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Aim: Randomized trials reporting 5‐year outcomes have shown bariatric surgery to induce diabetes remission and improve cardiovascular risk. However, the longer‐term effects of surgery are uncertain, with only one randomized trial reporting 10‐year diabetes outcomes in people with obesity. We aimed to compare 10‐year diabetes outcomes of people who are overweight but not obese, randomly assigned to receive either multidisciplinary diabetes care, or multidisciplinary diabetes care combined with gastric band (GB) surgery. Methods: Between 2009 and 2011, 51 adults were randomized. After 5 years, they were discharged to receive community care and reassessed after 10 years. The primary outcome was diabetes remission, defined as glycated haemoglobin (HbA1c) <6.5% (48 mmol/mol) without glucose‐lowering medication. Results: Forty‐one participants (20 medical and 21 GB) completed the 10‐year assessment. The median (Q1, Q3) weight loss in the GB group was 9.8 (6.7, 16.3)% at 10 years compared with 5.6 (3.4, 7.6)% in the medical group (median difference 4.2%; p =.008). Diabetes remission occurred in five GB participants and no medical participants (relative risk 0.76, 95% CI: 0.55‐0.93, p =.048). GB participants used fewer glucose‐lowering medications at 10 years but HbA1c, fasting glucose, calculated cardiovascular risk, quality‐of‐life and incident diabetes complications did not differ significantly between the groups. Conclusion: When compared with medical care, GB surgery achieved greater weight loss and modestly increased the likelihood of diabetes remission. However, it did not improve HbA1c, cardiovascular risk or quality of life. [ABSTRACT FROM AUTHOR]

Background Adult non-alcoholic fatty liver disease ( NAFLD) involves lobular necroinflammatory activity and fibrosis is typically centrilobular, whereas paediatric NAFLD has predominantly portal fibrosis. The reasons for these differences are unclear. We aimed to determine (a) how centrilobular and portal fibrosis in children relate to histological parameters; and (b) whether atypical fibrosis patterns exist in adults that are unexplained by current fibrogenesis models. Methods Histological features of paediatric ( n = 38) and adult ( n = 56) NAFLD were assessed using conventional scoring systems. Keratin-7 immunostaining was used to assess hepatic progenitor cell numbers and the ductular reaction. Centrilobular and portal components of fibrosis were independently scored and fibrosis patterns were classified according to accepted types. Post-treatment (rosiglitazone/gastric banding) biopsies were also examined in adults. Results Twenty-six children (68.4%) had portal-predominant fibrosis, although the typical 'adult' pattern was seen in 11 (28.9%). Portal fibrosis was associated with a ductular reaction ( P = 0.021) and hepatic progenitor cell expansion ( P < 0.001), whereas centrilobular fibrosis was associated with lobular inflammation ( P = 0.026) and ballooning ( P = 0.001). Before intervention, six adults (10.7%) had atypical fibrosis including 3 (5.4%) with a previously unrecognized pattern of very fine, non-zonal sinusoidal fibrosis. Despite improvements in steatosis and inflammation, more patients developed this unusual pattern after intervention with most having had surgery (9 of 10 adults; P < 0.001). Conclusion Differing associations with portal and centrilobular fibrosis in children and atypical fibrosis patterns in adults suggest that multiple fibrogenic pathways exist in NAFLD. This has implications for therapy and understanding pathogenesis. [ABSTRACT FROM AUTHOR]

Objective: The molecular mechanisms underpinning the loss of skeletal muscle mass and strength associated with insulin resistance remain to be extensively investigated. There is mounting recognition that certain ligands of the transforming growth factor (TGF)-β family are upregulated in insulin resistant states, including obesity. This study analyses the expression of potent ligands of this family, TGF-β1 and myostatin (MSTN) and downstream components of the canonical TGF-β family signaling pathway (Smads) in skeletal muscle from lean and insulin resistant obese subjects. Design and Methods: Biopsies taken from the rectus abdominis muscle of lean ( n = 13) and obese subjects ( n = 20) were analyzed for the expression of TGF-β1 and MSTN as well as TGF-β signaling components, Smad2, 3, and 4, and transcription of the muscle regulatory factors (MRFs), MyoD and myogenin. Results: Increases in Smad2 and Smad3 phosphorylation, Smad4 and total Smad3 were observed to be coincident with altered transcription of MyoD and myogenin. TGF-β1 and MSTN protein levels were not significantly altered. Conclusion: Thus, increased Smad signaling is likely to account for, at least, a proportion of obesity and insulin resistance-related muscle atrophy through reduced MRF, particularly MyoD, transcription. The major regulatory ligand may not be MSTN and further members of the TGF-β1 superfamily should be considered. [ABSTRACT FROM AUTHOR]

