Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding.

BACKGROUND: Increasing numbers of pregnancies are seen in obese women treated surgically with laparoscopic adjustable gastric banding (LAGB). We compared their maternal and fetal outcomes with obese women without LAGB and normal-weight controls. METHODS: Sixty-nine obese women with LAGB (83 pregnancies) were compared with 120 obese women without LAGB and 858 controls. RESULTS: By comparison with normal controls, post-LAGB pregnancies had higher rates of gestational hypertension (9.6% vs 2.4%, p < 0.05), preeclampsia/eclampsia (12.0% vs 2.3%, p < 0.001), abortion (10.8% vs 0.3%, p < 0.001), cesarean section (45.9% vs 28.2%, p < 0.01), preterm delivery (17.6% vs 3.6%, p < 0.001), and babies needing neonatal intensive care (20.3% vs 9.0%, p < 0.01). Compared with the no-LAGB obese group, the post-LAGB pregnancies had lower rates of gestational hypertension (9.6% vs 23.5%, p < 0.05), preeclampsia/eclampsia (12.0% vs 20.8%, p < 0.05), and cesarean section (45.9% vs 65.8%, p < 0.01). The post-LAGB obese women gained less weight during the pregnancy (6.6 +/- 7.9 vs 14.8 +/- 10.1 kg, p < 0.001) and experienced less gestational hypertension (14.8% vs 33%), preeclampsia/eclampsia (7.4% vs 14.8%), and macrosomia (4.2% vs 16%) than in pregnancies before LAGB. No significant differences in maternal and fetal outcomes emerged between post-LAGB pregnant women who lost versus those who gained weight during pregnancy. Compared with those no longer morbidly obese, women still morbidly obese after LAGB had a lower weight gain (2.8 +/- 11.8 vs 8.6 +/- 9.5 kg, p < 0.05) and a higher gestational hypertension rate (29.4% vs 8.9%, p < 0.05). CONCLUSION: The risks of negative maternal and fetal outcomes for obese women can be reduced by LAGB if the women are closely followed up.

Predictors of low bone mineral density in elderly males with chronic obstructive pulmonary disease: the role of body mass index.

OBJECTIVE: The aim of this study was to investigate the relationships between nutritional indices (Body mass index (BMI), serum albumin), sarcopenia, bone mineral density (BMD) and the severity of their pulmonary obstruction in elderly patients with chronic obstructive pulmonary disease (COPD). METHODS: The method involved was a prospective transversal study; 82 males >65 years old, 41 stable patients with COPD and 41 healthy elderly individuals (controls). All subjects underwent spirometry, biochemical analyses and dual energy X-ray absorptiometry. The significance of the differences between mean values and prevalence rates was tested. The relationships between BMD and independent predictors were analysed by multiple linear regressions. Logistic regression models were applied on dichotomised variables. RESULTS: In patients with COPD, the prevalence of osteoporosis was higher in subjects with sarcopenia (46% vs. 0%; p < 0.05) and with BMI < 25.1 kg/m(2) (58% vs. 15%; p < 0.02). Multiple regression analysis indicated that BMI, appendicular skeletal muscle mass (ASMM), albumin, and forced expiration volume after 1 s (FEV1) explained the 70% of BMD variability at the hip and 56% at the spine. Logistic regression showed that a BMI < 25.1 kg/m(2) was independently associated with osteoporosis risk (OR = 10.0; 95%CI 1.3-76); no independent effect emerged for FEV1% (

Prevalence of aging-associated cognitive decline in an Italian elderly population: results from cross-sectional phase of Italian PRoject on Epidemiology of Alzheimer's disease (IPREA).

BACKGROUND AND AIMS: The prevalence of the preclinical phase of dementia varies greatly, according to the diagnostic criteria and assessment procedures applied. The purpose of this study was to estimate the prevalence of cognitive impairment according to the Aging-Associated Cognitive Decline (AACD) diagnostic criteria in an Italian elderly population. METHODS: In a multicenter community-based prospective study, 4785 Italian subjects aged 65-84 years, randomly selected from the registries of 12 Italian municipalities, were assessed by personal and informant interviews, physical and neurological examinations and an extensive neuropsychological battery. RESULTS: Of these older subjects, 274 (9.2%) fulfilled all the AACD criteria, whereas 561 (18.8%) fulfilled only 3 of them (AACD-3). When the two groups diagnosed according to AACD criteria (AACD and AACD- 3) were merged, the prevalence was 28.0% (28.3% for men, 27.6% for women). Two other groups of subjects were also identified: a) Subjects with Objective evidence of Cognitive Decline without cognitive complaints (OCD), 508 (17.0%), i.e., subjects with documented neuropsychological deficits, although neither subjects nor informants reported cognitive complaints; and b) Subjects with Cognitive Complaints without objective demonstrable cognitive deficits (CC), 44 (1.5%), i.e., subjects and/or informants reported cognitive complaints without evidence of neuropsychological deficits. Thus, taking into account the additional OCD group, a total of 1343 persons with cognitive impairment without dementia (45.0%) was identified. CONCLUSIONS: On the basis of our results, we estimate that 45% of our population-based Italian sample aged 65-84 years had some kind of cognitive deficits without dementia.

