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![Fig. 1. Edmonton Obesity Staging System (EOSS) (modified from [16]).](profile/Adrian-Billeter/publication/327948900/figure/fig1/AS:687037166399488@1540813833075/Edmonton-Obesity-Staging-System-EOSS-modified-from-16_Q320.jpg)
Metabolic diseases, comprising type 2 diabetes mellitus (T2DM), dyslipidemia, and non-alcoholic steatohepatitis (NASH), are rapidly increasing worldwide. Conservative medical therapy, including the newly available drugs, has only limited effects and does neither influence survival or the development of micro- or macrovascular complications, nor the...
Context in source publication
Context 1
... EOSS is not based on the degree of obesity according to BMI but on the absence or presence -as well as the severity -of comorbidities and organ dys- function. Figure 1 shows the five EOSS classification groups, which are based on the patients' medical, mental, and functional status. ...
Citations
... Despite bariatric surgery promising outcome in ameliorating obesity and the associated comorbidities [10], there is still a lack of reports addressing its potentially beneficial effect on obesity-related albuminuria in non-diabetic, nonhypertensive patients. ...
Background
Obesity is a risk factor for chronic kidney disease and albuminuria. Despite the well-documented obesity association with diabetes mellitus and hypertension, its predisposition to albuminuria is not related to these comorbidities, and, in some times, its occurrence is independent of DM or hypertension.
Purpose of the study
The present study aimed to evaluate bariatric surgery effect on albuminuria in patients with severe obesity with no DM or hypertension.
Materials and methods
The study consisted of 137 patients with extreme obesity and albuminuria scheduled for bariatric surgery and did not have diabetes or hypertension. They underwent an assessment for 24-h urinary albumin at baseline (T0) and 6 months postoperatively (T2).
Results
Albuminuria remission occurred in 83% of patients; there was a statistically highly significant difference between the baseline and the 6-month postoperative in the 24-h urinary albumin assessment. Weight loss and BMI at T2 were independent predictors of albuminuria remission.
Conclusion
The current work emphasizes the importance and promising role of bariatric surgery as an effective weight reduction management method in improving albuminuria, an early sign of chronic kidney disease, and a potential risk factor for cardiovascular disease.
... Benefits of bariatric surgery for morbid obesity and metabolic indications are well established, and primary surgical interventions are increasing in numbers globally [1]. The vast majority of patients undergoing bariatric surgical procedures for metabolic indications do so for better control and/ or cure of diabetes; whilst a proportion of morbidly obese patients qualifying for weight loss surgery also suffer from diabetes and other metabolic comorbidities [2]. This then leaves the bariatric and metabolic surgical services with a large pool of qualifying patients who are diabetics with variable diabetes control at the pre-operative stage [3]. ...
Purpose
UK guidelines recommend an HbA1c < 8.5% prior to elective surgery. Optimisation of pre-operative glycaemic control can be often difficult. Aim to correlate the effect of pre-operative HbA1c on the peri-operative complication rates and whether elective bariatric surgery should be delayed in poorly controlled diabetics.
Material and Methods
Retrospective data of consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass, one-anastomosis gastric bypass and laparoscopic sleeve gastrectomy during January 2014 and April 2018. Patients were categorised into group 1, non-diabetics with an HbA1c < 6.5%; group 2, well-controlled diabetics with HbA1c between 6.5 and 8.4%; and group 3, poorly controlled diabetics with HbA1c ≥ 8.5%. Primary outcome was peri-operative complication rates.
Results
Group 1 (n = 978), 81.8% female, median (i.q.r.) age 44.0 (34–52) years, median (i.q.r.) BMI 42.0 (38.7–46.7); group 2 (n = 350), 66.3% female, age 51.0 (45–59) years, BMI 41.8 (37.5–46.5); and group 3 (n = 90), 60% female, age 52.0 (45–56) years and BMI 41.4(36.9–44.8). Early complication rates in each group were low, 1.0% vs 1.7% vs 1.1% (p = 0.592). Mean length of stay was 2 days across the groups (p > 0.05). There was no difference in 30-day re-admission rates between groups 2.8%, 2.9% and 3.3% (p = 0.983). At 6 months and 1 year, there was sustained and equal reduction in HbA1c in all groups (p < 0.05).
Conclusion
Patients undergoing metabolic surgery for poorly controlled diabetes achieve non-inferior peri-operative outcomes. Hence, delaying metabolic surgery in an attempt to optimise diabetic control is not justifiable.