The rising problem of obesity is causing major health problems, reduced quality of life and reduced life expectancy. It now generates approximately 10% of all health costs. The progression of the problem indicates preventive measures have been unsuccessful so far. Only bariatric surgical treatments have been able to achieve substantial and durable weight loss. Gastric banding and gastric bypass are used in more than 90% of bariatric operations. The proportion of each varies from greater than 95% bands in Australia, about 50/50 in Europe and USA and nearly 100% bypass in South America. The availability of follow up is a prime determinant of choice. Understanding the mechanisms of effect for the bariatric procedures is central to optimizing their effect. The traditional narrow concepts of restrictive (blocking the transit of food) and malabsorptive (preventing the absorption of food) should be discarded and the importance of induction of satiety, change of taste, diversion of chyme, neural and hormonal mediation and the effects of aversion need to be included. The primary mechanism of effect for gastric banding is the generation of a background of satiety and early post-prandial satiation via specifically structured vagal afferents at the level of the band. At five years after banding or bypass, there is typically a loss of 30-35 kg representing 50-60% of excess weight. This weight loss has been shown to be associated with major improvement or complete resolution of multiple common and serious health problems plus improvement in quality of life and in survival. Level 1 evidence supports the use of the gastric band over optimal lifestyle therapy. Randomized controlled trials has shown gastric banding to achieve better weight loss, health and quality of life than optimal lifestyle therapies for adults above a BMI of 30 and adolescents above a BMI of 35. In adults with mild to severe obesity and type 2 diabetes gastric banding leads to remission in three out of four individuals. Perioperative risk is significant with gastric bypass and late revisional procedures can be required after both procedures. Gastric banding is indicated in any adult who has a BMI over 30, has problems with their obesity and has made substantial effort to reduce their weight by lifestyle methods. Gastric bypass or biliopancreatic diversion should be considered in those with BMI greater than 35 if banding is contraindicated or has been unsuccessful. [ABSTRACT FROM AUTHOR]

High levels of readiness to change (RTC) are considered critical to the long-term success of weight management programs including bariatric surgery. However, there are no data to support this assertion. We hypothesize that RTC level will not influence weight outcomes following surgery. In 227 consecutive patients undergoing adjustable gastric banding surgery, we recorded reasons for seeking surgery, and RTC measured with the University of Rhode Island Change Assessment. Scores were blinded until study completion. The primary outcome measure was percentage of excess BMI loss at 2 years (%EBMIL-2); others included compliance and surgical complications. Of 227 subjects, 204 (90%) had weight measurement at 2 years. There was no significant correlation between RTC score and %EBMIL-2 (r = 0.047, P = 0.5). Using the median split for RTC score the lowest 102 subjects mean %EBMIL-2 was 52.9 ± 26.9% and the highest 52.2 ± 28.3%, P = 0.869. There was no weight loss difference between highest and lowest quartiles, or a nonlinear relationship between weight loss and RTC score. There was no significant relationship between RCT score and compliance, or likelihood of complications. Those motivated by appearance were more likely to be younger women who lost more weight at 2 years. Poor attendance at follow-up visits was associated with less weight loss, especially in men. Measures of RTC did not predict weight loss, compliance, or surgical complications. Caution is advised when using assessments of RTC to predict outcomes of bariatric surgery.Obesity (2009) 17 4, 698–705. doi:10.1038/oby.2008.609 [ABSTRACT FROM AUTHOR]

The article discusses a study which explored the relationship between symptoms of depression and raised C-reactive protein (CRP) levels after controlling for confounding factors. Particular focus is given on depression and obesity, considered as the common ailments of modern society. Beck Depression Inventory is used in measuring depression and confounding variables include age, gender and hip measures. Results showed that five factors are linked with raised CRP levels, including higher body mass index, female gender and estrogen therapy.

The article focuses on a study which assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric banding (LAGB) and explored the nature and extent of change in eating patterns, their clinical associates and impact on weight loss. The study noted that uncontrolled eating and grazing are the two high-risk eating patterns after surgery.

The article focuses on a study that investigated which core behavioral features of binge eating are most strongly related to psychological disturbance. The study revealed that the loss of control (LOC) over eating was most closely related to psychological markers of distress common in binge eating disorders (BED). The study suggested that persons who report subjective binge episodes or do not meet BED frequency criteria for objective binge episodes may still be at elevated risk of psychological disturbance and benefit from clinical intervention.

The article deals with a study which examined the clinical, anthropometric, biochemical and polysomnographic predictors of excessive daytime sleepiness as measured by the Epworth Sleepiness Scale (ESS) in obese patients. All patients in the study had preoperative clinical, hematologic, and biochemical measurements and completed multiple questionnaires. The study found no significant relationship between ESS score and any measure of diagnostic polysomnography factors, including total apnea hypopnea index.

The article presents the findings of a study on the changes in body composition with weight loss among obese subjects randomized to surgical and medical programs. The fat-free mass to fat mass loss ratios of surgical group was 1:5.5 while the medical group was 1:5.9. Favorable changes in total body nitrogen or potassium were noted in each group. The medical group lost less fat-free mass and skeletal muscle and had increased total body protein.

Focuses on the overview of obesity and bariatric surgery for obese people in New Zealand. Range of diseases caused by obesity; Usage of BioEnterics LAP-Band System designed for laparoscopic placement during surgical operations; Efficacy of bariatric surgery in controlling the comorbidities of obesity; Assurance of safety on the use of the surgery.

