Browsing by Subject "Bariatric Surgery"
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Item Open Access A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life.(Clinical obesity, 2017-10) Kolotkin, RL; Andersen, JRThis is the first systematic review of reviews to assess the effect of obesity and weight loss on health-related quality of life (HRQoL). We identified 12 meta-analyses/systematic reviews published between January 2001 and July 2016. They addressed the following themes: (i) the relationship between weight/body mass index and HRQoL (baseline/pre-intervention; n = 2). (ii) HRQoL after weight loss (varied interventions and/or study design; n = 2). (iii) HRQoL after weight loss (randomized controlled trials only; n = 2). (iv) HRQoL after bariatric surgery (n = 6). We found that in all populations, obesity was associated with significantly lower generic and obesity-specific HRQoL. The relationship between weight loss and improved HRQoL was consistently demonstrated after bariatric surgery, perhaps due to a greater than average weight loss compared with other treatments. Improved HRQoL was evident after non-surgical weight loss, but was not consistently demonstrated, even in randomized controlled trials. This inconsistency may be attributed to variation in quality of reporting, assessment measures, study populations and weight-loss interventions. We recommend longer-term studies, using both generic and obesity-specific measures, which go beyond HRQoL in isolation to exploring mediators of HRQoL changes and interactions with other variables, such as comorbidities, fitness level and body image.Item Open Access Asthma medication usage is significantly reduced following bariatric surgery.(Surgical endoscopy, 2019-06) Guerron, Alfredo D; Ortega, Camila B; Lee, Hui-Jie; Davalos, Gerardo; Ingram, Jennifer; Portenier, DanaIntroduction
Asthma is an important healthcare problem affecting millions in the United States. Additionally, a large proportion of patients with asthma suffer from obesity. These patients exhibit poor asthma control and reduced therapy response, increasing utilization of healthcare resources. Pulmonary symptoms improve after bariatric surgery (BS), and we hypothesized that asthma medication usage would decrease following BS.Methods
A retrospective data analysis was performed in adult patients from a single institution's database. Patients with obesity using at least one asthma medication pre-operatively who underwent BS were studied for up to 3-years post-operation. Poisson generalized linear mixed models for repeated measures were used to evaluate the effects of time and procedure type on the number of asthma medication.Results
Bariatric patients with at least one prescribed asthma medication (mean 1.4 ± 0.6) were included (n = 751). The mean age at time of operation was 46.8 ± 11.6 years, mean weight was 295.9 ± 57 lbs, and mean body mass index (BMI) was 49 ± 8.2 kg/m2; 87.7% were female, 33.4% had diabetes, 44.2% used gastroesophageal reflux disease (GERD) medication, and 64.4% used hypertension medication. The most common procedure was Roux-en-Y gastric bypass (79%), followed by sleeve gastrectomy (10.7%), adjustable gastric banding (8.1%), and duodenal switch (2.3%). The mean number of prescribed asthma medications among all procedures decreased by 27% at 30 days post-operation (p < 0.0001), 37% at 6 months (p < 0.0001), 44% at 1 year (p < 0.0001), and 46% at 3 years (p < 0.0001) after adjusting for risk factors. No significant differences in medication use over time between procedure types were observed. In the adjusted analysis, the mean number of asthma medications was 12% higher in patients using at least one GERD medication (p = 0.015) and 8% higher with 10-unit increase in pre-operative BMI (p = 0.006).Conclusion
BS significantly decreases asthma medication use starting 30 days post-operation with a sustained reduction for up to 3 years.Item Embargo Navigating inflammatory response and microbiome signatures: three case studies(2024) Kim, Yeon JiThe immune system constantly distinguishes the variegated microbiota harbored by the host as either commensals or pathogens. Inflammation is the body’s natural response to pathogens and injury to restore homeostasis. Yet today, diseases associated with chronic systematic inflammation that occurs in the absence of an infection are responsible for the majority of global deaths. Simultaneously, advanced sequencing technologies have underscored the systematic effects that the gut microbiome and its metabolites have on various organs and inflammatory diseases. Of particular interest are short chain fatty acids (SCFAs), which are bacterial metabolites with potent immunomodulatory properties. SCFAs can have systematic effects throughout the body by modulating the immune system and circulating to other organs. For instance, the interaction between the gut and lung microbiomes, and their metabolites such as SCFAs, is termed the gut-lung microbiome axis. Despite the booming interest in the microbiome field, the ability for precision microbiome engineering to improve human health is limited in part due to the