MARCO AURELIO SANTO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
15 resultados
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- The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services(2020) OGASSAVARA, Nicolas Chiu; DIAS, Joao Gabriel Magalhaes; PAJECKI, Denis; SIQUEIRA, Jose de Oliveira; SANTO, Marco Aurelio; TESS, Beatriz HelenaBackground: Limited access to publicly funded, insurance-covered, and self-paid obesity surgery is a reality worldwide. Waiting lists for procedures are usually based on chronologic criteria and body mass index (BMI)-defined obesity categorization. Obesity classification systems assess overall health and have been proposed as an alternative. Objective: To investigate the correlation between BMI-based classification and the Edmonton Obesity Staging System (EOSS) to support current evidence that the assessment of the clinical severity of obesity could be a helpful tool to maximize access to surgery. Setting: University hospital, Brazil. Methods: Retrospective analysis of all 2011 to 2014 adult patients who underwent obesity surgery under the public health system. Data on sex, age, presurgical BMI, and co-morbidities were extracted from hospital records. Spearman correlation coefficients were used to assess the strength and direction of the relationship between BMI classification and EOSS. Results: Of 565 patients, 79% were female, mean age 44.1 +/- 10.9 years and mean BMI 46.9 +/- 6.2 kg/m(2). The most common EOSS stage was 2 (86.5%), followed by stages 3 (8.5%) and 1 (4.9%). There was no correlation between the severity of obesity measured by BMI and EOSS (p = - .030, P = .475). Older patients had higher Edmonton scores (p = .308, P < .001). No difference was observed regarding sex. Conclusions: No correlation was found between EOSS and BMI and between these and sex. Age correlated with both obesity indicators. EOSS was reproducible in Brazilian surgical patients and may be an important tool from a health services perspective contributing to the more efficient use of limited resources for obesity surgery.
- Type 2 Diabetes Metabolic Improvement After Roux-en-Y Gastric Bypass May Include a Compensatory Mechanism That Balances Fatty Acid beta and omega Oxidation(2020) MACHADO, Natasha Mendonca; TORRINHAS, Raquel Susana; SALA, Priscila; ISHIDA, Robson Kiyoshi; GUARDA, Ismael Francisco Mota Siqueira; MOURA, Eduardo Guimaraes Hourneaux de; SAKAI, Paulo; SANTO, Marco Aurelio; WAITZBERG, Dan LinetzkyBackground More than half of patients who undergo Roux-en-Y gastric bypass (RYGB) can experience type 2 diabetes (T2D) remission, but the systemic and gastrointestinal (GI) metabolic mechanisms of this improvement are still elusive. Methods Paired samples collected before and 3 months after RYGB from 28 women with obesity and T2D were analyzed by metabolomics with gas chromatography coupled to mass spectrometry. Samples include plasma (n = 56) and biopsies of gastric pouch (n = 18), gastric remnant (n = 10), duodenum (n = 16), jejunum (n = 18), and ileum (n = 18), collected by double-balloon enteroscopy. Results After RYGB, improvements in body composition and weight-related and glucose homeostasis parameters were observed. Plasma-enriched metabolic pathways included arginine and proline metabolism, urea and tricarboxylic acid (TCA) cycles, gluconeogenesis, malate-aspartate shuttle, and carnitine synthesis. In GI tissue, we observed alterations of ammonia recycling and carnitine synthesis in gastric pouch, phenylacetate metabolism and trehalose degradation in duodenum and jejunum, ketone bodies in jejunum, and lactose degradation in ileum. Intermediates molecules of the TCA cycle were enriched, particularly in plasma, jejunum, and ileum. Fluctuations of dicarboxylic acids (DCAs) were relevant in several metabolomic tests, and metabolite alterations included aminomalonate and fumaric, malic, oxalic, and succinic acids. The product/substrate relationship between these molecules and its pathways may reflect a compensatory mechanism to balance metabolism. Conclusions RYGB was associated with systemic and GI metabolic reprogramming. DCA alterations link omega and beta fatty acid oxidation to homeostatic mechanisms, including TCA cycle improvement.
