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
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
- Exercise-Induced Increases in Insulin Sensitivity After Bariatric Surgery Are Mediated By Muscle Extracellular Matrix Remodeling (vol 69, pg 1675, 2020)(2021) DANTAS, Wagner S.; ROSCHEL, Hamilton; MURAI, Igor H.; GIL, Saulo; DAVULURI, Gangarao; AXELROD, Christopher L.; GHOSH, Sujoy; NEWMAN, Susan S.; ZHANG, Hui; SHINJO, Samuel K.; NEVES, Willian das; MEREGE-FILHO, Carlos; TEODORO, Walcy R.; CAPELOZZI, Vera L.; PEREIRA, Rosa Maria; BENATTI, Fabiana B.; SA-PINTO, Ana L. de; CLEVA, Roberto de; SANTO, Marco A.; KIRWAN, John P.; GUALANO, Bruno
- C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass(2021) CLEVA, Roberto de; KAWAMOTO, Flavio; BORGES, Georgia; CAPRONI, Priscila; CASSENOTE, Alex Jones Flores; SANTO, Marco AurelioOBJECTIVES: Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission. METHODS: We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770 (R)) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM. RESULTS: The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass. CONCLUSION: Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients.
- Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac Autonomic Function(2021) GIL, Saulo; PECANHA, Tiago; DANTAS, Wagner S.; MURAI, Igor Hisashi; MEREGE-FILHO, Carlos Alberto Abujabra; SA-PINTO, Ana Lucia de; PEREIRA, Rosa Maria Rodrigues; CLEVA, Roberto de; SANTO, Marco Aurelio; REZENDE, Diego Augusto Nunes; KIRWAN, John P.; GUALANO, Bruno; ROSCHEL, HamiltonBackground Bariatric surgery improves cardiovascular health, which might be partly ascribed to beneficial alterations in the autonomic nervous system. However, it is currently unknown whether benefits from surgery on cardiac autonomic regulation in post-bariatric patients can be further improved by adjuvant therapies, namely exercise. We investigated the effects of a 6-month exercise training program on cardiac autonomic responses in women undergoing bariatric surgery. Methods Sixty-two women eligible for bariatric surgery were randomly allocated to either standard of care (control) or an exercise training intervention. At baseline (PRE) and 3 (POST3) and 9 (POST9) months after surgery, we assessed chronotropic response to exercise (CR%; i.e., percentage change in heart rate from rest to peak exercise) and heart rate recovery (HRR30s, HRR60s, and HRR120s; i.e., decay of heart rate at 30, 60, and 120 s post exercise) after a maximal exercise test. Results Between-group absolute changes revealed higher CR% (Delta = 8.56%, CI95% 0.22-19.90, P = 0.04), HRR30s (Delta = 12.98 beat/min, CI95% 4.29-21.67, P = 0.01), HRR60s (Delta = 22.95 beat/min, CI95% 11.72-34.18, P = 0.01), and HRR120s (Delta = 34.54 beat/min, CI95% 19.91-49.17, P < 0.01) in the exercised vs. non-exercised group. Conclusions Our findings demonstrate that exercise training enhanced the benefits of bariatric surgery on cardiac autonomic regulation. These results highlight the relevance of exercise training as a treatment for post-bariatric patients, ensuring optimal cardiovascular outcomes.
