New Insights on Bariatric Surgery Outcomes

Ikramuddin, Sayeed; Livingston, Edward H.

doi:10.1001/jama.2013.280927

Cited by 17 publications

(6 citation statements)

References 10 publications

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“…Numerous studies have demonstrated that intensive lifestyle intervention consisting of rigorous exercise and dietary restriction can be effective, but result in only modest weight loss (∼5-6% of baseline body weight) (Ikramuddin and Livingston, 2013). Importantly, this weight loss is not sustained long-term (The Look AHEAD Research Group, 2014) despite a few individuals losing significant excess body weight (Blackburn, 1995).…”

Section: Bariatric Surgery Is the Most Effective And Durable Treatmentioning

confidence: 99%

Bile acids and bariatric surgery

Albaugh

Banan

Ajouz

et al. 2017

Molecular Aspects of Medicine

116

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Bariatric surgery, specifically Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG), are the most effective and durable treatments for morbid obesity and potentially a viable treatment for type 2 diabetes (T2D). The resolution rate of T2D following these procedures is between 40-80% and far surpasses that achieved by medical management alone. The molecular basis for this improvement is not entirely understood, but has been attributed in part to the altered enterohepatic circulation of bile acids. In this review we highlight how bile acids potentially contribute to improved lipid and glucose homeostasis, insulin sensitivity and energy expenditure after these procedures. The impact of altered bile acid levels in enterohepatic circulation is also associated with changes in gut microflora, which may further contribute to some of these beneficial effects. We highlight the beneficial effects of experimental surgical procedures in rodents that alter bile secretory flow without gastric restriction or altering nutrient flow. This information suggests a role for bile acids beyond dietary fat emulsification in altering whole body glucose and lipid metabolism strongly, and also suggests emerging roles for the activation of the bile acid receptors farnesoid x receptor (FXR) and G-protein coupled bile acid receptor (TGR5) in these improvements. The limitations of rodent studies and the current state of our understanding is reviewed and the potential effects of bile acids mediating the short-and long-term metabolic improvements after bariatric surgery is critically examined.

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Section: Bariatric Surgery Is the Most Effective And Durable Treatmentioning

confidence: 99%

Bile acids and bariatric surgery

Albaugh

Banan

Ajouz

et al. 2017

Molecular Aspects of Medicine

116

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“…Noteworthy, there are studies that suggest a preventive effect of bariatric surgery on diabetes development (330). Positive effects over other comorbidities include OSA (331), dyslipidemia (332), hepatic fibrosis (333), and cardiovascular risk (334, 335). Furthermore, there is evidence showing that bariatric surgery-induced weight loss reduces cancer risk in some retrospective cohort studies (336, 337).…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Mechanisms Linking Excess Adiposity and Carcinogenesis Promotion

et al. 2014

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Obesity constitutes one of the most important metabolic diseases being associated to insulin resistance development and increased cardiovascular risk. Association between obesity and cancer has also been well established for several tumor types, such as breast cancer in post-menopausal women, colorectal, and prostate cancer. Cancer is the first death cause in developed countries and the second one in developing countries, with high incidence rates around the world. Furthermore, it has been estimated that 15–20% of all cancer deaths may be attributable to obesity. Tumor growth is regulated by interactions between tumor cells and their tissue microenvironment. In this sense, obesity may lead to cancer development through dysfunctional adipose tissue and altered signaling pathways. In this review, three main pathways relating obesity and cancer development are examined: (i) inflammatory changes leading to macrophage polarization and altered adipokine profile; (ii) insulin resistance development; and (iii) adipose tissue hypoxia. Since obesity and cancer present a high prevalence, the association between these conditions is of great public health significance and studies showing mechanisms by which obesity lead to cancer development and progression are needed to improve prevention and management of these diseases.

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“…The NHPs in this study were spontaneously obese but metabolically healthy, in comparison to the typical patient often reported in the literature that is morbidly obese and very metabolically unhealthy undergoing VSG. A BMI equivalent calculation in NHPs ( Vaughan and Mattison, 2016 ) shows that our cohort, while obese, is a BMI ratio of approximately 1-1.5 fold higher than normal as opposed to the more severely elevated BMIs of patients, almost 2-fold higher than normal, who commonly undergo bariatric surgery ( Ikramuddin and Livingston, 2013 ). Additionally, our cohort was free of metabolic comorbidities at enrollment, an MHO phenotype ( Wu et al., 2012 ).…”

Section: Discussionmentioning

confidence: 80%

A nonhuman primate model of vertical sleeve gastrectomy facilitates mechanistic and translational research in human obesity

et al. 2021

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Summary The obesity epidemic significantly contributes to overall morbidity and mortality. Bariatric surgery is the gold standard treatment for obesity and metabolic dysfunction, yet the mechanisms by which it exerts metabolic benefit remain unclear. Here, we demonstrate a model of vertical sleeve gastrectomy (VSG) in nonhuman primates (NHP) that mimics the complexity and outcomes in humans. We also show that VSG confers weight loss and durable metabolic benefit, where equivalent caloric intake in shams resulted in significant weight gain following surgery. Furthermore, we show that VSG is associated with early, weight-independent increases in bile acids, short-chain fatty acids, and reduced visceral adipose tissue (VAT) inflammation with a polarization of VAT-resident immunocytes toward highly regulatory myeloid cells and Tregs. These data demonstrate that this strongly translational NHP model can be used to interrogate factors driving successful intervention to unravel the interplay between physiologic systems and improve therapies for obesity and metabolic syndrome.

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New Insights on Bariatric Surgery Outcomes

Cited by 17 publications

References 10 publications

Bile acids and bariatric surgery

Bile acids and bariatric surgery

Mechanisms Linking Excess Adiposity and Carcinogenesis Promotion

A nonhuman primate model of vertical sleeve gastrectomy facilitates mechanistic and translational research in human obesity

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