CONCLUSION In patients with documented CAD , C-reactive protein and fibrinogen were predictive for future cardiovascular risk , but did not provide further information on top of that obtained from models including traditional risk factors . Our data emphasize the clinical importance of traditional risk factors in patients with CAD
Results from the meta-regression approach showed an inverse relation between cardiovascular risks and BMI reduction .
Conclusions The present study showed an overall reduction of cardiovascular risk after bariatric surgery .
In summary , our study showed that laparoscopic bariatric surgery is an effective therapeutic option to reduce the cardiovascular risk in severe obese patients
Background This study aims to evaluate the 12–24-month impact of bariatric surgery on the foremost modifiable traditional risk factors of cardiovascular disease .