ABSTRACT
It is predicted that by 2030, globally, an estimated 2.16 billion adults will be overweight, and 1.12 billion will be obese. This study examined genetic data regarding Reward Deficiency Syndrome (RDS) to evaluate their usefulness in counselling patients undergoing bariatric surgery and gathered preliminary data on the potential use in predicting short term (6-month) weight loss outcomes. Methods: Patients undergoing bariatric surgery (n = 34) were examined for Genetic Addiction Risk Severity (GARS) [measures the presence of risk alleles associated with RDS]; as well as their psychosocial traits (questionnaires). BMI changes and sociodemographic data were abstracted from Electronic Health Records. Results: Subjects showed ∆BMI (M = 10.0 ± 1.05 kg/m2) and a mean % excess weight loss (56 ± 13.8%). In addition, 76% of subjects had GARS scores above seven. The homozygote risk alleles for MAO (rs768062321) and DRD1 (rs4532) showed a 38% and 47% prevalence among the subjects. Of the 11 risk alleles identified by GARS, the DRD4 risk allele (rs1800955), was significantly correlated with change in weight and BMI six months post-surgery. We identified correlations with individual risk alleles and psychosocial trait scores. The COMT risk allele (rs4680) showed a negative correlation with EEI scores (r = -0.4983, p < 0.05) and PSQI scores (r = -0.5482, p < 0.05). The GABRB3 risk allele (rs764926719) correlated positively with EEI (r = 0.6161, p < 0.01) and FCQ scores (r = 0.6373, p < 0.01). The OPRM1 risk allele showed a positive correlation with the DERS score (r = 0.5228, p < 0.05). We also identified correlations between DERS and BMI change (r = 0.61; p < 0.01). Conclusions: These data support the potential benefit of a personalized medicinal approach inclusive of genetic testing and psychosocial trait questionnaires when counselling patients with obesity considering bariatric surgery. Future research will explore epigenetic factors that contribute to outcomes of bariatric surgery.
ABSTRACT
OBJECTIVES: To compare the efficacy of intensive functional exercise training with that of usual cardiac rehabilitation (CR) in very old adults soon after coronary bypass surgery (CABG). DESIGN: Randomized controlled trial. SETTING: In-hospital CR. PARTICIPANTS: Individuals aged 75 and older (n = 173, mean 78.5 ± 3.2) participated in inpatient CR, which started soon after surgery (13.1 ± 5.3 days) and lasted for a mean of 20.4 ± 3.2 days. INTERVENTION: Participants were randomly assigned to an inpatient CR intervention group (IG; n = 84) or a control group (CG; n = 89). All participants participated in the inpatient CR program. In addition, IG participants participated in resistance training and special balance training (5 d/wk). MEASUREMENTS: Six-minute walk test, cardiopulmonary exercise testing, Timed-Up-and-Go Test (TUG), and a maximal isometric strength test were used to access functional capacity and the MacNew questionnaire to evaluate health-related quality of life (HRQL). RESULTS: There were significant improvements (P < .001) in all measured variables over the duration of CR. Improvements in functional capacity were significantly greater in the IG than the CG for 6-minute walk distance (6-MWD) (IG Δ 67.3 ± 49.0 m vs CG Δ 41.9 ± 51.7 m; P = .003), TUG time (IG Δ -2.4 ± 2.2 seconds vs CG Δ -1.2 ± 3.4 seconds; P = .005), and relative workload (IG Δ 0.19 ± 0.21 W/kg vs CG Δ 0.13 ± 0.11 W/kg; P = .03). CONCLUSION: There were significant improvements in all measured variables in very old adults participating in CR soon after CABG. With additional functional exercise training, participants randomized to IG improved significantly more than those randomized to CG on 6-MWD, TUG time, and relative workload.
