ROBERTO DE CLEVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
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- Early glycemic control and incretin improvement after gastric bypass: the role of oral and gastrostomy route(2019) FERNANDES, Gustavo; SANTO, Marco Aurelio; CRESPO, Andrea de Fatima Crispino Bastos; BIANCARDI, Gabriel Barbosa; MOTA, Filippe Camarotto; ANTONANGELO, Leila; CLEVA, Roberto deBackground: Patients with obesity have a suppressed incretin effect and a consequent imbalance of glycemic homeostasis. Several studies have shown improved type 2 diabetes after Roux-en-Y gastric bypass (RYGB). The mechanisms of early action are linked to caloric restriction, improvement of insulin resistance, pancreatic beta cell function, and the incretin effect of glycogen-like protein 1 and gastric inhibitory polypeptide, but reported data are conflicting. Objective: The objective of this study was to evaluate glycemic metabolism, including the oral glucose tolerance test and enterohormonal profile in the early postoperative period in severely obese patients who underwent RYGB with gastrostomy, comparing the preoperative supply of a standard bolus of nutrient against the postoperative administration through an oral and a gastrostomy route. Setting: Clinics Hospital of University of Sao Paulo, Brazil. Methods: Eleven patients with obesity and diabetes underwent RYGB with a gastrostomy performed in the excluded gastric remnant. Patients were given preoperative assessments of glycemic and enterohormone profiles and an oral glucose tolerance test; these were compared with early postoperative assessments after oral and gastrostomy route administrations. Results: The mean preoperative body mass index of the group was 44.1 +/- 6.6 kg/m(2), mean fasting blood glucose of 194.5 +/- 62.4 mg/dL, and glycated hemoglobin 8.7 +/- 1.6%. In 77.7% of the patients, there was normalization of the glycemic curve in the early postoperative period as evaluated by the oral glucose tolerance test. Significant decreases in glycemia, insulinemia, and homeostatic model assessment-insulin resistance were also observed, regardless of the route of administration. There was significant increase in glycogen-like protein 1 by the postoperative oral route and reduction of gastric inhibitory polypeptide in both routes. Ghrelin did not change. Conclusion: Glycemia and peripheral insulin resistance reductions were observed in early postoperative RYGB, independent of the oral or gastrostomy route. Incretin improvement, mediated by glycogen-like protein 1 increased was observed only in the postoperative oral route, while GIP reduced for both routes.
- Exercise Mitigates Bone Loss in Women With Severe Obesity After Roux-en-Y Gastric Bypass: A Randomized Controlled Trial(2019) MURAI, Igor H.; ROSCHEL, Hamilton; DANTAS, Wagner S.; GIL, Saulo; MEREGE-FILHO, Carlos; CLEVA, Roberto de; SA-PINTO, Ana L. De; LIMA, Fernanda; SANTO, Marco A.; BENATTI, Fabiana B.; KIRWAN, John P.; PEREIRA, Rosa M.; GUALANO, BrunoContext: Bone loss after bariatric surgery potentially could be mitigated by exercise. Objective: To investigate the role of exercise training (ET) in attenuating bariatric surgery-induced bone loss. Design: Randomized, controlled trial. Setting: Referral center for bariatric surgery. Patients: Seventy women with severe obesity, aged 25 to 55 years, who underwent Roux-en-Y gastric bypass (RYGB). Intervention: Supervised, 6-month, ET program after RYGB vs. standard of care (RYGB only). Outcomes: Areal bone mineral density (aBMD) was the primary outcome. Bone microarchitecture, bone turnover, and biochemical markers were secondary outcomes. Results: Surgery significantly decreased femoral neck, total hip, distal radius, and whole body aBMD (P < 0.001); and increased bone turnover markers, including collagen type I C-telopeptide (CTX), procollagen type I N-propeptide (P1NP), sclerostin, and osteopontin (P < 0.05). Compared with RYGB only, exercise mitigated the percent loss of aBMD at femoral neck [estimated mean difference (EMD), -2.91%; P = 0.007;], total hip (EMD, -2.26%; P = 0.009), distal radius (EMD, -1.87%; P = 0.038), and cortical volumetric bone mineral density at distal radius (EMD, -2.09%; P = 0.024). Exercise also attenuated CTX (EMD, -0.20 ng/mL; P = 0.002), P1 NP (EMD, -17.59 ng/mL; P = 0.024), and sclerostin levels (EMD, -610 pg/mL; P = 0.046) in comparison with RYGB. Exercise did not affect biochemical markers (e.g., 25(OH)D, calcium, intact PTH, phosphorus, and magnesium). Conclusion: Exercise mitigated bariatric surgery-induced bone loss, possibly through mechanisms involving suppression in bone turnover and sclerostin. Exercise should be incorporated in postsurgery care to preserve bone mass.
