International journal of obesity : journal of the International Association for the Study of Obesity
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Randomized Controlled Trial Comparative Study
Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: effects of bariatric surgery vs standard medical therapy.
Roux-en-Y gastric bypass (RYGB) produces more durable glycemic control than sleeve gastrectomy (SG) or intensive medical therapy (IMT). However, the contribution of acylated ghrelin (AG), a gluco-regulatory/appetite hormone, to improve glucose metabolism and body composition in patients with type 2 diabetes (T2D) following RYGB is unknown. ⋯ Enhanced AG suppression persists for up to 2 years after RYGB, and this effect is associated with decreased android obesity and improved insulin secretion. Together, these findings suggest that AG suppression is partly responsible for the improved glucose control after RYGB surgery.
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Review Comparative Study
Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?
The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. ⋯ Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals.
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Randomized Controlled Trial
High-intensity intermittent exercise attenuates ad-libitum energy intake.
To examine the acute effects of high-intensity intermittent exercise (HIIE) on energy intake, perceptions of appetite and appetite-related hormones in sedentary, overweight men. ⋯ High-intensity intermittent exercise suppresses subsequent ad-libitum energy intake in overweight inactive men. This format of exercise was found to be well tolerated in an overweight population.
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Randomized Controlled Trial
Sleep restriction increases the neuronal response to unhealthy food in normal-weight individuals.
Sleep restriction alters responses to food. However, the underlying neural mechanisms for this effect are not well understood. ⋯ This inverse relationship between insula activity and food intake and enhanced activation in brain reward and food-sensitive centers in response to unhealthy foods provides a model of neuronal mechanisms relating short sleep duration to obesity.
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Comparative Study
Ultrasound-guided peripheral regional anaesthesia: a feasibility study in obese versus normal-weight women.
In particular, obese patients may profit from peripheral regional anaesthesia due to avoidance of general anaesthesia. Currently, ultrasound (US) guidance is described as the golden standard in regional anaesthesia, but no studies have so far evaluated the US behaviour of peripheral nerve structures in obese versus normal-weight patients. To be able to perform such studies, it is necessary to develop new and more objective methods to quantify nerve visibility by US. We therefore designed a prospective, observational, comparative and blinded study to investigate the visibility of peripheral nerves in obese versus normal-weight patients by using a novel method based on histogram grey-scale values. ⋯ The novel technique of comparing histogram grey-scale values to determine the visibility of the peripheral nerve in different patient categories was found feasible. Median nerves are appropriately visible by US in both normal and obese subjects, whereas sciatic nerves are less visible in obese as compared with normal-weight women. Our results serve as the rationale behind difficulties in peripheral regional anaesthesia in obese patients.