Evolution analysis of segmental body composition in bariatric patients with weight regain and undergoing pharmacological therapy with liraglutide
Keywords:Obesity; Post-bariatric; Liraglutide.
Obesity is a chronic, multifactorial disease, responsible for several morbidities, and bariatric surgery is an efficient alternative for rapid weight loss. About 20 to 25% of patients, even losing weight after the procedure, tend to regain weight after the second year. This study aimed to analyze the evolution of segmental body composition in bariatric patients with weight regain and undergoing pharmacological therapy with liraglutide. This is a retrospective, longitudinal study through data analysis in the medical records of an institution specialized in clinical and surgical treatment of obesity. The sample was comprised of 22 bariatric patients treated between January 2016 and December 2019. Anthropometric data from segmental impedance measurements were collected, as well as data on the clinical evolution regarding the proposed treatment. The results showed that in both doses, the loss of mass was relevant in all segments, indicating significance. BMI reduced 9.3% in all patients in the 24 weeks analyzed. With 2.4mg/day of liraglutide, there was a 7.2% weight loss and, with a 3.0mg/day dose, the loss was 9.84% of the weight. Considering both doses, the overall weight loss was 9.2%.The percentages of mean differences in fat were similar between trunk and limbs. With respect to lean mass, although there was no statistical significance, we have a clinical significance of protection.
Abdulla, H., Phillips, B., Smith, K., Wilkinson, D., Atherton, P. J., & Idris, I. (2014). Physiological mechanisms of action of incretin and insulin in regulating skeletal muscle metabolism. Current diabetes reviews, 10(5), 327–335. https://doi.org/10.2174/1573399810666141017153749
Bastos, E. C., Barbosa, E. M., Soriano, G. M., dos Santos, E. A., & Vasconcelos, S. M. (2013). Determinants of weight regain after bariatric surgery. Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 26 Suppl 1, 26–32. https://doi.org/10.1590/s0102-67202013000600007
Blackman, A., Foster, G. D., Zammit, G., Rosenberg, R., Aronne, L., Wadden, T., Claudius, B., Jensen, C. B., & Mignot, E. (2016). Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial. International journal of obesity (2005), 40(8), 1310–1319. https://doi.org/10.1038/ijo.2016.52
Bray, G. A., Frühbeck, G., Ryan, D. H., & Wilding, J. P. (2016). Management of obesity. Lancet (London, England), 387(10031), 1947–1956. https://doi.org/10.1016/S0140-6736(16)00271-3
Cadegiani, F. A., Diniz, G. C., & Alves, G. (2017). Aggressive clinical approach to obesity improves metabolic and clinical outcomes and can prevent bariatric surgery: a single center experience. BMC obesity, 4, 9. https://doi.org/10.1186/s40608-017-0147-3
Camilleri, M., & Acosta, A. (2018). Combination Therapies for Obesity. Metabolic syndrome and related disorders, 16(8), 390–394. https://doi.org/10.1089/met.2018.0075
Cintra Junior, W., Modolin, M., Colferai, D. R., Rocha, R. I., & Gemperli, R. (2021). Post-bariatric body contouring surgery: analysis of complications in 180 consecutive patients. Revista do Colegio Brasileiro de Cirurgioes, 48, e20202638. https://doi.org/10.1590/0100-6991e-20202638
Cotugno, M., Nosso, G., Saldalamacchia, G., Vitagliano, G., Griffo, E., Lupoli, R., Angrisani, L., Riccardi, G., & Capaldo, B. (2015). Clinical efficacy of bariatric surgery versus liraglutide in patients with type 2 diabetes and severe obesity: a 12-month retrospective evaluation. Acta diabetologica, 52(2), 331–336. https://doi.org/10.1007/s00592-014-0644-5
Crane, J., & McGowan, B. (2016). The GLP-1 agonist, liraglutide, as a pharmacotherapy for obesity. Therapeutic advances in chronic disease, 7(2), 92–107. https://doi.org/10.1177/2040622315620180.