complexity of interconnected systems. Many environmental factors and lifestyle choices influence both the microbiome and inflammation, and the bidirectional interactions between the microbes and the immune system are still being uncovered.In this dissertation, the overarching hypothesis that there exist microbial taxa whose prevalence is correlated with inflammatory markers was tested in three specific case studies: 1) obese asthma, 2) occupational exposure to hog farm dust, and 3) hematopoietic stem cell transplant (HSCT). Obesity and asthma are both inflammatory diseases that often co-occur: almost 40% of people with asthma also have concurrent obesity in the United States (US). However, the additive effects of obesity and asthma on the gut and lung microbiomes are understudied. Interestingly, individuals that received bariatric surgery report reduced asthma symptoms and for some, complete cessation of asthma medication. Bariatric surgery also alters the gut microbiome community and restores circulating levels of glucagon-like peptide-1 (GLP-1), a satiety and insulin-inducing hormone. Recent studies also suggest that GLP-1 is a gut microbiome regulator and may confer protection against lung inflammation. Thus, the microbiome of human bronchoalveolar lavage fluid (BALF) from individuals with different obesity, asthma, and bariatric surgery status was characterized. Furthermore, a murine loss-of-function and intervention model was utilized to untangle the role of GLP-1 receptor signaling in modulating the gut and lung microbiomes and host respiratory and inflammatory health following bariatric surgery. Results indicated that the percentage of eosinophils in BALF was negatively correlated with body mass index and positively correlated with the prevalence of Capnocytophaga and Flavobacteriaceae in human BALF, suggesting that these taxa may be of interest in type 2-high asthma. While GLP-1 receptor signaling deficiency did not lead to significantly altered host respiratory or inflammatory metrics herein, mice fed high fat diet had lower fecal prevalence of SCFA-associated taxa Bifidobacterium, Lachnospiraceae UCG-001, and Parasutterella. The prevalence of each taxon was positively correlated with serum GLP-1 levels and negatively with serum leptin levels, body weight, and glucose intolerance. The second case study focuses on dust inside hog concentrated animal feeding operations (CAFOs), as workers are exposed to this dust that induces respiratory inflammation in vitro and in vivo. North Carolina raises 10 million hogs annually, mostly in CAFOs, leading to an extremely high concentration of CAFOs in southeastern North Carolina counties. Despite studies from other continents discovering over 150 antibiotic resistant genes in hog farm dust, its equivalent in the United States remains mostly uncharacterized. Furthermore, studies that analyze the inflammatory and microbiome effects of hog farm dust exposure in tandem are scarce. As such, shotgun metagenomic sequencing was applied to two hog CAFO dust samples from North Carolina to characterize its microbiome and resistome. In addition, C57BL/6 mice were exposed to hog dust extract or saline via intranasal instillation for three weeks. Contrary to previous studies, exposure to hog dust extract did not lead to significant changes in host respiratory, inflammatory, and gut microbiome changes herein, and minimal effects on lung microbiome composition were reported. Potential confounding variables included cage effects and the dust originating from a relatively small farm. Although shotgun sequencing analyses were hindered by low sequencing depth, even at a shallow sequencing depth 23 antibiotic resistance genes and a total of 686 species were identified between the two dust samples. Lastly, the fecal microbiome of patients undergoing HSCT were analyzed in two intervention studies: pre-transplant high intensity interval training (HIIT) and home-based treatment after transplant. Since hematopoietic stem cells are the progenitors of all blood cells, HSCT is the only curative treatment for many hematologic malignancies. Unfortunately, 40-60% of HSCT recipients experience graft-versus-host-disease (GvHD), a potentially life-threatening inflammatory response wherein the engrafted donor immune system recognizes normal host cells as foreign and attacks them. Mounting research identifies the gut microbiome as a modulator of GvHD, however, its role has not been investigated in these two interventions with successful pilot trials. Pre-transplant HIIT intervention aims to improve cardiovascular health as poor cardiovascular fitness is associated with worsened treatment outcomes. On the other hand, receiving post-transplant care at home results in comparable treatment outcomes (as hospital care) while increasing patient comfort and reducing financial burden. For both interventions, fecal microbiome was compared between individuals receiving the intervention and their respective controls matched for age, sex, disease, and conditioning regimen. In line with previous studies, a markedly lower fecal microbiome diversity evidenced by the domination