Obesitas Wetenschap

Enhancement of Neural Salty Preference in Obesity.

Cell Physiol Biochem. 2017 Oct 20;43(5):1987-2000

Authors: Li Q, Jin R, Yu H, Lang H, Cui Y, Xiong S, Sun F, He C, Liu D, Jia H, Chen X, Chen S, Zhu Z

Abstract
BACKGROUND/AIMS: Obesity and high salt intake are major risk factors for hypertension and cardiometabolic diseases. Obese individuals often consume more dietary salt. We aim to examine the neurophysiologic effects underlying obesity-related high salt intake.
METHODS: A multi-center, random-order, double-blind taste study, SATIETY-1, was conducted in the communities of four cities in China; and an interventional study was also performed in the local community of Chongqing, using brain positron emission tomography/computed tomography (PET/CT) scanning.
RESULTS: We showed that overweight/obese individuals were prone to consume a higher daily salt intake (2.0 g/day higher compared with normal weight individuals after multivariable adjustment, 95% CI, 1.2-2.8 g/day, P < 0.001), furthermore they exhibited reduced salt sensitivity and a higher salt preference. The altered salty taste and salty preference in the overweight/obese individuals was related to increased activity in brain regions that included the orbitofrontal cortex (OFC, r = 0.44, P= 0.01), insula (r = 0.38, P= 0.03), and parahippocampus (r = 0.37, P= 0.04).
CONCLUSION: Increased salt intake among overweight/obese individuals is associated with altered salt sensitivity and preference that related to the abnormal activity of gustatory cortex. This study provides insights for reducing salt intake by modifying neural processing of salty preference in obesity.

PMID: 29055956 [PubMed - as supplied by publisher]

New Onset Diabetes and Non-Alcoholic Fatty Liver Disease after Liver Transplantation.

Ann Hepatol. 2017 Oct 16;16(6):932-940

Authors: Andrade AR, Bittencourt PL, Codes L, Evangelista MA, Castro AO, Sorte NB, Almeida CG, Bastos JA, Cotrim HP

Abstract
Background &amp; Aims. Non-alcoholic fatty liver disease (NAFLD) is an emerging cause of graft dysfunction after liver transplantation (LT) frequently related to the development of new onset diabetes after LT (NODAT). This study was undertaken to evaluate the frequencies of NODAT and NAFLD after LT, to investigate their major risk factors and the impact of de novo or recurrent NAFLD in graft function.
MATERIAL AND METHODS: 119 patients submitted to LT were prospectively evaluated.
RESULTS: After 4 ± 1 years, NODAT, recurrent and de novo NAFLD were observed in 31%, 56% and 43% of the subjects, respectively. Only 3 patients had non-alcoholic steatohepatitis (NASH) without fibrosis. Other risk factors for NAFLD such as arterial hypertension (AHT), metabolic syndrome (MS), hypertriglyceridemia and obesity were seen in 51%, 50%, 35% and 24% of the subjects, respectively. In addition, insulin resistance (IR), assessed by HOMA-IR and β-cell dysfunction, determined by HOMA-β, were observed in 16% and 94% of the patients, respectively. Occurrence of NODAT was associated with male gender, higher waist circumference, higher HOMA-IR and lower HOMA-β values. No correlation was found between NAFLD and NODAT, MS, hypertriglyceridemia, obesity and HOMAIR and HOMA-β levels.
CONCLUSIONS: NODAT, recurrent and de novo NAFLD are common after LT but are not associated with signs of graft dysfunction, possibly due to the low frequency of IR and NASH. No correlation is observed between NAFLD and NODAT, MS, hypertriglyceridemia, obesity and IR. β-cell dysfunction and diabetes, however, are seen in most of the patients, possibly due to calcineurin inhibitor toxicity.

PMID: 29055928 [PubMed - in process]

Evidence-Based Medicine and the Problem of Healthy Volunteers.

Ann Hepatol. 2017 Oct 16;16(6):832-834

Authors: Marchesini G, Marchignoli F, Petta S

Abstract
Healthy controls are subjects without the disease being studied but may have other conditions indirectly affecting outcome. In the present epidemics of obesity a few subjects with undiagnosed nonalcoholic fatty liver disease enter clinical studies as controls, producing biased results. Stricter selection criteria should be considered to prevent this risk.

