ROBERTO DE CLEVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
9 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 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, BrunoBackgroundObesity 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.
- SMALL INTESTINAL L CELL DENSITY IN PATIENTS WITH SEVERE OBESITY AFTER ROUX-EN-Y GASTRIC BYPASS(2022) ESTABILE, Priscila Costa; SANTO, Marco Aurelio; MOURA, Eduardo Guimaraes Horneaux de; KUGA, Rogerio; CAPRONI, Priscila; CLEVA, Roberto de; MOTA, Filippe Camarotto; MILLEO, Fabio Quirillo; ARTONI, Roberto FerreiraBACKGROUND: Enteroendocrine L cells can be found in the entire gastrointestinal tract and their incretins act on glycemic control and metabolic homeostasis. Patients with severe obesity and type 2 diabetes mellitus may have lower density of L cells in the proximal intestine.AIMS: This study aimed to analyze the density of L cells in the segments of the small intestine in the late postoperative of Roux-en-Y gastric bypass in diabetic patients with standardization of 60 cm in both loops, alimentary and biliopancreatic.METHODS: Immunohistochemistry analysis assays were made from intestinal biopsies in three segments: gastrointestinal anastomosis (GIA= Point A), enteroentral anstomosis (EEA= Point B= 60 cm distal to the enteroenteral anastomosis (Point C).RESULTS: A higher density of L cells immunostaining the glucagon-1 peptide was onwerved in the distal portion (Point C) When compared to the more proximal portions (Points A and B).CONCLUSIONS: The concentration of L cells is higher 60 cm distal to enteroenteral anastomosis when comparing to proximal segments and may explain the difference in intestinal lumen sensitization and enterohormonal response after Roux-en-Y gastric bypass.HEADINGS:calibre das Gastcvarizes Bypass. Immunohistochemistry. L Cell. Glucagon-Lke Peptiedo 1. Diabets Mellitus, Type 2.
- Muscle strength and body composition in severe obesity(2017) GADDUCCI, Alexandre Vieira; CLEVA, Roberto de; SANTAREM, Gabriela Correia de Faria; SILVA, Paulo Roberto Santos; GREVE, Julia Maria D'Andrea; SANTO, Marco AurelioOBJECTIVE: The aim of our study was to evaluate associations between maximum voluntary contraction torques of the lower limbs and body composition for subjects with severe obesity. METHODS: Body composition was evaluated by bioelectrical impedance analysis, and maximum voluntary contraction torques of the lower limbs were measured using an isokinetic dynamometer. One hundred thirty-two patients were enrolled (100 females and 32 males). Eighty-seven patients had a body mass index between 40 and 49.9 kg/m(2) (the A group), and 45 patients had a body mass index between 50 and 59.9 kg/m(2) (the B group). RESULTS: Absolute extension and flexion torques had weak associations with fat-free mass but a moderate association with absolute extension torque and fat-free mass of the lower limbs. There were no significant differences between the A and B groups with respect to absolute extension and flexion torques. For the A group, absolute extension and flexion torques were moderately associated with fat-free mass and with fat-free mass of the lower limbs. For the B group, there were only moderate associations between absolute extension and flexion torques with fat-free mass of the lower limbs. CONCLUSIONS: Our findings demonstrate that both groups exhibited similar absolute torque values. There were weak to moderate associations between absolute extension and flexion torques and fat-free mass but a moderate association with fat-free mass of the lower limbs. Individuals with severe obesity should strive for greater absolute torques, fat-free mass and especially fat-free mass of the lower limbs to prevent functional limitations and physical incapacity.
- LACTATE CAN BE A MARKER OF METABOLIC SYNDROME IN SEVERE OBESITY?(2021) DE-CLEVA, Roberto; CARDIA, Lilian; VIEIRA-GADDUCCI, Alexandre; GREVE, Julia Maria; SANTO, Marco AurelioBackground: In the last decades, numerous studies have confirmed the importance of lactate by-product to the nutrient signal of the intracellular redox state to regulatory functions in energy metabolism. Aim: To evaluate changes in blood lactate in patients with severe obesity and its correlation with body composition and metabolic profile. Methods: Twenty-four people with severe obesity (BMI=40 kg/m(2)) were evaluated in a prospective case-control study before and six months after Roux-in-Y gastric bypass. The blood lactate, total cholesterol, and fractions, C-reactive protein and HOMA-IR were analyzed after 12 h fasting. Body mass composition was evaluated by bioelectrical impedance and respiratory quotient was measured by indirect calorimetry. Results: The initial lactate level was 2.5 +/- 1.1 mmol/l and returned to normal level (1.9 +/- 3.6 mmol/l, p=0.0018) after surgery. This reduction was positively correlated with a decrease in BMI (p=0.0001), % free fat mass (p=0,001), % fat mass (p=0.001) and HOMA-IR (p=0.01). There was normalization of lactatemia in 70% of patients. There was no correlation between lactatemia and C-reactive protein. Conclusions: There was a significant improvement of metabolic parameters, normalization of blood lactate, fat mass loss, although these individuals remained with a high BMI.
