Plasma Lipopolysaccharide Is Closely Associated With Glycemic Control and Abdominal Obesity Determinants associated with the correction of glomerular hyper-filtration one year after bariatric surgery. Enhanced recovery after liver surgery. Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Musculoskeletal function following bariatric surgery. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Improved memory function two years after bariatric surgery. Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review
OBJECTIVE It is of vital importance to eluci date the triggering factors of obesity and type 2 diabetes to improve patient care . Bariatric surgery has been shown to prevent and even cure diabetes , but the mechanism is unknown . Elevated levels of lipopolysaccharide ( LPS ) predict incident diabetes , but the sources of LPS are not clarified . The objective of the current study was to evaluate the potential impact of plasma LPS on abdominal obesity and glycemic control in subjects undergoing bariatric surgery .  RESEARCH DESIGN AND METHODS This was a prospect i ve observational study involving a consecutive sample of 49 obese subjects undergoing bariatric surgery and 17 controls .  Main assessment s were plasma LPS , HbA1c , adipose tissue volumes ( computed tomography ) , and quantified bacterial DNA in adipose tissue compartments . RESULTS Plasma levels of LPS were elevated in obese individuals compared with controls ( P < 0.001 ) and were reduced after bariatric surgery ( P = 0.010 ) . LPS levels were closely correlated with HbA1c ( r = 0.56 ; P = 0.001 ) and intra-abdominal fat volumes ( r = 0.61 ; P < 0.001 ) , but only moderately correlated with subcutaneous fat volumes ( r = 0.33 ; P = 0.038 ) . Moreover , there was a decreasing gradient ( twofold ) in bacterial DNA levels going from mesenteric via omental to subcutaneous adipose tissue compartments ( P = 0.041 ) . Finally , reduced LPS levels after bariatric surgery were directly correlated with a reduction in HbA1c ( r = 0.85 ; P < 0.001 ) . CONCLUSIONS Our findings support a hypothesis of translocated gut bacteria as a potential trigger of obesity and diabetes , and suggest that the antidiabetic effects of bariatric surgery might be mechanistically linked to , and even the result of , a reduction in plasma levels of LPS 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 INTRODUCTION In a majority of cases , enhanced recovery after surgery program ( ERP ) leads to a reduced rate of postoperative complications and shortened hospital stays following digestive surgery . The program 's preoperative , perioperative and postoperative measures are implemented by the members of a motivated multidisciplinary team . Having shown its merits in digestive surgery , ERP would be particularly useful in liver surgery due to the elevated rates of morbidity and mortality this type of operation continues to entail . The objective of this review was to evaluate the efficacy of ERP  in liver surgery . METHOD This is a systematic narrative review of the literature on the efficacy of ERP  in liver surgery by laparotomy or laparoscopy . RESULTS Notwithst and ing a number of studies ( n=30 : 5 r and omized trials , 14 cohort studies and 11 meta-analyses ) less sizable than with regard to digestive surgery in general and colorectal surgery in particular , analysis of the literature confirms that in liver surgery , ERP is associated with an overall decrease in complications by 30 to 60 % , but without improvement in the rates of hospital readmission and postoperative mortality . All of the studies report a reduction in average length of stay ( ALOS ) by 2.3 days and in functional recovery , a more objective indicator than ALOS , by 2.5 days . As of now , the economic impact of the ERP programs in liver surgery is neither positive nor negative , the above-mentioned savings being counterbalanced by heightened costs for material and equipment . Laparoscopic surgery is independently associated with better outcomes in terms of complications , functional recovery and ALOS ; that is why it is important to incorporate this surgical approach in ERP as often as possible . Given a lack of robust evidence , Prehabilitation , which is a preoperative optimization process leading to improved functional reserve , has yet to be assigned a place in ERP programs pertaining to liver surgery . Possible roadblocks to application of an ERP program can be overcome through coordination by a team leader , a motivated multidisciplinary team , training courses and dedicated teaching sessions . CONCLUSION ERP is a care improvement process that has a major play to play in organization of liver surgery , and its large-scale application is to be recommended Introduction