conferenceObject LACTATE AS MARKER OF METABOLIC SYNDROME IN SEVERE OBESITY Basic science and research in bariatric surgery(2019) VIEIRA, A. Gadducci; CARDIA, L.; OLIVEIRA, F. Costa De; MARIA, J. Greve De; SANTOS, P. Silva Roberto; PAJECKI, D.; AURELIO, M. Santo; CLEVA, R. DeconferenceObject LIVER FUNCTION IMPROVEMENT AFTER BARIATRIC SURGERY: USING THE INDOCYANINE GREEN TEST IN THE FOLLOW-UP OF OBESE PATIENTS NASH and bariatric surgery(2019) SILVA, M. B. D. B. E.; MESQUITA, G. H. A. D.; DANTAS, A. C. B.; MOTA, F. C.; KAWAMOTO, F. M.; PAJECKI, D.; RICCIOPPO, D.; CLEVA, R. D.; ANDRAUS, W.; SANTO, M. A.; CECCONELLO, I.conferenceObject EXERCISE AS A TREATMENT TO ATTENUATE BONE LOSS IN WOMEN AFTER ROUX-EN-Y GASTRIC BY PASS : A RANDOMIZED CONTROLLED TRIAL(2019) MURAI, I. H.; ROSCHEL, H.; DANTAS, W. S.; GIL, S.; MEREGE-FILHO, C. A.; CAPARBO, V.; TAKAYAMA, L.; SA-PINTO, A. L.; CLEVA, R.; SANTO, M. A.; KIRWAN, J.; PEREIRA, R. M.; GUALANO, B.- Exercise Mitigates The Loss In Muscle Mass And Functionality In Obese Women Undergoing Bariatric Surgery(2019) GIL, Saulo; DANTAS, Wagner Silva; MURAI, Igor Hisashi; MEREGE FILHO, Carlos; SANTO, Marco Aurelio; CLEVA, Roberto de; PEREIRA, Rosa Maria Rodrigues; SHINJO, Samuel Katsuyuki; KIRWAN, John P.; GUALANO, Bruno; ROSCHEL, Hamilton
- Very low-calorie diet in candidates for bariatric surgery: change in body composition during rapid weight loss(2019) SERAFIM, Marcela Pires; SANTO, Marco Aurelio; GADDUCCI, Alexandre Vieira; SCABIM, Veruska Magalhaes; CECCONELLO, Ivan; CLEVA, Roberto deOBJECTIVE: To analyze the changes in the body composition of morbidly obese patients induced by a very low-calorie diet. METHODS: We evaluated 120 patients selected from a university hospital. Body composition was assessed before and after the diet provided during hospitalization, and changes in weight, body mass index, and neck, waist and hip circumferences were analyzed. Bioimpedance was used to obtain body fat and fat-free mass values. The data were categorized by gender, age, body mass index and diabetes diagnosis. RESULTS: The patients consumed the diet for 8 days. They presented a 5% weight loss (without significant difference among groups), which represented an 85% reduction in body fat. All changes in body circumference were statistically significant. There was greater weight loss and a greater reduction of body fat in men, but the elderly showed a significantly higher percentage of weight loss and greater reductions in body fat and fat-free mass. Greater reductions in body fat and fat-free mass were also observed in superobese patients. The changes in the diabetic participants did not differ significantly from those of the non-diabetic participants. CONCLUSIONS: The use of a VLCD before bariatric surgery led to a loss of weight at the expense of body fat over a short period, with no significant differences in the alteration of body composition according to gender, age, body mass index and diabetes status.
