Chih-Kun Huang

Psychiatric disorders of patients seeking obesity treatment

BackgroundObese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment.MethodsSubjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment.ResultsOf the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group.ConclusionA high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.

Effect of conjugated linoleic acid supplementation on weight loss and body fat composition in a Chinese population.

OBJECTIVE Conjugated linoleic acid (CLA) has several benefits, including body fat reduction, as proved in animals. However, the results of CLA-induced body composition alterations in humans are inconsistent, and no related data are available for Chinese populations. This study aimed to determine whether CLA affects body weight (BW) loss and body composition of overweight and obese Chinese subjects. METHODS In this randomized, double-blind, placebo-controlled trial, subjects with a body mass index (BMI) of 24 to 35 kg/m(2) randomly received 1.7 g of cis-9,trans-11 and trans-10,cis-12 CLA (n = 30) or placebo (salad oil; n = 33) in 200 mL of sterilized milk twice daily for 12 wk. Changes in body composition were determined by bioimpedance measurements. RESULTS Sixty-three subjects completed the study (CLA, n = 30). After 12 wk, compared with the baseline, the BW, BMI, total fat mass, fat percentage, subcutaneous fat mass, and waist-to-hip ratio decreased in the CLA group (P < 0.05). The CLA group was stratified by BMI and gender. The BW, BMI, subcutaneous fat mass, and waist-to-hip ratio decreased in 27 subjects with a BMI ≥ 27, and these indices, except subcutaneous fat mass, were lower in female subjects. The levels of total cholesterol, triacylglycerol, low-density lipoprotein, and plasma fasting glucose increased, whereas those of high-density lipoprotein decreased after 3 mo of CLA treatment. The changes were not significantly different from the baseline values. CONCLUSION The supplementation of CLA for 12 wk in overweight and grade I obese Chinese subjects yielded lower obesity indices, with no obvious adverse effects.

The effect of surgical weight reduction on left ventricular structure and function in severe obesity.

The aim of this study was to examine the effect of surgical weight reduction on cardiac structure and function and to seek the determinants of these changes. Sixty‐six severely obese adults (BMI ≥35 kg/m2) who received bariatric surgery underwent echocardiographic examination before and 3 months after surgery. At 3 months after surgery, BMI and systolic blood pressure (BP) decreased (43.3 ± 6.3 to 34.1 ± 5.6 kg/m2, P < 0.001, and 146 ± 12 to 130 ± 14 mm Hg, P < 0.001, respectively). In left ventricular (LV) geometry, the relative wall thickness (RWT) and LV mass index decreased significantly (0.43 ± 0.05 to 0.35 ± 0.05, P < 0.001, and 50 ± 11 to 39 ± 11 g/m2.7, P < 0.001, respectively) without changes in chamber size. Multivariate analyses showed change in systolic BP to be an independent predictor for the changes in RWT and LV mass index. In myocardial performance, peak systolic mitral annular velocity and all diastolic indexes showed significant improvements. We concluded that LV hypertrophy and function improved rapidly after bariatric surgery in severely obese adults. BP reduction was the major determinant for the regression of LV hypertrophy in the early stage of surgical weight reduction.

Novel bariatric technology: laparoscopic adjustable gastric banded plication: technique and preliminary results

BACKGROUND The laparoscopic adjustable gastric band has been widely accepted as 1 of the safest bariatric procedures to treat morbid obesity. However, because of variations in the results and the complications that tend to arise from port adjustment, alternative procedures are needed. We have demonstrated, in a university hospital setting, the safety and feasibility of a novel technique, laparoscopic adjustable gastric banded plication, designed to improve the weight loss effect and decrease gastric band adjustment frequency. METHODS We enrolled 26 patients from May 2009 to August 2010. Laparoscopic adjustable gastric banded plication was performed using 5-port surgery. We placed Swedish bands using the pars flaccida method, divided the greater omentum, and performed gastric plication below the band to 3 cm from the pylorus using a single-row continuous suture. The data were collected and analyzed pre- and postoperatively. RESULTS The mean operative time was 87.3 minutes without any intraoperative complications. The average postoperative hospitalization was 1.33 days. The mean excess weight loss at 1, 3, 6, 9, and 12 months after surgery was 21.9%, 31.9%, 41.3%, 55.2%, and 59.5%, respectively. The mean follow-up time was 8.1 months (range 2-15), and the gastric band adjustment rate was 1.1 times per patient during this period. Two complications developed: gastrogastric intussusception and tube kinking at the subcutaneous layer. Both cases were corrected by reoperation. No mortality was observed. CONCLUSION Laparoscopic adjustable gastric banded plication provides both restrictive and reductive effects and is reversible. The technique is safe, feasible, and reproducible and can be used as an alternative bariatric procedure. Comparative studies and long-term follow-up are necessary to confirm our findings.