Graphical Abstract
... Weight loss is currently the only effective treatment, and MBS is the most sustainable means of weight loss. Schwarz et al. have even proposed a staging system for NAFLD analogous to Edmonton classification for T2DM [40]. In a recent seminal study conducted by Lesailly et al., which lasted for 10 years, included 109 bariatric patients and implemented histologic apart from clinical and biological data, the researchers found that fibrosis post-MBS was reduced in 33.8% of patients (95% CI 23.6-45.2%). ...
Background
Emerging evidence has revealed that obstructive sleep apnea (OSA) is associated with non-alcoholic fatty liver disease (NAFLD). However, the impact of OSA on NAFLD among obese patients undergoing metabolic and bariatric surgery (MBS), especially during follow-up period, remains unclear.Objective
To analyze the correlation based on preoperative characteristics and postoperative conditions among bariatric patients with comorbid OSA and NAFLD. Methods: Clinical data of patients who underwent MBS in our institution between January 2016 and June 2019 were reviewed retrospectively. Correlation analysis and linear regressions were used to identify how OSA links with NAFLD before and after treatment of MBS.ResultsOf 308 patients, 181 were diagnosed with OSA and enrolled in the present study, and 127 completed follow-up visits at 6 months. The proportion of NAFLD in the mild-moderate OSA and severe OSA groups was 75.0% and 96.0%, respectively. MBS was effective at improving sleep apnea and nocturnal hypoxia, as well as liver steatosis and fibrosis (P < 0.05). And we also found that there were significant correlations not only between OSA- and NAFLD-related characteristics at baseline but also between their improvements after surgery, eventually leading to similar prognosis of NAFLD for both groups (P < 0.05), no matter what presurgical differences existed. In addition, the results of the univariate and multivariate linear regression analyses supported preoperative liver/spleen Hounsfield units ratio (LSR) by computerized tomography (CT) as an independent predictor of the effect of MBS on liver steatosis.Conclusion
In conclusion, MBS plays a pivotal role in the control of medical conditions in obese patients with OSA and NAFLD. Given the correlation between OSA and NAFLD in the present study, in the case of both the severity at baseline as well as the improvement after surgery, OSA may pose an impact on the prognosis of NAFLD in bariatric patients.
... The criteria used for considering the bariatric surgery for the treatment to reduce weight of obese patients (6,(11)(12)(13)(14) 1. The bariatric surgery should be considered as a treatment for those obese patients with a body mass index (BMI) of 32.5 kg/m² or more, who have co-morbidities that fail to achieve adequate control by full effort of any other methods; or a BMI of 37.5 kg/m² or more without co-morbidities. ...
Background: The prevalence of obesity is increasing in Thailand. The Thai Society for Metabolic and Bariatric Surgery just developed the first Thailand guideline for Bariatric surgery as a gold standard treatment of morbid obesity. Objective: To enhance the quality of care in obesity treatment through metabolic and bariatric surgery Methods: The present study would provide suggestions for management that were derived from available knowledge, peer-reviewed of scientific literature, and expert opinion. The guideline was developed by performing a review of currently available literatures regarding obesity, obesity treatments, and metabolic surgery from all references published worldwide. Results: The intent of issuing such a guideline is to provide definite criteria for surgery, pre-operative care, and post-operative care, including practical points in each step. Conclusion: This is the first practice guideline on bariatric surgery for the treatment of obese patient in Thailand. The guideline would be revised in the future should additional evidence become available and future research is needed to gather more evidence and study clinical outcomes for the development of future practice guidelines.
... This was a different approach from that adopted by the National Institutes of Health consensus surgical indication criteria [2], which have been embraced by most countries, including Brazil. One question needing further examination would be the utility of EOSS in identifying patients with lower BMI ranges who will benefit most from metabolic surgery [29]. ...
Background:
Limited access to publicly funded, insurance-covered, and self-paid obesity surgery is a reality worldwide. Waiting lists for procedures are usually based on chronologic criteria and body mass index (BMI)-defined obesity categorization. Obesity classification systems assess overall health and have been proposed as an alternative.
Objective:
To investigate the correlation between BMI-based classification and the Edmonton Obesity Staging System (EOSS) to support current evidence that the assessment of the clinical severity of obesity could be a helpful tool to maximize access to surgery.
Setting:
University hospital, Brazil.
Methods:
Retrospective analysis of all 2011 to 2014 adult patients who underwent obesity surgery under the public health system. Data on sex, age, presurgical BMI, and co-morbidities were extracted from hospital records. Spearman correlation coefficients were used to assess the strength and direction of the relationship between BMI classification and EOSS.
Results:
Of 565 patients, 79% were female, mean age 44.1 ± 10.9 years and mean BMI 46.9 ± 6.2 kg/m2. The most common EOSS stage was 2 (86.5%), followed by stages 3 (8.5%) and 1 (4.9%). There was no correlation between the severity of obesity measured by BMI and EOSS (ρ = -.030, P = .475). Older patients had higher Edmonton scores (ρ = .308, P < .001). No difference was observed regarding sex.