- Comment on: Sleeve gastrectomy versus Roux-En-Y gastric bypass in patients aged >= 65 years: a comparison of short-term outcomes(2021) DANTAS, Anna Carolina Batista; PAJECKI, Denis; SANTO, Marco Aurelio
- Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in the Elderly: 1-Year Preliminary Outcomes in a Randomized Trial (BASE Trial)(2021) PAJECKI, Denis; DANTAS, Anna Carolina Batista; TUSTUMI, Francisco; KANAJI, Ana Lumi; CLEVA, Roberto de; SANTO, Marco AurelioPurpose Despite the increasing prevalence of elderly obese patients, bariatric surgery remains controversial in this population. Recent publications have focused on perioperative safety, but few studies have addressed clinical outcomes. Objectives This study aimed to evaluate 1-year outcomes of laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients 65 years or older. Methods Thirty-six elderly obese patients were recruited for an open-label randomized trial from September 2017 to May 2019, comparing LSG to LRYGB. One-year outcomes were evaluated based on weight loss, functionality, and control of clinical conditions. Results The median age (67 x 67 years; p=0.67) and initial body mass index (BMI) (46.3 x 51.3 kg/m(2); p=0.28) were similar between groups. Preoperative BMI (after weight loss pre-operative treatment) was higher in LRYGB group (41.9 x 47.6 kg/m(2); p= 0.03). After 12 months, EWL and TWL were higher in LRYGB group (60 x 68%; p=0.04; 24.9 x 31.4%; p<0.01). HbA1c reduction was higher after LRYGB (-1.1 x -0.5%; p<0.01) as well as LDL control (-27.5 x +11.5 mg/dL p= 0.02). No difference was noted between LRYGB and LSG concerning hypertension control, triglycerides, HDL, and functionality. Conclusion Weight loss, diabetes, and LDL control were better achieved with LRYGB after 12 months.
- Nutritional guidance, monitoring, and supplementation before and after bariatric surgery - Are we doing this correctly?(2021) SILVA, Mariane Marques da; WAITZBERG, Dan Linetzky; DIPPPOLITO, Regiane Macedo Silva; SALA, Priscila; BARCELOS, Samira; SANTO, Marco Aurelio; MARTINEZ, Ana Cristina; TORRINHAS, Raquel SusanaBackground and aims: minimizing nutritional depletions after a Roux-en-Y gastric bypass (RYGB) may improve clinical results in the treatment of obesity. We evaluated nutritional aspects of obese women undergoing RYGB at a reference university hospital with a department specialized in bariatric surgery. Method: based on the Dietary Reference Intakes developed by the Food and Nutrition Council, Institute of Medicine, and the guidelines issued by the American Society for Metabolic and Bariatric Surgery, we assessed the quantitative and qualitative adequacy of nutritional intake, supplementation, and biochemical monitoring of 20 women both before and 3 and 12 months after a RYGB. Data on nutritional intake was obtained by applying different food surveys, quantitatively interpreted by the Virtual Nutri Plus (R) software and using reference nutritional databases. Results: nutritional intake deficits were already found before the RYGB (p <= 0.05). These worsened postoperatively (p <= 0.05), a period also marked by a qualitatively poor diet. The nutritional supplementation prescribed did not fully achieve the reference recommendations, and was poorly complied with by patients. Furthermore, nutritional monitoring was not carried out in all patients, recommended biochemical markers were not screened, and vitamin D depletions occurred. Conclusion: our data suggest that institutions specialized in bariatric patient care may not be adequately adhering to well known guidelines, or applying efficient strategies to improve compliance.
bookPart Atividades de Gastrocirurgia(2021) SANTO, Marco Aurélio- Pharmacokinetics of oral levonorgestrel and ethinylestradiol in women after Roux-en-Y gastric bypass surgery(2021) BRITO, Claudia Moreira de; MELO, Maria Edna de; MANCINI, Marcio C.; SANTO, Marco Aurelio; CERCATO, CintiaBackground: Most patients undergoing Roux-en-Y gastric bypass (RYGB) are women in reproductive age. It is not known if bariatric surgery affects the pharmacokinetics of oral contraceptives. Objectives: The primary objective was to evaluate ethinylestradiol (EE) and levonorgestrel (LNG) absorption in women undergoing RYGB, compared with nonoperated controls matched by age and body mass index (BMI). A secondary objective was to assess whether the time since surgery and BMI in the postoperative period influenced the absorption parameters. Setting: University hospital, Brazil. Methods: This study was designed to compare the maximum plasma concentration (C-max), the time to the peak plasma level (T-max), the area under the curve (AUC(0-8) and AUC(0-infinity)) after a single dose of a combined oral contraceptive with 0.03 mg EE and 0.15 mg LNG among 20 women after RYGB and 20 controls. Blood samples were obtained for 8 hours. Results: The mean LNG AUC(0-8) and LNG AUC(0-infinity) were higher in RYGB group (P = .048 and P = .004, respectively). We found a positive correlation for LNG AUC(0-8) (P = .045) and AUC(0-infinity) (P = .004) and the time since surgery, and we found a negative correlation for LNG Cmax (P = .018), AUC(0-8) (P = .003), and AUC(0-infinity) (P = .001) and BMI. Conclusion: No significant differences were found in oral EE pharmacokinetics. The operated group showed higher mean LNG AUC(0-8) and AUC(0-infinity) but it was not considered clinically significant. The present study suggests that RYGB may not affect EE and LNG absorption.
