MARCO AURELIO SANTO

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Lattes
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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

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  • article
    Long-term follow-up after transoral outlet reduction following Roux-en-Y gastric bypass: Back to stage 0?
    (2023) BRUNALDI, Vitor Ottoboni; OLIVEIRA, Guilherme Henrique Peixoto de; KERBAGE, Anthony; RIBAS, Pedro Henrique; NUNES, Felipe; FARIA, Galileu; MOURA, Diogo de; RICCIOPPO, Daniel; SANTO, Marco; MOURA, Eduardo de
    Background and study aims Significant weight regain affects up to one-third of patients after Roux-en-Y gastric bypass (RYGB) and demands treatment. Transoral outlet reduction (TORe) with argon plasma coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short term. However, no study has investigated the course of gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedure year.Patients and methods Patients eligible for a 36-month follow-up visit after TORe underwent upper gastrointestinal endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJ anastomosis (GJA) size. Comparisons between APC and APC-FTS TORe were a secondary aim.Results Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to pre-procedure levels. Only the energy/fatigue domain improvement was kept between the 1- and 3-year visits.Conclusions Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered iterative rather than a one-off procedure.
  • conferenceObject
    ROBOTIC-ASSISTED REVISIONAL ROUX-EN-Y GASTRIC BYPASS FOR LARGE HIATAL HERNIA AND MASSIVE INTRATHORACIC SLEEVE MIGRATION
    (2023) SANTO FILHO, Marco Aurelio; DANTAS, Anna Carolina Batista; ARABI, Arthur Youssif Mota; PAJECKI, Denis; SANTO, Marco Aurelio
  • article 18 Citação(ões) na Scopus
    Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass
    (2017) SALA, Priscila; BELARMINO, Giliane; TORRINHAS, Raquel S.; MACHADO, Natasha M.; FONSECA, Danielle C.; RAVACCI, Graziela R.; ISHIDA, Robson K.; GUARDA, Ismael F. M. S.; MOURA, Eduardo G. de; SAKAI, Paulo; SANTO, Marco A.; SILVA, Ismael D. C. G. da; PEREIRA, Claudia C. A.; LOGULLO, Angela F.; HEYMSFIELD, Steven; GIANNELLA-NETO, Daniel; WAITZBERG, Dan L.
    OBJECTIVES: Vitamin B12 (B12) deficiency after Roux-en-Y gastric bypass (RYGB) is highly prevalent and may contribute to postoperative complications. Decreased production of intrinsic factor owing to gastric fundus removal is thought to have a major role, but other components of B12 metabolism may also be affected. We evaluated changes in the expression levels of multiple B12 pathway-encoding genes in gastrointestinal (GI) tissues to evaluate the potential roles in contributing to post-RYGB B12 deficiency. METHODS: During double-balloon enteroscopy, serial GI biopsies were collected from 20 obese women (age, 46.9 +/- 6.2 years; body mass index, 46.5 +/- 5.3 kg/m(2)) with adult-onset type 2 diabetes (fasting plasma glucose >= 126 mg/dl; hemoglobin A1c >= 6.5%) before and, at the same site, 3 months after RYGB. Gene expression levels were assessed by the Affymetrix Human GeneChip 1.0 ST microarray. Findings were validated by real-time quantitative PCR (RT-qPCR). RESULTS: Gene expression levels with significant changes (P <= 0.05) included: transcobalamin I (TCN1) in remnant (-1.914-fold) and excluded (-1.985-fold) gastric regions; gastric intrinsic factor (GIF) in duodenum (-0.725-fold); and cubilin (CUBN) in duodenum (+0.982-fold), jejunum (+1.311-fold), and ileum (+0.685-fold). Validation by RT-qPCR confirmed (P <= 0.05) observed changes for TCN1 in the remnant gastric region (-0.132-fold) and CUBN in jejunum (+2.833-fold). CONCLUSIONS: RYGB affects multiple pathway-encoding genes that may be associated with postoperative B12 deficiency. Decreased TCN1 levels seem to be the main contributing factor. Increased CUBN levels suggest an adaptive genetic reprogramming of intestinal tissue aiming to compensate for impaired intestinal B12 delivery.
