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P-138: Bmi-independent inflammation in omental adipose tissue associated with insulin resistance in morbid obesity
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Abstracts: 2010 Poster Session / Surgery for Obesity and Related Diseases 6 (2010) S27-S79
Roux-en-Y gastric bypass (LRYGB) at University of Colorado Hospital, from 2004 to 2009. Results: Demographics including, age (37.2 vs. 43.8 years old), sex (93.6% vs. 82.7% females), and BMI (50.9 vs. 47.0 kg/m2) were compared. The incidence of preoperative comorbidities, including HTN (50.9% vs. 55.1%), T2DM (28.2% vs. 23.6%), GERD (50.9% vs. 50.0%), OSA (44.5% vs. 34.3%), and DJD (63.6% vs. 63.0%), were very similar with the exception of a significantly higher rate of OSA in the Medicaid group. Postoperatively, percent excess weight loss was calculated at 1 week (12.4% vs. 11.0%), 3 weeks (19.0% vs. 19.3%), 9 weeks (30.4% vs. 32.1%), 6 months (50.8% vs. 56.5%), and 1 year (60% vs. 71.5%, p⫽0.005). Hospital readmission rates for major complications such as surgical site infection, dehydration, bowel obstruction, and venous thromboembolism totaled 6.4% vs. 9.8%. There was zero mortality and 1 leak (0.3%) (non-Medicaid) in total. Conclusion: In a review of Medicaid vs. non-Medicaid LRYGB patients, although there was a trend towards higher BMI, higher rates of T2DM, and significantly higher sleep apnea, the perioperative morbidity and mortality was very low and actually less than that of the non-Medicaid group. The non-Medicaid LRYGB patients lost a significantly greater percent of excess weight at one year. P-138
BMI-INDEPENDENT INFLAMMATION IN OMENTAL ADIPOSE TISSUE ASSOCIATED WITH INSULIN RESISTANCE IN MORBID OBESITY Richard A. Perugini, MD; Olga Hardy; Sarah Nicoloro; Karen Gallagher-Dorval; Vishwajeet Puri; Juerg Straubhaar; Michael Czech; Molecular Medicine, University of Massachusetts Medical School, Worcester, MA; Surgery, University of Massachusetts Medical School, Worcester, MA Background: Obesity is a strong risk factor for resistance to insulin-mediated glucose disposal, a precursor of type 2 diabetes and other disorders. To identify molecular pathways that may cause such obesity-associated insulin resistance in human subjects, we exploited the fact that not all obese individuals are prone to insulin resistance. Thus the degree of obesity as a variable was removed by studying morbidly obese human subjects of similar BMI values who are insulin-sensitive versus insulin resistant. Methods: Combining gene expression profiling with computational approaches, we determined the global gene expression signatures of omental and subcutaneous adipose tissue samples obtained from similarly obese patients undergoing gastric bypass surgery. Results: Gene sets related to chemokine activity and chemokine receptor binding were identified as most highly expressed in the omental tissue from insulin-resistant compared to insulin sensitive subjects, independent of BMI. These upregulated genes included chemokines CCL2, CCL3, CCL4, CCL8, CXCL2, CXCL10 and IL8/CXCL8, and were not differentially expressed in subcutaneous adipose tissues between the two groups of subjects. Strikingly, insulin resistance, but not BMI, was associated with increased macrophage infiltration in the omental adipose tissue, as was adipocyte size, in these morbidly obese subjects.
