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. Female Pelvic Floor Symptoms Before and After Bariatric Surgery The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population Employment Outcomes One Year after Bariatric Surgery: the Role of Patient and Psychosocial Factors Cardiovascular mortality in dialysis patients. National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year Melanocortin-4 Receptor Mutations and Polymorphisms Do Not Affect Weight Loss after Bariatric Surgery Hepatic histology in obese patients undergoing bariatric surgery. Dietary factors related to the increase of cardiovascular risk factors in traditional Tepehuanos communities from Mexico. A 10 year follow-up study. Supervised Physical Training Improves Weight Loss After Roux-en-Y Gastric Bypass Surgery: A Randomized Controlled Trial. Cognitive function after bariatric surgery: evidence for improvement 3 years after surgery.
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 Background Obesity is a risk factor for female pelvic floor disorders . The study objective was to determine whether there was a difference in the subjective reporting of pelvic symptoms before and after bariatric surgery . Methods This was a prospect i ve cohort study of female patients that underwent bariatric surgery .  Patients completed a demographic question naire , the Pelvic Floor Distress Inventory-20 ( PFDI-20 ) , and the Pelvic Floor Impact Question naire-7 ( PFIQ-7 ) before surgery and at 6 and 12 months following surgery . Body mass index ( BMI ) was compared between time points using Student ’s t tests ( P < 0.05 significant ) . Symptom and impact on quality of life prevalence were compared using McNemar ’s test and question naire scores were compared using the Wilcoxon matched pairs test ( P < 0.025 significant ) . Results At 12 months after surgery , 63 patients had completed the study . Even with significant weight loss ( BMI , 43.7 kg/m2 to BMI , 29 kg/m2 ; P < 0.001 ) , there was no significant difference in the prevalence of pelvic floor symptoms before and after surgery ( 94 % to 81 % , P = 0.2 ) . Prevalence of pelvic floor symptom impact on quality of life did significantly decrease after surgery ( 56 % to 30 % ; P = 0.004 ) . Baseline PFDI-20 and PFIQ-7 scores were low ; however , there was still a significant reduction in PFDI-20 and PFIQ-7 scores after surgery ( P < 0.001 ) . Conclusions Prevalence of pelvic floor symptoms did not vary greatly after surgery ; however , significant weight reduction did improve the degree of bother and quality of life related to these symptoms Our purpose was to assess the cost , quality of life impact , and the cost – utility of bariatric surgery in a managed care population . We studied 221 patients who underwent bariatric surgery between 2001 and 2005 . We analyzed medical cl aims data for all patients and survey data for 122 survey respondents ( 55 % response rate ) . Patients were generally middle-aged , female , and white . Sixty-four percent underwent open and 33 % underwent laparoscopic Roux-en-Y procedures .  One year after surgery , mean body mass index fell from 51 to 31 kg/m2 in women and from 59 to 35 kg/m2 in men with substantial improvements in comorbidities . Postsurgical mortality and morbidity were low . Total per member per month costs increased in the 6 months before bariatric surgery , were lower in the 12 months after bariatric surgery , but increased somewhat over the next 12 months . When presurgical quality of life was assessed prospect ively , average health utility scores improved by 0.14 one year after surgery . In analyses that took a lifetime time horizon , projected future costs based on age and obesity and discounted costs and health utilities at 3 % per year , the cost – utility ratio for bariatric surgery versus no surgery was approximately $ 1,400 per quality -adjusted life-year gained . In sensitivity analyses , bariatric surgery was more cost-effective in women , non-whites , more obese patients , and when performed laparoscopically . Although not cost-saving , bariatric surgery represents a very good value for money . Its long-term cost effectiveness appears to depend on the natural history and cost of late postsurgical complications and the natural history and cost of untreated morbid obesity Background Patients undergoing bariatric surgery  generally report improved work performance after this procedure ; however , previous research has been limited by a lack of st and ardized employment measures and a failure to account for the impact of psychiatric illness on employment outcomes . To address these limitations , this study aims to assess changes in patients ’ employment impairment and productivity 12 months post-surgery and to identify psychosocial predictors of change in employment outcomes . Methods A total of 164 patients underwent bariatric surgery between February 2010 and November 2012 in this prospect i ve cohort study . The primary outcome was a change in employment impairment ( EI ) as measured by total Lam Employment Absence and Productivity Scale ( LEAPS ) scores and changes in participants ’ job status category . Multiple linear regression models assessed whether baseline demographic or clinical factors , including a history of psychiatric illness and changes in depressive , anxiety and quality of life ( QOL ) symptoms , were associated with a change in LEAPS scores . Results Participants reported a significant reduction in EI post-surgery ( p < 0.0001 ) and improvement in work productivity ( p < 0.0001 ) 12 months after surgery . Only changes in depression ( confidence interval ( CI ) 0.46 , 0.76 , p < 0.0001 ) , anxiety ( CI 0.49 , 0.85 , p < 0.0001 ) and mental QOL ( CI −0.30 , −0.17 , p < 0.0001 ) were significant predictors of change in EI total scores . Logistic regression analysis did not identify significant predictors of change in participant job status . Conclusions Patients with pre-bariatric surgery psychiatric distress are more likely to report greater employment impairment and worse employment productivity pre-surgery . These patients also experience the greatest improvements in post-surgery employment functioning In their broad spectrum , cardiovascular diseases are , collectively , the major cause of death in patients on dialysis .  