Conclusions:
No correlation was found between EOSS and BMI and between these and sex. Age correlated with both obesity indicators. EOSS was reproducible in Brazilian surgical patients and may be an important tool from a health services perspective contributing to the more efficient use of limited resources for obesity surgery.
... [88,89] The enterohormone GLP-2 is secreted in an equimolar ratio with incretin GLP-1, and it functions is the inhibition of hunger, in hypothalamic arcuate nucleus level, in addition, reduction of hepatic glucose production and increase insulin sensitivity. [90] A potential disadvantage with physical jejunostomy is known, that GLP-2 is one of the enterohormones associated with intestinal readaptative processes, and enteric to small bowel resection readaptation is related to magnitude of resection, [91][92][93] so a latero-lateral anastomosis could implicate less rehabilitation compared with jejunostomy if there were paracrine mechanisms that regulate activity of GLP-2. ...
Background and objectives: To investigate the effect of carbohydrate intake before laparoscopic Roux-en-Y gastric bypass (LRYGB) on body weight, body composition and glycaemic status after surgery. Methods: In a tertiary centre cohort study, dietary habits, body composition and glycaemic status were evaluated before and 3, 6 and 12 months after LRYGB. Detailed dietary food records were processed by specialized dietitians on the basis of a standard protocol. The study population was subdivided according to relative carbohydrate intake before surgery. Results: Before surgery, 30 patients had a moderate relative carbohydrate intake (26%-45%, M-CHO), a mean body mass index (BMI) of 40.4 ± 3.9 kg/m² and a mean glycated haemoglobin A1c (A1C) of 6.5 ± 1.2% compared to 20 patients with a high relative carbohydrate intake (> 45%, H-CHO), mean BMI of 40.9 ± 3.7 kg/m² (non-significant, NS) and a mean A1C of 6.2% (NS). One year after surgery, body weight, body composition and glycaemic status were similar in the M-CHO (n = 25) and H-CHO groups (n = 16), despite less caloric intake in the H-CHO group (1317 ± 285 g vs. 1646 ± 345 g in M-CHO, p < 0.01). Their relative carbohydrate intake converged to 46% in both groups, but the H-CHO group reduced the absolute total carbohydrate consumption more than the M-CHO group (190 ± 50 g in M-CHO vs. 153 ± 39 g in H-CHO, p < 0.05), and this was especially pronounced for the mono- and disaccharides (86 ± 30 g in M-CHO vs. 65 ± 27 g in H-CHO, p < 0.05). Conclusion: A high relative carbohydrate intake before LRYGB, did not influence the change in body composition or diabetes status after surgery, despite a significantly lower total energy intake and less mono- and disaccharide consumption after surgery.
Zusammenfassung
Die Adipositas ist weltweit ein zunehmendes Problem. Seit dem Jahr 2010 waren erstmals mehr Menschen übergewichtig als untergewichtig. Insbesondere die adipositasassoziierten Erkrankungen, allen voran der Diabetes mellitus Typ II, stellen das Gesundheitssystem vor enorme Herausforderungen. Am 3. Juli 2020 hat der Deutsche Bundestag Adipositas als Krankheit anerkannt und die Entwicklung eines Disease-Management-Programms (DMP) angestoßen, das zurzeit ausgearbeitet wird. Bisher richtet sich die Indikation einer Behandlung der Adipositas in Deutschland nach der S3-Leitlinie „Chirurgie der Adipositas und metabolischer Erkrankungen“ der DGAV von 2018 und der S3-Leitlinie „Prävention und Therapie der Adipositas“ der Deutschen Adipositas-Gesellschaft e. V. von 2014. Dieser Artikel gibt einen Überblick über die aktuell in Deutschland verfügbaren konservativen, medikamentösen, endoskopischen und chirurgischen Therapiemethoden des Übergewichts und der Adipositas und erläutert die Indikationen. Vor dem Hintergrund der Neuausrichtung der Adipositasbehandlung im Rahmen des DMP und der anstehenden Überarbeitungen der Leitlinien sollte die bisherige Indikationsstellung kritisch diskutiert werden. Die wissenschaftlichen Erkenntnisse der letzten Jahre zeigen, dass durch eine chirurgische Behandlung der Adipositas aktuell im Langzeitverlauf nicht nur der größte Gewichtsverlust erreicht wird, sondern auch, dass adipositasassoziierte Erkrankungen effektiver behandelt werden und die Gesamtmortalität im Vergleich zur konservativen Behandlung deutlich effektiver gesenkt wird.