conferenceObject Exercise Suppresses The Ubiquitin-proteasome System In The Skeletal Muscle Of Obese Women Following Bariatric Surgery(2020) GIL, Saulo; GUALANO, Bruno; DANTAS, Wagner S.; MURAI, Igor H.; GHOSH, Sujoy; SHINJO, Samuel K.; MEREGE-FILHO, Carlos; TEODORO, Walcy R.; PEREIRA, Rosa Maria; BENATTI, Fabiana B.; SA-PINTO, Ana L. de; LIMA, Fernanda; CLEVA, Roberto de; SANTO, Marco A.; KIRWAN, John P.; ROSCHEL, Hamilton- Bariatric Surgery Impact on Reproductive Hormones, Semen Analysis, and Sperm DNA Fragmentation in Men with Severe Obesity: Prospective Study(2020) WOOD, Guilherme Jacom Abdulmassih; TISEO, Bruno C.; PALUELLO, Davi V.; MARTIN, Hamilton de; SANTO, Marco Aurelio; NAHAS, William; SROUGI, Miguel; COCUZZA, MarcelloPurpose Growing evidence in the literature suggests that obesity is capable of altering reproductive hormone levels and male fertility. Effects on classic semen parameters and sperm DNA fragmentation (SDF), however, have not been properly established. Additionally, the impact of bariatric surgery (BS) on those parameters is still controversial. Materials and Methods In Phase 1, 42 patients with obesity and 32 fertile controls were submitted to reproductive hormone evaluation, semen analysis, and SDF testing. In Phase 2, patients with obesity were submitted to BS or clinical follow-up and were invited to 6-month revaluation. Results Phase 1: Men with obesity have higher levels of estradiol, LH, and FSH and lower levels of total testosterone (TT) when compared with eutrophic fertile men. Additionally, they present worse semen parameters, with reduction in ejaculated volume and sperm concentration, worse sperm motility and morphology, and higher SDF. Phase 2: 32 patients returned to revaluation. Eighteen were submitted to BS (group S) and 14 were not submitted to any specific therapeutic regimen (group NS). In group S, TT more than doubled after surgery (294.5 to 604 ng/dL,p < 0.0001). Worsening of sperm concentration and total ejaculated sperm count were also noticed, and 2 patients became azoospermic after BS. SDF, however, improved after the procedure. No changes in the variables studied were observed in non-operated patients. Conclusion In this prospective study, we have found that BS results in improvements in reproductive hormone levels and SDF after 6-month follow-up. Sperm concentration, however, reduced after the procedure.
- Outpatient Screening of Health Status Among Postbariatric Patients during the COVID-19 Pandemic in Sao Paulo, Brazil(2020) GOESSLER, Karla Fabiana; NICOLETTI, Carolina Ferreira; REZENDE, Diego Augusto Nunes; SIECZKOWSKA, Sofia Mendes; ESTEVES, Gabriel Perri; GENARIO, Rafael; OLIVEIRA JUNIOR, Gersiel Nascimento de; MEIRELES, Kamila; PINTO, Ana Jessica; NAKAHARA-MELO, Michele; CLEVA, Roberto de; SANTO, Marco Aurelio; KIRWAN, John; ROSCHEL, Hamilton; GUALANO, Bruno
- Intestinal expression of toll-like receptor gene changes early after gastric bypass surgery and association with type 2 diabetes remission(2020) SALA, Priscila; TORRINHAS, Raquel Susana Matos de Miranda; FONSECA, Danielle C.; MACHADO, Natasha Mendonca; SINGER, Joelle; SINGER, Pierre; RAVACCI, Graziela Rosa; BELARMINO, Giliane; FERREIRA, Beatriz A. M.; MARQUES, Mariane; ISHIDA, Robson Kiyoshi; GUARDA, Ismael Francisco Mota Siqueira; MOURA, Eduardo Guimaraes Hourneaux de; SAKAI, Paulo; SANTO, Marco Aurelio; SUNAGA, Daniele Yumi; HEYMSFIELD, Steven B.; BEZERRA, Daniele Pereira dos Santos; CORREA-GIANNELLA, Maria Lucia; WAITZBERG, Dan LinetzkyObjectives: Abnormal activation of toll-like receptors (TLRs) is observed in obese rodents and is correlated with local dysbiosis and increased gut permeability. These purported changes trigger systemic inflammation associated with obesity-related comorbidities, including type 2 diabetes (T2D). Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for severe obesity and known to induce changes in the gut microbiota and decrease systemic inflammation in humans. This study examined the intestinal expression of TLR-encoding genes in obese women (n = 20) treated with RYGB surgery and the relationship of these genes with T2D remission (T2Dr Methods: Intestinal biopsies were performed before and 3 months after RYGB surgery. Partial and complete T2Dr after 1 year was assessed using the American Diabetes Association criteria. Affymetrix Human GeneChip 1.0 ST array (microarray) and TaqMan assay (real-time quantitative polymerase chain reaction) were used to analyze intestinal gene expression, and associations with systemic markers of energy homeostasis were examined. Results: Patients experienced significant weight loss (P < 0.001) and altered gut TLR gene expression 3 months after surgery. The main effects were a reduction in jejunal TLR4 expression in patients with complete and partial T2Dr (P < 0.05). There was a postoperative decrease in jejunal TLR7 expression in patients with complete T2Dr that correlated inversely with high-density lipoprotein cholesterol and positively with triglyceride concentrations, but not with weight loss. Conclusions: RYGB-induced weight loss-independent changes in the expression of intestinal TLR-encoding genes in obese women and complete T2Dr that was correlated with systemic markers of energy homeostasis. The modulation of intestinal TLRs may mediate inflammatory mechanisms linked to T2Dr after RYGB surgery.
- The recommendations of the Brazilian College of Surgeons and the Brazilian Bariatric and Metabolic Surgery Societies on the return of bariatric and metabolic operations in geographic regions of the country where the procedures have been allowed by local policies, in the period of COVID-19 pandemic(2020) SILVA, LEONARDO EMILIO DA; COHEN, RICARDO VITOR; DE-ANDRADE, JAMES CAMARA; SZEGÖ, THOMAS; SANTO, MARCO AURÉLIO; RAMOS, ALMINO CARDOSO; VILAS-BOAS, MARCOS LEÃO; MORAES-ZENÓBIO, CRISTIANE MOULIN; ALENCAR-MENEGUESSO, ANNELISE MOTA; VON-BAHTEN, LUIZ CARLOSABSTRACT Prioritizing surgical procedures aims at facilitating patient’s access according to the clinical needs, maximizing access equity, and minimizing the damage from delayed access. Previous categorization of elective bariatric surgery have been adapted to define an objective prioritizing system that reflects those principles for bariatric and metabolic operations. Given the factors that contribute to the morbidity and mortality of obese and type 2 diabetes patients, surgical prioritization should be based on clinical risk stratification. For patients with type 2 diabetes, we suggest that the operation may be prioritized for those with a higher risk of morbidity and mortality in a relatively short term. Likewise, it is necessary to guide the surgical team regarding the necessary care both in the pre, per and postoperative periods of bariatric and metabolic surgery. These recommendations aim to reduce the risk of in-hospital contamination of the surgical team among health professionals and between health professionals and patients. In summary, these recommendations have been shaped after a thorough analysis of the available literature and are extremely important to mitigate the harm related to the clinical complications of obesity and its comorbidities while keeping healthcare providers’ and patients’ safety.
