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SOARD Category 1 CME Credit Featured Articles, Volume 10, November–December 2014
SOARD Category 1 CME Credit Featured Articles, Volume 10, November–December 2014 Effects of laparoscopic Roux-en-Y gastric bypass on bone mineral density and markers of bone turnover Kosisochi M. Obinwanne, Kevin P. Riess, Kara J. Kallies, Michelle A. Mathiason, Brian R. Manske, Shanu N. Kothari. Surg Obes Relat Dis 2014;10;1056-1062.
Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution Nancy C. Mead, Panagiotis Sakkatos, George C. Sakellaropoulos, George L. Adonakis, Theodore K. Alexandrides, Fotis Kalfarentzos. Surg Obes Relat Dis 2014;10;1166-1173.
Objectives: After reading the featured articles published in this issue of Surgery for Obesity and Related Diseases (SOARD) participants in the SOARD CME program should be able to demonstrate increased understanding of the material specific to the article featured and be able to apply relevant information to clinical practice. Objectives are stated at the beginning of each featured article; the questions follow with three to five response choices, and a critique discussing the objective. Disclosure Statement: It is the policy of the American Society for Metabolic and Bariatric Surgery that speakers and/or anyone in control of content of a CME Category 1 event must disclose any financial or other relationship with (1) any manufacturer(s) of commercial products that may be discussed in the speaker’s presentation and/or (2) commercial supporters of the event. All disclosures are included under the list of author names. There was no commercial support received for this activity. Accreditation Statement: The American Society for Metabolic and Bariatric Surgery (ASMBS) is accredited by the Accreditation Council for Continuing Medical Education
(ACCME) to provide continuing medical education for physicians. The American Society for Metabolic and Bariatric Surgery (ASMBS) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. SOARD CME Online provides two articles from each issue for 2 credits per month; 1 credit per article. The articles this month on SOARD CME Online are: Effects of laparoscopic Roux-en-Y gastric bypass on bone mineral density and markers of bone turnover Kosisochi M. Obinwanne, Kevin P. Riess, Kara J. Kallies, Michelle A. Mathiason, Brian R. Manske, Shanu N. Kothari. Surg Obes Relat Dis 2014;10;1056-1062. Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution Nancy C. Mead, Panagiotis Sakkatos, George C. Sakellaropoulos, George L. Adonakis, Theodore K. Alexandrides, Fotis Kalfarentzos. Surg Obes Relat Dis 2014;10;1166-1173.
http://dx.doi.org/10.1016/j.soard.2014.10.004 1550-7289/r 2014 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 10 (2014) 1238–1240
VOLUME 10
NUMBER 6
1239
NOVEMBER/DECEMBER 2014
ARTICLE 1
Question 3
Effects of laparoscopic Roux-en-Y gastric bypass on bone mineral density and markers of bone turnover
Which of the following statements regarding bone mineral density values in women is true?
Kosisochi M. Obinwanne, Kevin P. Riess, Kara J. Kallies, Michelle A. Mathiason, Brian R. Manske, Shanu N. Kothari. Surg Obes Relat Dis 2014;10;1056-1062.
A. Peak bone mass is achieved in the 3rd decade of life. B. There is a steady increase in bone mass as menopause approaches. C. Estrogen plays a crucial role in the inhibition of bone formation. D. Compared to premenopausal women, menopausal women have a greater resistance to bone loss after a Roux-en-Y gastric bypass. E. After Roux-en-Y gastric bypass, the lumbar spine has been shown to be most prone to bone loss.
Learning Objectives
To understand the impact of a Roux-en-Y gastric bypass on bone loss.
To understand the significance of calcium and vitamin D supplementation in gastric bypass patients.
To understand the important role played by calcium, vitamin D, and PTH in bone health.
To understand the complex relationship between obesity and osteoporosis. Question 1 Which of the following is a mechanism by which obesity contributes to bone loss? A. Decreased adipocyte differentiation leading to a concomitant decrease in osteoclast differentiation B. Mechanical loading which increases the proliferation and differentiation of osteoclasts C. Increased osteoclastic activity due to the upregulation of certain proinflammatory cytokines D. Increased levels of free sex steroids E. Associated hyperinsulinemia
Question 4 Which of the following statements regarding vitamin D is false? A. Deficiency in morbidly obese patients may occur as a result of sequestration in adipose tissue. B. Vitamin D deficiency may trigger increased production of parathyroid hormone. C. Ingested vitamin D is principally absorbed in the small intestine. D. Deficiency in morbidly obese patients may occur as a result of vitamin D sequestration in bone. E. Preoperative vitamin D deficiency is a predictor for deficiency after a Roux-en-Y gastric bypass.