- Nutritional Inadequacies Among Post-bariatric Patients During COVID-19 Quarantine in Sao Paulo, Brazil(2021) NICOLETTI, Carolina Ferreira; ESTEVES, Gabriel Perri; GENARIO, Rafael; SANTO, Marco Aurelio; CLEVA, Roberto de; GUALANO, Bruno; ROSCHEL, HamiltonPost bariatric control of food intake is influenced by psychological and behavioral factors. We investigated dietary habits and food intake during COVID-19 quarantine among recently operated patients. Patients were assessed for total and per meal energy and macronutrient intake as well as frequency of food consumption per processing level. Patients were also classified according to adherence to nutritional recommendations from our outpatient clinic. Main results are indicative of inappropriate nutritional intake during COVID-19 quarantine in postoperative bariatric patients. We observed that many patients failed to meet the recommended protein intake (89.2%) along a relatively high intake of ultra-processed foods (similar to 1/4 of the diet). Our data suggest the need for the implementation of strategies to extend nutritional care to at-risk patients during social distancing.
- Correlation between Body Composition and Walking Capacity in Severe Obesity(2015) SANTAREM, G. Correia de Faria; CLEVA, R. de; SANTO, Marco Aurelio; BERNHARD, Biaseto; GADDUCCI, Alexandre Vieira; GREVE, Julia Maria D'Andrea; SILVA, Paulo Roberto SantosBackground Obesity is associated with mobility reduction due to mechanical factors and excessive body fat. The six-minute walk test (6MWT) has been used to assess functional capacity in severe obesity. Objective To determine the association of BMI, total and segmental body composition with distance walked (6MWD) during the six-minute walk test (6MWT) according to gender and obesity grade. Setting University of Sao Paulo Medical School, Brazil; Public Practice. Methods Functional capacity was assessed by 6MWD and body composition (%) by bioelectrical impedance analysis in 90 patients. Results The mean 6MWD was 514.9 +/- 50.3 m for both genders. The male group (M: 545.2 +/- 46.9 m) showed a 6MWD higher (p = 0.002) than the female group (F: 505.6 +/- 47.9 m). The morbid obese group (MO: 524.7 +/- 44.0 m) also showed a 6MWD higher (p = 0.014) than the super obese group (SO: 494.2 +/- 57.0 m). There was a positive relationship between 6MWD and fat free mass (FFM), FFM of upper limps (FFM_UL), trunk (FFM_TR) and lower limbs (FFM_LL). Female group presented a positive relationship between 6MWD and FFM, FFM_UL and FFM_LL and male group presented a positive relationship between 6MWD and FFM_TR. In morbid obese group there was a positive relationship between 6MWD with FFM, FFM_UL, FFM_TR and FFM_LL. The super obese group presented a positive relationship between 6MWD with FFM, FFM_TR and FFM_LL. Conclusions Total and segmental FFM is associated with a better walking capacity than BMI.
