The Lap-Band is an effective tool for weight loss even in the United States.

BACKGROUND: Despite impressive results with the Lap-Band in Europe and Australia, the early Food and Drug Administration A trial in the United States showed fairly poor results. This prospective study attempts to determine if the Lap-Band can produce effective weight loss in morbidly obese Americans. METHODS: Five hundred four consecutive patients have undergone placement of the Lap-Band (Inamed). Four hundred fourteen patients were women (82%) and 90 were men (18%). The median preoperative weight was 138 kg, and the preoperative median body mass was 49 kg/m(2). RESULTS: Five hundred two bands were placed laparoscopically. One was converted to an open procedure because of lack of exposure, and one was placed open because of multiple previous abdominal surgeries. Median operating time was 50 minutes, and median length of stay was 1.8 days. Percent excess weight loss at 6, 12, 24, and 36 months for all patients was 36%, 50%, 61%, and 65%, respectively. Complications occurred in 96 patients (19%) primarily consisting of port tubing separations, slips, postoperative dysphagia, and port infections. There was one (.2%) mortality. CONCLUSIONS: The Lap-Band system is an effective tool for weight loss surgery in morbidly obese patients in the United States.

Nutritional behavior as a predictor of early success after vertical gastroplasty.

BACKGROUND: Patients' nutritional habits are seldom taken in account in planning surgery for clinically severe obesity. Our proposed hypothesis is that the patient's nutritional behavior may influence the outcome of bariatric surgery. METHODS: The impact of nutritional behavior on the postoperative weight-loss was evaluated before and after bariatric surgery. A 6-month prospective consecutive case study was carried out on patients undergoing a Silastic ring vertical gastroplasty (SRVG). Patients were interviewed and examined before and at 1, 3 and 6 months after surgery. Demographic and clinical data were collected from the patients' medical charts. Nutritional data collected from a self-filled questionnaire included information on hunger and satiety perception, nutritional behavior (intake, eating habits and maximum consistency of consumed food) and concomitant symptoms. RESULTS: The sample included 69 patients: 56 were women (81%); average age was 32 years (range 18 50). Average preoperative BMI was 43.4 +/- 5.3 kg/m2 (range 35-58). 6 months after surgery, BMI was 30.3 +/- 3.8 kg/m2 (range 21-42). weight loss forecast models showed a statistically significant role of factors related to: anthropometrical preoperative data, hunger perception, prevalence of oral mucosal sore, and nutritional behavior. CONCLUSION: The short nutrition outcomes after gastric restrictive surgery were looked at, with their impact on weight-loss success. The Eating Status concept should be part of a systematic profiling of morbidly obese patients for preoperative nutritional behavior and postoperative nutritional education, to achieve the best comprehensive treatment in regard to weight loss and quality of life.

Intentional weight loss, blood lipids and coronary morbidity and mortality.

PURPOSE OF REVIEW: Although weight reduction has been recommended to reduce cardiovascular risk, studies on the association between weight loss and coronary morbidity and mortality show conflicting results. This review summarizes findings from large studies examining this issue and accentuates the importance of carrying out additional well-designed research. RECENT FINDINGS: Many observational studies report that weight loss in older men and women is associated with increased cardiovascular morbidity and mortality. Recent studies suggest that this association may arise from the confounding effect of preexisting disease. Many studies do not report whether weight loss is intentional or unintentional. Unintentional weight loss may mask beneficial changes in cardiovascular risk due to intentional weight loss. In addition to issues related to the cause of weight loss, use of reported rather than measured weight may bias the results of large studies. However, one recent observational study with a methodology aimed at overcoming these limitations found that individuals who intentionally lost weight experienced a decreased coronary risk. SUMMARY: Weight reduction in overweight individuals is not universally associated with good health. This is true even if the weight loss results in normal body mass index. Reports of increased coronary risk associated with intentional weight loss may be explained by comorbidities that are also associated with weight loss. Individuals who are overweight and at high coronary risk may benefit from professionally supervised dieting and avoiding regain of lost weight. Clinical trials on cardiovascular outcomes in individuals who lose weight under supervised dieting are needed to assess this recommendation definitively.

Immunomodulatory and protective effects of moxifloxacin against Candida albicans-induced bronchopneumonia in mice injected with cyclophosphamide.