  • article 1 Citação(ões) na Scopus
    Exercise modifies hypothalamic connectivity and brain functional networks in women after bariatric surgery: a randomized clinical trial
    (2023) MEREGE-FILHO, Carlos A. A.; GIL, Saulo S.; KIRWAN, John P.; MURAI, Igor H.; DANTAS, Wagner S.; NUCCI, Mariana P.; PASTORELLO, Bruno; LIMA, Alisson Padilha de; BAZAN, Paulo R.; PEREIRA, Rosa M. R.; SA-PINTO, Ana L. de; LIMA, Fernanda R.; BRUCKI, Sonia M. D.; CLEVA, Roberto de; SANTO, Marco A.; LEITE, Claudia da Costa; OTADUY, Maria Concepcion Garcia; ROSCHEL, Hamilton; GUALANO, Bruno
    BackgroundObesity is a disease that may involve disrupted connectivity of brain networks. Bariatric surgery is an effective treatment for obesity, and the positive effects on obesity-related conditions may be enhanced by exercise. Herein, we aimed to investigate the possible synergistic effects of Roux-en-Y Gastric Bypass (RYGB) and exercise training on brain functional networks. MethodsThirty women eligible for bariatric surgery were randomly assigned to a Roux-en-Y gastric bypass (RYGB: n = 15, age = 41.0 & PLUSMN; 7.3 years) or RYGB plus Exercise Training (RYGB + ET: n = 15, age = 41.9 & PLUSMN; 7.2 years). Clinical, laboratory, and brain functional connectivity parameters were assessed at baseline, and 3 (POST3) and 9 months (POST9) after surgery. The 6-month, three-times-a-week, exercise intervention (resistance plus aerobic exercise) was initiated 3 months post-surgery (for RYGB + ET). ResultsExercise superimposed on bariatric surgery (RYGB + ET) increased connectivity between hypothalamus and sensorial regions (seed-to-voxel analyses of hypothalamic connectivity), and decreased default mode network (DMN) and posterior salience (pSAL) network connectivity (ROI-to-ROI analyses of brain networks connectivity) when compared to RYGB alone (all p-FDR < 0.05). Increases in basal ganglia (BG) network connectivity were only observed in the exercised training group (within-group analyses). ConclusionExercise training is an important component in the management of post-bariatric patients and may improve the hypothalamic connectivity and brain functional networks that are involved in controlling food intake.
  • conferenceObject
    NEUROPSYCHOLOGICAL ASSESSMENT OF COGNITIVE FUNCTIONS IN PATIENTS WITH SEVERE OBESITY
    (2023) MESSIAS, Jucilaine; DANTAS, Anna Carolina Batista; ARABI, Arthur Youssif Mota; SANTO, Marco Aurelio; CLEVA, Roberto de
  • article 4 Citação(ões) na Scopus
    Management of biliary stones in bariatric surgery
    (2022) TUSTUMI, Francisco; PINHEIRO FILHO, Joao Emilio Lemos; STOLZEMBURG, Lucas Cata Preta; SERIGIOLLE, Leonardo Carvalho; COSTA, Thiago Nogueira; PAJECKI, Denis; SANTO, Marco Aurelio; NAHAS, Sergio Carlos
    Morbidly obese and post-bariatric surgery patients are at increased risk for biliary stones formation. The complications related to biliary stones may impose complexity on their management. This study aimed to review the management of biliary conditions in obese and bariatric patients. In this study, a narrative review was performed of the medical, surgical, and endoscopic procedures for the management of biliary stones and their related complications. Knowing the main prophylactic and therapeutic interventions options is essential for clinicians to properly manage the biliary stones in patients candidates or submitted to bariatric surgery.
  • article 2 Citação(ões) na Scopus
    Roux-en-Y gastric bypass affects the expression of genes related to the intestinal folate metabolism pathway in obese women
    (2023) FERREIRA, Beatriz de Azevedo Muner; FONSECA, Danielle Cristina; SALA, Priscila; ALVES, Juliana Tepedino Martins; PRUDENCIO, Ana Paula Aguiar; MACHADO, Natasha Mendonca; MARQUES, Mariane; BARCELOS, Samira; ISHIDA, Robson Kiyoshi; GUARDA, Ismael Francisco Mota Siqueira; MOURA, Eduardo Guimaraes Hourneaux De; SAKAI, Paulo; SANTE, Marco Aurelio; TORRINHAS, Raquel Susana Matos de Miranda; WAITZBERG, Dan Linetzky
    Objectives: Roux-en-Y gastric bypass (RYGB) promotes sustained weight loss, and the resulting new gastroin-testinal anatomy can contribute to nutritional depletions. Folate deficiency is one of the most frequently observed nutritional deficiencies after RYGB. The aim of this study was to assess whether RYGB affects the expression of genes related to the intestinal folate metabolism pathway as an additional molecular mecha-nism contributing to its postoperative deficiency. Methods: Biopsies from the duodenum, jejunum, and ileum of 20 obese women were collected before and 3 mo after RYGB. The expression of genes involved in intestinal folate metabolism was assessed by microarray and reverse transcriptase polymerase chain reaction (RT-qPCR). Folate intake (7-d food record) and plasma levels (electrochemiluminescence) also were measured. Results: Compared with the preoperative phase, transcriptomic alterations were observed in all intestinal segments studied after RYBG, mainly marked by decreased expression of genes encoding folate transporters/ receptors and increased expression of genes involved in folate biosynthesis (P < 0.05). Reduced folate intake and plasma folate levels were also observed simultaneously (P < 0.05). Plasma folate concentrations corre-lated inversely with intestinal FOLR2 and SHMT2 genes (P < 0.001). Conclusion: The present findings suggested that impaired expression of genes related to intestinal folate metabolism may contribute to the early systemic deficiency after RYGB and highlight a potential transcrip-tomic reprogramming of the intestine in response to RYGB to compensate for folate depletion induced by this surgical technique.(c) 2023 Elsevier Inc. All rights reserved.