Conclusion: Our findings strongly support the hypothesis that inflammation of omental adipose tissue mediates insulin resistance in human obesity. P-139
BODY CONTOURING AFTER MASSIVE WEIGHT LOSS IN THE MALE PATIENT – SPECIAL CONSIDERATIONS AND OUTCOMES Jonathan Toy, MD; Tae Chong; Joseph Michaels, V. MD; Devin Coon, BA; J. Peter Rubin, MD; Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA Background: Increasing numbers of patients are presenting to plastic surgeons for the treatment of post weight-loss deformities. Interestingly, males account for only 10-20% of body contouring patients. Similar to other areas of medicine, there are gender differences regarding evaluation, approach, and complications. Methods: Data was prospectively collected on all body contouring patients presenting to the senior author (JPR) over a four-year period. Patient demographics, intraoperative details and post-operative details were documented. Chi square analysis was utilized for dichotomous variables and Student’s t-test for continuous data. Significant factors were evaluated using a binary logistic regression. p values ⬍0.05 were assigned statistical significance. SPSS statistical software was utilized for data analysis. Results: Over the 4-year period, 435 women and 48 men (8.9%) underwent body contouring surgery. The overall incidence of hematoma and seroma formation was 4.1% and 14.3%, respectively. Male gender was associated with an increased risk of hematoma (6/48, OR 4.22, p⬍0.05) and seroma formation (12/48, OR 2.15, p⬍0.05). However, male gender was not an independent predictor of wound dehiscence, flap loss, transfusion, or surgical site infection. Furthermore, while men were more likely to develop hematoma and seroma, this was not associated with an increased incidence of reoperation. Conclusion: There are differences in the evaluation and surgical outcomes based on gender in the body contouring population. Males are at an increased risk of hematoma and seroma formation. These differences require further study. P-140
OBESITY AND WEIGHT-LOSS QUALITY-OF-LIFE (OWLQOL) IMPROVEMENT AFTER LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING—1 YEAR INTERIM RESULTS OF THE APEX STUDY John Dixon, MD; Daniel Jones, MD; Michael Oefelein, MD; Obesity Research Unit, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia; Bariatric Program, Harvard Medical School, Boston, MA; Allergan, Irvine, CA Background: Bariatric surgery has been established as an effective treatment to reduce weight in severely obese patients refractory to behavioral and medical therapies. Numerous co-morbid illnesses have been associated with obesity. The purpose of this study is to report detailed 1 year OWLQOL results after surgical placement of the adjustable gastric band (AP Band, Allergan, Irvine, CA).
Abstracts: 2010 Poster Session / Surgery for Obesity and Related Diseases 6 (2010) S27-S79
Roux-en-Y gastric bypass (LRYGB) at University of Colorado Hospital, from 2004 to 2009. Results: Demographics including, age (37.2 vs. 43.8 years old), sex (93.6% vs. 82.7% females), and BMI (50.9 vs. 47.0 kg/m2) were compared. The incidence of preoperative comorbidities, including HTN (50.9% vs. 55.1%), T2DM (28.2% vs. 23.6%), GERD (50.9% vs. 50.0%), OSA (44.5% vs. 34.3%), and DJD (63.6% vs. 63.0%), were very similar with the exception of a significantly higher rate of OSA in the Medicaid group. Postoperatively, percent excess weight loss was calculated at 1 week (12.4% vs. 11.0%), 3 weeks (19.0% vs. 19.3%), 9 weeks (30.4% vs. 32.1%), 6 months (50.8% vs. 56.5%), and 1 year (60% vs. 71.5%, p⫽0.005). Hospital readmission rates for major complications such as surgical site infection, dehydration, bowel obstruction, and venous thromboembolism totaled 6.4% vs. 9.8%. There was zero mortality and 1 leak (0.3%) (non-Medicaid) in total. Conclusion: In a review of Medicaid vs. non-Medicaid LRYGB patients, although there was a trend towards higher BMI, higher rates of T2DM, and significantly higher sleep apnea, the perioperative morbidity and mortality was very low and actually less than that of the non-Medicaid group. The non-Medicaid LRYGB patients lost a significantly greater percent of excess weight at one year. P-138