In a previous study, moxifloxacin was shown to ameliorate immunosuppression and enhance cytokine production in several tissues, including the lungs of cyclophosphamide-injected mice. We examined here the effects of moxifloxacin on Candida albicans lung infection in cyclophosphamide-injected mice. Mice were injected on day 0 with 250 mg of cyclophosphamide/kg, and on days 1 to 4 they were given moxifloxacin at 22.5 mg/kg/day compared to controls given ceftazidime at 75 mg/kg/day or saline. On day 6, C. albicans (10 7 CFU/mouse) was inoculated intratracheally, and animals were observed for the development of bronchopneumonia, weight loss, mortality, the presence of C. albicans, and lung cytokine production. Histopathology on day 10 postinoculation revealed bronchopneumonia in 50, 67, and 0% of saline-, ceftazidime-, and moxifloxacin-treated mice, respectively (P < 0.05). The mortality rates were 28, 17, and 5%, respectively (P < 0.05), and weight loss occurred at 20, 32, and 0%, respectively (P < 0.05). By day 15, C. albicans was eliminated from all moxifloxacin-treated mice but was still isolated from lung homogenates of 50 to 60% of the saline- and ceftazidime-treated groups. Among the cytokines tested on days 0 to 15, we found an increased production of tumor necrosis factor alpha, KC (functional interleukin-8), and gamma interferon in the lungs of ceftazidime- and saline-treated controls compared to the moxifloxacin pretreatment that abolished their secretion. In conclusion, moxifloxacin protected cyclophosphamide-injected mice from C. albicans-induced lung infection and significantly reduced pneumonia, weight loss, and mortality despite the lack of direct antifungal activity. This is most likely due to an immunomodulating activity conferred by moxifloxacin, as shown in this model and in our previous studies. Its potential protective role should be studied in patients undergoing chemotherapy and immune suppression.

Weight and BMI over 6 years in Korean children: relationships to body image and weight loss efforts.

OBJECTIVE: To investigate the relationships among longitudinal weight status, body dissatisfaction, and attitude to weight loss among Korean children from the age of 7-8 to 13-14 years old. RESEARCH METHODS AND PROCEDURES: 351 Korean school children's heights and weights were measured at the ages of 7-8 and 13-14 years old; at the age of 13-14, they completed a questionnaire about body dissatisfaction and weight loss efforts. RESULTS: At the age of 7-8, 15.7% of children were overweight by International obesity Task Force standards, as compared with 26.2% at the age of 13-14. Of the 55 7- to 8-year-old overweight children, 85.5% were still overweight at the age of 13-14 years old. Greater concerns about body image and stronger desires to be thinner were observed among stable overweight children and among those in whom there had been a rapid increase in BMI over the 6-year study period. Girls favored thinner shapes than did boys, regardless of their weight status or BMI changes. In girls, the level of body dissatisfaction was related only to weight loss desire, regardless of weight status or changes in BMI. In boys, however, weight loss desire was related only to weight loss attempts and was independent of weight status, BMI changes, and level of body dissatisfaction. DISCUSSION: Regardless of weight status, changes in BMI should be considered when dealing with body dissatisfaction and attitudes to weight loss in children.

Special Feeding and Care of Senescent Spontaneously Hypertensive Rats.

This study investigated the impact of feeding methods on body weight of senescent female spontaneously hypertensive rats (SHRs) and showed that supplementing powdered feed was useful as they approached heart failure at 22 to 23 months of age. SHRs are genetically predisposed to systemic hypertension and will, with age, progress into complete heart failure resulting in death. Close to the time of heart failure, some rats experienced a loss of appetite and weight loss. It was postulated that either elevated blood pressure, age-associated health issues, or the effort required to access pelleted food prevented the rats from eating properly, resulting in malnutrition and weight loss. As they aged, the rats benefited from the addition of powdered food to ensure that body weights remained stable and to prevent malnutrition that could lead to premature death. Animals were fed commercially available rat chow pellets until they showed persistent signs of weight loss or a lack of interest in their food. At that time, the rats were also given powdered rat chow in shallow bowls to facilitate the eating and the digestion of their food. The rats were weighed weekly to confirm they consumed sufficient calories daily and to ensure that the change to the powdered chow was having the desired effect. Prior to being fed the powdered rat chow, the rats had shown signs of progressive weight loss. After starting the powdered chow, the rats either maintained or gained weight. This study shows that as the female SHR matures, special care and handling is key to maintaining body weights and good health. With only modest changes in routine (i.e., powdered food) and an attentive eye on the rats' daily activities, it was possible to maintain these senescent female SHRs in a healthy condition until the termination of the study or onset of heart failure.

