Dietary weight loss in people with severe obesity stabilizes neuropathy and improves symptomatology

Callaghan, Brian C.; Reynolds, Evan; Banerjee, Mousumi; Akıncı, Gülçin; Chant, Ericka; Villegas-Umana, Emily; Rothberg, Amy E.; Burant, Charles F.; Feldman, Eva L.

doi:10.1002/oby.23246

Cited by 18 publications

(14 citation statements)

References 42 publications

(32 reference statements)

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“…While bariatric surgery is one potential intervention to simultaneously improve multiple metabolic risk factors, another comparable intervention is medical weight loss. We previously studied PN and CAN outcomes in 72 participants with obesity 2 years after medical weight loss using a similar study design [21]. We found that medical weight loss (MWL) more modestly improved the metabolic profile compared with bariatric surgery, with 10.3% weight loss for MWL vs 23.8% for bariatric surgery, a reduction in the National Cholesterol Education Program (NCEP)-defined waist circumference of 7.3% for MWL vs 12.5% for bariatric surgery, a reduction in triacylglycerol of 17.7% for MWL vs 19.1% bariatric surgery, increases in HDL-cholesterol of 11.5% for MWL vs 38.6% for bariatric surgery, and a reduction in HbA 1c of 5.0% for MWL vs 7.5% for bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary PN outcomes included nine nerve conduction study measures of three nerves (peroneal distal motor latency, peroneal amplitude, peroneal F wave index, peroneal CV, sural peak latency, sural amplitude, tibial distal motor latency, tibial amplitude, tibial F wave index), the Michigan Neuropathy Screening Instrument (MNSI) questionnaire, examination and combined index [17], the Utah Early Neuropathy Scale (UENS) [18], quantitative sensory testing (QST) of vibration and cold detection thresholds, vibration perception threshold from neurothesiometer testing [19] and monofilament testing. The nerve conduction studies, QST, neurothesiometer and monofilament testing were completed as previously described [19][20][21]. We defined clinical PN using the Toronto Consensus Definition of probable neuropathy as determined by one of six neuromuscular specialists (including BCC); this required the presence of at least two neuropathy symptoms, abnormal sensory examination or abnormal reflexes [22].…”

Section: Pn Outcomesmentioning

confidence: 99%

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The effect of surgical weight loss on diabetes complications in individuals with class II/III obesity

et al. 2023

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Aims/hypothesis The aim of this study was to determine the effect of bariatric surgery on diabetes complications in individuals with class II/III obesity (BMI > 35 kg/m 2 ). Methods We performed a prospective cohort study of participants with obesity who underwent bariatric surgery. At baseline and 2 years following surgery, participants underwent metabolic phenotyping and diabetes complication assessments. The primary outcomes for peripheral neuropathy (PN) were a change in intra-epidermal nerve fibre density (IENFD, units = fibres/mm) at the distal leg and proximal thigh, the primary outcome for cardiovascular autonomic neuropathy (CAN) was a change in the expiration/inspiration (E/I) ratio, and the primary outcome for retinopathy was a change in the mean deviation on frequency doubling technology testing. Results Among 127 baseline participants, 79 completed in-person follow-up (age 46.0 ± 11.3 years [mean ± SD], 73.4% female). Participants lost a mean of 31.0 kg (SD 18.4), and all metabolic risk factors improved except for BP and total cholesterol. Following bariatric surgery, one of the primary PN outcomes improved (IENFD proximal thigh, +3.4 ± 7.8, p<0.01), and CAN (E/I ratio −0.01 ± 0.1, p=0.89) and retinopathy (deviation −0.2 ± 3.0, p=0.52) were stable. Linear regression revealed that a greater reduction in fasting glucose was associated with improvements in retinopathy (mean deviation point estimate −0.7, 95% CI −1.3, −0.1). Conclusions/interpretation Bariatric surgery may be an effective approach to reverse PN in individuals with obesity. The observed stability of CAN and retinopathy may be an improvement compared with the natural progression of these conditions; however, controlled trials are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Pn Outcomesmentioning

confidence: 99%

The effect of surgical weight loss on diabetes complications in individuals with class II/III obesity

et al. 2023

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“…The prevalence of peripheral neuropathy measured with the Michigan Neuropathy Screening Instrument (MNSI) was found to be reduced (pre-bariatric surgery 20.4% to post-bariatric surgery 10.5%) approximately 10 years after Roux-en-Y gastric bypass and sleeve gastrectomy [47]. Several randomized controlled studies (DiRECT, DROPLET and PREVIEW) have demonstrated the efficacy of low-calorie diets (LCDs; 800-850 kcal/day) in severe obesity [48][49][50]; and recently, a dietary weight loss study of 800 kcal/day (for 12 weeks) followed by 1200-1500 kcal/day resulted in an improvement in metabolic parameters, whilst intraepidermal nerve fibre density (IENFD) remained stable after 2 years [51].…”

