GRUP DE RECERCA UNITAT FUNCIONAL D’OBESITAT

Hospital Clínic de Barcelona (Barcelona)

Director: Josep Vidal Cortada, Director Institut Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona

jovidal@clinic.ub.es

(+34) 932 27 98 46

(+34) 934 51 66 38

MEMBRES DEL GRUP INVESTIGADOR

Josep Vidal Cortada, Director Institut Malalties Digestives i Metabòliques, Hospital Clínic de Barcelona. a/e: jovidal@clinic.ub.es

Amanda Jiménez, Especialista, Hospital Clínic de Barcelona. a/e: Ajimene1@clinic.cat

Lílliam Flores, Especialista Sènior, Hospital Clínic de Barcelona. a/e: lflores@clinic.cat

Violeta Moizé, Dietista Nutricionista, Hospital Clínic de Barcelona. a/e: vmoize@clinic.cat

Alba Andreu, Dietista Nutricionista, Hospital Clínic de Barcelona. a/e: aandreu@clinic.cat

Judit Molero, Dietista Nutricionista, Hospital Clínic de Barcelona. a/e: lflores@clinic.cat

Sílvia Cañizares, Psicòloga Clínica, Hospital Clínic de Barcelona. a/e: scanizar@clinic.cat

Lucía Rodríguez, Infermera, Hospital Clínic de Barcelona. a/e: lrodrig@clinic.cat

Judith Viaplana, Infermera, IDIBAPS, a/e: viaplana@clinic.cat

Carla Mestre, Dietista, IDIBAPS, a/e: cmestre@clinic.cat

Rebeca Fernández, Biòloga, CIBERDEM, a/e: rfernand@clinic.cat

ACTIVITATS I CAPACITATS DEL GRUP DE RECERCA

Les activitats del grup de recerca es poden agrupar en 3 apartats. El primer és el coneixement de la relació entre obesitat i algunes de les comorbiditats que s’hi associen. En aquesta línia ens centrem fonamental en dues associacions: la primera la relació entre obesitat i diabetis i la segona entre obesitat i deteriorament cognitiu. Estudiem en models animals els processos que determinen la massa beta cel·lular pancreàtica i quins factors fan que aquesta adaptació s’alteri en models d’obesitat. Emprant tècniques d’imatge, biomarcadors, i qüestionaris de cribratge mirem de comprendre la relació entre obesitat i funció cognitiva. Completem aquest apartam amb l’estudi de com aquestes relacions es modifiquen en el model del pacient intervingut de cirurgia bariàtrica. La segona línia té a veure amb el model de cirurgia bariàtrica. Específicament en aquest camp estudiem d’una els mecanismes associats a la variabilitat en la pèrdua de pes que s’observa després de la cirurgia i de l’altre quins son els factors associats i quines serien les pautes per mantenir l’estat nutricional en el pacient operat. Tenim especial interès en el pacients d’edat avançada com a model amb especial risc per una preservació insuficient de la massa magra corporal. La darrera línia té a veure amb la recerca sobre les estratègies no quirúrgiques de tractament de l’obesitat. D’una banda participant en l’estudi PREDIMED-PLUS, en que s’avalua el impacte d’una dieta mediterrània hipocalòrica i canvis en l’estil de vida com a estratègia de prevenció primària de malaltia CV en persones amb obesitat i síndrome metabòlica. De l’altra avaluant el impacte de diferents estratègies educatives (individuals i grupals) sobre el manteniment del pes perdut en persones operades d’obesitat.

LÍNIES DE RECERCA

Línia: Obesitat i Diabetis.
Investigador principal: Josep Vidal

Línia: Obesitat i Deteriorament Cognitiu.
Investigador principal: Amanda Jiménez

Línia: Fracàs tractament quirúrgic obesitat.
Investigador principal:Lílliam Flores

Línia: Nutrició i cirurgia bariàtrica.
Investigador principal: Violeta Moizé

Línia: Educació i cirurgia bariàtrica.
Investigador principal: Alba Andreu

Línia: Obesitat i dieta mediterrània.
Investigador principal: Josep Vidal

MILLORS PUBLICACIONS DEL GRUP (2015-2017)

Aminian A, Brethauer SA, Andalib A, Nowacki AS, Jimenez A, Corcelles R, Hanipah ZN, Punchai S, Bhatt DL, Kashyap SR, Burguera B, Lacy AM, Vidal J, Schauer PR.
Individualized Metabolic Surgery Score: Procedure Selection Based on Diabetes Severity.
Ann Surg. 2017 Oct;266(4):650-657.
PMID: 28742680

