Metabolic Changes After Bariatric Surgery

NCT ID: NCT02893891

Last Updated: 2018-03-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-03-31

Study Completion Date

2017-12-31

Brief Summary

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Literature data clearly demonstrate that treatment of obese patients is very expensive, long and achieve weight loss may not be permanent, and regardless of whether the treatment dominated diet therapy, physical activity, or pharmacotherapy. Experience of the last decade has shown that after surgical interventional treatment of obesity occurs not only long-term (10 years and over) weight loss of 35-40%, but also an important endocrine changes.

In recent years, it was discovered a number of signaling molecules produced by adipose tissue, whose physiological significance beyond the general metabolic aspects organism. The fat is therefore currently understood as an endocrine organ whose hormones modulate the function of many systems, including the skeleton. These hormones include the adipokines that modulate metabolism skeleton as at tissue level (Leptin, Adiponectin) and indirectly - by activation of neurohumoral hypothalamic centers - Leptin.

Studying endocrine interactions between adipose tissue and bone is a highly topical issue. This mutual communication is a homeostatic feedback system in which adipokines and molecules secreted by osteoblasts and osteoclasts are the connecting link active axes fat - bone tissue. However, the mechanisms of this axis remain largely unknown.

Detailed Description

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Obesity is an important medical problem. The number of obese individuals is increasing continuously in response to various environmental and genetic factors. For some morbidly obese patients, surgery is the only effective type of therapy. Despite bariatric surgery having good outcomes in terms of weight loss, it is associated with some adverse effects: several studies have reported subsequent alterations in bone metabolism. Of the surgical techniques available (laparoscopic gastric banding, Roux-en-Y bypass, biliopancreatic diversion), laparoscopic sleeve gastrectomy (LSG) is currently the technique of choice. Because restrictive procedures such as LSG do not involve bypassing segments of small bowel where micronutrient absorption takes place, fewer metabolic disturbances are expected than with other surgical techniques.

The observed changes in bone metabolism and status in post-bariatric surgery patients potentially involve several mechanisms, including reduced absorption of essential nutrients, diminished calcium absorption leading to secondary hyperparathyroidism, poor vitamin D absorption and restricted energy delivery. In addition, body weight protects against osteoporosis via the bone-strengthening effects of long-term weight bearing. However, long-term decreases in bone mineral density in patients who have undergone successful bariatric surgery are an unexpected, negative effect of this type of therapy.

In the study, parameters of fat and bone tissue and body composition changes are assessed in groups of bariatric patients after LSG, gastric plication and intragastric balloon treatment. Other anticipated benefits of the study treatment include improving the quality of life of. lt will also lead to the introduction of new processes, materials and methods. lt is also possible to expect shortening of the hospital stay, decrease in postoperative morbidity, and the possibility to perform the procedure on an outpatient basis.

The study has been designed as a prospective study, which is in conformity with the principles and guidelines of the Helsinki Declaration, good clinical practice and has been approved by the Ethical Committee of the Faculty of Medicine, University of Ostrava.

The patients enrolled in the study are followed for the period of twelve months. Timetable of the study procedures and controls:

Preoperative examination:

* Demographic data on age, sex, weight, height, smoking
* Assessment of body composition and sampling of blood
* Questionnaires for quality of Life Examination 3 months postoperatively
* Assessment of body composition and sampling of blood
* Questionnaires for quality of Life Examination 6 months after surgery
* Assessment of body composition and sampling of blood
* Questionnaires for quality of Life Examination 12 months after surgery
* Assessment of body composition and sampling of blood
* Questionnaires for quality of Life

Statistical data processing for statistical evaluation descriptive statistics are used (arithmetical average, standard deflection, frequency tables), X2 test, Fisher's exact test, analysis of variance (ANOVA), calculating of the OR (odds ratio) with 95 % confidence intervals, and logistic regression. Statistical tests are evaluated at the significance level of 5%. Statistical analysis is performed in the "Stata 10" programme. Program EpiData is used for data collection.

