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Changes of food preference toward foods with low caloric density have been demonstrated after bariatric surgery and may contribute to sustained body weight loss. It has been hypothesized that olfactory perception as an integral part of food selection might be altered after bariatric surgery. Sniffin’ Sticks® were used to investigate the olfactory perception of morbidly obese patients undergoing either Roux-en-Y gastric bypass (RYGB, n = 15) or sleeve gastrectomy (SG, n = 15) before 1, 6, 12, and 24 weeks after surgery. Obese patients without surgical intervention served as controls (CG, n = 12). Results are presented using the testing odor threshold, discrimination, and identification score (TDI; higher scores indicate better olfactory perception). Body weight loss was recorded. Initial BMI of the SG group (56.04 ± 7.096 kg m−2) was higher compared to the BMI of the RYGB (48.71 ± 6.49 kg m−2) and CG (50.35 ± 6.78 kg m−2); p = 0.011. Body weight loss among the surgical groups was not different (p = 0.011) while controls did not lose weight. Mean baseline TDI scores were significantly lower in the SG group 27.1 ± 3.9 vs. 32.6 ± 3.6 (RYGB) and 32.1 ± 5.3 (CG), respectively, whereas there were after 24 weeks no changes in RYGB and CG patients; the TDI score in the SG group increased significantly to 31.1 ± 3.5 (p

Purpose of review Duodenal-jejunal bypass liners (DJBLs) are a novel therapy with potential treating a range of metabolic diseases. This review discusses the weight loss and glycaemic improvements observed following the use of the DJBL. Recent findings We summarize the evidence for the clinical application of DJBL to date. Within this, we outline the evidence available on the mechanisms of the observed effects. Summary Based on the most recent trials, we cannot fully mimic the clinical or physiological effects of bariatric surgery with this device, but we are getting closer.

Editeur : Future Medicine ; ISSN: 2044-9038 ; ESSN: 2044-9046; Roux-en-Y gastric bypass is one of the most effective treatments for morbid obesity as it results in long-term weight loss and significant remission of obesity-related comorbidities. Although it is successful in causing weight loss, the underlying mechanisms are not completely understood. A significant decrease in calorie intake related to a shift in food preferences towards lower-calorie-dense foods has been observed after the surgery. This modification in ingestive behavior occurs through changes in the sensory and reward domain of taste. Potential mediators of these taste modifications are the exaggerated levels of gut hormones or altered gut nutrient sensing. Understanding the molecular mechanisms involved in the Roux-en-Y gastric bypass-induced taste/food preference modifications would be crucialfor the development of 'knifeless' treatments. Obesity is a leading cause of death [101]. The comorbidities of obesity include cardiovascular disease, Type 2 diabetes mellitus, cancer, nonalcoholic fatty liver disease, arthritis and infertility, among others [1-6]. Roux-en-Y gastric bypass (RYGB) is one of the most effective treatments for morbid obesity [7], resulting in long-term weight loss maintenance, significant remission of obesity-related comorbidities [8-10] and decreased overall mortality [10]. RYGB results in five main anatomical changes: Reduction of the stomachize (15-30 ml), leaving a large stoma to allow food rapid passage between the esophagus and midgut; Food bypassing the stomach and the first part of the proximal small bowel; Altered bile flow through the same proximal small bowel; Anastomosis of the midgut to the stomach, allowing earlier contact of food with the distal small bowel; Disruption of vagal fibers across the stomach, while leaving the main branches of the vagus intact. Although the RYGB procedure is successful in causing weight loss, the relevant mechanisms are not completely understood. Even though the procedure was originally designed to cause restriction, the flow of food is accelerated from the esophagus to the midgut through the large gastro-jejunostomy [11]. Calorie malabsorption does not play a physiologically significant role as fecal fat and calorie loss is minimal, while many patients actually report constipation after RYGB [11,12]. Significant increase in energy expenditure have been reported after RYGB in animals [6,13-15] and in one study in humans [16] but this change may be triggered by changes in body composition. However, one study has shown that diet-induced thermogenesis of multiple meals results in an overall increase in 24-h energy expenditure compared with a group of patients that lost the same amount of weight with a vertical-banded gastroplasty [16]. Significant decrease in calorie intake has also been reported after the surgery in humans [17,18]. The decrease in total calorie intake is related to reductions in hunger, increases in satiety, changes in meal patterns, in addition to a shift in food preferences towards lower-calorie-dense foods [18-22]. Here, we review the changes in eating behavior after RYGB, and focus on potential mechanisms underlying this shift, including changes in quantitative taste identification and taste ingestive motivation (reward). Finally, we explore potential mediators underlying this mechanism, such as gut hormones or nutrient sensing.