Surgical results of single-incision transumbilical laparoscopic Roux-en-Y gastric bypass

BACKGROUND Conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the reference standard for bariatric surgery but requires 5-7 trocar incisions. We have developed a new procedure-single-incision transumbilical LRYGB (SITU-LRYGB)-that results in minimal scarring and is more cosmetically acceptable. To compare the surgical results and patient satisfaction between 5-port LRYGB and the novel SITU-LRYGB at a university hospital. METHODS We performed 5-port or SITU-LRYGB on 140 morbidly obese patients; the patients chose the operation method. We used a novel liver traction method and omega-umbilicoplasty specifically designed for SITU-LRYGB. RESULTS Before surgery, the patients in the 5-port surgery group were more obese than those in the SITU group (120.8 kg versus 108.9 kg, P = .013). The rate of hypertension was also greater in the former group. The operative time was longer for SITU-LRYGB (101.1 versus 81.1 min, P = .001) without increased intraoperative complications. The total morphine dose for the SITU group seemed to be greater but the difference was not statistically significant. No difference in complications was observed. Postoperatively, the percentage of excess body weight lost the SITU and 5-port surgery groups was 21.2% and 20.9%, 40.4% and 39.4%, 55.0% and 55.2%, 64.8% and 75.2%, and 75.4% and 78.2% at 1, 3, 6, 9, and 12 months, respectively. The SITU-LRYGB patients reported greater satisfaction related to scarring than those who had undergone 5-port surgery (score 4.57 versus 3.96, respectively, P = .005). No patient died. CONCLUSION Compared with conventional LRYGB, SITU-LRYGB resulted in acceptable complications, the same recovery, comparative weight loss, and better patient satisfaction related to scarring.

The Relationship Between Visceral Adiposity and the Risk of Erosive Esophagitis in Severely Obese Chinese Patients

A higher prevalence of erosive esophagitis is found in obese than in nonobese patients; however, it remains unclear why some obese patients develop this disease, whereas others do not. Accordingly, we elucidated the risk factors associated with erosive esophagitis in severely obese Chinese patients. Between June 2007 and January 2009, a total of 260 Chinese patients with morbid obesity referred for bariatric surgery were enrolled in this cross‐sectional study. All patients received preoperative endoscopy for evaluation of the presence and severity of erosive esophagitis. Demographic variables, anthropometric measurements, and metabolic factors were included in a logistic regression model to identify the factors predictive of erosive esophagitis. The prevalence of erosive esophagitis was 32.3%. Multiple logistic regression showed that increased waist circumference (odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.01–1.04), increased insulin resistance (OR = 1.57, 95% CI = 1.06–2.31), and presence of reflux symptoms (OR = 2.40, 95% CI = 1.22–4.74) were independent risk factors associated with erosive esophagitis. In conclusion, among Chinese patients with morbid obesity, increased waist circumference and insulin resistance were risk factors for erosive esophagitis, which highlights the critical role of visceral adiposity in the pathogenesis of erosive esophagitis.

Laparoscopic Roux-en-Y gastric bypass for nonobese type II diabetes mellitus in Asian patients

BACKGROUND The beneficial role of laparoscopic Roux-en-Y gastric bypass (LRYGB) for type 2 diabetes mellitus (T2 DM) in morbidly obese patients has been established; however, there is scant evidence supporting its effectiveness in nonobese T2 DM Asian patients. The objective of this study was to evaluate the effect of LRYGB in nonobese T2 DM patients and elucidate the predictors of DM remission after one year follow-up. METHODS Between June 2009 and May 2011, twenty-nine nonobese (body mass index (BMI)<27 kg/m(2)) Asian patients with T2 DM who underwent LRYGB were enrolled. All patients were prospectively followed up for one year. Baseline demographic characteristics, diabetic status, and clinical and biochemical data were collected preoperatively and one year after LRYGB. DM remission was defined as those with hemoglobin A1 c (HbA1 c)<6.5% without oral hypoglycemic drugs (OHA)/insulin. Outcomes in the DM remission group were compared with the nonremission group and analyzed. RESULTS All clinical and biochemical parameters, except uric acid, were significantly improved. DM remission was achieved in eleven patients (37.9%) of whom five (45.5%) were male. Blood glucose, HbA1 c, c-peptide, homeostatic model assessment (HOMA-%B), and low density lipoprotein (LDL)-cholesterol were the significant variables in patients with DM remission; however, multiple logistic regression showed that only preoperative HOMA-%B (odds ratio (OR) = 1.13, 95% CI = 1.03-1.24) was a predictor for DM remission. Though no mortality was seen, the complication rate was 20.7%, of which 17.3% was related to marginal ulcers. CONCLUSION LRYGB resulted in significant clinical and biochemical improvements in nonobese Asian patients, with HOMA-%B indicating β-cell function as the main predictor of T2 DM remission. Appropriate patient selection with better β-cell function and evidence from long-term follow-up may justify this therapeutic approach.

