title: A Preliminary Observation of Weight Loss Following Left Gastric Artery Embolization in Humans Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients. Ghrelin and obestatin levels in hypertensive obese patients Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Gastric Bypass Surgery Is Followed by Lowered Blood Pressure and Increased Diuresis - Long Term Results from the Swedish Obese Subjects (SOS) Study Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. Effect of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Glucose and Gut Hormones: a Prospective Randomised Trial Renal Function and Remission of Hypertension After Bariatric Surgery: a 5-Year Prospective Cohort Study
abstract: Background / Objectives . Embolization of the left gastric artery ( LGA ) , which preferentially supplies the gastric fundus , has been shown to produce weight loss in animal models . However , weight loss after LGA embolization in humans has not been previously established . The aim of this study was to evaluate postprocedural weight loss in patients following LGA embolization .  Subjects/ Methods . A retrospective analysis of the medical records of patients who underwent LGA embolization for upper gastrointestinal ( GI ) bleeding was performed . Postprocedural weight loss in this group was compared to a control group of patients who had undergone embolization of other arteries for upper GI bleeding . Results . The experimental group ( N = 19 ) lost an average of 7.3 % of their initial body weight within three months of LGA embolization , which was significantly greater than the 2 % weight loss observed in the control group ( N = 28 ) ( P = 0.006 ) . No significant differences were seen between the groups in preprocedural body mass index ( BMI ) , age , postprocedural care in the intensive care unit , history of malignancy , serum creatinine , or left ventricular ejection fraction . Conclusions . The current data suggest that body weight in humans may be modulated via LGA embolization . Continued research is warranted with prospect i ve studies to further investigate this phenomenon Overweight patients with uncomplicated essential hypertension were followed up biweekly for six months : 24 not receiving antihypertensive-drug therapy ( Group I ) and 83 on  regular but inadequate ( despite drug manipulation ) antihypertensive-drug therapy ( Group II ) . All patients in Group I and 57 r and omly selected patients from group II ( IIa ) participated in a weight-reduction program . The remaining 26 from Group II ( IIb ) did not receive a dietary program .  Salt intake was in the normal range in all three groups . All patients on the dietary program lost at least 3 kg ( mean , 10.5 kg ) , and all but two showed a meaningful reduction in blood pressure ; 75 per cent of Group I and 61 per cent of Group IIa returned to normal blood pressure . The weight and blood-pressure reductions were highly significant ( P less than 0.001 ) , were present in both sexes and all ages , and were directly associated . In Group IIb , no significant change in blood pressure or weight occurred ( P greater than 0.30 ) Objectives To investigate plasma total ghrelin and obestatin levels and the ghrelin/obestatin ratio prospect ively , in hypertensive obese patients . Methods Height , weight , and waist and hip circumferences were measured in hypertensive and normotensive obese patients and matched healthy controls ; the body mass index and waist to hip ratio were calculated . Fasting glucose and insulin levels were measured and the homeostasis model assessment of insulin resistance ( HOMA-IR ) was determined . Fasting ghrelin and obestatin concentrations were measured by radioimmunoassay and the ghrelin/obestatin ratio was calculated . Results A total of 38 hypertensive obese patients , 40 normotensive obese patients and 38 controls were enrolled . Hypertensive obese patients had lower plasma levels of ghrelin and obestatin than normotensive obese patients or controls . In addition , normotensive obese patients had lower plasma ghrelin and obestatin levels than controls . In hypertensive obese patients , ghrelin and obestatin levels were negatively associated with systolic and diastolic blood pressure , fasting insulin and HOMA-IR . In normotensive obese patients , ghrelin , obestatin and the ghrelin/obestatin ratio were negatively associated with fasting insulin and HOMA-IR . In both patient groups , fasting obestatin and ghrelin concentrations were significantly and positively correlated with each other . Conclusion Changes in the levels of ghrelin and obestatin may play a role in the pathophysiology of obesity and hypertension BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline Objective To compare two bariatric surgical principles with regard to effects on blood pressure and salt intake . Background In most patients bariatric surgery induces a sustained weight loss and a reduced cardiovascular risk profile but the long-term effect on blood pressure is uncertain . Methods Cohort study with data from the prospect i ve , controlled Swedish Obese Subjects ( SOS ) study involving 480 primary health care centres and 25 surgical departments in Sweden . Obese patients treated with non-surgical methods ( Controls , n = 1636 and n = 1132 at 2 y and 10 y follow up , respectively ) were compared to patients treated with gastric bypass ( GBP , n = 245 and n = 277 , respectively ) or purely restrictive procedures ( vertical b and ed gastroplasty or gastric b and ing ;  VBG/B , n = 1534 and n = 1064 , respectively ) . Results At long-term follow-up ( median 10 y ) GBP was associated with lowered systolic ( mean : −5.1 mm Hg ) and diastolic pressure ( −5.6 mmHg ) differing significantly from both VBG/B ( −1.5 and −2.1 mmHg , respectively ; p<0.001 ) and Controls ( + 1.2 and −3.8 mmHg , respectively ; p<0.01 ) . Diurnal urinary output was + 100 ml ( P<0.05 ) and + 170 ml ( P<0.001 ) higher in GBP subjects than in weight-loss matched VBG/B subjects at the 2 y and 10 y follow-ups , respectively . Urinary output was linearly associated with blood pressure only after GBP and these patients consumed approximately 1 g salt per day more at the follow-ups than did VBG/B ( P<0.01 ) . Conclusions The purely