of a single phylum was observed in people undergoing HSCT. Across all patients, patients that developed chronic GvHD had lower fecal prevalence of Streptococcus and Anaerostipes hadrus compared to those that did not. Furthermore, individuals that underwent HIIT intervention had higher fecal alpha diversity metrics and lower prevalence of Roseburia inulinivorans and Enterococcus faecium as compared to matched controls. While no fecal taxa were identified as being differentially abundant based on post-transplant care environment, the potential role of microbiome of the built environment on patient microbiome and health merits further attention. As taxa of interest reported here, namely A. hardus and R. inulinivorans, are both SCFA producers, future studies should further investigate the gut-SCFA axis in people with hematologic malignancies. Altogether, this dissertation emphasizes the importance of SCFA-producing taxa across a wide range of inflammatory states and identifies taxa of interest to be validated in larger cohorts for future mechanistic studies. The interdisciplinary studies herein provide methods and a framework for analyzing the gut microbiome, the low biomass murine lung tissue microbiome, and host health metrics in tandem with practical suggestions for future studies. Continuing to fill the research gaps regarding the complex interplay between environmental exposure, microbiomes, and inflammation will lead to precision microbiome engineering strategies. These strategies may be of broad interest due to their ability to be applied to different inflammatory conditions that are often studied separately.
Item Open Access Substance use after bariatric surgery: A review.(Journal of psychiatric research, 2016-05) Li, Linlin; Wu, Li-TzyPrevalence of obesity has increased dramatically. Obese individuals may undergo bariatric surgery to lose excessive body fat and mitigate obesity-related comorbidities. However, bariatric patients are particularly vulnerable to substance use problems. We conducted a review to examine the prevalence change and factors associated with substance use and determine the association between substance use and health status after weight loss among bariatric patients.We searched peer-reviewed articles published between January 1990 and January 2015 in several databases (PubMed, PsycINFO, Cochrane Library, Google Scholar) using different keywords combinations. Studies that focused on pre-surgery substance use only or without reported effect measurements were excluded.Overall, 40 studies were included in the review. Preoperative history of substance use was a reliable correlate of postoperative substance use. The prevalence of postoperative alcohol use was higher among patients with preoperative history of alcohol use than those without. Postoperative prevalence of alcohol use ranged from 7.6% to 11.8%. No significant prevalence change in cigarette smoking from pre-to postoperative period was observed. Time effect was not observed on smoking or drug use prevalence, while an increase in alcohol consumption was inconsistent across studies. The proportion of new-onset substance users among bariatric patients after surgery ranged from 34.3% to 89.5%.Substance use is associated with poor health among bariatric patients. Preoperative assessment and postoperative follow-up should include interventions to reduce relapse among users and prevent substance use initiation.Item Open Access The Gut/Lung Microbiome Axis in Obesity, Asthma, and Bariatric Surgery: A Literature Review.(Obesity (Silver Spring, Md.), 2021-04) Kim, Yeon Ji; Womble, Jack T; Gunsch, Claudia K; Ingram, Jennifer LMounting evidence suggests that obesity, parameters of metabolic syndrome, and asthma are significantly associated. Interestingly, these conditions are also associated with microbiome dysbiosis, notably in the airway microbiome for patients with asthma and in the gut microbiome for patients with obesity and/or metabolic syndrome. Considering that improvements in asthma control, lung function, and airway hyperresponsiveness are often reported after bariatric surgery, this review investigated the potential role of bacterial gut and airway microbiome changes after bariatric surgery in ameliorating asthma symptoms. Rapid and persistent gut microbiota alterations were reported following surgery, some of which can be sustained for years. The gut microbiome is thought to modulate airway cellular responses via short-chain fatty acids and inflammatory mediators, such that increased propionate and butyrate levels following surgery may aid in reducing asthma symptoms. In addition, increased prevalence of Akkermansia muciniphila after Roux-en-Y gastric bypass and sleeve gastrectomy may confer protection against airway hyperreactivity and inflammation. Metabolic syndrome parameters also improved following bariatric surgery, and whether weight-loss-independent metabolic changes affect airway processes and asthma pathobiology merits further research. Fulfilling knowledge gaps outlined in this review could facilitate the development of new therapeutic options for patients with obesity and asthma.