The population of patients treated with peritoneal dialysis and hemodialysis  are not only subject to the traditional risk factors for heart disease , but also to certain uremia-associated risk factors that are unique in this population . In the dialysis population , data regarding the effectiveness of routine pharmacologic and procedural interventions on cardiovascular outcomes are limited . Most dialysis patients are excluded from clinical trials , and so data from r and omized controlled trials investigating outcomes in patients undergoing  peritoneal dialysis or hemodialysis are almost absent . In this review , we discuss some of the major cardiovascular problems in the dialysis population , the impact of those problems on survival , and when data are available , the impact of therapeutic strategies BACKGROUND The increase in obesity coupled with greater acceptance of the field of bariatric surgery has result ed in a substantial rise in the number of weight-loss operations . Because obese individuals are at high risk for surgical complications , concern about the safety of bariatric procedures exists . Earlier investigations of the clinical features associated with surgical complications have produced conflicting results . We sought to identify risk factors for surgical complications in a large , nationally representative population of US veterans . STUDY DESIGN We analyzed data  on bariatric procedures performed at 12 Veterans ' Affairs medical centers approved to perform weight-loss operations between 1998 and 2004 . Detailed pre- , intra- , and postoperative information and longterm mortality data were prospect ively collected using the National Surgical Quality Improvement Program methodology . We used multivariable logistic regression to identify clinical features associated with postoperative complications . RESULTS Among 575 bariatric patients assessed between 1998 and 2004 , 74 % were men with a mean age of 51 years . Thirty-day mortality was 1.4 % . Overall complication rate was 19.7 % . Of those with complications , one-half were of considerable clinical importance , as they were associated with prolonged length of stay . Clinical features that were predictive of adverse events in our multivariable analyses were superobesity , weight>350 pounds , and smoking . A more than 20 pack-year history of smoking was also associated with difficulty in weaning from a ventilator postoperatively . CONCLUSIONS We identified smoking and superobesity as preoperative risk factors associated with postoperative complications . Future studies should examine the effect of preoperative weight loss and smoking cessation on bariatric procedure outcomes Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions Bariatric surgery is the most effective long term weight-loss therapy for severe and morbidly obese patients . Melanocortin-4 Receptor ( MC4R ) mutations , the most frequent known cause of monogenic obesity , affect the regulation of energy homeostasis . The impact of such mutations on weight loss after bariatric surgery is still debated . The objective is to determine the impact of MC4R status on weight loss in obese subjects over one year after bariatric surgery . A total of 648 patients , who were referred to bariatric surgery in a single clinical nutrition department , were genotyped for their MC4R status . The following four groups were categorized : functional MC4R mutations , MC4R single nucleotide polymorphisms ( SNPs ) : Val103Ile ( V103L ) and Ile251Leu ( I251L ) , MC4R variant rs17782313 ( downstream of MC4R ) and MC4R SNP A-178C on the promoter . Each patient was matched with two r and omly paired controls without mutation . Matching factors were age , sex , baseline weight and type of surgery procedure ( Roux-en-Y gastric bypass and adjustable gastric b and ing ) . We compared weight loss between cases and controls at 3 , 6 and 12 months after surgery . Among 648 patients , we identified 9 carriers of functional MC4R mutations , 10 carriers of MC4R V103L and I251L SNPs , 7 carriers of the rs17792313 variant and 22 carriers of the A-178C SNP . Weight loss at 3 , 6 and 12 months did not differ between cases and controls , whatever the MC4R mutations . This is the first case-control study to show that MC4R mutations and polymorphisms do not affect weight loss and body composition over one year after bariatric surgery BACKGROUND / AIMS Obesity is one of the most important clinical associations with non-alcoholic steatohepatitis ( NASH ) . Our aim was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD)/NASH in morbidly obese patients and the risk factors to more aggressive liver disease in this population . METHODS Review of available studies on prevalence of NAFLD/NASH in severely obese patients su bmi tted to bariatric surgery .  