- OBESITY AND SEVERE STEATOSIS: THE IMPORTANCE OF BIOCHEMICAL EXAMS AND SCORES(2021) SILVA, Miller Barreto de Brito e; TUSTUMI, Francisco; DANTAS, Anna Carolina Batista; MIRANDA, Barbara Cristina Jardim; PAJECKI, Denis; DE-CLEVA, Roberto; SANTO, Marco Aurelio; NAHAS, Sergio CarlosINTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients. OBJECTIVE: The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population. METHODS: This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery. RESULTS: A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m(2) (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%. CONCLUSIONS: NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.
- Constraints of Weight Loss as a Marker of Bariatric Surgery Success: An Exploratory Study(2021) GIL, Saulo; GOESSLER, Karla; DANTAS, Wagner S.; MURAI, Igor Hisashi; MEREGE-FILHO, Carlos Alberto Abujabra; PEREIRA, Rosa Maria R.; CLEVA, Roberto de; SANTO, Marco Aurelio; KIRWAN, John P.; ROSCHEL, Hamilton; GUALANO, BrunoPurpose The aim of this exploratory study was to investigate whether the degree of weight loss properly reflects improvements in cardiometabolic health among patients who underwent Roux-en-Y gastric bypass. Methods In this ancillary analysis from a clinical trial, patients were clustered into tertiles according to the magnitude of the percentage weight loss (1st tertile: ""higher weight loss"": -37.1 +/- 5.8%; 2nd tertile: ""moderate weight loss"": -29.7 +/- 1.4%; 3rd tertile: ""lower weight loss"": -24.2 +/- 2.3%). Delta changes (9 months after surgery-baseline) in clustered cardiometabolic risk (i.e., blood pressure index, fasting glucose, high-density lipoprotein [HDL] and triglycerides [TG]), glycated hemoglobin (HbA1c), homeostasis model assessment (HOMA-IR), and C-reactive protein (CRP) were calculated. Results A total of 42 patients who had complete bodyweight data (age = 40 +/- 8 year; BMI = 47.8 +/- 7.1 kg/m(2)) were included. Surgery led to substantial weight loss (-37.9 +/- 11.3 kg, P < 0,001), and clinically significant improvements in blood pressure index (-17.7 +/- 8.2 mmHg, P < 0.001), fasting glucose (-36.6 +/- 52.5 mg/dL, P < 0.001), HDL (9.4 +/- 7.1 mg/dL, P < 0.001), TG (-35.8 +/- 44.1 mg/dL P < 0,001), HbA1c (-1.2 +/- 1.6%, P < 0.001), HOMA-IR (-4.7 +/- 3.9 mg/dL, P < 0.001) and CRP (-8.5 +/- 6.7 mu g/mL P < 0.001). Comparisons across tertiles revealed no differences for cardiometabolic risk score, fasting glucose, HbAc1, HOMA-IR, blood pressure index, CRP, HDL, and TG (P > 0.05 for all). Individual variable analysis confirmed cardiometabolic improvements across the spectrum on weight-loss. There were no associations between weight loss and any dependent variable. Conclusion Weight loss following bariatric surgery does not correlate with improvements in cardiovascular risk factors. These findings suggest that weight loss alone may be insufficient to assess the cardiometabolic success of bariatric surgery, and the search for alternate proxies that better predict surgery success are needed.