Resting VO2, maximal VO2 and metabolic equivalents in free-living healthy elderly women.

BACKGROUND & AIMS: Maximal VO2 (VO2max) and metabolic equivalents (METs) decline with aging due to body composition and cardiovascular modifications. However, a detailed evaluation of these variables for this population has not been done. The aim of this study was to evaluate VO2max and METs in healthy elderly women, and to establish whether the calculated resting VO2 (3.5 ml/min/kg) underestimates the true METs. METHODS: 81 females over 65 years old attending a twice-weekly mild fitness program were studied. Body composition was measured by DEXA. VO2max and resting VO2 (VO(2rest-meas)) were measured by indirect calorimetry. METs were measured (METs-meas) using the VO2max/VO(2rest-meas) ratio, and calculated (METs-cal) from the ratio between measured VO2max and calculated resting VO2 (3.5 ml/min/kg of body weight). RESULTS: The VO(2rest-meas) and VO2max measured by indirect calorimetry were 2.9+/-0.4 ml/min/kg and 17.5+/-2.8 ml/min/kg, respectively. The METs-meas were higher than the METs-cal (6.1+/-1.2 vs 5.0+/-0.8; p<0.001). The 25th-75th percentile range of measured METs was 5.2-6.8. CONCLUSIONS: Our study confirmed that, in elderly women, METs values ranging between 5 and 7 are compatible with an acceptable physical activity. The estimated resting VO2 (3.5 ml/min/kg) does not appear to be applicable to elderly women, because it underestimates the real METs in this population.

Weight loss and changes in use of antidiabetic medication in obese type 2 diabetics after laparoscopic gastric banding.

BACKGROUND: Interest in bariatric surgery is growing as an effective method for long-term metabolic control in morbidly obese patients with type 2 diabetes. We analyzed the weight loss and changes in use of diabetic medication in obese patients with type 2 diabetes treated with laparoscopic adjustable gastric banding (LAGB). METHODS: From 1993 to 2005, 1791 morbid obese patients underwent LAGB at our institution. Of the 1791 patients, 394 (22%) had type 2 diabetes mellitus at baseline. Of the 394 patients with diabetes, 52 were receiving diabetic medication. The median follow-up period for the drug-treated diabetic patients was 3 years (range .25-9). RESULTS: The drug-treated diabetic patients were older (age 47.6 +/- 7.5 versus 37.5 +/- 10.7 years, P <.001), weighed more (body mass index 49.1 +/- 9.5 versus 45.6 +/- 7.5 kg/m(2), P 0.001), and were more frequently affected by co-morbidities than the nondiabetic patients at surgery. The percentage of excess weight loss 1 year after surgery was less (32.4% +/- 14.1% versus 41.1% +/- 19.9%, P <.01) for the drug-treated diabetic patients than for the nondiabetic patients. This difference was maintained for 5 years of follow-up. A significant decline occurred in the use of both oral diabetic medication and insulin after surgery. Of the 52 patients treated with oral antidiabetic medication at baseline, 33 required oral antidiabetic medication at the end of follow-up. Of the 6 patients who also required insulin at baseline, 2 did so at the end of follow-up. The use of diabetic medication had increased in 4 patients (7.7%), was unchanged in 12 (23.1%), had decreased in 17 (32.7%), and was suspended in 19 (36.5%) of 52 patients. CONCLUSION: The amount of weight loss after LAGB was less in drug-treated diabetic patients than in nondiabetic patients. However, LAGB was associated with a sustained reduction in the use of diabetic medication.

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.

An uncommon case of failed suicide in a 94-year-old woman: "masked" depression or rational decision?