The long-term effects of lifestyle changes, diet and medical therapy on obesity are limited. Bariatric surgery is the most effective long-term treatment with the greatest chances for amelioration of obesity-associated complications, including type 2 diabetes mellitus (T2DM). There is increasing evidence in the literature that bariatric operations have a profound effect on human physiology, by reducing hunger, increasing satiety, paradoxically increasing energy expenditure, and even promoting healthy food preferences. Some of these operations improve glucose homeostasis in patients with T2DM independently of weight loss. Changes in the gut hormone levels of glucagon-like peptide 1, peptide YY and ghrelin have been proposed as some of the mediators implicated in changing physiology. The aim of this review is to critically explore the current knowledge on the putative mechanisms of the change in weight and improvement in T2DM glycaemic control after the most commonly performed bariatric operations.

Stroke is a worldwide major health issue. As some of the risk factors are modifiable, it is of high importance to understand how we can minimize the risk for stroke. Multifactorial interventions should be provided to patients in the frame of primary and secondary prevention. Obesity is a well-established modifiable factor as well as the dietary pattern that mostly depends on the social environment, the lifestyle and the habits of each individual. So, dietary changes should be part of the holistic approach which includes improvements in the regulation of hypertension, hyperlipidaemia and hyperglycaemia. In the present review, we try to provide a global approach on how diet can influence the risk of stroke and especially the nutritional influence on lipid profile and vessel disease and the role of dietary modification in the secondary stroke prevention. The importance of salt restriction, DASH and Mediterranean diet low in saturated and high in polyunsaturated fats, and the management of obesity seem to be the most important dietary priorities.

Stroke represents one of the most important menaces to public health. A number of modifiable and non-modifiable risk factors have been identified and studied in detail; among those, obesity, the new world epidemic, seems to be one of the most important in terms of prevention. The discovery of the secretory role of the adipose tissue and of adipokines has opened new fields of research. A number of studies have been published on their relation to cardiovascular risk and the potential of using them as prevention markers. In the present review the physiology of leptin, adiponectin and resistin is described and their role in the pathogenesis of stroke is examined.

Patients show an elevated postprandial satiety gut hormone release after Roux-en-Y Gastric bypass (gastric bypass). The altered gut hormone response appears to have a prominent role in the reduction of appetite and body weight (BW) after gastric bypass. Patients with insufficient BW loss after gastric bypass have an attenuated postprandial gut hormone response in comparison with patients who lost an adequate amount of BW. The effects of additional gut hormone administration after gastric bypass are unknown.The effects of peripheral administration of peptide YY3-36 (PYY3-36; 300 nmol kg(-1)), glucagon-like peptide-1 (GLP-1) analogue Exendin-4 (20 nmol kg(-1)) and somatostatin analogue octreotide (10 μg kg(-1)) on feeding and BW were evaluated in rats after gastric bypass.Gastric bypass rats weighed (P0.01) and ate less on postoperative day 5 (P0.001) and thereafter, whereas postprandial plasma PYY and GLP-1 levels were higher compared with sham-operated controls (P0.001). Administration of both PYY3-36 and Exendin-4 led to a further decrease in food intake in bypass rats compared with saline treatment (P=0.02 and P0.0001, respectively). Similar reduction in food intake was observed in sham rats (P=0.02 and P0.001, respectively). Exendin-4 treatment resulted in a significant BW loss in bypass (P=0.03) and sham rats (P=0.04). Subsequent treatment with octreotide led to an increase in food intake in bypass (P=0.007), but not in sham rats (P=0.87).Peripheral administration of PYY3-36 and Exendin-4 reduces short-term food intake, whereas octreotide increases short-term food intake in rats after gastric bypass. The endogenous gut hormone response after gastric bypass can thus potentially be further enhanced by additional exogenous therapy with pharmacological doses of gut hormones in patients with insufficient weight loss or weight regain after surgery.