- A randomized clinical trial on the effects of exercise on muscle remodelling following bariatric surgery(2021) GIL, Saulo; KIRWAN, John P.; MURAI, Igor H.; DANTAS, Wagner S.; MEREGE-FILHO, Carlos Alberto Abujabra; GHOSH, Sujoy; SHINJO, Samuel K.; PEREIRA, Rosa M. R.; TEODORO, Walcy R.; FELAU, Sheylla M.; BENATTI, Fabiana B.; SA-PINTO, Ana L.; LIMA, Fernanda; CLEVA, Roberto; SANTO, Marco Aurelio; GUALANO, Bruno; ROSCHEL, HamiltonBackground Muscle atrophy and strength loss are common adverse outcomes following bariatric surgery. This randomized, controlled trial investigated the effects of exercise training on bariatric surgery-induced loss of muscle mass and function. Additionally, we investigated the effects of the intervention on molecular and histological mediators of muscle remodelling. Methods Eighty women with obesity were randomly assigned to a Roux-en-Y gastric bypass (RYGB: n = 40, age = 42 +/- 8 years) or RYGB plus exercise training group (RYGB + ET: n = 40, age = 38 +/- 7 years). Clinical and laboratory 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). A healthy, lean, age-matched control group was recruited to provide reference values for selected variables. Results Surgery resulted in a similar (P = 0.66) reduction in lower-limb muscle strength in RYGB and RYGB+ET (-26% vs. -31%), which was rescued to baseline values in RYGB + ET (P = 0.21 vs. baseline) but not in RYGB (P < 0.01 vs. baseline). Patients in RYGB+ET had greater absolute (214 vs. 120 kg, P < 0.01) and relative (2.4 vs. 1.4 kg/body mass, P < 0.01) muscle strength compared with RYGB alone at POST9. Exercise resulted in better performance in timed-up-and-go (6.3 vs. 7.1 s, P = 0.05) and timed-stand-test (18 vs. 14 repetitions, P < 0.01) compared with RYGB. Fat-free mass was lower (POST9-PRE) after RYBG than RYGB + ET (total: -7.9 vs. -4.9 kg, P < 0.01; lower-limb: -3.8 vs. -2.7 kg, P = 0.02). Surgery reduced Types I (similar to - 21%; P = 0.99 between-group comparison) and II fibre cross-sectional areas (similar to - 27%; P = 0.88 between-group comparison), which were rescued to baseline values in RYGB+ET (P > 0.05 vs. baseline) but not RYGB (P > 0.01 vs. baseline). RYGB + ET showed greater Type I (5187 vs. 3898 mu m(2), P < 0.01) and Type II (5165 vs. 3565 mu m(2), P < 0.01) fCSA than RYGB at POST9. RYGB + ET also resulted in increased capillarization (P < 0.01) and satellite cell content (P < 0.01) than RYGB at POST9. Gene-set normalized enrichment scores for the muscle transcriptome revealed that the ubiquitin-mediated proteolysis pathway was suppressed in RYGB + ET at POST9 vs. PRE (NES: -1.7; P < 0.01), but not in RYGB. Atrogin-1 gene expression was lower in RYGB + ET vs. RYGB at POST9 (0.18 vs. 0.71-fold change, P < 0.01). From both genotypic and phenotypic perspectives, the muscle of exercised patients resembled that of healthy lean individuals. Conclusions This study provides compelling evidence-from gene to function-that strongly supports the incorporation of exercise into the recovery algorithm for bariatric patients so as to counteract the post-surgical loss of muscle mass and function.
- Modified body adiposity index for body fat estimation in severe obesity(2017) BERNHARD, A. B.; SCABIM, V. M.; SERAFIM, M. P.; GADDUCCI, A. V.; SANTO, M. A.; CLEVA, R. deBackgroundThe body adiposity index (BAI) comprises a simple method for estimating body fat (BF) that needs to be validated in patients with severe obesity. The present study aimed to determine BAI accuracy with respect to the determination BF in patients with severe obesity. MethodsA cross-sectional prospective study comparing two methods for BF estimation was conducted in 433 patients with severe obesity between August 2012 to December 2014. BF was estimated by bioelectrical impedance analysis (BIA) with specific equations developed for BF estimation in patients with severe obesity and BAI. The BF estimation in 240 patients with severe obesity (Group 1: G1) was used to evaluate BAI limitations and to develop a specific equationin this population. The new equationproposed was validated in another 158 patients with severe obesity (Group 2: G2). ResultsThere was a significant difference between BF determination by BIA and BAI (P=0.039). The mean (SD) BF in G1 was 52.3%(6.1%) determined by BIA and 51.6%(8.1%) determined by BAI. Sex, waist-hip ratio (WHR) and obesity grade determined significant errors on BF estimation by BAI. A new equation(modified body adiposity index; MBAI) was developed by linear regression to minimise these errors [MBAI%=23.6+0.5x(BAI); add 2.2 if body mass index50kgm(-2) and 2.4 if WHR1.05]. The new equationreduced the difference [1.2% (5.9%), P<0.001 to 0.4%(4.12%), P=0.315] and improved the correlation (0.6-0.7) between methods. ConclusionsBAI present significant limitations in severe obesity and MBAI was effective for BF estimation in this population.