AIM: We report an unusual case of "failed suicide" in an oldest old woman who was apparently "aging successfully". METHOD: This case was analysed in the light of a careful literature review. RESULTS: This was an unusual case of failed suicide, attempted by a 94-year-old woman who had planned the suicide several days earlier. CONCLUSIONS: The unusual features of this case relate to: 1) the person's female gender and very advanced age; 2) her apparently "successful aging" condition; 3) the violent method and unusual means she used; 4) the suicide note written several days beforehand.

Reliability of body temperature measurements in hospitalised older patients.

AIMS AND OBJECTIVES: To compare different body temperature assessment methods in older people and to assess the role of cognitive and functional characteristics in temperature recordings. BACKGROUND: Axillary gallium-in-glass thermometers are commonly used. Their accuracy depends on the proper placement of the device and their permanence in place for eight minutes. With adequate instruction, well-functioning patients can measure their axillary temperature by themselves, while in cognitively and functionally impaired older people, inadequate understanding of instructions and misplacement of the thermometer might determine significant recording errors. Electronic ear and axillary temperature measurements are faster, but their accuracy has not been demonstrated convincingly with older people. METHODS: Patients (n = 107; aged 65-104 years) were recruited. Barthel Index and Short Portable Mental Status Questionnaire (SPMSQ) scores were obtained for each patient. Temperature readings were obtained using: the axillary gallium-in-glass thermometer, with (T(nurse)) and without (T(self)) the nurse's assistance; the electronic axillary thermometer (T(el)) and the infrared tympanic thermometer (T(tymp)). The T(nurse) was considered as the reference method. RESULTS: Mean difference and standard deviation (mean +/- SD) in temperature recordings between the different techniques and T(nurse) differed significantly from zero for T(self) (-0.40 SD 0.42) and T(tymp) (+0.19 SD 0.48). No significant differences in temperature recordings emerged between T(nurse) and T(el). In simple linear regression models, the difference between T(self) and T(nurse) significantly correlated with age, gender, SPMSQ score and Barthel Index. Multiple linear regression analysis showed an underestimation of body temperature in older patients with cognitive impairments. CONCLUSION: Unassisted gallium-in-glass axillary temperature assessment is inadequate, in older patients. The differences between T(self) and T(nurse) are significantly influenced by age and mental decline. T(el) provides adequate accuracy. Relevance to clinical practice. In geriatric settings, the electronic axillary thermometer is a safe and accurate alternative to the more traditional gallium-in-glass thermometer, with the advantage of saving time (five seconds in recording vs. eight minutes).

Fat-free mass and fat mass reference values by dual-energy X-ray absorptiometry (DEXA) in a 20-80 year-old Italian population.

BACKGROUND & AIMS: To establish reference values for fat-free mass (FFM), the FFM index (FFMI), fat mass (FM) and the FM index (FMI) in an Italian adult population, developing percentile distribution curves for age brackets between 20 and 80 years. METHODS: A multicenter, retrospective study was conducted on a sample of 1866 healthy Italian adults, 1435 females and 431 males. FFM and FM were measured by dual-energy X-ray absorptiometry. FFMI and FMI were calculated as the ratio of FFM and FM to height squared. RESULTS: The reference range for the FFMI (25-75th percentile) was similar in all age groups, i.e. 18.7-21 kg/m(2) in men and 14.9-17.2 kg/m(2) in women. In both genders, FM, the FMI and FM as a percentage of body weight (FM%) increased with age. The reference values for FM% in the two age brackets 20-29 and 60-69 were, respectively, 13-20% and 22.5-29.3% for men and 26.1-34.9%, 32.5-39.6% for women. CONCLUSIONS: These body composition ranges can be used by clinicians and nutritionists as reference values for a Caucasian population in the Mediterranean area when evaluating body composition variations occurring in aging, malnutrition and chronic diseases.

The effects of the surgical removal of subcutaneous adipose tissue on energy expenditure and adipocytokine concentrations in obese women.