Question 2 Regarding markers of bone turnover, which of the following statements is false? A. Osteocalcin is a marker for bone formation. B. Bone alkaline phosphatase is a marker of bone formation. C. Serum calcium level is not a reliable marker of bone turnover. D. Urinary cross-linked N-telopeptide (NTX) is a marker of bone resorption. E. PTH levels post-gastric bypass remain the same.
ARTICLE 2 Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution Nancy C. Mead, Panagiotis Sakkatos, George C. Sakellaropoulos, George L. Adonakis, Theodore K. Alexandrides, Fotis Kalfarentzos. Surg Obes Relat Dis 2014;10;1166-1173.
1240
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 10 (2014) 1238–1240
Learning Objectives:
To recognize the importance of possible nutritional sequelae following different types of bariatric surgery and potential effects on pregnancy outcomes. To recognize the importance of close monitoring of women who become pregnant following bariatric surgery. To recognize the effects of surgery on metabolic complications of pregnancy. To recognize the effects of surgery on neonatal outcomes. To recognize the potential effects of surgery on adult and childhood health of offspring as well as on future generations. Question 1 Which of the following nutritional indices should be closely monitored in women who become pregnant following surgery? A. B. C. D. E.
Serum albumin Hemoglobin Folic acid Vitamin B12 All of the above
Question 2 Which of the following is potentially the most dangerous nutritional complication following malabsorptive surgery? A. B. C. D. E.
Iron deficiency anemia Hypoproteinemia Vitamin A deficiency Vitamin D deficiency Vitamin B12 deficiency
Question 3 Which of the following statements is/are true regarding neonatal outcomes following bariatric surgery? A. Neonates born following malabsorptive procedures (BPD) have a lower mean birth weight than those born after mixed (RYGB) or restrictive (SG) procedures. B. Neonates born following malabsorptive procedures (BPD) are more often born premature than those born after mixed (RYGB) or restrictive (SG) procedures. C. Women who become pregnant following surgery have lower gestational weight gain and fewer metabolic complications than in pregnancies that occurred before surgery. D. Neonates born to mothers following bariatric surgery have a lower birth weight and length as well as smaller head circumference than their siblings born before surgery. E. Both A and C. Question 4 Recent studies investigating later childhood development of children born before and after malabsorptive surgery have shown: A. B. C. D. E.
lower incidence of nutritional deficiencies. smaller stature. lower incidence of severe obesity. Both A and C Both B and C
Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution Nancy C. Mead, Panagiotis Sakkatos, George C. Sakellaropoulos, George L. Adonakis, Theodore K. Alexandrides, Fotis Kalfarentzos. Surg Obes Relat Dis 2014;10;1166-1173.
Objectives: After reading the featured articles published in this issue of Surgery for Obesity and Related Diseases (SOARD) participants in the SOARD CME program should be able to demonstrate increased understanding of the material specific to the article featured and be able to apply relevant information to clinical practice. Objectives are stated at the beginning of each featured article; the questions follow with three to five response choices, and a critique discussing the objective. Disclosure Statement: It is the policy of the American Society for Metabolic and Bariatric Surgery that speakers and/or anyone in control of content of a CME Category 1 event must disclose any financial or other relationship with (1) any manufacturer(s) of commercial products that may be discussed in the speaker’s presentation and/or (2) commercial supporters of the event. All disclosures are included under the list of author names. There was no commercial support received for this activity. Accreditation Statement: The American Society for Metabolic and Bariatric Surgery (ASMBS) is accredited by the Accreditation Council for Continuing Medical Education
(ACCME) to provide continuing medical education for physicians. The American Society for Metabolic and Bariatric Surgery (ASMBS) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. SOARD CME Online provides two articles from each issue for 2 credits per month; 1 credit per article. The articles this month on SOARD CME Online are: Effects of laparoscopic Roux-en-Y gastric bypass on bone mineral density and markers of bone turnover Kosisochi M. Obinwanne, Kevin P. Riess, Kara J. Kallies, Michelle A. Mathiason, Brian R. Manske, Shanu N. Kothari. Surg Obes Relat Dis 2014;10;1056-1062. Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution Nancy C. Mead, Panagiotis Sakkatos, George C. Sakellaropoulos, George L. Adonakis, Theodore K. Alexandrides, Fotis Kalfarentzos. Surg Obes Relat Dis 2014;10;1166-1173.
http://dx.doi.org/10.1016/j.soard.2014.10.004 1550-7289/r 2014 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 10 (2014) 1238–1240
VOLUME 10
NUMBER 6
1239
NOVEMBER/DECEMBER 2014
ARTICLE 1
Question 3
Effects of laparoscopic Roux-en-Y gastric bypass on bone mineral density and markers of bone turnover
Which of the following statements regarding bone mineral density values in women is true?