OJECTIVE: To construct and validate a scoring system for evidence-based selection of bariatric and metabolic surgery procedures according to severity of type 2 diabetes (T2DM).
BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) account for >95% of bariatric procedures in United States in patients with T2DM. To date, there is no validated model to guide procedure selection based on long-term glucose control in patients with T2DM.
METHODS: A total of 659 patients with T2DM who underwent RYGB and SG at an academic center in the United States and had a minimum 5-year follow-up (2005-2011) were analyzed to generate the model. The validation dataset consisted of 241 patients from an academic center in Spain where similar criteria were applied.
RESULTS: At median postoperative follow-up of 7 years (range 5-12), diabetes remission (HbA1C <6.5% off medications) was observed in 49% after RYGB and 28% after SG (P < 0.001). Four independent predictors of long-term remission including preoperative duration of T2DM (P < 0.0001), preoperative number of diabetes medications (P < 0.0001), insulin use (P = 0.002), and glycemic control (HbA1C < 7%) (P = 0.002) were used to develop the Individualized Metabolic Surgery (IMS) score using a nomogram. Patients were then categorized into 3 stages of diabetes severity. In mild T2DM (IMS score ≤25), both procedures significantly improved T2DM. In severe T2DM (IMS score >95), when clinical features suggest limited functional β-cell reserve, both procedures had similarly low efficacy for diabetes remission. There was an intermediate group, however, in which RYGB was significantly more effective than SG, likely related to its more pronounced neurohormonal effects. Findings were externally validated and procedure recommendations for each severity stage were provided.
CONCLUSIONS: This is the largest reported cohort (n = 900) with long-term postoperative glycemic follow-up, which, for the first time, categorizes T2DM into 3 validated severity stages for evidence-based procedure selection.

Vidal J, Corcelles R, Jiménez A, Flores L, Lacy AM.
Metabolic and Bariatric Surgery for Obesity.
Gastroenterology. 2017 May;152(7):1780-1790
PMID: 28193516

Metabolic and bariatric surgery (MBS) leads to weight loss in obese individuals and reduces comorbidities such as type 2 diabetes. MBS is superior to medical therapy in reducing hyperglycemia in persons with type 2 diabetes, and has been associated with reduced mortality and incidences of cardiovascular events and cancer in obese individuals. New guidelines have been proposed for the use of MBS in persons with type 2 diabetes. We review the use of MBS as a treatment for obesity and obesity-related conditions and, based on recent evidence, propose that health care systems make the appropriate changes to increase accessibility for eligible patients.
Moizé V, Pi-Sunyer X, Vidal J, Miner P, Boirie Y, Laferrère B.
Effect on Nitrogen Balance, Thermogenesis, Body Composition, Satiety, and Circulating Branched Chain Amino Acid Levels up to One Year after Surgery: Protocol of a Randomized Controlled Trial on Dietary Protein During Surgical Weight Loss.
JMIR Res Protoc. 2016 Nov 28;5(4):e220
PMID: 27895003

BACKGROUND: Bariatric surgery (BS), the most effective treatment for severe obesity, typically results in 40-50 kg weight loss in the year following the surgery. Beyond its action on protein metabolism, dietary protein intake (PI) affects satiety, thermogenesis, energy efficiency, and body composition (BC). However, the required amount of PI after surgical weight loss is not known. The current daily PI recommendation for diet-induced weight loss is 0.8 g/kg ideal body weight (IBW) per day, but whether this amount is sufficient to preserve fat-free mass during active surgical weight loss is unknown.
OBJECTIVE: To evaluate the effect of a 3-month dietary protein supplementation (PS) on nitrogen balance (NB), BC, energy expenditure, and satiety in women undergoing either gastric bypass or vertical sleeve gastrectomy.
METHODS: In this randomized prospective study, participants will be randomized to a high protein supplementation group (1.2 g/kg IBW per day) or standard protein supplementation group (0.8 g/kg IBW per day) based on current guidelines. Outcome measures including NB, BC, circulating branched chain amino acids, and satiety, which will be assessed presurgery, and at 3-months and 12-months postsurgery.
RESULTS: To date, no studies have examined the effect of dietary PS after BS. Current guidelines for PI after surgery are based on weak evidence.
CONCLUSIONS: The results of this study will contribute to the development of evidence-based data regarding the safe and optimal dietary PI and supplementation after BS.