- Anemia Before and After Roux-en-Y Gastric Bypass: Prevalence and Evolution on Long-Term Follow-up(2019) CLEVA, Roberto de; CARDIA, Lilian; RICCIOPPO, Daniel; KAWAMOTO, Miwa; KANASHIRO, Newton; SANTO, Marco AurelioPurpose Anemia due to iron deficiency or inflammatory state is often associated with obesity. Bariatric surgery is responsible for increasing iron deficiency, but weight loss decreases the inflammatory state associated with obesity. The objective of our study was to investigate the prevalence and causes of anemia before and after bariatric surgery for severe obesity in a 5-year follow-up. Materials and Methods Retrospective study, with electronic record analysis of obese patients, submitted to Roux-en-Y gastric bypass. Laboratory data were collected before and up to 60 months after surgery. Diagnosis and classification of anemia were done according to hemoglobin levels, serum ferritin, and transferrin saturation. Results Preoperatively, 8.8% of patients had anemia (93.2%, mild), and 43.8% of the patients had anemia due to chronic disease. After 24 months, there was a progressive increase of iron-deficiency anemia (72.4%) and decrease in anemia due to chronic disease (15.5%) and mixed (12.1%), with maintenance of this profile during long-term follow-up. Conclusion Anemia is very frequent in severely obese patients and must be investigated both before and after bariatric surgery. The cause of anemia must be determined in order to use the best treatment available. We observed a reduction in the prevalence of chronic disease anemia during long-term follow-up probably due to the improvement in the systemic inflammatory state.
- Changes in the intestinal microbiota of superobese patients after bariatric surgery(2019) PAJECKI, Denis; OLIVEIRA, Lea Campos de; SABINO, Ester Cerdeira; SOUZA-BASQUEIRA, Marcela de; DANTAS, Anna Carolina Batista; NUNES, Gabriel Cairo; CLEVA, Roberto de; SANTO, Marco AurelioOBJECTIVES: The gut microbiota is associated with obesity and weight loss after bariatric surgery and has been related to its changing pattern. Exactly how the bacterial population affects weight loss and the results of surgery remain controversial. This study aimed to evaluate the intestinal microbiota of superobese patients before and after gastric bypass surgery (RYGB). METHOD: DNA fragments for the microbiota obtained from stool samples collected from nine superobese patients before and after bariatric surgery were sequenced using Ion Torrent. RESULTS: We observed that with a mean follow-up of 15 months, patients achieved 55.9% excess weight loss (EWL). A significant population reduction in the Proteobacteria phylum (11 to 2%, p=0.0025) was observed after surgery, while no difference was seen in Firmicutes and Bacteroidetes. Further analyses performed with two specific individuals with divergent clinical outcomes showed a change in the pattern between them, with a significant increase in Firmicutes and a decrease in Bacteroidetes in the patient with less weight loss (%EWL 50.79 vs. 61.85). CONCLUSIONS: RYGB affects the microbiota of superobese patients, with a significant reduction in Proteobacteria in patients with different weight loss, showing that different bacteria may contribute to the process.
conferenceObject RESTING METABOLIC RATE AND BODY COMPOSITION AFTER 36 MONTHS OF BARIATRIC SURGERY Basic science and research in bariatric surgery(2019) VIEIRA, A. Gadducci; CARDIA, L.; SANTOS, P. Silva Roberto; ANDREA, J. Greve Maria D.; AURELIO, M. Santo; CLEVA, R. De