OBJECTIVE: To analyze the effects of the surgical removal of subcutaneous adipose tissue by ultrasound-assisted megalipoplasty (UAM) on energy expenditure and adipocytokine concentrations in obese women. METHODS: Fifteen premenopausal obese women with BMI 37.5+/-6.3 kg/m(2) (range: 30.7-53.6 kg/m(2)) underwent UAM. Body composition (by DEXA), resting metabolic rate (REE) by indirect calorimetry, insulin resistance (by the HOMA method), leptin, C-reactive protein, interleukin-6, resistin and adiponectin were measured before and 1, 3, 28 and 180 days after the procedure. RESULTS: UAM significantly reduced fat mass at day 3, without further changes in the following days. REE increased at day 3 after UAM, returned to baseline levels at day 28 and significantly declined at day 180. Leptin levels transiently increased after UAM and then declined according to fat mass reduction. C-reactive protein, interleukin-6 and resistin levels acutely increased after UAM and then returned to the baseline levels. Adiponectin levels acutely declined after the procedure and then stabilized to a plasma level slightly lower than at baseline. Insulin resistance deteriorated in the acute post-operative phase and then improved. CONCLUSION: The surgical removal of subcutaneous fat was associated to an acute inflammatory reaction with high REE and insulin-resistance. Later on, the metabolic effects of fat mass removal appeared, with a reduction of leptin levels and REE and an improvement of insulin resistance.

Lower extremity motor performance and body mass index in elderly people: the Italian Longitudinal Study on Aging.

OBJECTIVES: To test the association between body mass index (BMI) and lower extremity motor performance in elderly people. DESIGN: Multicenter, cross-sectional, observational study. SETTING: A sample of individuals aged 65 and older recruited for the baseline survey of the Italian Longitudinal Study on Aging. PARTICIPANTS: Two thousand six hundred seventy-two individuals (1,436 men, 1,236 women) independent with transfers and toileting and independent or requiring assistance for bathing or dressing. MEASUREMENTS: Motor function was assessed using a Motor Performance Test (MPT), with a set of six tasks exploring lower extremity performance (LEP): rising once from a chair, turning in a half circle, tandem walking, standing on one leg, stair climbing, and walking 5 m. RESULTS: The highest prevalence rates of difficulty in performing the tasks occurred in men and women, respectively, in tandem walking (14%, 28%), stair climbing (17.0%, 43%) and walking 5 m (15%, 30%). In both sexes, moderate (men: odds ratio (OR)=1.99, 95% confidence interval (CI)=1.16-3.43; women OR=2.07, 95% CI=1.18-3.65) and severe obesity (men: OR=3.45, 95% CI=1.21-9.89; women: OR=3.16, 95% CI=1.43-6.95) were each independently associated with overall motor performance impairment after adjusting for age, smoking, and comorbidity. Best performance was generally observed in the normal-weight and overweight groups. CONCLUSION: The results confirm that, in both sexes, overweight is not related to motor impairment. Only in women, low BMI is associated with higher probability of overall motor performance impairment. These data suggest that moderate obesity should be distinguished from severe obesity when assessing the relationship between BMI and LEP.

Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls.

BACKGROUND: To compare the mortality rate of obese patients treated by laparoscopic gastric banding (LAGB) with the mortality rate of matched obese patients observed at medical centers. The net effect of bariatric surgery on total mortality is still controversial. Gastric bypass has been shown to reduce the relative risk of death, but similar data with LABG are still lacking. METHODS: The surgical series was composed of 821 patients with a body mass index (BMI) >40 kg/m(2) consecutively treated with LAGB at Padova University, Italy. The reference group was composed of 821 gender-, age-, and BMI-matched patients selected from a sample of 4681 adults with a BMI >40 kg/m(2) observed at 6 Italian medical centers not using surgical therapy. RESULTS: The mean follow-up was 5.6 +/- 1.9 and 7.2 +/- 1.2 years in the surgical and reference group, respectively. The vital status was known in 97.6% of the surgical group (8 deaths) and in 97.4% of the reference group (36 deaths). In the surgical group, the percentage of excess weight loss was 39.8% +/- 17.9% 1 year after LAGB and 37.2% +/- 23.8% 5 years after LAGB. The rate of late revisional surgery was 12.2%. Survival was estimated using the Kaplan-Meier method, and the differences between the 2 groups were evaluated using the log-rank test. The survival rate was significantly greater in the surgical group (P = 0.0004). On multivariate Cox analysis, the 5-year relative risk of death in the surgical group, adjusted for gender, age, and baseline BMI, was 0.36 (95% confidence interval 0.16-0.80). CONCLUSION: LAGB was associated with a 0% operative mortality rate and 40% stable excess weight loss. LAGB patients had a 5-year 60% lower risk of death than comparable morbidly obese patients.

When are indwelling urinary catheters appropriate in elderly patients?

Indwelling catheters are commonly used in elderly patients with urinary retention, incontinence, pressure ulcers, and cancer, ostensibly for the patient's comfort but sometimes to ease the burden of health care workers. Indwelling catheterization is overused; catheters should be inserted only for specific, well-documented indications. The best way to avoid catheter-associated infections and other complications is to avoid long-term catheter use whenever possible. Given the risks involved, catheterization is indicated only as a last resort, after other options have failed.

