Changes of epicardial fat thickness after laparoscopic sleeve gastrectomy: a prospective study.

PURPOSE: Epicardial fat thickness is an interesting parameter of early atherosclerosis. We prospectively assessed whether weight loss following laparoscopic sleeve gastrectomy (LSG) leads to a significant reduction in the epicardial fat thickness (EFT) and the correlation between the decline in the epicardial fat thickness with other clinical parameters. METHODS: A prospective analysis of 98 cases that were scheduled to undergo LSG and followed up for 12 months was conducted. EFT was assessed using two-dimensional (2 D) echocardiography. RESULTS: A total of 98 cases and 70 controls were enrolled. EFT demonstrated a significant reduction at follow-up in the whole group (median 8.9 (1.95) versus 7.65 (1.67) mm, respectively). The degree of reduction was higher in the LSG cohort compared to control cohort 1.3 (0.4) versus 1 (0.4), respectively; p < .001). The univariate regression analysis demonstrated a notable correlation of the EFT with the weight, body mass index (BMI), fasting blood glucose (FBG), and creatinine with a p-value of <.0001, .001, .022, and .018, respectively while the multivariate analysis showed a strong correlation between EFT and weight and creatinine with a p-value of <.0001 and .033 respectively. CONCLUSION: LSG can have a favourable impact on metabolic syndrome aspects, namely EFT, as it can decrease it considerably.

Factors associated with resolution of type-2 diabetes mellitus after sleeve gastrectomy in obese adults.

Many bariatric procedures are more effective for improving type-2 diabetes mellitus (T2DM) than conventional pharmacotherapy. The current research evaluated factors linked to complete and partial remission or improvement of T2DM after laparoscopic sleeve gastrectomy (LSG). The current prospective study included all diabetic patients who were submitted LSG between January 2015 and June 2018 and completed a 2-year follow-up period. Patients were assessed at baseline and 2 years after LSG. This work comprised of 226 diabetic cases. Two years after LSG, 86 patients (38.1%) achieved complete remission of DM, and 24 (10.6%) reached partial remission. Only 14 patients (6.2%) showed no change in their diabetic status. On univariate analysis, age ≤ 45 years, duration of diabetes ≤ 5 years, use of a single oral antidiabetic, HbA1c ≤ 6.5%, HOMA-IR ≤ 4.6, C-peptide > 2.72 ng/mL, and BMI ≤ 40 kg/m2 predicted complete remission. The independent predictors of complete remission were age ≤ 45 years, duration of diabetes ≤ 5 years, use of a single oral antidiabetic, HOMA-IR ≤ 4.6, and C-peptide > 2.72 ng/mL. A combined marker of young age, short duration of DM, and low HOMA-IR predicted complete remission with sensitivity 93% and specificity 82%. Independent predictors of complete remission of T2DM after LSG were younger age, shorter duration, single oral antidiabetic, lower HOMA-IR, and higher C-peptide.

Vitamin D receptor gene polymorphisms and 25(OH) vitamin D: Lack of association to glycemic control and metabolic parameters in type 2 diabetic Egyptian patients.

BACKGROUND: Vitamin D deficiency and vitamin D receptor (VDR) gene polymorphisms have been linked to type 2 diabetes mellitus (T2DM) and its metabolic parameters, however there are conflicting results therefore we aimed to evaluate VDR gene polymorphisms (Fok1, Bsm1 and Taq1) and vitamin D status in Egyptian patients with T2DM and to detect the associations of these polymorphisms to their metabolic parameters and glycemic control. METHODS: 50 patients with T2DM and 50 healthy age matched control subjects were enrolled. FBG, 2 h -PPG, fasting lipids, Hb A1c, calcium, phosphorus, urea, creatinine, ALT, AST were measured. BMI has calculated. Serum 25 hydroxy vitamin D [25(OH)D] has measured by ELISA. VDR gene polymorphisms detection has done by polymerase chain reaction through restriction fragment length polymorphism (PCR-RFLP) technique. RESULTS: Our study has shown lower mean levels of 25(OH)D in patients with T2DM (28.54 ±â€¯10.02) in comparison with control subjects (44.65 ±â€¯7.19), p < 0.001. Vitamin D insufficiency was more prevalent in T2DM 58% than in healthy control subjects 4%. There were statistically significant differences between patients with type 2 diabetes and controls regarding the distribution of FokI genotypes and alleles (p = 0.005) and non significant difference regarding Bsm1 and Taq1. Neither VDR gene polymorphisms nor 25(OH)D showed significant association with glycemic control, fasting lipids and BMI in patients with T2DM. CONCLUSIONS: Vitamin D deficiency is prevalent in Egyptian patients with T2DM. Associations were found only between VDR FokI gene polymorphism and susceptibility to Egyptian patients with T2DM. Non significant differences in VDR gene polymorphisms distribution has found regarding glycemic control and metabolic parameters.