Davies, M. J., Bergenstal, R., Bode, B., Kushner, R. F., Lewin, A., Skjøth, T. V., Andreasen, A. H., Jensen, C. B., DeFronzo, R. A., & NN8022-1922 Study Group (2015). Efficacy of Liraglutide for Weight Loss Among Patients With Type 2 Diabetes: The SCALE Diabetes Randomized Clinical Trial. JAMA, 314(7), 687–699. https://doi.org/10.1001/jama.2015.9676
Dias, P. C., Henriques, P., Anjos, L., & Burlandy, L. (2017). Obesity and public policies: the Brazilian government's definitions and strategies. Obesidade e políticas públicas: concepções e estratégias adotadas pelo governo brasileiro. Cadernos de saude publica, 33(7), e00006016. https://doi.org/10.1590/0102-311X00006016
El Ansari, W., & Elhag, W. (2021). Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps-a Scoping Review. Obesity surgery, 31(4), 1755–1766. https://doi.org/10.1007/s11695-020-05160-5
Faria G. R. (2017). A brief history of bariatric surgery. Porto biomedical journal, 2(3), 90–92. https://doi.org/10.1016/j.pbj.2017.01.008
Gadde, K. M., Martin, C. K., Berthoud, H. R., & Heymsfield, S. B. (2018). Obesity: Pathophysiology and Management. Journal of the American College of Cardiology, 71(1), 69–84. https://doi.org/10.1016/j.jacc.2017.11.011.
Grannell, A., Martin, W. P., Dehestani, B., Al-Najim, W., Murphy, J. C., & le Roux, C. W. (2021). Liraglutide Does Not Adversely Impact Fat-Free Mass Loss. Obesity (Silver Spring, Md.), 29(3), 529–534. https://doi.org/10.1002/oby.23098
Harder, H., Nielsen, L., Tu, D. T., & Astrup, A. (2004). The effect of liraglutide, a long-acting glucagon-like peptide 1 derivative, on glycemic control, body composition, and 24-h energy expenditure in patients with type 2 diabetes. Diabetes care, 27(8), 1915–1921. https://doi.org/10.2337/diacare.27.8.1915
Isaacs, D., Prasad-Reddy, L., & Srivastava, S. B. (2016). Role of glucagon-like peptide 1 receptor agonists in management of obesity. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 73(19), 1493–1507. https://doi.org/10.2146/ajhp150990
Jimenez, J. M., Ruiz-Tovar, J., López, M., Marc-Hernandez, A., Carbajo, M. A., Cao, M. J., Garcia, S., & Castro, M. J. (2020). Assessment of body composition in obese patients undergoing one anastomosis gastric bypass: cross-sectional study. Scientific reports, 10(1), 18884. https://doi.org/10.1038/s41598-020-75589-2
Kadouh, H., Chedid, V., Halawi, H., Burton, D. D., Clark, M. M., Khemani, D., Vella, A., Acosta, A., & Camilleri, M. (2020). GLP-1 Analog Modulates Appetite, Taste Preference, Gut Hormones, and Regional Body Fat Stores in Adults with Obesity. The Journal of clinical endocrinology and metabolism, 105(5), 1552–1563. https://doi.org/10.1210/clinem/dgz140
Kushner, R. F. (2018). Weight Loss Strategies for Treatment of Obesity: Lifestyle Management and Pharmacotherapy. Progress in cardiovascular diseases, 61(2), 246–252. https://doi.org/10.1016/j.pcad.2018.06.001
Ladenheim, E. E. (2015). Liraglutide and obesity: a review of the data so far. Drug design, development and therapy, 9, 1867–1875. https://doi.org/10.2147/DDDT.S58459
Lattari, T. G., Onzi, T. R., Stedile, L. J. M., & Pincelli, M. P. (2020). Evaluation of quality of life in patients undergoing bariatric surger. R. bras. Qual. Vida, Ponta Grossa, v. 12, n. 1, e10492. https://dói.org/10.3895/rbqv.v12n0.10492.
Mancini, M. C. Tratado de Obesidade. (2ª. ed.): Guanabara Koogan, 2015.
Mancini, M. C., & Halpern, A. Tratamento farmacológico da obesidade. Arquivos Brasileiros de Endocrinologia & Metabologia, v. 46, p. 497-512, 2002.
