The effects of weight changes after middle age on the rate of disability in an elderly population sample.

OBJECTIVES: To analyze the association between weight loss and weight gain after middle age and the prevalence of late disability. DESIGN: Secondary analysis of baseline data from a longitudinal population study. SETTING: Progetto Veneto Anziani Study. PARTICIPANTS: Two thousand nine hundred ten (1,187 male, 1,723 female) Italians aged 65 and older. MEASUREMENTS: Disability status (impairment in at least one activity of daily living) was analyzed according to current body mass index (BMI), BMI at age 50, and intercurrent weight changes (weight gain >10%, weight gain 5-10%, weight stable, weight loss 5-10%, weight loss >10%). RESULTS: In subjects with normal weight at aged 50, weight gain of more than 10%, weight gain of 5% to 10%, and weight loss of more than 10% were significantly associated with disability (reference stable weight). Adjustment for major chronic diseases did not affect the relationship between weight gain and disability but attenuated the association between weight loss and disability. In participants with obesity at aged 50, weight gain of more than 10% and weight gain of 5% to 10% were associated with the presence of disability; adjustment for chronic diseases did not affect these associations. In these participants, no associations were found between weight loss and disability status. CONCLUSION: Weight gain after middle age was associated with late disability, particularly in participants who were already obese. Weight loss after middle age was associated with disability only in normal-weight participants, and this association was attenuated after adjustment for chronic diseases.

Upper airway size is related to obesity and body fat distribution in women.

The aim of this study is to analyze the relationships between obesity, fat distribution and pharyngeal transversal area in women. Cross-sectional areas of the pharynx at the oro-pharyngeal junction and at the glottis and mean pharyngeal area were measured by acoustic pharyngometry in 145 women (age 42.9 +/- 15.1 years; range 14-82 years). Body weight, waist, hip and neck circumferences, and sagittal abdominal diameter (SAD) were determined. Pharyngeal area at the oro-pharyngeal junction, measured both in orthostatic and in lying position, was negatively related to BMI, waist, hip and SAD. Mean pharyngeal area was negatively related to BMI and to SAD only in orthostatic position. No significant correlations were found between pharyngeal areas at the glottis and any anthropometric measurements. In multiple regression analysis, only SAD retained independent relationship with pharyngeal area at the level of the oro-pharyngeal junction in both the positions and with mean pharyngeal area in the orthostatic position. We demonstrated an inverse association between upper airways size and both adiposity and visceral fat distribution in women.

Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results.

BACKGROUND: This study examines 1,791 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 12 years follow-up. Long-term results of LAGB with a high follow-up rate are not common. METHODS: Between September 1993 and December 2005, 1,791 consecutive patients (75.1% women, mean age 38.7 years, mean weight 127.7 +/- 24 kg, mean BMI 46.2 +/- 7.7) underwent LAGB by the same surgical team. Perigastric dissection was used in 77.8% of the patients, while subsequently pars flaccida was used in 21.5% and a mixed approach in 0.8%. Data were analyzed according to co-morbidities, conversion, short- and long-term complications and weight loss. Fluoroscopy-guided band adjustments were performed and patients received intensive follow-up. The effects of LAGB on life expectancy were measured in a case/control study involving 821 surgically-treated patients versus 821 treated by medical therapy. RESULTS: Most common baseline co-morbidities (%) were hypertension (35.6), osteoarthritis (57.8), diabetes (22), dyslipidemia (27.1), sleep apnea syndrome (31.4), depression (21.2), sweet eating (22.5) and binge eating (18.5). Conversion to open was 1.7%: due to technical difficulties (1.2) and due to intraoperative complications (0.5). Together with the re-positioning of the band, additional surgery was performed in 11.9% of the patients: hiatal hernia repair (2.4), cholecystectomy (7.8) and other procedures (1.7). There was no mortality. Reoperation was required in 106 patients (5.9%): band removal 55 (3.7%), band repositioning 50 (2.7 %), and other 1 (0.05 %). Port-related complications occurred in 200 patients (11.2%). 41 patients (2.3%) underwent further surgery due to unsatisfactory results: removal of the band in 12 (0.7%), biliopancreatic diversion in 5 (0.27%) and a biliopancreatic diversion with gastric preservation ("bandinaro") in 24 (1.3%). Weight in kg was 103.7 +/- 21.6, 102.5 +/- 22.5, 105.0 +/- 23.6, 106.8 +/- 24.3, 103.3 +/- 26.2 and 101.4 +/- 27.1 at 1, 3, 5, 7, 9, 11 years after LAGB. BMI at the same intervals was 37.7 +/- 7.1, 37.2 +/- 7.2, 38.1 +/- 7.6, 38.5 +/- 7.9, 37.5 +/- 8.5 and 37.7 +/- 9.1. The case/control study found a statistically significant difference in survival in favor of the surgically-treated group. CONCLUSIONS: LAGB can achieve effective, safe and stable long-term weight loss. In experienced hands, the complication rate is low. Follow-up is paramount.