restrictive techniques VBG/B exerted a transient blood pressure lowering effect , whereas gastric bypass was associated with a sustained blood pressure reduction and an increased diuresis . The daily salt consumption was higher after gastric bypass than after restrictive bariatric surgery OBJECTIVES To determine relationship of intra-abdominal pressure to central obesity and the comorbidity of obesity . DESIGN Non-r and omized , prospect i ve . SETTING University hospital , operating room . SUBJECTS Eighty-four anaesthetized consecutive patients prior to gastric bypass for morbid obesity and five non-obese patients before colectomy for ulcerative colitis . MAIN OUTCOME MEASURES Weight , body mass index ( BMI ) , co-morbid history , sagittal abdominal diameter , waist : hip ( W : H ) ratio and urinary bladder pressure , as an estimate of intra-abdominal pressure . RESULTS Urinary bladder pressure was greater in the obese than the non-obese ( 18 + /- 0.7 vs. 7 + /- 1.6 cm H2O , P < 0.001 ) , correlated with sagittal abdominal diameter ( r = + 0.67 , P < 0.001 ) and was greater ( P < 0.05 ) in patients with , than those without , morbidity probably ( hypoventilation , gastroesophageal reflux , venous stasis , stress incontinence , incisional hernia ) or possibly ( hypertension , diabetes ) due to increased abdominal pressure . W : H ratio correlated with urinary bladder pressure in men ( r = + 0.6 , P < 0.05 ) but not women ( r = -0.3 ) . CONCLUSIONS Increased sagittal abdominal diameter was associated with increased intraabdominal pressure which contributed to obesity-related comorbidity . W : H ratio was not a reliable indicator of intra-abdominal pressure for women who often have both peripheral and central obesity . Further studies are needed to evaluate the relationship between intra-abdominal pressure and Type II diabetes and hypertension Background  Laparoscopic Roux-en-Y gastric bypass ( LRYGB )  is the most common bariatric technique . Laparoscopic sleeve gastrectomy ( LSG ) is a restrictive procedure ; the metabolic and endocrine effects of which remain unknown . We compared the effects of both procedures on glucose metabolism and fasting and meal-stimulated gut hormone levels . Methods Seven patients were r and omised to LRYGB and eight to LSG .  All patients were evaluated before and at 3 and 12 months postoperatively . Plasma levels of glucose , insulin , ghrelin , leptin , peptide YY ( PYY ) , GLP-1 and pancreatic polypeptide were measured before and after 10 and 60 min of a st and ard test meal ingestion . Results Age , body mass index and preoperative hormone levels were similar in both groups . A significant reduction of plasma glucose and insulin levels was observed after surgery . Moreover , a normalisation of homeostatic model assessment for insulin resistance value was also seen after both procedures . The fasting and postpr and ial leptin levels were significantly lower in the LRYGB group . LSG was followed by a significant reduction in fasting ghrelin levels . In the LRYGB group , GLP-1 levels increased significantly after the test meal . Conclusions LRYGB and LSG markedly improved glucose homeostasis . Only LSG decreased fasting and postpr and ial ghrelin levels , whereas GLP-1 and PYY levels increased similarly after both procedures Purpose This study examines the effect of Roux-en-Y gastric bypass ( RYGB ) and laparoscopic adjustable gastric b and ing ( LAGB ) on renal function for at least 5 years post-operatively in a tertiary referral center for bariatric surgery . Material s and Methods This prospect i ve cohort study of patients undergoing RYGB and LAGB  measured  renal function , blood pressure , and diabetes status pre-operatively and then 1 and 5 years post-operatively . Renal function was assessed using the Modification of Diet in Renal Disease ( MDRD ) , Chronic Kidney Disease Epidemiology Collaboration ( CKD-EPI ) , and Cockcroft-Gault formulae . Hypertension and diabetes were defined by the European Society of Hypertension and European Society of Cardiology joint guidelines and American Diabetes Association guidelines , respectively . A sub-group who had completed 10 years post-operative follow-up was also included . Results Estimated glomerular filtration rate ( eGFR ) increased over 5 years after RYGB ( N = 190 ; 94 ± 2 mL/min/1.73 m2 to 102 ± 22 mL/min/1.73 m2 , p = 0.01 ) and LAGB ( N = 271 ; 88 ± 1 to 93 ± 22 mL/min/1.73 m2 , p = 0.02 ) . In a sub-group with up to 10 years post-operative date , this trend was maintained . In patients with renal impairment , eGFR improved over 5 years ( 52 ± 2 to 68 ± 7 mL/min/1.73 m2 , p = 0.01).Remission of hypertension was greater after RYGB than LAGB at 1 year ( 32 vs. 16 % , p = 0.008 ) and at 5 years post-operatively ( 23 vs. 11 % , p = 0.02 ) . Conclusions Bariatric surgery stabilizes eGFR post-operatively for at least 5 years . In a sub-group with renal impairment , eGFR is increased in the first post-operative year and this is maintained for up to 5 years . RYGB is an effective procedure in achieving blood pressure control
target: Evidence suggests significant improvement in obesity-hypertension in patients who undergo surgical weight-reduction procedures .
  Malabsorptive techniques such as the Roux-en-Y gastric bypass or surgical resection techniques such as laparoscopic sleeve gastrectomy appear to offer superior results in regards to hypertension control over restrictive techniques such as Gastric B and ing .
  Though long-term control of hypertension following surgery remains a concern , available follow-up post-operative data of up to 10 years suggests a sustained , if lessened , effect on hypertension control over time
background: Obesity continues to increase in prevalence worldwide .
  Hypertension has long been associated with obesity , and weight loss continues to be a first-line therapy in the treatment of hypertension .
  Lifestyle modification and pharmacologic therapy , however , often meet with treatment failure .
  Bariatric surgery continues to be the most successful approach to sustained weight loss .
  This review focuses on the underlying physiologic mechanisms of obesity-hypertension , and the impact of bariatric surgery on the treatment of hypertension .