Summary Objective Severe obesity can be associated with evidence of androgen excess and insulin resistance, which are features of the metabolic and polycystic ovary syndromes (PCOS). In this study, we examined the association between clinical and biochemical features of these syndromes and assess changes with weight loss. Design A consecutive series of 107 severely obese premenopausal women presenting for obesity surgery. Measurements Pre-operative assessment included details of clinical comorbidity, anthropometric measures and biochemical measures, including fasting insulin, glucose, lipid profile and sex hormone analysis. Changes in these measures for 42 of 52 (81%) patients at 1 year post surgery are reported. Results Neck circumference and younger age were independent predictors of higher free androgen index (FAI) (combined r 2 = 0·36). If neck circumference is not included, then younger age, higher body mass index and raised fasting insulin levels were all independent predictors of FAI (r 2 = 0·29). Waist to hip ratio showed no predictive value (r = 0·14). Neck circumference was also a good clinical predictor of menstrual irregularity, hirsutism, infertility, insulin resistance and the PCOS. Neck circumference of less than 39, 39–42 and greater than 42 cm reflect a low, intermediate and high risk of the metabolic and PCOS syndromes in obese premenopausal women. For 42 patients who were followed for 1 year after surgery, the weight loss was associated with reduction of FAI, less insulin resistance and improved menstrual regularity and resolution of the PCOS in 11 of 12 cases. Conclusions Neck circumference is a good predictive measure of hyperinsulinaemia and raised androgens in obese premenopausal women. Weight loss following surgery improves ovarian function and vasculopathic risk. [ABSTRACT FROM AUTHOR]

Abstract Background Standard non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of colorectal cancer; however, their use as preventive agents is limited by their inherent toxicity. Drugs that selectively inhibit cyclooxygenase-2 (COX-2) may be useful in this setting as they are supposedly less toxic. No study has directly compared the ability of standard NSAIDs and selective COX-2 inhibitors to inhibit colorectal cancer at clinically relevant doses. Methods Aberrant crypt foci (ACF) were induced in Sprague–Dawley rats by using 1,2-dimethylhydrazine (DMH). Test agents or vehicle were then administered for 3 weeks, twice daily through orogastric gavage. At the end of this period, the number and multiplicity of ACF were determined. The agents tested at equivalent anti-inflammatory doses were: sulindac and indomethacin (standard NSAIDs), meloxicam (selective COX-2 inhibitor), celecoxib (specific COX-2 inhibitor) and sulindac sulfone (no known COX activity). Acute gastrotoxicity of NSAID in rats was compared by using quantitative histology. Results All test agents reduced the number of ACF. There was a 42% reduction with indomethacin, 46% with sulindac, 46% with meloxicam, 22% with celecoxib and 36% with sulindac sulfone. Only the COX-2 inhibitors caused no significant gastrotoxicity in rats. Conclusions Cyclooxygenase-2 inhibitors are potentially ideal chemopreventive agents as they inhibit ACF and are not gastrotoxic. [ABSTRACT FROM AUTHOR]

The author reflects on the current ethics review process in Australia in 2016. Topics discussed include multisite quality and safety initiatives, national Bariatric Surgery Registry (BSR), and clinical quality registries (CQRs). Also being discussed is the human research ethics committee (HREC) of the nation.

Reports on the use of laparoscopically placed, adjustable gastric band (LAGB) for the management of obesity. Safety of the procedure; Perioperative problems including the slippage of the band in 12 percent of patients and 11 percent which required repair of tubing or access port.

Abstract Background Standard non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of colorectal cancer; however, their use as preventive agents is limited by their inherent toxicity. Drugs that selectively inhibit cyclooxygenase-2 (COX-2) may be useful in this setting as they are supposedly less toxic. No study has directly compared the ability of standard NSAIDs and selective COX-2 inhibitors to inhibit colorectal cancer at clinically relevant doses. Methods Aberrant crypt foci (ACF) were induced in Sprague–Dawley rats by using 1,2-dimethylhydrazine (DMH). Test agents or vehicle were then administered for 3 weeks, twice daily through orogastric gavage. At the end of this period, the number and multiplicity of ACF were determined. The agents tested at equivalent anti-inflammatory doses were: sulindac and indomethacin (standard NSAIDs), meloxicam (selective COX-2 inhibitor), celecoxib (specific COX-2 inhibitor) and sulindac sulfone (no known COX activity). Acute gastrotoxicity of NSAID in rats was compared by using quantitative histology. Results All test agents reduced the number of ACF. There was a 42% reduction with indomethacin, 46% with sulindac, 46% with meloxicam, 22% with celecoxib and 36% with sulindac sulfone. Only the COX-2 inhibitors caused no significant gastrotoxicity in rats. Conclusions Cyclooxygenase-2 inhibitors are potentially ideal chemopreventive agents as they inhibit ACF and are not gastrotoxic. [ABSTRACT FROM AUTHOR]