Section: Discussionmentioning

confidence: 99%

The Peripheral Neuropathy Prevalence and Characteristics Are Comparable in People with Obesity and Long-Duration Type 1 Diabetes

et al. 2022

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Introduction: Peripheral neuropathy is reported in obesity even in the absence of hyperglycaemia.Objective: To compare the prevalence and characterise the phenotype of peripheral neuropathy in people living with obesity (OB) and long-duration type 1 diabetes (T1D). Patients and Methods:We performed a prospective cross-sectional study of 130 participants including healthy volunteers (HV) (n = 28), people with T1D (n = 51), and OB (BMI 30-50 kg/m 2 ) (n = 51). Participants underwent assessment of neuropathic symptoms (Neuropathy Symptom Profile, NSP), neurological deficits (Neuropathy Disability Score, NDS), vibration perception threshold (VPT) and evaluation of sural nerve conduction velocity and amplitude.Results: Peripheral neuropathy was present in 43.1% of people with T1D (age 49.9 ± 12.9 years; duration of diabetes 23.4 ± 13.5 years) and 33.3% of OB (age 48.2 ± 10.8 years). VPT for high risk of neuropathic foot ulceration (VPT C 25 V) was present in 31.4% of T1D and 19.6% of OB. Participants living with OB were heavier (BMI 42.9 ± 3.5 kg/m 2 ) and had greater centripetal adiposity with an increased body fat percentage (FM%) (P \ 0.001) and waist circumference (WC) (P \ 0.001) compared to T1D. The OB group had a higher NDS (P \ 0.001), VAS for pain (P \ 0.001), NSP (P \ 0.001), VPT (P \ 0.001) and reduced sural nerve conduction velocity (P \ 0.001) and amplitude (P \ 0.001) compared to HV, but these parameters were comparable in T1D. VPT was positively associated with increased WC (P = 0.011), FM% (P = 0.001) and HbA1c (P \ 0.001) after adjusting for age (R 2 = 0.547). Subgroup analysis of respiratory quotient (RQ) measured in the OB group did not correlate with VPT (P = 0.788), J. P. H. Wilding and Uazman Alam are joint senior authors.

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“…However, in both studies, measures of large fibre function and nerve conduction did not improve [ 79 , 80 ]. Another prospective study of participants attending a medical weight management program showed an improvement in symptomology and a stability of intraepidermal nerve fibre density over 2 years [ 81 ]. Taken together, these findings suggest that improvements in metabolic profiles, as may occur in the setting of bariatric surgery or caloric restriction-induced weight loss, may be associated with improvements in small fibre measures and neuropathy symptom scores.…”

Section: Metabolic Peripheral Neuropathymentioning

confidence: 99%

Current and Emerging Pharmacotherapeutic Interventions for the Treatment of Peripheral Nerve Disorders

et al. 2022

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Peripheral nerve disorders are caused by a range of different aetiologies. The range of causes include metabolic conditions such as diabetes, obesity and chronic kidney disease. Diabetic neuropathy may be associated with severe weakness and the loss of sensation, leading to gangrene and amputation in advanced cases. Recent studies have indicated a high prevalence of neuropathy in patients with chronic kidney disease, also known as uraemic neuropathy. Immune-mediated neuropathies including Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy may cause significant physical disability. As survival rates continue to improve in cancer, the prevalence of treatment complications, such as chemotherapy-induced peripheral neuropathy, has also increased in treated patients and survivors. Notably, peripheral neuropathy associated with these conditions may be chronic and long-lasting, drastically affecting the quality of life of affected individuals, and leading to a large socioeconomic burden. This review article explores some of the major emerging clinical and experimental therapeutic agents that have been investigated for the treatment of peripheral neuropathy due to metabolic, toxic and immune aetiologies.

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Dietary weight loss in people with severe obesity stabilizes neuropathy and improves symptomatology

Cited by 18 publications

References 42 publications

The effect of surgical weight loss on diabetes complications in individuals with class II/III obesity

The effect of surgical weight loss on diabetes complications in individuals with class II/III obesity

The Peripheral Neuropathy Prevalence and Characteristics Are Comparable in People with Obesity and Long-Duration Type 1 Diabetes

Current and Emerging Pharmacotherapeutic Interventions for the Treatment of Peripheral Nerve Disorders

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