ROBERTO DE CLEVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
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Agora exibindo 1 - 4 de 4
- 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.
- Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial)(2020) PAJECKI, Denis; DANTAS, Anna Carolina Batista; KANAJI, Ana Lumi; OLIVEIRA, Daniel Riccioppo Cerqueira Ferreira de; CLEVA, Roberto de; SANTO, Marco AurelioBackground: The aging population along with the obesity epidemic has increased the number of older patients undergoing bariatric surgery. Nevertheless, there is still conflicting data regarding surgical safety in this population. Objectives: The aim of this study was to compare the surgical morbidity of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for older patients. Setting: University hospital, Sao Paulo, Brazil. Methods: We performed a prospective randomized clinical trial from September 2017 to May 2019. Obese patients aged >= 65 years were randomized to LSG or LRYGB. Data collection included demographic information, body mass index (BMI), and co-morbidities. We assessed readmission, postoperative complications, and mortality. Complications were scored according to Clavien-Dindo classification. Results: A total of 36 patients, with a BMI between 35.5 and 52.8 kg/m(2) were randomized to either LSG (18 patients) or LRYGB (18 patients). The overall complication rate was similar between LSG and LRYGB (3 versus 7, P=.13). Severe complication was more prevalent in LRYGB patients but had no statistically significant difference (0 versus 3, P=.07). Each group had 1 readmission and there was no mortality in 90-day follow-up. Conclusions: Morbidity and mortality rates of bariatric surgery are low in elderly obese patients. Despite not statistically significant, LSG had a lower rate of severe complications compared with LRYGBin this population setting.
- Use of noninvasive markers to predict advanced fibrosis/cirrhosis in severe obesity(2016) CLEVA, Roberto de; DUARTE, Livio Fiolo; CRENITTE, Milton Roberto Furst; OLIVEIRA, Claudia Pinto Marques de; PAJECKI, Denis; SANTO, Marco AurelioBackground: Nonalcoholic steatohepatitis is observed in 25%-55% of patients with severe obesity and in 2%-12% with bridging fibrosis or cirrhosis. There is currently no noninvasive test for the diagnosis of severe liver fibrosis before bariatric surgery. Objectives: To determine the best noninvasive test for predicting advanced liver disease in patients with severe obesity. Setting: University tertiary care hospital, Brazil. Methods: A cross-sectional retrospective study was conducted with 699 patients with severe obesity undergoing bariatric surgery: 568 without a biopsy (nonbiopsy cohort) and 131 patients who had undergone an intraoperative liver biopsy. The tissues were subjected to histologic diagnosis (Brunt criteria) and classified as advanced fibrosis (stages 3 and 4) or no significant fibrosis (absence of nonalcoholic steatohepatitis and stages 1 or 2). The following predictive indices of cirrhosis were calculated in all patients: aspartate aminotransferase/alanine aminotransferase ratio (AAR), age platelet (AP) index, aminotransferase-to-platelet ratio index (APRI), cirrhosis discriminant score (CDS), and hepatitis C antiviral long-term treatment against cirrhosis (HALT-C). The cutoff values, sensitivity, specificity, and areas under the receiver operating characteristic curves (AUROCs) were calculated for patients with biopsies. Results: The AUROC of the AAR, AP, APRI, CDS, and HALT-C model for predicting advanced fibrosis or cirrhosis were, respectively, .522, .88, .99, .905, and .921. The calculated cutoff values, sensitivity, and specificity, respectively, were as follows: AAR: .94, .7, .45; AP 5, .7, .93; APRI .44, 1.0, .97; CDS 6, .7, .97; and HALT-C: .76, 1.0, .77. Conclusion: APRI index was the best predictor of advanced liver disease in patients with severe obesity. (Surg Obes Relat Dis 2016;12:862-867.) (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.
- Resting metabolic rate and weight loss after bariatric surgery(2018) CLEVA, Roberto de; MOTA, Filippe Camarotto; GADDUCCI, Alexandre Vieira; CARDIA, Lilian; GREVE, Julia Maria D'Andrea; SANTO, Marco AurelioBackground: There is an increased interest in understanding how variation in body composition (BC) and energy expenditure is related to successful weight loss after surgery. It has been suggested that low resting metabolic rate (RMR) could be associated with poor weight loss. Objectives: To determine the relation among changes in BC, RMR, and weight loss after bariatric surgery. Setting: University tertiary care hospital, Brazil. Methods: A cohort of 45 patients submitted to bariatric surgery was prospectively studied. BC was evaluated by bioelectrical impedance analysis and RMR by indirect calorimetry before and 6 months after surgery. The RMR value was adjusted per kilogram of weight (RMR/kg). The patients were divided in 4 groups, based on patterns of change in the RMR/kg after surgery. The RMR/kg could decrease (group 1), remain stable (group 2), have a small increase (group 3), or have a major increase (group 4). Results: A significant relation between fat-free mass and RMR for both pre- (P <.01) and postoperative periods (P <.01) was observed. Excess weight loss had a significantly correlation only with post-RMR/kg (P <.01). The pattern of change in RMR/kg was strongly correlated with weight loss, considering an excess weight loss >50% a successful weight loss: No patients achieved success in group 1; 61% of patients did in group 2; 80% di in group 3; and all patients in group 4 had successful weight loss. Conclusions: We demonstrate a clearly correlation between the postoperative RMR and weight loss. The increase in RMR/kg after surgery is a major factor related to a satisfactory excess weight loss after surgery.