- Argon plasma coatmlation alone versus argon plasma coagulation plus full-thickness endoscopic suturing to treat weight regain after Roux-en-Y gastric bypass: a prospective randomized trial (with videos)(2020) BRUNALDI, Vitor Ottoboni; FARIAS, Galileu Ferreira Ayala; REZENDE, Daniel Tavares de; CAIRO-NUNES, Gabriel; RICCIOPPO, Daniel; MOURA, Diogo Turiani Hourneaux de; SANTO, Marco Aurelio; MOURA, Eduardo Guimaraes Hourneaux deBackground and Aims: A significant number of patients regain weight after Roux-en-Y gastric bypass. Ablation with argon plasma coagulation (APC) plus endoscopic full-thickness suturing (FTS-APC) and ablation alone have been reported for treating weight regain when associated with gastrojejunostomy (GJ) dilation. However, comparative controlled data are still lacking. Methods: This was a pilot single-center open-label randomized trial comparing the effectiveness and safety of APC alone versus FTS-APC for transoral outlet reduction. Patients with at least 20% weight regain from the nadir, and GJ >= 15 mm were considered eligible. The primary outcome was percentage total weight loss (%TWL) at 12 months. Secondary outcomes were the incidence of adverse events, amelioration of metabolic laboratory parameters, and improvement in quality of life and eating behavior. Results: Forty patients meeting the eligibility criteria were enrolled from October 2017 to July 2018. Technical and clinical success rates were similar between the groups. At 12 months, the mean %TWL was 8.3% +/- 5.5% in the APC alone group versus 7.5% +/- 7.7% in the Fl S-APC group (P = .71). The pre-revisional % solid gastric retention at 1 hour positively correlated with the probability of achieving >= 10% TWL at 12 months. Both groups experienced significant reductions in low-density lipoprotein and triglyceride levels at 12 months, and improvement in eating behavior and quality of life at 3 months. There were 2 cases of stenoses (1 from each group), which were successfully treated with endoscopic balloon dilation. Conclusion: APC alone is similar to FTS-APC in terms of technical and clinical outcomes within 1 year of followup.
- Gut Microbiota Profile of Obese Diabetic Women Submitted to Roux-en-Y Gastric Bypass and Its Association with Food Intake and Postoperative Diabetes Remission(2020) ASSAL, Karina Al; PRIFTI, Edi; BELDA, Eugeni; SALA, Priscila; CLEMENT, Karine; DAO, Maria-Carlota; DORE, Joel; LEVENEZ, Florence; TADDEI, Carla R.; FONSECA, Danielle Cristina; ROCHA, Ilanna Marques; BALMANT, Bianca Depieri; THOMAS, Andrew Maltez; SANTO, Marco A.; DIAS-NETO, Emmanuel; SETUBAL, Joao Carlos; ZUCKER, Jean-Daniel; BELARMINO, Giliane; TORRINHAS, Raquel Susana; WAITZBERG, Dan L.Gut microbiota composition is influenced by environmental factors and has been shown to impact body metabolism. Objective: To assess the gut microbiota profile before and after Roux-en-Y gastric bypass (RYGB) and the correlation with food intake and postoperative type 2 diabetes remission (T2Dr). Design: Gut microbiota profile from obese diabetic women was evaluated before (n = 25) and 3 (n = 20) and 12 months (n = 14) after RYGB, using MiSeq Illumina-based V4 bacterial 16S rRNA gene profiling. Data on food intake (7-day record) and T2Dr (American Diabetes Association (ADA) criteria) were recorded. Results: Preoperatively, the abundance of five bacteria genera differed between patients with (57%) and without T2Dr (p < 0.050). Preoperative gut bacteria genus signature was able to predict the T2Dr status with 0.94 accuracy ROC curve (receiver operating characteristic curve). Postoperatively (vs. preoperative), the relative abundance of some gut bacteria genera changed, the gut microbial richness increased, and the Firmicutes to Bacteroidetes ratio (rFB) decreased (p < 0.05) regardless of T2Dr. Richness levels was correlated with dietary profile pre and postoperatively, mainly displaying positive and inverse correlations with fiber and lipid intakes, respectively (p < 0.05). Conclusions: Gut microbiota profile was influenced by RYGB and correlated with diet and T2Dr preoperatively, suggesting the possibility to assess its composition to predict postoperative T2Dr.
conferenceObject Exercise Training Improves Cardiac Autonomic Responses In Obese Women Undergoing Bariatric Surgery(2020) ROSCHEL, Hamilton; GIL, Saulo; PECANHA, Tiago; DANTAS, Wagner; MURAI, Igor; SHINJO, Samuel K.; MEREGE-FILHO, Carlos; PEREIRA, Rosa Maria Rodrigues; BENATTI, Fabiana B.; PINTO, Ana Lucia de Sa; LIMA, Fernanda R.; CLEVA, Roberto; SANTO, Marco A.; REZENDE, Diego A. N.; KIRWAN, John P.; GUALANO, Bruno