Ruiz-Lozano T, Vidal J, de Hollanda A, Canteras M, Garaulet M, Izquierdo-Pulido M.
Evening chronotype associates with obesity in severely obese subjects: interaction with CLOCK 3111T/C.
Int J Obes (Lond). 2016 Oct;40(10):1550-1557
PMID: 27339606

BACKGROUND: Chronotype has been related to obesity and metabolic disturbances. However, little is known about the relationship between circadian preferences and genetic background in CLOCK genes with obesity and weight loss among severely obese patients after bariatric surgery.
OBJECTIVES: The research goals were (1) to examine whether evening chronotype is related to obesity and weight loss evolution in severely obese followed during 6 years after bariatric surgery and (2) to examine potential interactions between circadian preferences and CLOCK 3111T/C for obesity in this population.
SUBJECTS/METHODS: Participants (n=252, 79% female; age (mean±s.d.): 52±11 years; body mass index (BMI): 46.4±6.0 kg m-2) were grouped into evening and morning types. Obesity and weight loss parameters, energy and macronutrients intake, energy expenditure, chronotype, meal timing, sleep duration and CLOCK genotype were studied.
RESULTS: Evening-type subjects showed significantly higher initial body weight (P=0.015) and BMI (P=0.014) than morning types. Moreover, evening-type, when compared with morning types, lost less weight (percentage of excess weight loss) after bariatric surgery (P=0.015). Weight-loss progression between the two chronotype groups differed significantly from the fourth year after the bariatric surgery toward a higher weight regain among evening types (P<0.05). We also detected a significant interaction between CLOCK 3111T/C SNP and chronotype for body weight at baseline (P<0.001). Specifically, among carriers of the risk allele C, evening types showed higher body weight than morning types (P=0.012). In addition, CLOCK 3111T/C SNP significantly associated with obesity and sleep duration in the older subjects.
CONCLUSIONS: Evening chronotype is associated with higher obesity in severely obese subjects and with lower weight loss effectiveness after bariatric surgery. In addition, circadian preferences interact with CLOCK 3111T/C for obesity. The circadian and genetic assessment could provide tailored weight loss recommendations in subjects who underwent bariatric surgery.

de Hollanda A, Casals G, Delgado S, Jiménez A, Viaplana J, Lacy AM, Vidal J.
Gastrointestinal Hormones and Weight Loss Maintenance Following Roux-en-Y Gastric Bypass.
J Clin Endocrinol Metab. 2015 Dec;100(12):4677-84.
PMID: 26505823

CONTEXT: Factors underlying variable weight loss (WL) after Roux-en-Y gastric bypass (RYGB) are poorly understood.
OBJECTIVE: Our objective was to gain insight on the role of gastrointestinal hormones on poor WL maintenance (P-WLM) following RYGB.
DESIGN AND PATIENTS: First, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and ghrelin responses to a standardized mixed liquid meal (SMLM) were compared between subjects with good WL (G-WL, n = 32) or P-WLM (n = 22). Second, we evaluated food intake (FI) following blockade of gut hormonal secretion in G-WL (n = 23) or P-WLM (n = 19) subjects. Finally, the impact of dietary-induced WL on the hormonal response in subjects with P-WLM (n = 14) was assessed.
SETTING: This study was undertaken in a tertiary hospital.
MAIN OUTCOME MEASURES: In studies 1 and 3, the outcomes measures were the areas under the curve of gut hormones following a SMLM; in study 2, FI following subcutaneous injection of saline or octreotide were evaluated.
RESULTS: P-WLM associated a blunted GLP-1 (P = .044) and PYY (P = .001) responses and lesser suppression of ghrelin (P = .032) following the SMLM challenge. On saline day, FI in the G-WL (393 ± 143 kcal) group was less than in the P-WLM (519 ± 143 Kcal; P = .014) group. Octreotide injection resulted in enlarged FI in both groups (G-WL: 579 ± 248 kcal, P = .014; P-WLM: 798 ± 284 Kcal, P = .036), but the difference in FI between groups remained (P < .001). In subjects with P-WLM, dietary-induced WL resulted in larger ghrelin suppression (P = .046), but no change in the GLP-1 or PYY responses.
CONCLUSION: Our data show gastrointestinal hormones play a role in the control of FI following RYGB, but do not support that changes in GLP-1, PYY, or ghrelin play a major role as determinants of P-WLM after this type of surgery.

INSTITUCIONS QUE RECONEIXEN AL GRUP DE RECERCA

El nostre grup forma part de l’Àrea 3 del Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (fetge, aparell digestiu i metabolisme), el coordinador de l’àrea és el Dr. Jordi Bruix i en Josep Vidal n’és un investigador principal.

Josep Vidal és també IP d’un grup del Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas (CIBERDEM). Part dels integrants del grup de la Unitat Funcional d’Obesitat formen part del grup CIBERDEM.