Bariatic Surgery: Outcomes & Impact on Pathophysiology

减肥手术：结果

• 批准号: 7122447
• 负责人: PAUL David BERK
• 金额: $ 57.24万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7122447
• 关键词: adipose tissue; brain electrical activity; clinical research; cooperative study; fatty acid metabolism; fibrogenesis; gastrointestinal hormones; gene expression; human subject; hunger; laparoscopy; lipid metabolism; noninsulin dependent diabetes mellitus; obesity; outcomes research; pathologic process; patient oriented research; pyloric region; stomach /intestine bypass; stomach surgery; triglycerides; weight loss

DESCRIPTION (provided by applicant): The increasing prevalence of obesity in the U.S. is well documented by a series of surveys conducted by the National Center for Health Statistics. Its 1999-2000 data revealed that a staggering 62.5 % of adult Americans aged = 20 were overweight (BMI >= 25), and 30.5 % were obese (BMI >= 30). Projections suggest that by the year 2025 45% of adult Americans will be frankly obese. The increasing prevalence of obesity has fueled an increase in obesity-associated healthcare costs that reached $100 billion annually (5.7% of our national health expenditure) by 1995, and is surely even greater today. Obesity is associated with markedly increased risks of many comorbidities, of which hypertension, non-insulin-dependent diabetes mellitus (NIDDM), dyslipidemias, and cardiovascular disease are major contributors to 300,000 obesity related deaths annually. Non-alcoholic fatty liver disease (NAFLD) has recently emerged as a serious complication of obesity, and its most severe form, nonalcoholic steatohepatitis (NASH), is now the third most common indication for liver transplantation. Medical therapies for obesity are of very limited success. The best results for long term control of weight and of the various co-morbidities of obesity derive from bariatric surgery. The Mount Sinai School of Medicine has a large and innovative bariatric surgery program, which has focused on the development of minimally invasive (laparoscopic) bariatric methods. In this application, we propose to study the efficacy and safety of a novel, two stage surgical treatment of morbid-and super-obesity (BMI = 60) that combines an initial restrictive operation (sleeve gastrectomy) with a subsequent malabsorptive procedure (biliopancreatic diversion with duodenal switch) performed after the loss of ca. 100 Ib, when the patient is a better operative risk. Preliminary data suggest the approach is both effective and safe, with an appreciable reduction in operative morbidity and mortality compared with conventional, open abdominal surgery in this population. The nature of the protocol allows collaborating scientists to conduct virtually unique studies of changes in adipose tissue fatty acid metabolism, hepatic histology, triglyceride accumulation and fibrogenesis, patterns of adipocyte and hepatocyte gene expression, alterations in levels of circulating hormones that modulate hunger and satiety, and changes in regional brain activity in response to food stimuli, that result from extensive weight loss. In a second protocol, effects of laparoscopic Roux-en-Y gastric bypass on short and long term control of weight and NIDDM in obese patients with initial BMIs = 35 will be compared with results of ADA-recommended optimal medical care. By conducting this as a cooperative study at multiple sites within the Bariatric Surgery Clinical Research Consortium, the results will make a compelling statement about the optimal approach to control of obesity and NIDDM in this population, that represents an ever-increasing subset of adult Americans.

描述（由申请人提供）： 美国卫生统计中心进行的一系列调查已经证明了美国肥胖症的越来越多。它的1999-2000数据显示，超重的成年美国人中有62.5％的成年美国人超重（BMI> = 25），肥胖为30.5％（BMI> = 30）。预测表明，到2025年，45％的成年美国人将坦率地肥胖。肥胖症患病率的日益增加促进了与肥胖相关的医疗费用的增加，到1995年，每年达到1000亿美元（占我们国家健康支出的5.7％），今天肯定会更大。肥胖与许多合并症的风险显着增加有关，其中高血压，非胰岛素依赖性糖尿病（NIDDM），血脂异常和心血管疾病是每年300,000次与肥胖有关的死亡的主要因素。非酒精性脂肪肝疾病（NAFLD）最近已成为严重的肥胖症并发症，其最严重的非酒精性脂肪性肝炎（NASH）现在是肝移植的第三大最常见的指示。肥胖症的医疗疗法的成功非常有限。长期控制体重和肥胖的各种合并症的最佳结果是源自减肥手术。西奈山医学院有一项大型且创新的减肥手术计划，该计划的重点是发展微创（腹腔镜）减肥方法的发展。在此应用中，我们建议研究新颖，两级手术治疗的病态和超级肥胖（BMI = 60），该治疗结合了初始限制性操作（袖子胃切除术）与随后的不良过程（胆汁疾病转移）（Duododenal Switch switchal switch switch switch of duododenal switch）损失后的损失。 100 IB，当患者是一种更好的手术风险时。初步数据表明该方法既有效又安全，与该人群中常规的腹部手术相比，手术发病率和死亡率明显降低。该协议的性质使科学家可以对脂肪组织脂肪酸代谢的变化，肝组织学，甘油三酸酯的积累和纤维化，脂肪细胞和肝细胞基因表达的模式进行实际独特的研究，这会导致饥饿和饱腹感的损失及其恢复的变化，从而响应了较大的疾病，从而响应了较大的疾病。在第二个方案中，腹腔镜roux-en-y胃旁路对初始BMIS = 35的肥胖患者的短期和长期控制重量和NIDDM的影响将与ADA征用的最佳医疗结果进行比较。通过在减肥手术临床研究联盟内的多个地点进行合作研究，结果将对该人群中控制肥胖和NIDDM的最佳方法发表令人信服的陈述，这代表了成年美国人的不断增长。