ObjectiveTo investigate the short-term efficacy of laparoscopic sleeve gastrectomy (LSG) for obesity with type 2 diabetes mellitus (T2MD) in China.
MethodsClinical randomized controlled trial literatures about domestic LSG treatment of obesity with T2MD were obtained from Wanfang Data, China Knowledge Resource Integrated Database, PubMed and Web of Science English Data. The literatures were selected according to the inclusive and exclusive criteria, then evaluated. Methodological quality assessment and meta analysis were evaluated according to the data extracted from those literatures. The short-term efficacy (fasting blood glucose or glycosylated hemoglobin) was evaluated after operation.
ResultsOne hundred and seven patients performed LSG were retrieved from 7 literatures. The levels of fasting blood glucose and glycosylated hemoglobin on the postoperative 6 months were all obviously decreased as compared with the levels before operation (fasting blood glucose:MD=2.99, 95% CI 2.39-3.60, P < 0.000 01; glycosylated hemoglobin:MD=2.24, 95% CI 1.43-3.04, P < 0.000 01), which on the postoperative 12 months were all obviously decreased as compared with the levels on the postoperative 6 months (fasting blood glucose:MD=0.56, 95% CI 0.16-0.95, P=0.006; glycosylated hemoglobin:MD=0.52, 95% CI 0.22-0.81, P=0.000 6). The postoperative fasting blood glucose and glycosylated hemoglobin levels in patients accepted LSG showed a downward trend.
ConclusionsLSG on obesity with T2MD has an obvious short-term curative effect. But its long-term efficacy still needs to be supported by large samples randomized controlled clinical research data.
Objective To investigate the short term and long term effects of laparoscopic gastric bypass on obesity related type 2 diabetes. Methods Twenty obese patients with type 2 diabetes underwent laparoscopic gastric bypass between Nov. 2009 and Feb. 2012 were identified in the computer database of West China Hospital of Sichuan University. All patients had short term follow-up of less than 1 year and among them 11 were with long term follow-up of 1 year or more. Body weight， body mass index （BMI）， blood glucose， glycosylated hemoglobin （HbA1c）， homeostasis model assessment of insulin resistance-insulin resistance （HOMA-IR）， blood pressure， and blood lipids were examined. Short term （＜1 year） and long term （≥1 year） remission rates of diabetes were calculated and factors which might have effects on the remission of diabetes were analyzed. Results Of patients with short term follow-up，body weight， fasting plasma glucose （FPG）， 2h plasma glucose （2hPG）， HbA1c， and HOMA-IR were reduced significantly. Among them， 18 of 20 patients （90.0%） reached the glucose and medication standards of complete remission and partial remission， 9 patients were defined as completely remitted （9/20， 45.0%）. Those accompanied with hypertension and （or） hyperlipemia were all improved clinically. The duration of diabetes， fasting and 2 h C peptide were found to be related to short term diabetes remission. Patients with long term follow-up of 1 year or more were observed to have significant reductions in body weight， FPG， 2hPG， HbA1c， and HOMA-IR as well. Hypertension and hyperlipidemia were all well controlled. The remission rate of diabetes reached 9/11 （81.8%）and those who were defined as completely remitted took a proportion of 6/11 （54.5%）. In these patients， those who did not reach the standards of complete remission had longer duration of diabetes and higher FPG when compared with those who did. No severe adverse event was found during the follow-up in either group. Most patients investigated were satisfied with the surgery.Conclusion Laparoscopic gastric bypass is effective and safe on short term and long term treatment of obesity related type 2 diabetes.