PMID: 29055914 [PubMed - in process]

Impact of bariatric surgery on outcomes of patients with nonalcoholic fatty liver disease: a nationwide inpatient sample analysis, 2004-2012.

Surg Obes Relat Dis. 2017 Sep 14;:

Authors: McCarty TR, Echouffo-Tcheugui JB, Lange A, Haque L, Njei B

Abstract
BACKGROUND: Bariatric surgery in eligible morbidly obese individuals may improve liver steatosis, inflammation, and fibrosis; however, population-based data on the clinical benefits of bariatric surgery in patients with nonalcoholic fatty liver disease (NAFLD) are lacking.
OBJECTIVES: To assess the relationship between bariatric surgery and clinical outcomes in hospitalized patients with NAFLD.
SETTING: United States inpatient care database.
METHODS: The Nationwide Inpatient Sample database was queried from 2004 to 2012 with co-diagnoses of NAFLD and morbid obesity. Hospitalizations with a history of prior bariatric surgery (Roux-en-Y gastric bypass, gastric band, and sleeve gastrectomy) were also identified. The primary outcome was in-hospital mortality. Secondary outcomes included cirrhosis, myocardial infarction, stroke, and renal failure. Poisson regression was used to derive adjusted incidence risk ratios for clinical outcomes in patients with prior bariatric surgery compared with those without bariatric surgery.
RESULTS: Among 45,462 patients with a discharge diagnosis of NAFLD and morbid obesity, 18,618 patients (41.0%) had prior bariatric surgery. There was a downward trend in bariatric surgery procedures (percent annual change of -5.94% from 2004 to 2012). In a multivariable analysis, prior bariatric surgery was associated with decreased inpatient mortality compared with no bariatric surgery (incidence risk ratios = .08; 95% confidence interval, .03-.20, P<.001). Prior bariatric surgery was also associated with decreased incidence risk ratios for cirrhosis, myocardial infarction, stroke, and renal failure (all P<.001).
CONCLUSIONS: Prior bariatric surgery is associated with decreased in-hospital morbidity and mortality in morbidly obese NAFLD patients. Despite this, the proportion of NAFLD patients with bariatric surgery has declined from 2004 to 2012.

PMID: 29055669 [PubMed - as supplied by publisher]

Effect of meal size and texture on gastric pouch emptying and glucagon-like peptide 1 after gastric bypass surgery.

Surg Obes Relat Dis. 2017 Sep 09;:

Authors: Stano S, Alam F, Wu L, Dutia R, Ng SN, Sala M, McGinty J, Laferrère B

Abstract
BACKGROUND: Roux-en-Y gastric bypass (RYGB) accelerates gastric pouch emptying, enhances postprandial glucagon-like peptide 1 (GLP-1) and insulin, and lowers glucose concentrations. To prevent discomfort and reactive hypoglycemia, it is recommended that post-RYGB patients eat small, frequent meals and avoid caloric drinks. However, the effect of meal size and texture on GLP-1 and metabolic response has not been studied.
OBJECTIVES: To demonstrate that frequent minimeals and solid meals (S) elicit less GLP-1 and insulin release and less reactive hypoglycemia and are better tolerated compared with a single isocaloric liquid meal (L).
SETTING: A university hospital.
METHODS: In this prospective study, 32 RYGB candidates were enrolled and randomized to L or S groups before gastric bypass. Each subject received an L or S 600-kcal single meal (SM) administered at hour 0 or three 200-kcal minimeals administered at hours 0, 2, and 4 on 2 separate days. Twenty-one patients were retested 1 year after RYGB. Blood and visual analogue scale measurements were collected up to 6 hours postprandially. Outcome measures included gastric pouch emptying, glucose, insulin, and GLP-1; hunger, fullness, and stomach discomfort were measured by visual analogue scale.
RESULTS: Twenty-one were patients retested after RYGB (L: n = 12; S: n = 9). Meal texture had a significant effect on peak GLP-1 (L-SM: 106.1 ± 67.2 versus S-SM: 45.3 ± 25.2 pM, P = .004), peak insulin, and postprandial glucose. Hypoglycemia was more frequent after the L-SM meal compared with the S-SM. Gastric pouch emptying was 2.4 times faster after RYGB but was not affected by texture.
CONCLUSIONS: Meal texture and size have significant impact on tolerance and metabolic response after RYGB.

PMID: 29055668 [PubMed - as supplied by publisher]