Morbid obesity and obstructive sleep apnea ( OSA ) interact at an inflammatory level . Bariatric surgery reduces inflammatory responses associated with obesity . Heme oxygenase-1 ( HO-1 ) is an enzyme with anti-inflammatory properties , which might be increased in morbid obesity or OSA . We studied morbidly obese patients with OSA to determine : ( a ) HO-1 plasma concentrations according to OSA severity and their relationship with insulin resistance and inflammation and ( b ) the impact of bariatric surgery on HO-1 and parameters of insulin resistance and inflammation . Material and Methods We analyzed the homeostasis model insulin resistance index ( HOMA ) and plasma concentrations of HO-1 , tumor necrosis factor alpha , interleukin-6 , interleukin-1-beta , C reactive protein ( CRP ) , and adiponectin according to polysomnography findings in 66 morbidly obese patients before bariatric surgery  and 12 months after surgery . Results Before surgery , HO-1 plasma concentrations were similar in three groups of patients with mild , moderate , and severe OSA , and correlated with HOMA ( r = 0.27 , p = 0.02 ) . Twelve months after surgery , low- grade inflammation and insulin resistance had decreased in all the groups , but HO-1 plasma concentration had decreased only in the severe OSA group ( p = 0.02 ) . In this group , the reduction in HO-1 correlated with a reduction in CRP concentrations ( r = 0.43 , p = 0.04 ) and with improved HOMA score ( r = 0.37 , p = 0.03 ) . Conclusions Bariatric surgery decreases HO-1 concentrations in morbid obesity with severe OSA , and this decrease is associated with decreases in insulin resistance and in inflammation BACKGROUND Asthma in obese subjects is poorly understood , and these patients are often refractory to st and ard therapy . OBJECTIVES We sought to gain insights into the pathogenesis and treatment of asthma in obese subjects by determining how obesity and bariatric surgery affect asthma control , airway hyperresponsiveness ( AHR ) , and markers of asthmatic inflammation . METHODS We performed a prospect i ve study of ( 1 ) asthmatic and nonasthmatic patients undergoing bariatric surgery compared at baseline and ( 2 ) asthmatic patients followed for 12 months after bariatric surgery .  RESULTS We studied 23 asthmatic and 21 nonasthmatic patients undergoing bariatric surgery .  At baseline , asthmatic patients had lower FEV(1 ) and forced vital capacity and lower numbers of lymphocytes in bronchoalveolar lavage fluid . After surgery , asthmatic participants experienced significant improvements in asthma control ( asthma control score , 1.55 to 0.74 ; P < .0001 ) and asthma quality of life ( 4.87 to 5.87 , P < .0001 ) . Airways responsiveness to methacholine improved significantly ( methacholine PC(20 ) , 3.9 to 7.28 , P = .03 ) . There was a statistically significant interaction between IgE status and change in airways responsiveness ( P for interaction = .01 ) . The proportion of lymphocytes in bronchoalveolar lavage fluid and the production of cytokines from activated peripheral blood CD4(+ ) T cells increased significantly . CONCLUSIONS Bariatric surgery improves AHR in obese asthmatic patients with normal serum IgE levels . Weight loss has dichotomous effects on airway physiology and T-cell function typically involved in the pathogenesis of asthma , suggesting that obesity produces a unique phenotype of asthma that will require a distinct therapeutic approach Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment OBJECTIVE Bariatric surgery is an effective method for acute weight loss . While the impact of bariatric surgery on general medical conditions ( e.g. , type 2 diabetes ) is well documented , few studies focus on physical functional outcomes following weight-loss induced by bariatric surgery . DESIGN AND METHODS We report on 50 women aged 20 - 74 scheduled for Roux-en-Y gastric bypass ( RYGB ) procedure who were enrolled for a prospect i ve 1-year study . Height , weight , and waist circumference were recorded preoperatively and at 6 and 12 months , postoperatively . To track musculoskeletal/physical function changes , the  timed-get-up- and -go ( TGUG ) and short-form health survey-36 ( SF-36 ) and short musculoskeletal function assessment ( SFMA ) question naires were administered . RESULTS Patients had significant weight loss and functional improvement . At 1 year mean weight loss was 48.5 kg and mean TGUG improvement was 3.1 s. SMFA and SF-36 also showed improvement in functional components with weight loss at 6 months and 1-year post surgery . Significant associations were observed between TGUG and SMFA measures at all time points . Final weight at 1 year post bariatric surgery was also significantly correlated with most