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Background: There is an increased prevalence of subclinical hypothyroidism (SCH) in patients with obesity. It is unclear if this biochemical abnormality may be a secondary phenomenon of obesity or a real hypothyroid state. Methods: A retrospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between October 2007 and November 2012 was performed. Weight loss, body mass index (BMI) and excess weight loss, baseline glucose, lipid profiles, and TSH levels were obtained before operation and postoperative determinations at 3, 6, and 12 months after surgery. Results: Sixty patients were included. Prevalence of subclinical hypothyroidism was 16.7 % preoperatively, 10 % at 3 months, 3.3 % at 6 months, and 1.7 % at 12 months. A significant correlation could be established between TSH decrease and weight loss at 12 months (Pearson 0.603; p = 0.007). TSH decrease showed a significant correlation with glucose and glycated hemoglobin decrease from 6th month onwards. Referring to lipid profile, an association of TSH decrease with total cholesterol, LDL cholesterol, or HDL cholesterol could not be determined. A significant association between TSH decrease and triglycerides and cardiovascular risk index triglycerides/HDL cholesterol reductions could also be established 12 months after surgery. Conclusions: SCH is usually corrected after bariatric surgery, while there are no significant changes in total or LDL cholesterol. This suggests that, in morbidly obese subjects, SCH is, in most patients, just a consequence of the abnormal fat accumulation and not a real hypothyroid state. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) has shown to be effective in serum triglycerides reduction and HDL cholesterol increase, but with little effect on total cholesterol and LDL cholesterol. Physical activity is recognized as an effective non-pharmacological intervention to reduce body fat mass and hypercholesterolemia. Methods: A prospective observational study of all the patients undergoing LSG as bariatric technique between 2007 and 2012 was performed. All patients completed the Spanish Version of the Modifiable Physical Activity Questionnaire at two time points: baseline (pre-intervention) and 1 year after surgery, both in face-to-face interviews. Lipid profiles were monitored at the same time points. Results: A total of 50 patients were included in the study, 44 females (88 %) and six males (12 %) with a mean age of 42.7 ± 10.3 years. Comorbidities included dyslipidemia in 50 % (40 % hypercholesterolemia and 10 % hypertriglyceridemia). Preoperatively, four patients (8 %) reported moderately active physical activity and one patient (2 %) active physical exercise. The rest of the patients were sedentary. One year after surgery, 30 patients (60 %) performed any kind of active physical activity, while the rest were sedentary. Lipid profile 12 months after surgery showed significantly lower total cholesterol levels in the active group (182.8 mg/dl vs 220 mg/dl in the sedentary group; p = 0.003). LDL cholesterol levels were also lower in the active group (103.2 vs 133 mg/dl in the sedentary group; p = 0.015). Conclusion: The performance of routine moderate physical activity in addition to LSG achieves a significant improvement in all parameters of the lipid profile. [ABSTRACT FROM AUTHOR]

Background: A continuous feeling of hunger is the major cause of dietary treatment failure in obese patients, making dietary leave. The aim of this study was to evaluate the effect of percutaneous electrical neurostimulation (PENS) of T6 dermatome on appetite, weight loss and dietary compliance. Methods: A prospective, randomized study was performed. The patients were randomized into two groups: those undergoing PENS of dermatome T6 associated with the implementation of a 1,200-Kcal diet (group 1) and those following only a 1,200-Kcal diet (group 2). A third group of obese patients (BMI > 30 Kg/m) with fecal incontinence undergoing PENS of posterior tibial nerve was evaluated. Results: One hundred five patients were included in the study, 45 in groups 1 and 2, and 15 in group 3. The median pain perception after PENS of dermatome T6 was 1. There were no complications. Only the patients in group 1 experienced significant reductions of weight, BMI, and appetite. All of the patients in group 1 experienced appetite reduction compared to 20 % of the patients in group 2 and 30 % of the patients in group 3 ( p < 0.001). Weight loss ≥5 Kg was achieved in 76.7 % of the patients in group 1, 6.7 % of the patients in group 2, and 0 % of the patients in group 3 ( p < 0.001). Dietary compliance after 12 weeks was 93.3 % in group 1, 56.7 % in group 2, and 50 % in group 3( p = 0.006). Conclusions: PENS of dermatome T6 was associated with appetite reduction in all of the patients and, along with a proper diet, achieved a significantly greater weight reduction than diet alone. [ABSTRACT FROM AUTHOR]

Background: C-Reactive protein (CRP) has been associated with the macro- and microvascular effects of hypertension and diabetes mellitus. Referring to serum cortisol, it has been proposed to contribute to the pathogenesis of metabolic syndrome, and it has been demonstrated that weight loss normalizes cortisol levels and improves insulin resistance. The aims of this study were to analyze CRP and cortisol levels pre- and postoperatively in morbidly obese patients undergoing a laparoscopic sleeve gastrectomy and to correlate them with weight loss and parameters associated with cardiovascular risk. Methods: A prospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between October 2007 and May 2011 was performed. Results: A total of 40 patients were included in the study. CRP levels decreased significantly 12 months after surgery (median reduction of 8.9 mg/l; p = 0.001). Serum cortisol levels decreased significantly 6 months after surgery (median reduction of 34.9 μg/dl; p = 0.001). CRP values reached the normal range (<5 mg/l) 1 year after surgery. Referring to cortisol, a significant association was observed with the cardiovascular risk predictor (triglyceride/high-density lipoprotein cholesterol ratio) from the 6th month after surgery onward (Pearson correlation coefficient, 0.559; p = 0.008). Conclusion: CRP levels are increased preoperatively and in the postoperative course up to 1 year after surgery. Serum cortisol levels remain elevated until the 6th month after surgery. From this moment onward, serum cortisol is associated with the cardiovascular risk predictor reflecting the cardiovascular risk decreasement during the weight loss. [ABSTRACT FROM AUTHOR]

Background: Despite routine supplementation of vitamins and minerals after bariatric surgery, an important number of patients suffer from deficiencies. Little is still known about the novel restrictive procedure, sleeve gastrectomy. Methods: A retrospective study of 30 morbidly obese patients undergoing a laparoscopic sleeve gastrectomy, between May 2008 and September 2010, was performed. Baseline albumin, ferritin, iron, zinc, calcium, vitamin D, parathormone (PTH), vitamin B12, and folic acid were obtained before operation and postoperative determinations 1, 3, 6, 9, 12, 18, and 24 months after surgery. Results: Before surgery, 96.7% of the patients presented vitamin D deficiency, 20% had elevated PTH, 3.3% hypoalbuminemia, and 3.3% folic acid deficiency. One year after surgery, only one patient (3.3%) presented vitamin D deficiency and had elevated PTH. The rest of parameters were within normal range. The second year after surgery, the results remain similar. A significant difference was obtained when comparing preoperative vitamin D values and postoperative determinations 12 months after surgery (increasement of 51.9 ng/dl, 95% confidence interval (CI) (41.8-61.3); p < 0.001). A significant difference was determined when comparing preoperative PTH values and postoperative determinations 3 months after surgery (decreasement of 16.6 pg/ml, 95% CI (2.6-30.6); p = 0.03). A significant inverse correlation was observed between weight loss and vitamin D increasement at the third month after surgery (Pearson correlation coefficient −0.948; p = 0.033). Conclusions: Postoperative values of vitamin D show a progressive increasement, while PTH ones present a significant reduction, without any impact on serum calcium levels. We have demonstrated an inverse correlation between weight loss and vitamin D increasement at the third month after surgery. [ABSTRACT FROM AUTHOR]