Surface modification of poly(ether urethane urea) with modified dehydroepiandrosterone for improved in vivo biostability.

In this study, a fatty acid urethane derivative of dehydroepiandrosterone (DHEA) was synthesized and evaluated as a polyurethane additive to increase long-term biostability. The modification was hypothesized to reduce the water solubility of the DHEA and physically anchor the additive in the polyurethane during implantation. Polyurethane film weight loss in water as a function of time was studied to determine the polymer retention of the modified DHEA. The polyurethane film with unmodified DHEA had significant weight loss in the first day (10%) that was previously correlated to rapid leaching of the additive. The polyurethane film with modified DHEA had significantly less weight loss at all time points indicating improved polymer retention. The effect of the modified DHEA additive on the biostability of a poly(ether urethane urea) was examined after 5 weeks of subcutaneous implantation in Sprague-Dawley rats. Optical micrographs and infrared analysis of the specimens indicated that the modified DHEA bloomed to the surface of the film forming a crystalline surface layer approximately 10-15 microns thick. After explantation, this surface layer was intact without measurable differences in surface chemistry as monitored by attenuated total reflectance-Fourier transform infrared spectroscopy. There was no evidence of degradation of the polyurethane underneath the modified DHEA surface layer as compared with the polyurethane control. We have concluded that the modified DHEA self-assembled into a protective surface coating that inhibited degradation of the polyurethane. The roughness of the modified DHEA surface layer prevented adherent cell analysis to determine if the additive retained the ability to down-regulate macrophage activity. Subsequent studies will investigate the ability of surface-modifying additives to modulate cellular respiratory bursts in addition to the formation of an impermeable barrier. This bimodal approach to improving biostability holds great promise in the field of polyurethane biomaterials. (c) 2005 Wiley Periodicals, Inc. J Biomed Mater Res 73A: 108-115, 2005.

Determination of insulin, leptin and neuropeptide y by radioimmunoanalysis in patients with morbid obesity and anorexia nervosa after therapeutic interventionThe present study was conducted in order to analyze the relationship existing between leptin, insulin and neuropeptide Y (NPY) levels in massive weight loss and weight recovery. Twenty-three patients with severe obesity, 23 patients with anorexia nervosa and 28 healthy control subjects were studied. Patients with severe obesity underwent a vertical banded gastroplasty followed by an 800 kcal/day diet during 16 weeks, with evaluation taking place before (Body mass index, BMI, 52,1 8 Kg/m2) and after the drastic weight loss (BMI 39,2 6,2 Kg/m2). Patients with anorexia nervosa were treated with nutritional therapy exclusively during 16 weeks, and they were evaluated in the low weight situation (BMI 15,3 1,7 Kg/m2) and after weight recovery (BMI 18,9 2,8 Kg/m2). Normal subjects had a normal BMI from 20 to 27 (average 21,8 2 Kg/m2). BMI, percentage of body fat, and serum levels of leptin, insulin, and NPY, were determined in each patient and normal subjects. In severe obese patients serum leptin and insulin decreased significantly after drastic weight reduction (leptin: from 48,8 19,2 to 24,3 9,8 ng/ml; insulin: from 26,2 10,8 to 18 6 U/ml). In patients with anorexia nervosa serum leptin mean levels were significantly higher after weight recovery (3,7 1,9 vs 9,2 5,1 ng/ml). In subjects with morbid obesity NPY levels decreased after weight loss below those of control group (43,5 16,1 vs 57,3 12,8 pmol/l). On the other hand, patients with anorexia nervosa had NPY levels superior to those of control group. In subjects with anorexia, NPY levels decreased after weight recovery (69,1 16,7 a 59,1 20,3 pmol/l). In the whole population, Leptin and NPY plasma levels were correlated with body fat percentage. Leptin was positively correlated with BMI and body fat percentage in obese and anorectic subjects after weight loss or recovery, respectively. NPY was inversely correlated with body fat percentage in controls and obese subjects before treatment. These data reveal that the concentration of serum leptin and NPY correlates significantly with the total adiposity in subjects with a wide weight range and caloric intake. Leptin plasma levels are proportional to fat stores in patients with severe obesity and anorexia nervosa after drastic weight loss or recovery, respectively. NPY serum levels are negatively correlated with de total body fat in normal weight subjects and obese patients in their initial weight.