RESULTS Twelve observational and transversal studies were included , with consecutive recruitment , and prospect i ve evaluation of data , summing 1620 patients with severe obesity .  Prevalence of steatosis and NASH was 91 % ( range : 85 - 98 % ) and 37 % ( 24 - 98 % ) , respectively , with unexpected cirrhosis in 1.7 % ( 1 - 7 % ) . NASH was not related with age or body mass index , but there was an association between male sex and NASH/hepatic fibrosis . Diabetes mellitus and insulin resistance were the conditions most frequently associated with NASH , and hypertension with advanced hepatic fibrosis . CONCLUSIONS There is a very high prevalence of NAFLD in asymptomatic morbidly obese patients , more than one-third presenting histological criteria for NASH . This review underscores the large variations in prevalence of NASH between studies , calling for the need for a better agreement in the use of the histological criteria BACKGROUND AND AIMS  Tepehuanos Indians , a traditional Mexican ethnic group , followed a vegetarian diet exhibiting a low prevalence of obesity and the absence of diabetes . However , from the year 2000 the traditional diet of the Tepehuanos was modified by the introduction of western food . In this study we examine the changes in their customary diet and its impact on the prevalence of cardiovascular risk factors in this group . METHODS AND RESULTS Individuals from 12 Tepehuanos communities were r and omly enrolled during 1995 - 1996 and 2006 - 2007 . Using a 64-item semiquantitative food frequency question naire macronutrient intakes were calculated from values of Mexican food-composition tables . Cardiovascular risk factors such as obesity , hypertension , hyperglycemia and dyslipidemia were determined . The median ( 25 , 75 percentile ) of total caloric intake ( 1476 [ 1083 , 1842]-2100 [ 1366 , 2680]kcal/day , p<0.001 ) as well as the percentage of energy consumed from saturated fat ( 3.0 [2.7,4.1]-7.2 [ 3.9,7.4 ] , p<0.0001 ) and protein ( 8.2 [7.8,8.9]-16.8 [ 16.3,17.1 ] , p<0.0001 ) increased , whereas the percentage of total calorie intake from carbohydrates ( 66.4 [61.3,69.5]-61.3 [ 61,68.8 ] , p<0.0001 ) , polyunsaturated fat ( 11.2 [10.3,12.1]-4.0 [ 3.9,4.3 ] , p<0.0001 ) , and the polyunsaturated : saturated fat ratio ( 3.84 - 0.53 % , p<0.0001 ) decreased during the period of study . The prevalence of obesity ( 11.1 - 21.9 % , p=0.04 ) , impaired fasting glucose ( 5.9 - 14.9 % , p=0.04 ) , diabetes ( 0.0 - 0.88 % , p=0.48 ) , hypertension ( 1.7 - 3.4 % , p=0.43 ) , triglycerides ( 2.6 - 16.7 % , p=0.0006 ) , and low HDL-cholesterol ( 10.2 - 71.1 % , p<0.0001 ) increased . CONCLUSIONS Changes in the customary diet introduced in the Tepehuanos communities are related to the increase of cardiovascular risk factors OBJECTIVE Bariatric surgery results in significant weight loss and reduces cardiovascular morbidity . However , a large variation in postsurgery weight loss is seen . Physical activity promotes weight loss in nonsurgically treated subjects with obesity . The aim of this study was to investigate the effects of 6 months of supervised physical training following Roux-en-Y gastric bypass surgery ( RYGB ) on body weight and cardiovascular risk markers . METHODS Sixty participants eligible for RYGB were included . Six months post surgery , the participants were r and omly assigned to either twice-weekly supervised physical training sessions in a fitness center ( INT ) or a control group ( CON ) for 26 weeks . Before surgery and 6 , 12 , and 24 months after surgery , the participants underwent an examination program that included  anthropometric measurements , blood pressure , heart rate , blood sample s  , and an  abdominal computed tomography scan .  RESULTS RYGB significantly reduced body weight and improved cardiovascular risk markers ( all P < 0.01 ) . The supervised physical training intervention result ed in a 4.2-kg ( CI : -0.2 to -8.3 kg ) lower body weight in INT compared with CON at the study end ( P = 0.042 ) . The high-density lipoprotein concentration was significantly higher in INT than in CON at the termination of the intervention , but this was not maintained at the 24-months examination . CONCLUSIONS Physical training following RYGB improves weight loss and cardiovascular health BACKGROUND Bariatric surgery is associated with improved cognition , and it is possible that such improvements are found at extended follow-ups . We hypothesized that cognitive improvement would be maintained 3 years after bariatric surgery . METHODS Fifty bariatric patients were recruited from the Longitudinal Assessment of Bariatric Surgery parent project . Participants completed a computerized cognitive test battery to assess cognitive function  at 12 weeks , 12 months , 24 months , and 36 months after surgery . RESULTS Repeated measures revealed main effects for attention , executive function , and memory . Attention improved up to 24 months and then slightly declined although it still fell within the average range at 36 months . Improvements in executive function reached their peak at 36 months after surgery . Short-term improvements in memory were maintained at 36 months . No main effect emerged for language . CONCLUSIONS Bariatric surgery may lead to lasting improvements in cognition . Prospect i ve studies with extended follow-ups ( eg , 10 years ) should examine whether bariatric surgery can attenuate cognitive decline in severely obese patients
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 .