Kosisochi M. Obinwanne, Kevin P. Riess, Kara J. Kallies, Michelle A. Mathiason, Brian R. Manske, Shanu N. Kothari. Surg Obes Relat Dis 2014;10;1056-1062.
A. Peak bone mass is achieved in the 3rd decade of life. B. There is a steady increase in bone mass as menopause approaches. C. Estrogen plays a crucial role in the inhibition of bone formation. D. Compared to premenopausal women, menopausal women have a greater resistance to bone loss after a Roux-en-Y gastric bypass. E. After Roux-en-Y gastric bypass, the lumbar spine has been shown to be most prone to bone loss.
Learning Objectives
To understand the impact of a Roux-en-Y gastric bypass on bone loss.
To understand the significance of calcium and vitamin D supplementation in gastric bypass patients.
To understand the important role played by calcium, vitamin D, and PTH in bone health.
To understand the complex relationship between obesity and osteoporosis. Question 1 Which of the following is a mechanism by which obesity contributes to bone loss? A. Decreased adipocyte differentiation leading to a concomitant decrease in osteoclast differentiation B. Mechanical loading which increases the proliferation and differentiation of osteoclasts C. Increased osteoclastic activity due to the upregulation of certain proinflammatory cytokines D. Increased levels of free sex steroids E. Associated hyperinsulinemia
Question 4 Which of the following statements regarding vitamin D is false? A. Deficiency in morbidly obese patients may occur as a result of sequestration in adipose tissue. B. Vitamin D deficiency may trigger increased production of parathyroid hormone. C. Ingested vitamin D is principally absorbed in the small intestine. D. Deficiency in morbidly obese patients may occur as a result of vitamin D sequestration in bone. E. Preoperative vitamin D deficiency is a predictor for deficiency after a Roux-en-Y gastric bypass.
Question 2 Regarding markers of bone turnover, which of the following statements is false? A. Osteocalcin is a marker for bone formation. B. Bone alkaline phosphatase is a marker of bone formation. C. Serum calcium level is not a reliable marker of bone turnover. D. Urinary cross-linked N-telopeptide (NTX) is a marker of bone resorption. E. PTH levels post-gastric bypass remain the same.
ARTICLE 2 Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution Nancy C. Mead, Panagiotis Sakkatos, George C. Sakellaropoulos, George L. Adonakis, Theodore K. Alexandrides, Fotis Kalfarentzos. Surg Obes Relat Dis 2014;10;1166-1173.
1240
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 10 (2014) 1238–1240
Learning Objectives:
To recognize the importance of possible nutritional sequelae following different types of bariatric surgery and potential effects on pregnancy outcomes. To recognize the importance of close monitoring of women who become pregnant following bariatric surgery. To recognize the effects of surgery on metabolic complications of pregnancy. To recognize the effects of surgery on neonatal outcomes. To recognize the potential effects of surgery on adult and childhood health of offspring as well as on future generations. Question 1 Which of the following nutritional indices should be closely monitored in women who become pregnant following surgery? A. B. C. D. E.
Serum albumin Hemoglobin Folic acid Vitamin B12 All of the above
Question 2 Which of the following is potentially the most dangerous nutritional complication following malabsorptive surgery? A. B. C. D. E.
Iron deficiency anemia Hypoproteinemia Vitamin A deficiency Vitamin D deficiency Vitamin B12 deficiency
Question 3 Which of the following statements is/are true regarding neonatal outcomes following bariatric surgery? A. Neonates born following malabsorptive procedures (BPD) have a lower mean birth weight than those born after mixed (RYGB) or restrictive (SG) procedures. B. Neonates born following malabsorptive procedures (BPD) are more often born premature than those born after mixed (RYGB) or restrictive (SG) procedures. C. Women who become pregnant following surgery have lower gestational weight gain and fewer metabolic complications than in pregnancies that occurred before surgery. D. Neonates born to mothers following bariatric surgery have a lower birth weight and length as well as smaller head circumference than their siblings born before surgery. E. Both A and C. Question 4 Recent studies investigating later childhood development of children born before and after malabsorptive surgery have shown: A. B. C. D. E.
lower incidence of nutritional deficiencies. smaller stature. lower incidence of severe obesity. Both A and C Both B and C