Objective To explore the correlation between overweight, obesity and incidence of type 2 diabetes mellitus (T2DM). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2012), CNKI, VIP, CBM and WanFang Data were searched from inception to May, 2012 to collect the cohort studies on the correlation between overweight, obesity and incidence of T2DM. The studies were screened according to the inclusion and exclusion criteria by two researchers independently, the quality was evaluated, the data were extracted, and then meta-analysis was performed using RevMan 5.1 and Stata 11.0 software. Results A total of 8 studies involving 101 864 participants were included. The results of meta-analysis showed that, compared with the normal weight population, the onset risk of T2DM was obviously higher in the overweight (RR=2.59, 95%CI 2.11 to 3.19, Plt;0.000 01), and obese (RR=6.28, 95%CI 4.99 to 7.91, Plt;0.000 01) populations. In the subgroup analysis, the onset risk of T2DM was higher in the western obese population (RR=6.91, 95%CI 5.59 to 8.56) than the eastern obese population (RR=4.19, 95%CI 2.93 to 5.99). Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), the quality of the included studies on T2DM developed by overweight and obesity was low and medium respectively. Conclusion Overweight and obesity can increase the onset risk of T2DM which is higher in the female and western obese populations than the male and eastern obese populations respectively.
ObjectiveTo review the effect of obesity on the effectiveness of posterior lumbar fusion in patients with lumbar degenerative diseases (LDD).MethodsThe related literature at home and abroad was extensively reviewed. And the difficulty of operation, risk of complications, and long-term effectiveness of posterior lumbar fusion for obese patients with LDD were summarized.ResultsAlthough some relevant literature suggest that the posterior lumbar fusion for obese patients is difficult and the risk of postoperative complications is high, the overall research results do not suggest that obesity is a risk factor for the implementation of posterior lumbar fusion. By assessing the physical condition of patients and strictly grasping the surgical indications, obese patients can obtain good surgical efficacy.ConclusionPosterior lumbar fusion is an effective method for the treatment of LDD in obese patients. However, relevant studies need to be completed to further evaluate the safety and efficacy of posterior lumbar fusion for obese patients.
Objective To systematically review the efficacy of different exercises on inflammatory cytokines in individuals with overweight or obesity. Methods The CNKI, WanFang Data, VIP, PubMed, EBSCO, Cochrane Library, Web of Science and Embase databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of exercise on inflammatory cytokines in individuals with overweight or obesity from January, 2000 to April, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. The network meta-analysis was then performed using Stata 16.0 software. Results A total of 63 RCTs were included, 49 of which reported the changes in IL-6, 47 of which reported the changes in TNF-α, and 16 of which reported the changes in IL-10. The results of the network meta-analysis found that compared with those in the control group, aerobic exercise (AE) (SMD=?0.9, 95%CI ?1.4 to ?0.5, P<0.01) and high-intensity interval training (HIIT) (SMD=?1.3, 95%CI ?2.3 to ?0.3, P=0.011) significantly reduced IL-6. AE (SMD=?1.3, 95%CI ?1.7 to ?0.9, P<0.01), combined exercise (COM) (SMD=?0.7, 95%CI ?1.3 to ?0.1, P=0.02), and HIIT (SMD=?1.8, 95%CI ?2.6 to ?0.9, P<0.01) significantly reduced TNF-α; AE (SMD=0.8, 95%CI 0.1 to 1.5, P=0.03) significantly increased IL-10. The cumulative probability ranking results showed that HIIT was the most effective in reducing IL-6 and TNF-α and increasing IL-10, followed by AE and COM, and resistance training (RT) was the least effective. Conclusion Different exercise types have different effects on improving inflammation in individuals with overweight or obesity. HIIT can be suggested as the best exercise program to improve chronic inflammation in individuals with overweight or obesity. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective
To investigate the effects of transforming growth factor beta (TGF-β) on airway remodeling in obese asthmatic mice and intervention effects of pirfenidone.