Conditions

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Grade III Obesity Type 2 Diabetes Mellitus

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Laparoscopic sleeve gastrectomy

Patients undergoing bariatric surgery procedure of laparoscopic sleeve gastrectomy.

Group Type ACTIVE_COMPARATOR

Laparoscopic sleeve gastrectomy

Intervention Type PROCEDURE

Sleeve gastrectomy involves removing most of the stomach, limiting the amount of food the patient can eat.

Laparoscopic gastric plication

Patients undergoing bariatric surgery procedure of laparoscopic gastric plication.

Group Type ACTIVE_COMPARATOR

Laparoscopic gastric plication

Intervention Type PROCEDURE

Laparoscopic gastric plication involves sewing one or more large folds in the stomach. During the laparoscopic gastric plication, the stomach volume is reduced about 70%, which makes the stomach able to hold less and helps the patient eat less.

Intragastric balloon

Patients undergoing bariatric surgery procedure with intragastric balloon implantation.

Group Type ACTIVE_COMPARATOR

Intragastric balloon

Intervention Type PROCEDURE

The introduction of the balloon is non-invasive as it is inserted endoscopically (down the oesophagus). The balloon is then filled inside the stomach with a dyed physiological solution, which reduces the volume of the stomach.

Intragastric balloon implantation

Intervention Type DEVICE

Intragastric balloons (End-Ball, Medsil) will be implanted in the patients with morbid obesity.

Interventions

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Laparoscopic sleeve gastrectomy

Sleeve gastrectomy involves removing most of the stomach, limiting the amount of food the patient can eat.

Intervention Type PROCEDURE

Laparoscopic gastric plication

Laparoscopic gastric plication involves sewing one or more large folds in the stomach. During the laparoscopic gastric plication, the stomach volume is reduced about 70%, which makes the stomach able to hold less and helps the patient eat less.

Intervention Type PROCEDURE

Intragastric balloon

The introduction of the balloon is non-invasive as it is inserted endoscopically (down the oesophagus). The balloon is then filled inside the stomach with a dyed physiological solution, which reduces the volume of the stomach.

Intervention Type PROCEDURE

Intragastric balloon implantation

Intragastric balloons (End-Ball, Medsil) will be implanted in the patients with morbid obesity.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* History of conservative obesity treatments selected according to criteria IFSO (BMI greater than 40 or greater than 35 with comorbidities)

Exclusion Criteria

* Thyroid disease
* Diseases of the digestive system associated with disorders of intestinal absorption
* History of corticosteroid therapy in the past 12 months
Minimum Eligible Age

20 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Ostrava

OTHER

Sponsor Role collaborator

Vitkovice Hospital, Ostrava, Czech Republic

UNKNOWN

Sponsor Role collaborator

University Hospital Ostrava

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marek Bužga, MSc., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Faculty of Medicine, Ostrava University, Ostrava

Locations

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Vítkovice Hospital Ostrava

Ostrava, Moravian-Silesian Region, Czechia

Site Status

University Hospital Ostrava

Ostrava, Moravian-Silesian Region, Czechia

Site Status

Countries

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Czechia

References

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Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253.

Reference Type BACKGROUND
PMID: 11234459 (View on PubMed)

Suter M, Calmes JM, Paroz A, Giusti V. A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg. 2006 Jul;16(7):829-35. doi: 10.1381/096089206777822359.

Reference Type BACKGROUND
PMID: 16839478 (View on PubMed)

Bose M, Olivan B, Teixeira J, Pi-Sunyer FX, Laferrere B. Do Incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: What are the evidence? Obes Surg. 2009 Feb;19(2):217-229. doi: 10.1007/s11695-008-9696-3. Epub 2008 Sep 27.

Reference Type BACKGROUND
PMID: 18820978 (View on PubMed)

Buchwald H, Oien DM. Metabolic/bariatric surgery Worldwide 2008. Obes Surg. 2009 Dec;19(12):1605-11. doi: 10.1007/s11695-009-0014-5.

