Do bariatric patient's in rural areas achieve comparative weight loss as national average? single center experience in appalachia west virginia.

INTRODUCTION: Obesity is one of the leading public health concerns with over half a million Americans being classified as obese and almost two billion classified as overweight. This has an impact on overall health of the individual, with increased comorbidities and premature death, as well as increased economic cost. This study evaluates the weight loss of patients with limited societal support and resources cared for at a single bariatric center of excellence, The Center for Surgical Weight Control, in Cabell County, West Virginia. METHODS: Retrospective review of patients that have undergone either a Vertical Sleeve Gastrectomy (VSG) or a Roux-en-Y gastric bypass (RNYGB) between the years of 2017 and 2018 At the Center for Surgical Weight Control. Weight loss was evaluated at 6 months, 1 year, and 2 years. RESULTS: There were 290 patients between 2017 and 2018. On average, the VSG group lost 46% of excess body weight (EBW) at 6 months, 57% of EBW at 1 year, and 61% of EBW at 2 years. In the RNYGB group patients lost on average 54% of EBW at 6 months, 65% of EBW at 1 year, and 88% of EBW at 2 years. DISCUSSION: A loss of 5-15% of EBW can improve obesity-related comorbidities. These comorbidities include diabetes, hypertension, hyperlipidemia, gastroesophageal reflux disease, and obstructive sleep apnea. Improvement in these comorbidities not only benefits each patient individually, but will also help improve the effects on society as a whole. CONCLUSION: Obesity is a debilitating and deadly disease, thus makes it very important to address in order to reduce burden on both patients and society as a whole. There is an expected amount of weight loss a patient should have depending on the type of surgery they undergo. Our patients were successful at meeting and exceeding the expected percentage of EBW loss after both VSG and RNYGB.

Uremic Toxins Activates Na/K-ATPase Oxidant Amplification Loop Causing Phenotypic Changes in Adipocytes in In Vitro Models.

BACKGROUND: Oxidant stress plays a key role in the development of chronic kidney disease (CKD). Experimental CKD leads to accumulation of uremic toxins (UT) in the circulation resulting in increased ROS production, which in turn, is known to activate the Na/K-ATPase/ROS amplification loop. Studies in a murine model of obesity have shown that increased oxidative stress in plasma is due to increased ROS and cytokine production from dysfunctional adipocytes. Therefore, we hypothesized that adipocytes exposed to UTs will activate the Na/K-ATPase oxidant amplification loop causing redox imbalance and phenotypic alterations in adipocytes. We also aimed to demonstrate that the Na/K-ATPase signaling antagonist, pNaKtide, attenuates these pathophysiological consequences. METHODS: In the first set of experiments, 3T3-L1 murine pre-adipocytes were treated with varying concentrations of UTs, indoxyl sulfate (IS) (50, 100 and 250 µM) and p-cresol (50, 100 and 200 µM), with or without pNaKtide (0.7 µM) for five days in adipogenic media, followed by Oil Red O staining to study adipogenesis. RT-PCR analysis was performed to study expression of adipogenic, apoptotic and inflammatory markers, while DHE staining evaluated the superoxide levels in UT treated cells. In a second set of experiments, visceral fat was obtained from the West Virginian population. MSCs were isolated and cultured in adipogenic media for 14 days, which was treated with indoxyl sulfate (0, 25, 50 and 100 µM) with or without pNaKtide (1 µM). MSC-derived adipocytes were evaluated for morphological and molecular analysis of the above markers. RESULTS: Our results demonstrated that 3T3-L1 cells and MSCs-derived adipocytes, treated with UTs, exhibited a significant decrease in adipogenesis and apoptosis through activation of the Na/K-ATPase/ROS amplification loop. The treatment with pNaKtide in 3T3-L1 cells and MSC-derived adipocytes negated the effects of UTs and restored cellular redox in adipocytes. We noted a varying effect of pNaKtide, in adipocytes treated with UTs, on inflammatory markers, adipogenic marker and superoxide levels in 3T3-L1 cells and MSC-derived adipocytes. CONCLUSIONS: This study demonstrates for the first time that the Na/K-ATPase/ROS amplification loop activated by elevated levels of UTs has varying effect on phenotypic alterations in adipocytes in various in vitro models. Thus, we propose that, if proven in humans, inhibition of Na/K-ATPase amplification of oxidant stress in CKD patients may ultimately be a novel way to combat adipocyte dysfunction and metabolic imbalance in these patients.

Laparoscopic vertical sleeve gastrectomy: A 5-year veterans affairs review.

The aim of this study was to evaluate the outcomes after laparoscopic sleeve gastrectomy (SG) in a VA population.SG has recently gained popularity as a definitive bariatric surgery procedure. Data are lacking on long-term outcomes, particularly in a Veterans Affairs population.We retrospectively reviewed 223 patients who underwent SG for morbid obesity between January 2009 and June 2014. Data on length of stay, complications, interval weight loss, comorbidities, and number of therapies preoperatively and at long-term follow-up were collected.There were 164 males and 59 females who underwent SG. The mean body mass index was 45.4 kg/m. Mean excess weight loss at 1 year was 62.9%, and 47.0% at 5 years. Weight loss continued until 12 to 18 months, when there was a nadir in weight loss (P < .001). There were 4 deaths and 4 staple-line leaks, with 3 deaths related to late cardiac events. One early death occurred in a very high-risk patient. All staple-line leaks were managed nonoperatively. Of the 223 patients, 193 had hypertension, 137 diabetes, 158 hyperlipidemia, 119 obstructive sleep apnea (OSA), and 125 had gastroesophageal reflux disease. Preoperatively, patients were on a mean of 1.9 antihypertensive and 0.9 hyperlipidemic, anti-reflux and oral hypoglycemic agents. Fifty percent of patients with diabetes were on insulin and 68% with OSA used continuous positive airway pressure/bilevel positive airway pressure (CPAP/BiPAP). We found significant absolute reductions in mean antihypertensive medications (-0.8), hyperlipidemic agents (-0.4), antireflux agents (-0.4), oral hypoglycemics (-0.6), insulin use (-25%), and use of CPAP/BiPAP (-55%) (all P < .001).Laparoscopic sleeve gastrectomy is a safe and effective bariatric surgery procedure, resulting in significant early weight loss up to 18 months and long-term improvement in all major obesity-related comorbid conditions.