functional outcomes and changes in these outcomes . Partial correlations controlling for age revealed additional associations between body weight and functional outcomes , especially at the 6-month visit . CONCLUSION Our results suggest that significant rapid weight loss , such as that attained by bariatric surgery , acutely improves musculoskeletal function in morbidly obese patients . Additionally , for patients with musculoskeletal disease or injury , weight loss result ing from bariatric surgery may serve as an adjunct for improving global functional outcome , and enhancing the rehabilitation potential BACKGROUND & AIMS Severe obesity is implicated in development of nonalcoholic fatty liver disease ( NAFLD ) . Bariatric surgery induces weight loss and increases survival time of obese patients , but little is known about its effects on liver damage . We performed a 5-year prospect i ve study to evaluate fibrosis and nonalcoholic steatosis ( NASH ) in severely obese patients after bariatric surgery .  METHODS  Bariatric surgery was performed on 381 patients . Clinical and biological data , along with liver biopsies , were collected before and at 1 and 5 years after surgery . RESULTS Five years after surgery , levels of fibrosis increased significantly , but 95.7 % of patients maintained a fibrosis score < or= F1 . The percentage of patients with steatosis decreased from 37.4 % before surgery to 16 % , the NAFLD score from 1.97 to 1 , ballooning from 0.2 to 0.1 . Inflammation remained unchanged . The percentage of patients with probable or definite NASH decreased significantly over 5 years , from 27.4 % to 14.2 % . The kinetics of insulin resistance ( IR ) paralleled that of steatosis and ballooning ; the greatest improvements occurred within the first year and were sustained 5 years later . Steatosis and ballooning occurred more frequently in patients with a refractory IR profile . In multivariate analysis , the refractory IR profile independently predicted the persistence of steatosis and ballooning 5 years later . CONCLUSIONS Five years after bariatric surgery for severe obesity , almost all patients had low levels of NAFLD , whereas fibrosis slightly increased . Steatosis and ballooning were closely linked to IR ; long-term effects could be predicted by early improvement in IR 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 ABSTRACT Introduction : Established risk factors for gestational diabetes mellitus ( GDM ) include ethnicity , obesity , and family history of diabetes . Untreated GDM patients have higher rates of maternal and perinatal morbidity . GDM is an independent risk factor for future longer-term risk of type 2 diabetes mellitus ( T2DM ) , metabolic syndrome , cardiovascular morbidity , malignancies , ophthalmic , psychiatric , and renal disease in the mother . Offspring risk long-term adverse health outcomes , including T2DM , subsequent obesity , impacted neurodevelopmental outcome , increased neuropsychiatric morbidity , and ophthalmic disease . Areas covered : We critically review data from retrospective , prospect i ve , and meta- analysis studies pertaining to established GDM risk factors , complications during pregnancy and birth ( both mother and offspring ) , and long-term consequences ( both mother and offspring ) . Expert commentary : Many of the adverse consequences of GDM might be avoided with proper management and treatment . Patients belonging to high-risk ethnic groups , and /or with body mass index ≥ 25 kg/m2 , and /or known history of diabetes in first-degree relatives may benefit from universal screening and diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Group ( IADPSG ) . The IADPSG one-step method has several advantages , including simplicity of execution , greater patient-friendliness , and higher diagnostic accuracy . Additionally , evidence suggests that the recent increased popularity of bariatric surgery will help to decrease GDM rates over next 5 years . Similarly , metformin may be useful for treating and preventing obstetrical complications in confirmed GDM patients
However , the existing evidence does suggest that bariatric surgery has a generally positive impact on occupational outcomes .
This suggests that surgery may have wider economic , social and psychological benefits above and beyond its immediate health benefits
Introduction Obesity has been linked with reduced productivity in the workplace and is associated with higher levels of unemployment and absenteeism .
Studies have shown improvement in functioning and enhanced activity levels in patients after bariatric surgery .
Objectives We perform a systematic review and meta- analysis of the literature to assess the impact of bariatric surgery on occupational outcomes .