Methods
Seventy-five C57BL/6J mice were randomly divided into five groups, namely a blank control group (group A), an obese group (group B), an obese asthmatic group (group C), a budesonide treatment group (group D) and a pirfenidone treatment group (group E). The mice in the B, C, D, and E groups were fed with high fat diets, then the mice in the C, D, and E groups were sensitized and challenged with ovalbumin (OVA) to establish the model of chronic obese asthma. The mice in group A were fed with normal diets, sensitized and challenged with normal saline. The mice in group D were treated with budesonide (0.5 mg/ml), and the mice in group E were treated with pirfenidone (300 mg/kg). After 4 weeks of treatment, the total number of white cells as well as the percentage of leukocytes, eosinophils, neutrophils and macrophage in bronchoalveolar lavage fluid (BALF) were counted. ELISA and Western blot were used to evaluate the expression of TGF-β. The pathological changes of mice were observed under light microscope by HE and periodic acid-Schiff staining. Meanwhile the remodeling indices were measured including total bronchial wall area (WAt), smooth muscle area (WAm), and bronchial basement membrane perimeter (Pbm).
Results
The levels of leukocyte and eosinophils in BALF, expression of TGF-β, WAt/Pbm and WAm/Pbm in group C were higher than those in group A, B, D, and E (allP<0.05). The levels of eosinophils in BALF, WAt/Pbm in group E were lower than those in group D (allP<0.05). The level of TGF-β decreased in a sequence of group C>D>E>B>A (allP<0.05). The expression of TGF-β was in a positive correlation with eosinophil percentage in BALF (r=0.79,P<0.01).
Conclusions
The expression of TGF-β in the airway of obese asthmatic mice is closely related to airway inflammation, airway hyper-secretion and airway remodeling. Pirfenidone can effectively inhibit the expression of TGF-β and improve airway remodeling.
ObjectiveTo investigate the short-term effect of laparoscopic sleeve gastrectomy (LSG) in treatment of obesity in China.
MethodsLiteratures about the effect of LSG in treatment of obesity were searched from WanFang, CNKI, PubMed, and Web of Science, then these literatures were filtered according to the inclusive and exclusive criteria and evaluated. Meta analysis was performed based on data extracted from these literatures.
ResultsThree hundreds and eighty three cases of LSG were retrieved from 12 literatures. Compared with the preoperative, the body mass index (BMI) was lower in 6 months after LSG (MD=7.56, 95% CI: 5.77-9.34, P < 0.000 01), and compared with 6 months after LSG, the BMI was lower in 12 months after LSG (MD=3.19, 95% CI: 2.20-4.18, P < 0.000 01). Compared with 1 months after LSG, the excess weight loss (EWL%) was higher in 6 months after LSG (MD=-42.77, 95% CI:-45.77--39.77, P < 0.000 01), and compared with 6 months after LSG, EWL% was higher in 12 months after LSG (MD=-19.71, 95% CI:-25.54--13.87, P < 0.000 01). After the LSG, BMI decreased, but EWL% increased over time.
ConclusionsIn China, LSG has obviously short-term curative effect in the treatment of obesity.
Objective To systematically review the relationship between obesity and the incidence of digestive system cancers. Methods The PubMed, EMbase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect cohort studies on the relationship between obesity and digestive system cancers from January 1st, 2001 to October 31st, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. Results A total of 16 cohort studies were included. The results of meta-analysis revealed that compared with normal weight, obesity increased the incidence rate of various cancers of the digestive system, including colorectal cancer (RR=1.25, 95% CI 1.13 to 1.39, P<0.000 1), liver cancer (RR=1.65, 95%CI 1.41 to 1.92, P<0.000 01), pancreatic cancer (RR=1.34, 95%CI 1.19 to 1.51, P<0.000 01), gastric cancer (RR=1.09, 95%CI 1.05 to 1.14, P<0.000 1), and esophageal cancer (RR=2.39, 95%CI 1.98 to 2.89, P<0.000 01). Conclusion The current evidence indicates that obesity can increase the incidence rate of digestive system cancers. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To systematically review the effects of various exercise modalities on obese children and adolescents with metabolic syndrome (MetS). MethodsChinese and English databases such as CNKI, WanFang Data, VIP, PubMed and Web of Science were selected to search for RCTs on the effects of exercise on obese children and adolescents with MetS, and the search period was from January 2000 to November 2024. Two researchers independently screened the literature, extracted data and evaluated the risk of bias of the included studies, and net work meta?analysis was performed using Stata 17.0 and RevMan 5.4 software. ResultsA total of 15 RCTs involving 968 obese children and adolescents with MetS were included. The results of reticulated meta?analysis showed that compared with the non?exercise intervention group, aerobic exercise was effective in improving the patients' body mass index (BMI) (SMD=?1.21, 95%CI ?2.31 to ?0.11, P=0.031), total cholesterol (TC) (SMD=?0.44, 95%CI ?0.82 to ?0.05, P=0.028), triglyceride (TG) (SMD=?1.10, 95%CI ?1.98 to ?0.22, P=0.014), fasting blood glucose (FBG) (SMD=?0.70, 95%CI ?1.34 to ?0.07, P=0.030), systolic blood pressure (SBP) (SMD=?1.10, 95%CI ?1.83 to ?0.38, P=0.003), diastolic blood pressure (DBP) (SMD=?0.93, 95%CI ?1.49 to ?0.37, P=0.001). Resistance exercise can effectively improve the HDL cholesterol (SMD=0.55, 95%CI 0.09 to 1.02, P=0.020) and SBP (SMD=?1.16, 95%CI ?2.18 to ?0.14, P=0.025). Aerobic combined with resistance exercise can effectively improve waist circumference (WC) (SMD=?1.09, 95%CI ?1.74 to ?0.44, P=0.001), BMI (SMD=?1.22, 95%CI ?2.32 to ?0.12, P=0.030), HDL (SMD=0.56, 95%CI 0.13 to 1.00, P=0.011), and FBG (SMD=?0.57, 95%CI ?1.13 to ?0.02, P=0.044). The results of cumulative probability ranking showed that aerobic exercise was the most effective in improving TG, TC, FBG and DBP, resistance exercise was the most effective in improving SBP; and aerobic combined with resistance exercise was the most effective in improving WC, BMI and HDL. ConclusionDifferent exercise modes have different improvement effects on various body indexes in obese children and adolescents with MetS. Due to the limitation of the number and quality of included studies, more high quality studies are needed to verify the above conclusions.
ObjectiveTo investigate the effect of Roux-en-Y gastric bypass (RYGB) on the composition of intestinal microbiota among the biliopancreatic limb, the Roux limb, and the common channel in normal Sprague-Dawley (SD) rats.
MethodsSixteen SD rats were randomly divided into sham surgery group (Sham group) and RYGB group, each group enrolled 8 rats. Rats in Sham group underwent sham surgery of end to end anastomosis in situ after cutting off the stomach and jejunum, and rats in RYGB group underwent RYGB. Then quantitative real-time PCR (RT-PCR) method was used to detect the expression of total bacteria, Bifidobacterium, Bacteroides, and Lactobacillus mRNA at biliopancreatic limb, the Roux limb, and the common channel. At last the comparison of mRNA in 4 kinds of bacteria was performed.
ResultsCompared with Sham group, the weight of rats in RYGB group was lower at 8 weeks after surgery (P<0.01). RT-PCR results showed that, expression levels of total bacteria, Bifidobacterium, and Bacteroides mRNA at the Roux limb and the common channel in RYGB group were higher than corresponding site of rats in Sham group (P<0.05), but there was no significant difference at biliopancreatic limb between the 2 groups (P>0.05). Expression level of Lactobacillus mRNA at the Roux limb in RYGB group was higher than corresponding site of rats in Sham group (P<0.05), but there was no significant difference at biliopancreatic limb and the common channel between the 2 groups (P>0.05).
ConclusionRYGB can significantly improve expression levels of the total bacteria, Bifidobacterium, and Bacteroides mRNA at Roux limb and the common channel, increase the level of Lactobacillus mRNA at Roux limb, while has no influence on biliopancreatic limb.