Roux-en-Y gastric bypass (gastric bypass) patients reportedly have changes in perception and consumption of sweet-tasting foods. This study aimed to further investigate alterations in sweet food intake in rats and sucrose detection in humans after gastric bypass. Wistar rats were randomized to gastric bypass or sham-operations and preference for sucrose (sweet), sodium chloride (salty), citric acid (sour) and quinine hydrochloride (bitter) was assessed with standard two-bottle intake tests (vs. water). Intestinal T1R2 and T1R3 expression and plasma levels of glucagon-like-peptide 1 (GLP-1) and peptide YY (PYY) were measured. Furthermore, obese patients and normal weight controls were tested for sucrose taste detection thresholds pre- and postoperatively. Visual analogue scales measuring hedonic perception were used to determine the sucrose concentration considered by patients and controls as "just about right" pre- and postoperatively. Gastric bypass reduced the sucrose intake relative to water in rats (p

This is an introduction to the Gut tutorial “Cholangiocarcinoma and its management” hosted on BMJ Learning—the best available learning website for medical professionals from the BMJ Group. Cholangiocarcinoma originates in the biliary epithelium. Mortality rates from intrahepatic cholangiocarcinoma appear to have risen steadily over the past 30 years and it now causes more deaths than hepatocellular carcinoma annually in England and Wales. Primary sclerosing cholangitis is the commonest known predisposing factor for …

The escalating twin pandemics of obesity and type 2 diabetes mellitus (T2DM) present a major global public health burden. Bariatric surgery is an effective treatment for obese patients with T2DM, as it not only causes weight loss, but also improves metabolic risk factors including glycemia, hypertension and dyslipidemia. Although several studies have shown impressive remission rates of T2DM following bariatric surgery, these studies have used different definitions of remission. In an attempt to solve the problem of inconsistent definitions, the American Diabetes Association and International Diabetes Federation, two large diabetes organizations, have developed standardized criteria for T2DM remission. These criteria are comprised of clinical parameters including glucose, lipid and blood pressure control and medication usage. Studies using these criteria have reported lower rates of remission than those previously reported using nonstandardized definitions. This review describes the existing literature on remission of T2DM following bariatric surgery, and emphasizes the importance of using the standardized definitions established in order to improve remission rates and thus reduce the incidence of the macrovascular and microvascular complications of T2DM.

A 26-year-old nulliparous white woman presented to the emergency department in May, 2009, with pelvic pain, abdominal distension, and vomiting. Pelvic ultrasonography showed enlarged ovaries containing multiple cysts. She was diagnosed with ovarian hyperstimulation syndrome and recovered quickly with rehydration, antiemetics, and analgesia. Because she was not taking fertility treatment or other drugs that might have caused the ovarian hyperstimulation she was referred to the endocrinology clinic. She reported a 1 year history of episodes of pelvic pain, fl ushing, and vomiting, and amenorrhoea after stopping the oral contraceptive 1 year before. She had no medical history and family history was incomplete because she had been adopted. Examination was normal. Investigations showed a consistently raised plasma follicle stimulating hormone (FSH) (checked three times: 32 IU/L, 26 IU/L, and 32 IU/L; follicular phase normal range 2·5–10·2 IU/L), oestradiol (>3000 pmol/L; follicular phase normal range 72–530 pmol/L), and suppressed luteinising hormone (LH) (

