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Although the present results suggest that LSG could be of considerable benefit to elderly obese Japanese patients, long-term careful observation after bariatric surgery is especially important in elderly patients to prevent future osteoporosis. Geriatr Gerontol Int 2017; 17: 2068-2073.

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A case of Fisher syndrome presented by rapidly progressing bilateral palatoplegia after cytomegalovirus infection

Objective: In Japan, obesity is defined as a body mass index (BMI) ≥25 kg/m2. Sarcopenic obesity (low BMI with visceral fat accumulation) has high mortality and is common in elderly people. We evaluated the value of visceral fat area (VFA) measurement in elderly type 2 diabetes (T2D) patients for determining sarcopenic obesity. Methods: We analyzed 124 T2D patients who were hospitalized for glycemic control. They were divided into elderly people (aged ≥65 years) (n=74) and non-elderly people (aged <65 years) (n=50). They were further divided according to BMI (<25 kg/m2 and ≥25 kg/m2) and VFA (<100 cm2 and ≥100 cm2). We compared the number and percentages of significantly different metabolism related items by BMI or VFA grouping between the elderly and non-elderly groups. The correlation between BMI and VFA was also analyzed. Results: We observed the following patient characteristics: the elderly group; 55 men (74.3%), average age 73.2 years, BMI 24.7 kg/m2, and VFA 137.7 cm2; and the non-elderly group; 25 men (50%), average age 49.8 years, BMI 31.8 kg/m2, and VFA 180.7 cm2. Only 6/43 (14.0%) metabolism related items differed significantly between patients with BMI ≥25 kg/m2 and those with BMI <25 kg/m2 in the elderly group, whereas 18/43 (41.9%) items differed significantly between patients with BMI ≥25 kg/m2 and those with BMI <25 kg/m2 in the non-elderly group. In the elderly group, 15/43 (34.9%) metabolism related items differed significantly between patients with VFA ≥100 cm2 and those with VFA <100 cm2, whereas in the non-elderly group, 18/43 (41.9%) items differed significantly between patients with VFA ≥100 cm2 and those with VFA <100 cm2. The correlation between BMI and VFA was stronger in the non-elderly group than in the elderly group. Conclusion: Although BMI is a simple and useful index of obesity evaluation, sarcopenic obesity may be overlooked. In elderly patients who tend to have sarcopenic obesity, VFA measurement might be a more useful index of obesity. Disclosure T. Minamizuka: None. Y. Maeda: None. M. Koshizaka: Research Support; Self; Astellas Pharma Inc., Pfizer Health Research Foundation, Taisho Pharmaceutical Co., Ltd. T. Ishikawa: None. Y. Maezawa: None. K. Yokote: None.

Background/Purpose: Perioperative blood glucose management is important for complication prevention and early hospital discharge. The relation between blood glucose fluctuations and infection is few reported. This study aimed to find predictive risk factors to identify high-risk patients with diabetes requiring more extensive management. Methods: A retrospective study was performed on the perioperative blood glucose management of 105 patients. The presence of infection within one month after surgery was the primary outcome, and the predictive factors were identified. For statistical analysis, analysis of variance or Wilcoxon rank sum test was used. Based on univariate analysis, principle component analysis and logistic analysis were performed to prepare a prediction model of infection onset within one month after surgery using predictive risk factors. The area under the receiver operating characteristic curve (AUC) was evaluated. Results: Patients with infection within one month after surgery had higher mean blood glucose levels (185.1±28.7 vs. 168.3±33.6 mg/dL, P=0.013), larger preoperative blood glucose fluctuations (54.9±24.1 vs. 37.7±23.1 mg/dL, P=0.006), lower albumin level (3.6±0.6 vs. 3.9±0.6 g/dL, P=0.046), longer operation time (432.5±179.6 vs. 282.5±178.3 minute, P<0.001), more bleeding (972.3±920.1 vs. 436.4±795.8 mg/dL, P=0.003), and longer postoperative hospitalization periods (51.9±56.1 vs. 22.4±24.3 days, P<0.001) than patients without infection. They also had greater frequency of adverse events (hazard ratio (HR)=3.19, P=0.013) and mortality within 1 year (HR=4.03, P=0.026). Preoperative blood glucose fluctuation and operation time were considered as more reliable factors of the prediction model. The model had high prediction accuracy with AUC 0.801. Discussion: Preoperative blood glucose fluctuations and long operation time were risk factors for infection in perioperative patients with diabetes. This prediction model can detect these high-risk patients. Disclosure M. Koshizaka: Research Support; Self; Astellas Pharma Inc., Pfizer Health Research Foundation, Taisho Pharmaceutical Co., Ltd. R. Ishibashi: None. Y. Maeda: None. T. Ishikawa: None. Y. Maezawa: None. M. Takemoto: None. K. Yokote: None. Funding Pfizer Health Research Foundation