Surgical interventions to correct metabolic disorders

Abstract

O besity and related metabolic disorders are increasing especially in developing countries. It is widely accepted that in extremely obese patients bariatric surgery reduces body weight and improves type 2 diabetes and the metabolic syndrome. Weight loss partially explains this effect as do weight loss-independent mechanisms linked to gut hormones, peptide YY, ghrelin, glucagon-like peptide-1, and glucose-dependent insulinotropic peptide/gastric inhibitory polypeptide. Several groups performing established and novel surgical techniques have shown encouraging metabolic results. Herein we consider whether it is theoretically plausible to use surgery as an alternative or complementary approach to medical treatment of diabetes in overweight and mildly obese patients. Br J Diabetes Vasc Dis 2010;10:143-147.

Fatores de risco cardiovascular e prevalência de síndrome metabólica em idosos

“…As prevalências de SM encontradas em nossa amostra, avaliadas pela NCEP ATPIII, são elevadas, com maior prevalência de síndrome metabólica em mulheres (14)(15)(16) , o que pode ser justificado por elas tenderem a apresentar maior quantidade de gordura corporal. Com o avançar da idade, ocorre a redução dos níveis de estrogênio, com isso, há uma tendência para o desenvolvimento de dislipidemias e outras alterações metabólicas (17)(18)(19) . Verificou-se, na presente pesquisa, uma elevada prevalência de risco de complicações cardiovasculares e metabólicas associadas à obesidade abdominal.…”

“…Verificou-se, na presente pesquisa, uma elevada prevalência de risco de complicações cardiovasculares e metabólicas associadas à obesidade abdominal. No entanto, ao analisar os resultados de circunferência da cintura associada à idade, não foram observados dados estatisticamente significativos, mostrando que o risco de complicações relacionado à obesidade central é independente da idade no presente estudo, embora pesquisas ambulatoriais e de base populacional demonstrem aumento da SM com o avançar da idade (14,(19)(20)(21) . No entanto, vale ressaltar que, na maioria desses estudos, a amostra incluiu indivíduos a partir de 18 anos, enquanto neste estudo, a partir de 60 anos.…”

Diabetes is predominantly an intestinal disease

“…Taking into account that mechanisms independent of weight loss contribute to diabetes control it is theoretically plausible to consider surgery as an alternative or complementary therapy to medical treatment of T2DM, even in patients with lower BMIs than conventionally accepted for bariatric surgery, up to 30 kg/m 2 in patients with diabetes. [ 14 ] Landmark clinical trials have consistently shown that diabetic patients have a mean BMI close to 30. [ 14 ] In recent years several groups have published encouraging results of their early experiences of metabolic surgery (novel and established techniques) in overweight or mildly obese diabetic patients with BMI < 35.…”

Diabetes Improvement Following Bariatric and Metabolic Surgery

“…These facts lead to conclude that additional and, at some extent, weight lossindependent mechanisms are involved. These mechanisms, thus more metabolic than bariatric, could be summarised as reduced caloric intake and enhanced incretin effect (Lahsen & Berry, 2010).…”

“…The second theory, the "foregut hypothesis" or duodenal exclusion, clearly demonstrates that duodenum and proximal jejunum bypass of nutrients plays a major role in diabetes resolution. (Lahsen & Berry, 2010). Precisely, type 2 diabetic individuals having the metabolic syndrome have a very high risk of cardiovascular complications (Isomaa et al, 2001).…”