BMI-INDEPENDENT INFLAMMATION IN OMENTAL ADIPOSE TISSUE ASSOCIATED WITH INSULIN RESISTANCE IN MORBID OBESITY Richard A. Perugini, MD; Olga Hardy; Sarah Nicoloro; Karen Gallagher-Dorval; Vishwajeet Puri; Juerg Straubhaar; Michael Czech; Molecular Medicine, University of Massachusetts Medical School, Worcester, MA; Surgery, University of Massachusetts Medical School, Worcester, MA Background: Obesity is a strong risk factor for resistance to insulin-mediated glucose disposal, a precursor of type 2 diabetes and other disorders. To identify molecular pathways that may cause such obesity-associated insulin resistance in human subjects, we exploited the fact that not all obese individuals are prone to insulin resistance. Thus the degree of obesity as a variable was removed by studying morbidly obese human subjects of similar BMI values who are insulin-sensitive versus insulin resistant. Methods: Combining gene expression profiling with computational approaches, we determined the global gene expression signatures of omental and subcutaneous adipose tissue samples obtained from similarly obese patients undergoing gastric bypass surgery. Results: Gene sets related to chemokine activity and chemokine receptor binding were identified as most highly expressed in the omental tissue from insulin-resistant compared to insulin sensitive subjects, independent of BMI. These upregulated genes included chemokines CCL2, CCL3, CCL4, CCL8, CXCL2, CXCL10 and IL8/CXCL8, and were not differentially expressed in subcutaneous adipose tissues between the two groups of subjects. Strikingly, insulin resistance, but not BMI, was associated with increased macrophage infiltration in the omental adipose tissue, as was adipocyte size, in these morbidly obese subjects.
Conclusion: Our findings strongly support the hypothesis that inflammation of omental adipose tissue mediates insulin resistance in human obesity. P-139
BODY CONTOURING AFTER MASSIVE WEIGHT LOSS IN THE MALE PATIENT – SPECIAL CONSIDERATIONS AND OUTCOMES Jonathan Toy, MD; Tae Chong; Joseph Michaels, V. MD; Devin Coon, BA; J. Peter Rubin, MD; Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA Background: Increasing numbers of patients are presenting to plastic surgeons for the treatment of post weight-loss deformities. Interestingly, males account for only 10-20% of body contouring patients. Similar to other areas of medicine, there are gender differences regarding evaluation, approach, and complications. Methods: Data was prospectively collected on all body contouring patients presenting to the senior author (JPR) over a four-year period. Patient demographics, intraoperative details and post-operative details were documented. Chi square analysis was utilized for dichotomous variables and Student’s t-test for continuous data. Significant factors were evaluated using a binary logistic regression. p values ⬍0.05 were assigned statistical significance. SPSS statistical software was utilized for data analysis. Results: Over the 4-year period, 435 women and 48 men (8.9%) underwent body contouring surgery. The overall incidence of hematoma and seroma formation was 4.1% and 14.3%, respectively. Male gender was associated with an increased risk of hematoma (6/48, OR 4.22, p⬍0.05) and seroma formation (12/48, OR 2.15, p⬍0.05). However, male gender was not an independent predictor of wound dehiscence, flap loss, transfusion, or surgical site infection. Furthermore, while men were more likely to develop hematoma and seroma, this was not associated with an increased incidence of reoperation. Conclusion: There are differences in the evaluation and surgical outcomes based on gender in the body contouring population. Males are at an increased risk of hematoma and seroma formation. These differences require further study. P-140
OBESITY AND WEIGHT-LOSS QUALITY-OF-LIFE (OWLQOL) IMPROVEMENT AFTER LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING—1 YEAR INTERIM RESULTS OF THE APEX STUDY John Dixon, MD; Daniel Jones, MD; Michael Oefelein, MD; Obesity Research Unit, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia; Bariatric Program, Harvard Medical School, Boston, MA; Allergan, Irvine, CA Background: Bariatric surgery has been established as an effective treatment to reduce weight in severely obese patients refractory to behavioral and medical therapies. Numerous co-morbid illnesses have been associated with obesity. The purpose of this study is to report detailed 1 year OWLQOL results after surgical placement of the adjustable gastric band (AP Band, Allergan, Irvine, CA).