Reference Type BACKGROUND
PMID: 19885707 (View on PubMed)

Koerner A, Kratzsch J, Kiess W. Adipocytokines: leptin--the classical, resistin--the controversical, adiponectin--the promising, and more to come. Best Pract Res Clin Endocrinol Metab. 2005 Dec;19(4):525-46. doi: 10.1016/j.beem.2005.07.008.

Reference Type BACKGROUND
PMID: 16311215 (View on PubMed)

Magni P, Dozio E, Galliera E, Ruscica M, Corsi MM. Molecular aspects of adipokine-bone interactions. Curr Mol Med. 2010 Aug;10(6):522-32. doi: 10.2174/1566524011009060522.

Reference Type BACKGROUND
PMID: 20642443 (View on PubMed)

Pobeha P, Ukropec J, Skyba P, Ukropcova B, Joppa P, Kurdiova T, Javorsky M, Klimes I, Tkac I, Gasperikova D, Tkacova R. Relationship between osteoporosis and adipose tissue leptin and osteoprotegerin in patients with chronic obstructive pulmonary disease. Bone. 2011 May 1;48(5):1008-14. doi: 10.1016/j.bone.2011.02.017. Epub 2011 Mar 1.

Reference Type BACKGROUND
PMID: 21376149 (View on PubMed)

Boyce BF, Xing L. Functions of RANKL/RANK/OPG in bone modeling and remodeling. Arch Biochem Biophys. 2008 May 15;473(2):139-46. doi: 10.1016/j.abb.2008.03.018. Epub 2008 Mar 25.

Reference Type BACKGROUND
PMID: 18395508 (View on PubMed)

Makovey J, Naganathan V, Seibel M, Sambrook P. Gender differences in plasma ghrelin and its relations to body composition and bone - an opposite-sex twin study. Clin Endocrinol (Oxf). 2007 Apr;66(4):530-7. doi: 10.1111/j.1365-2265.2007.02768.x.

Reference Type BACKGROUND
PMID: 17371471 (View on PubMed)

Hamrick MW, Ferrari SL. Leptin and the sympathetic connection of fat to bone. Osteoporos Int. 2008 Jul;19(7):905-12. doi: 10.1007/s00198-007-0487-9. Epub 2007 Oct 9.

Reference Type BACKGROUND
PMID: 17924050 (View on PubMed)

Gomez-Ambrosi J, Rodriguez A, Catalan V, Fruhbeck G. The bone-adipose axis in obesity and weight loss. Obes Surg. 2008 Sep;18(9):1134-43. doi: 10.1007/s11695-008-9548-1. Epub 2008 Jun 19.

Reference Type BACKGROUND
PMID: 18563500 (View on PubMed)

Greco EA, Fornari R, Rossi F, Santiemma V, Prossomariti G, Annoscia C, Aversa A, Brama M, Marini M, Donini LM, Spera G, Lenzi A, Lubrano C, Migliaccio S. Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Pract. 2010 May;64(6):817-20. doi: 10.1111/j.1742-1241.2009.02301.x.

Reference Type BACKGROUND
PMID: 20518955 (View on PubMed)

Wucher H, Ciangura C, Poitou C, Czernichow S. Effects of weight loss on bone status after bariatric surgery: association between adipokines and bone markers. Obes Surg. 2008 Jan;18(1):58-65. doi: 10.1007/s11695-007-9258-0. Epub 2007 Dec 11.

Reference Type BACKGROUND
PMID: 18074189 (View on PubMed)

Buzga M, Svagera Z, Tomaskova H, Hauptman K, Holeczy P. Metabolic Effects of Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication: an 18-Month Prospective, Observational, Open-Label Study. Obes Surg. 2017 Dec;27(12):3258-3266. doi: 10.1007/s11695-017-2779-2.

Reference Type DERIVED
PMID: 28674838 (View on PubMed)

Other Identifiers

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SGS10/LF/2012

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

LFOU-SGS-Bariatric Surgery

Identifier Type: -

Identifier Source: org_study_id

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