Introduction Bariatric surgery is the best available intervention for weight reduction in morbidly obese patients. Although outcomes are not quite comparable to surgery, an endoscopically implanted device called the Endobarrier (Endoscopic duodenojejunal bypass liner) can lead to significant weight loss and improvement of glycaemic control when compared to either dietary caloric restriction or sham procedures. Surgery may be complicated in high-risk groups like patients with poorly controlled diabetes, multiple co-morbidities or a body mass index (BMI) >50 kg/m 2 . We aimed to analyse the effect of an Endobarrier as an effective risk reducing tool in such high-risk patients prior to surgery. Methods All patients who underwent an Endobarrier insertion between January and October, 2013 were analysed. This included patients with poorly controlled diabetes, patients with a BMI >50 kg/m 2 or those who were at a high risk of peri-operative complications based on obesity surgery mortality risk score (OSMRS: normal score 1–5). Patient outcomes which included length of stay, complications, weight loss, and impact on glycaemic control were prospectively observed. Results The Endobarrier was inserted in 18 patients (13 M) with median age of 53 years (range 32–68), median weight 159 kg (range 102–237), median BMI 54 kg/m 2 (range 37–70.4) and a median OSMRS of 4 (mortality risk=2.4%). Device insertion was successful in all patients with no early removals required to date. The median length of stay was 1 day (range 1–5). There were no major complications apart from a single case of upper GI bleed 3 months later, which settled conservatively. Median weight over 3–6 months was now reduced to 147 kg (range 77–192) with median weight loss of 16.2 kg (6.9–41 kg) and 20.4 kg (9–47 kg) at 3 and 6 months respectively. Post-procedure, diabetic medication were either decreased (n = 9/11) or no longer required (n = 2/11) in diabetic patients and at 3 months HbA1C levels improved significantly from a median of 8.7 to 6.7% (p = 0.01). Conclusion Endobarrier may be used as a stepping stone to surgery in high risk patients by safely and effectively reducing weight and improving glycaemic control. Disclosure of Interest None Declared.

The effects of bariatric surgery on microvascular complications remain underexplored despite more than 40 years of surgery on patients with type 2 diabetes. The literature has focused predominantly on glycemic control and very little on diabetes-related complications, which confer high rates of morbidity and mortality. Our aim was to assess whether the gastric bypass, sleeve gastrectomy, and gastric banding procedures are safe for the retinal and renal complications of type 2 diabetes, especially as they lead to rapid improvements in glycemia, which may paradoxically cause or exacerbate microvascular complications. Prospectively collected retinal photographs (two-field) and urine albumin creatinine ratios (ACRs) were analyzed retrospectively in 84 consecutive patients with type 2 diabetes before and 12–18 months after surgery. The results were confirmed by an independent ophthalmologist who was blinded to clinical information. Improvement or deterioration was defined as a decrease or increase of at least two …

BackgroundThe consumption of high fat and sugar diets is decreased after gastric bypass surgery (GB). The mechanisms remain unclear, with tests of motivated behavior toward fat and sugar producing conflicting results in a rat model. These discrepancies may be due to differences in presurgical maintenance diets. The authors used their GB rat model to determine whether the fat content of preoperative maintenance diets affects weight loss, calorie intake, and macronutrient selection after surgery.MethodsMale Wistar rats were either low-fat diet fed (LFDF) with normal chow or high-fat diet fed (HFDF) before randomization to GB or sham surgery. In food preference test 1, the animals were offered the choice of a vegetable drink (V8) or a high-calorie liquid (Ensure), and in food preference test 2, they could choose normal chow or a solid high-fat diet.ResultsThe GB groups did not differ significantly in terms of body weight loss or caloric intake. In food preference test 1, both groups responded similarly by reducing their preference for Ensure and increasing their preference for V8. In food preference test 2, the HFDF-GB rats reduced their preference for a solid high-fat diet gradually compared with the immediate reduction observed in the LFDF-GB rats.ConclusionThe consumption of presurgical maintenance diets with different fat contents did not affect postoperative weight loss outcomes. Both the LFDF-GB and HFDF-GB rats exhibited behaviors consistent with the possible expression of a conditioned taste aversion to a high-fat stimulus. These results suggest that for some physiologic parameters, low-fat-induced obesity models can be used for the study of changes after GB and have relevance to many obese humans who consume high-calorie but low-fat diets.