Surgically induced weight loss, including reduction in waist circumference, is associated with improved pulmonary function in obese patients

BACKGROUND Obesity is associated with impaired pulmonary function. We evaluated the effect of bariatric surgery on pulmonary function among obese patients and identified potential anthropometric factors of obesity corresponding to the reversal of impaired pulmonary function. METHODS Pulmonary function and anthropometric factors were studied in 94 obese patients aged 18-65 years with a body mass index >32 kg/m(2). Pulmonary function tests were performed preoperatively and 3 months after bariatric surgery. The measurements included forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)), total lung capacity, expiratory reserve volume, residual volume, and diffusing capacity of the lung for carbon monoxide. The anthropometric factors included the body weight, body mass index, waist circumference (WC), hip circumference, waist/height ratio, and waist/hip ratio. The changes in anthropometric parameters were analyzed in relation to pulmonary function test results. Multiple linear regression models were applied to identify the factors that influenced pulmonary function after bariatric surgery. RESULTS When measured 3 months after surgery, all anthropometric parameters for the 94 patients studied had significantly decreased, and the pulmonary function test parameters had significantly improved. Of the anthropometric parameters, the reduction in body weight, WC, and waist/height ratio correlated significantly with increases in the FEV(1) and FVC. In the multiple linear regression analysis, only the reduction in WC correlated significantly with the reductions in the FEV(1) and FVC. CONCLUSION After bariatric surgery, all anthropometric parameters of obesity decreased significantly and the pulmonary function improved. This improvement correlated best with the reduction in the WC and perhaps a decreased intra-abdominal pressure.

Augmenting weight loss after laparoscopic adjustable gastric banding by laparoscopic gastric plication

Augmenting weight loss after laparoscopic adjustable gastric banding by laparoscopic gastric plication Chih-Kun Huang, M.D.*, Shabbir Asim, M.D., Chi-Hsien Lo, M.D. Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan Department of Chemical Engineering, and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan Bariatric and Metabolic International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan Surgery for Obesity and Related Diseases 7 (2011) 235–236

Novel metabolic surgery for type II diabetes mellitus: loop duodenojejunal bypass with sleeve gastrectomy.

A total of 22 (14F/8M) patients with a mean age of 50.3 years (range, 33 to 64 y) and a mean body mass index of 28.4 kg/m2 (range, 21.8 to 38.3 kg/m2) underwent loop duodenojejunal bypass with sleeve gastrectomy from October 2011 to March 2012. The mean duration of onset of type 2 diabetes mellitus was 8 years (range, 1 to 20 y). All patients were on oral hypoglycemic agents; 3 (14%) patients were also using insulin. The mean preoperative glycosylated hemoglobin (HbA1c), fasting plasma sugar, and C-peptide levels dropped from 8.6% (range, 7% to 13.2%), 147 mg/dL (range, 108 to 241 mg/dL), and 2.4 ng/mL (range, 0.7 to 4.1 ng/mL) to 6.2% (range, 5.1% to 9.1%), 110 mg/dL (range, 72 to 234 mg/dL), and 1.3 ng/mL (range, 0.6 to 2.8 ng/mL) at 6 months, respectively. At 6 months, 11 (50%) patients showed type 2 diabetes mellitus remission (HbA1c<6.0%), and 20 (91%) patients achieved HbA1c<7.0% without medicine. There were no intraoperative or early postoperative complications. Loop duodenojejunal bypass with sleeve gastrectomy is safe, feasible, and shows good efficacy in terms of glycemic control in this preliminary report with short follow-up.