Modi, R., Rye, P., Cawsey, S., Birch, D. W., & Sharma, A. M. (2018). Liraglutide Effects on Upper Gastrointestinal Investigations: Implications Prior to Bariatric Surgery. Obesity surgery, 28(7), 2113–2116. https://doi.org/10.1007/s11695-018-3249-1
Montesi, L., El Ghoch, M., Brodosi, L., Calugi, S., Marchesini, G., & Dalle Grave, R. (2016). Long-term weight loss maintenance for obesity: a multidisciplinary approach. Diabetes, metabolic syndrome and obesity : targets and therapy, 9, 37–46. https://doi.org/10.2147/DMSO.S89836
Nuijten, M., Tettero, O. M., Wolf, R. J., Bakker, E. A., Eijsvogels, T., Monpellier, V. M., Hazebroek, E. J., Janssen, I., & Hopman, M. (2021). Changes in Physical Activity in Relation to Body Composition, Fitness and Quality of Life after Primary Bariatric Surgery: a Two-Year Follow-Up Study. Obesity surgery, 31(3), 1120–1128. https://doi.org/10.1007/s11695-020-05009-x
Pajecki, D., Halpern, A., Cercato, C., Mancini, M., de Cleva, R., & Santo, M. A. (2013). Short-term use of liraglutide in the management of patients with weight regain after bariatric surgery. Revista do Colegio Brasileiro de Cirurgioes, 40(3), 191–195. https://doi.org/10.1590/s0100-69912013000300005
Pereira A. S., et al. (2018). Metodologia da pesquisa científica. [free e-book]. Santa Maria/RS. Ed. UAB/NTE/UFSM.
Ryan, D. H., & Kahan, S. (2018). Guideline Recommendations for Obesity Management. The Medical clinics of North America, 102(1), 49–63. https://doi.org/10.1016/j.mcna.2017.08.006
Rye, P., Modi, R., Cawsey, S., & Sharma, A. M. (2018). Efficacy of High-Dose Liraglutide as an Adjunct for Weight Loss in Patients with Prior Bariatric Surgery. Obesity surgery, 28(11), 3553–3558. https://doi.org/10.1007/s11695-018-3393-7
Sampaio-Neto, J., Branco-Filho, A. J., Nassif, L. S., Nassif, A. T., Masi, F. D., & Gasperin, G. (2016). Proposal Of A Revisional Surgery To Treat Severe Nutritional Deficiency Post-Gastric Bypass. Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 29Suppl 1(Suppl 1), 98–101. https://doi.org/10.1590/0102-6720201600S100
De-Souza, D. A., & Greene, L. J. (2015). Nutritional issues in obese patients submitted to bariatric surgery. Re. "Bariatric surgery may not achieve intended outcomes in all patients". Nutrition (Burbank, Los Angeles County, Calif.), 31(9), 1184–1185. https://doi.org/10.1016/j.nut.2015.06.003
Suliman, M., Buckley, A., Al Tikriti, A., Tan, T., le Roux, C. W., Lessan, N., & Barakat, M. (2019). Routine clinical use of liraglutide 3 mg for the treatment of obesity: Outcomes in non-surgical and bariatric surgery patients. Diabetes, obesity & metabolism, 21(6), 1498–1501. https://doi.org/10.1111/dom.13672
Tonatto-Filho, A. J., Gallotti, F. M., Chedid, M. F., Grezzana-Filho, T., & Garcia, A. (2019). Bariatric Surgery In Brazilian Public Health System: The Good, The Bad And The Ugly, Or A Long Way To Go. Yellow Sign!. Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 32(4), e1470. https://doi.org/10.1590/0102-672020190001e1470
Webb, D. L., Abrahamsson, N., Sundbom, M., & Hellström, P. M. (2017). Bariatric surgery - time to replace with GLP-1?. Scandinavian journal of gastroenterology, 52(6-7), 635–640. https://doi.org/10.1080/00365521.2017.1293154
Wharton, S., Kuk, J. L., Luszczynski, M., Kamran, E., & Christensen, R. (2019). Liraglutide 3.0 mg for the management of insufficient weight loss or excessive weight regain post-bariatric surgery. Clinical obesity, 9(4), e12323. https://doi.org/10.1111/cob.12323
Wharton, S., Kamran, E., Muqeem, M., Khan, A., & Christensen, R. (2019). The effectiveness and safety of pharmaceuticals to manage excess weight post-bariatric surgery: a systematic literature review. Journal of drug assessment, 8(1), 184–191. https://doi.org/10.1080/21556660.2019.1678478.
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