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.

New approach to gerontology: building up "successful aging" conditions.

BACKGROUND AND AIMS: Great efforts have been made in developed societies to extend human life expectancy as much as possible. Continuing investments into extending the life-span into the "fourth age" actually reduce the opportunities of people to age successfully and die in dignity. Consequently, in recent years, the concept of "Successful Aging" (SA) has gained increased attention: investigators recognize the importance of separating pathologic changes from those which may be attributed to aging in itself, in order to interpret correctly the differences between Pathologic Aging, Normal Aging, and Successful Aging. Hence, according to recent literature on aging, our aim was to question here the validity of recommendations made in the literature for policy making in the treatment of aging and suggest new alternatives. METHODS: We have tried to understand and develop a method of analysis to the following question: what do we actually mean by SA? Successful Aging may be seen as an arbitrary, subjective term, so we studied which indicators characterize elderly persons as successful aged. RESULTS: The results of this study show that older people's views of SA appear to be multidimensional and more complex than the apparent viewpoint of many of early studies, which tended to focus on a single dimension of health - psychological or mental. CONCLUSIONS: We argue the proper use of various health indicators and health enhancers, as proposed in the current international literature, in the definition of SA.

Resting energy expenditure and body composition in bedridden institutionalized elderly women with advanced-stage pressure sores.

BACKGROUND: Our study investigated nutritional status, body composition, and resting energy expenditure (REE) in elderly patients with advanced-stage pressure sores (PS), in addition to researching any hypermetabolic condition and its relationship with PS size. METHODS: The study involved 52 institutionalized bedridden elderly women (aged 83.7 +/- 6.3 years), divided into two groups: 23 with advanced-stage (stage 3 and 4) PS and 29 without PS. Albumin, prealbumin, and retinol-binding protein were measured in all patients, and fat-free mass (FFM) and fat mass (FM) were obtained by dual-energy x-ray absorptiometry (DEXA). REE was measured by indirect calorimetry and predicted with the Harris-Benedict formula. PS area and volume were also measured. RESULTS: The elderly women with and without PS were comparable in age, FFM, and FM. Mean albumin, prealbumin, and retinol-binding protein values were lower in cases with PS. Unadjusted mean REE was significantly higher in patients with PS (1212.3 +/- 236.7 vs 1085.5 +/- 161.3 kcal/d; p <.05), even after adjusting for FFM or expressed per kilogram of body weight (25.8 +/- 6.7 vs 21.1 +/- 4.0 kcal/d/kg; p <.01). Hypermetabolism, i.e., a measured REE > 110% of the predicted REE, was seen in 74% of patients with PS and 38% of controls. The difference between measured and predicted REE (DeltaREE) correlated with PS volume (r = 0.58; p <.01), but not with area. CONCLUSION: Advanced-stage PS in elderly women are associated with a hypermetabolic state that is influenced by the volume of the PS.

High ghrelin concentration is not a predictor of less weight loss in morbidly obese women treated with laparoscopic adjustable gastric banding.

BACKGROUND: We analyzed the role of high plasma ghrelin concentrations at surgery as a negative predictor of weight loss in morbidly obese patients treated with laparoscopic gastric banding (LAGB). METHODS: Fasting plasma ghrelin concentrations were measured in 113 women before LAGB, and 16 of them were identified as having ghrelin concentrations clearly higher than expected according to the BMI levels. The 2-year postoperative outcome of these 16 patients was compared to the outcome of the remaining subjects. RESULTS: Mean fasting plasma ghrelin concentration in the group with hyperghrelinemia was 82.3+/-23.1 pg/ml and in women with normal ghrelin was 27.1+/-11.3 pg/ml (P<0.001). No differences in age, age at onset of obesity or degree of obesity were observed between the two groups. Women with hyperghrelinemia had a weight gain during the waiting time similar to women with normal ghrelin. The prevalence of comorbidities and eating behavior disturbances was similar in the two groups, but depression was 2.5 fold more prevalent in the hyperghrelinemic women than in the women with normal ghrelin. The %EWL after LAGB surgery was similar in women with high and normal ghrelin concentrations, with no differences in levels of postoperative band filling. No differences in band-related complications or revisional surgery rate were observed between the two groups. CONCLUSION: A high fasting ghrelin concentration at baseline did not significantly affect the outcome after LAGB in morbidly obese women, in terms of weight loss and complications rate.