  • article 7 Citação(ões) na Scopus
    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, Bruno
    Purpose 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.
  • article 0 Citação(ões) na Scopus
    Semen Analysis and Fertility Rates after Bariatric Surgery in Males
    (2017) ROSENBLATT, Alberto; FAINTUCH, Joel; PAJECKI, Denis; SANTO, Marco Aurelio; FAINTUCH, Salomao; CECCONELLO, Ivan
    Background: Obesity poses challenges to male reproduction, but the effect of bariatric surgery on semen parameters and fertility is debated. This study evaluates Roux-en-Y gastric bypass (RYGB) influence on these variables. Methods: Seventy-nine sexually active men attempting to conceive with a partner were stratified into four groups: Group 1 (n = 23)-bariatric follow-up >= 5 years; Group 2 (n = 23)-mean bariatric follow-up 2 years; Group 3-obese controls (n = 18); Group 4-lean controls (n = 15). Groups 2, 3, and 4 were matched for age; Groups 1, 2, and 3 were matched for body mass index (BMI). Sexual quality of life questionnaire for males (SQOL-M), fasting blood glucose, C-reactive protein, vitamin D, zinc, total testosterone (TT), and free testosterone (FT), estradiol (E2), sex hormone-binding globulin (SHBG), and semen parameters were investigated. Results: SQOL-M scores increased; vitamin D was low in most of Group 2 and Group 3 participants, negatively correlating with BMI (p < 0.01). TT, FT, and SHBG improved postoperatively; however, E2 remained elevated. Semen aberrations occurred in 57.1% of Group 2 patients and BMI correlated with oligoasthenoteratospermia. Scant bariatric men fathered a child (13.0% preoperatively, 4.3% postoperatively, not significant). Conclusion: Semen abnormalities and subfertility were observed after RYGB, despite improved androgenic profile and SQOL-M. Possible negative impacts of hyperestrogenism and hypovitaminosis D on semen parameters warrant further studies.
  • article 0 Citação(ões) na Scopus
    VALIDITY OF THE BRAZILIAN-PORTUGUESE VERSION OF MOOREHEAD-ARDELT QUALITY OF LIFE QUESTIONNAIRE II AMONG PATIENTS WITH SEVERE OBESITY
    (2023) CREMONESI, Mariane de Carvalho; DUARTE-GUERRA, Leorides; PAJECKI, Denis; SANTO, Marco Aurelio; LOTUFO-NETO, Francisco; WANG, Yuan-Pang
    Background: Patients with obesity present multiple comorbid psychiatric conditions and experience impairments in health-related quality of life. Reliable and valid tools that evaluate health-related quality of life are essential for clinical practice. Aims: This study aimed to investigate the reliability and validity of the six-item Moorehead-Ardelt Quality of Life Questionnaire II among Brazilian patients with severe obesity.Methods: We assessed 387 patients (mean age 43 years, 78.8% women, mean body mass index of 46.5 kg/m(2)) on the waiting list of a bariatric surgery center. Trained research assistants concurrently applied the Moorehead-Ardelt Quality of Life-II, the Montgomery-& Aring;sberg Depression Rating Scale, and the Global Assessment of Functioning for assessing health-related quality of life, comorbid depressive symptoms, and patient functioning level, respectively. Results: The internal consistency of the Moorehead-Ardelt Quality of Life-II was considered acceptable. The total score was correlated with the severity of depressive symptoms and functioning level. The more body mass index increases, the more health-related quality of life worsens. The Moorehead-Ardelt Quality of Life-II presented a unidimensional structure. Conclusions: The unidimensional Moorehead-Ardelt Quality of Life-II is a reliable and valid measure for evaluating health-related quality of life in Brazilian patients with severe obesity. The questionnaire allows to quickly assess the health-related quality of life of patients in different bariatric contexts, considering depression and functional level.