Friday, September 05, 2008

Operasi bariatrik di Australia

Dalam 17 tahun terakhir terjadi peningkatan 20 kali insiden operasi bariatrik (operasi untuk mengatasi obesitas). 5 years survival rate sesuai dengan populasi umum. 30-day postoperative mortalitas rendah (0.07%) dan <10% pasien mengalami komplikasi. Prosedur gastric reduction lebih aman dibanding prosedur bypass-type.

MJA 18 August 2008; 189 (4): 198-202 © The Medical Journal of Australia 2008
Incidence of bariatric surgery and postoperative outcomes: a population-based analysis in Western Australia. Fiona J Smith, C D'Arcy J Holman, Rachael E Moorin and David R Fletcher. Correspondence to: Fiona J Smith

 
Objective:

To investigate the incidence of bariatric surgery and postoperative outcomes in a population-based cohort of patients in Western Australia over a 17-year period.

Design and setting:

A population-based incidence study of all bariatric procedures (n = 1403) performed in WA hospitals over the period 1988–2004, based on hospital morbidity and death data from the WA Data Linkage System.

Main outcome measures:

Changes in incidence of bariatric procedures over time; mortality and complications within 30 days after surgery; survival rates after surgery relative to age-, sex-, and period-matched survival rates in the general population; factors predictive of re-admission to hospital.

Results:

The incidence of bariatric surgery increased from 1.2 procedures per 100 000 person-years in 1988 to 24.2 procedures per 100 000 person-years in 2004. Although some of this was ascribed to a rising prevalence of obesity generally, there was a 13-fold increase in the bariatric procedure rate within the obese population itself. At 5 years, the relative survival rate in bariatric patients was the same as the survival rate in the general population. Within the 30-day postoperative period, mortality was low (0.07%) and 9.6% of patients experienced complications. Those who had bypass-type procedures were more likely to be re-admitted within 30 days than those who had gastric reduction procedures (adjusted hazard ratio, 5.80 [95% CI, 3.42–9.84]).

Conclusion:

The use of bariatric surgery increased 20-fold over the study period. Relative survival after surgery was in line with population norms. The observed low mortality rates and moderate level of complications are similar to findings in other studies in which the proportion of reduction procedures has been high.

Manfaat teh hijau untuk diabetesi

Penelitian tentang efek teh hijau dilakukan pada 60 orang berusia 32-73 tahun, yang kadar gula darah puasa >110mg/dL atau gula darah sewaktu >140mg/dL. Subyek dibagi 2 kelompok, kelompok pertama mendapat teh hijau (green tea-extract powder mengandung 544 mg polyphenols (456 mg catechins) setiap hari selama 2 bulan kemudian dihentikan dan diamati selama 2 bulan, kelompok kedua diamati selama 2 bulan kemudian mendapat teh hijau selama 2 bulan.

Original Article

European Journal of Clinical Nutrition (2008) 62, 953–960;

Randomized controlled trial for an effect of green tea-extract powder supplementation on glucose abnormalities

Y Fukino1, A Ikeda2, K Maruyama1,2, N Aoki3, T Okubo4 and H Iso2

  1. 1Department of Nutritional Sciences, School of Food and Nutritional Sciences, University of Shizuoka, Suruga-ku, Shizuoka-shi, Japan
  2. 2Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita-shi, Osaka, Japan
  3. 3Department of Public Health, Hamamatsu University School of Medicine, Hamamatsu-shi, Japan
  4. 4Central Research Laboratories, Taiyou Kagaku Co. Ltd., Yokkaichi, Mie, Japan

Correspondence: Dr Y Fukino, School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Shizuoka-shi 422-8526, Japan. E-mail: fukino@u-shizuoka-ken.ac.jp

Objective:

We examined whether green tea-extract powder supplementation improves glucose abnormality.

Methods:

The study was conducted for volunteers who resided in eastern communities of Shizuoka Prefecture and who had fasting blood glucose levels of greater than or equal to6.1 mmol/l or nonfasting blood glucose levels of greater than or equal to7.8 mmol/l in a recent health check-up. Sixty subjects aged 32–73 years (49 males and 11 females) participated in the trial. The Early intervention group consumed a packet of green tea-extract powder containing 544 mg polyphenols (456 mg catechins) daily for the first 2 months and then entered the 2-month nonintervention period. The Later intervention group was observed for the first 2 months and then consumed green tea-extract powder as described above for the subsequent 2 months. Using the two-period crossover design, we analyzed the changes in fasting hemoglobin A1c level and other biomarkers in blood samples collected at baseline, 2 months and 4 months.

Results:

A significant reduction in hemoglobin A1c level and a borderline significant reduction in diastolic blood pressure were associated with the intervention. The intervention caused no significant changes in weight, body mass index, body fat, systolic blood pressure, fasting serum glucose level, homeostasis model assessment index, serum lipid level or hypersensitive C-reactive protein.

Conclusion:

Daily supplementary intake of green tea-extract powder lowered the hemoglobin A1c level in individuals with borderline diabetes.

Metabolically benign obesity

Identification and Characterization of Metabolically Benign Obesity in Humans

Norbert Stefan, MD; Konstantinos Kantartzis, MD; Jürgen Machann, PhD; Fritz Schick, PhD; Claus Thamer, MD; Kilian Rittig, MD; Bernd Balletshofer, MD; Fausto Machicao, PhD; Andreas Fritsche, MD; Hans-Ulrich Häring, MD

Arch Intern Med. 2008;168(15):1609-1616.

Background  Obesity represents a risk factor for insulin resistance, type 2 diabetes mellitus, and atherosclerosis. In addition, for any given amount of total body fat, an excess of visceral fat or fat accumulation in the liver and skeletal muscle augments the risk. Conversely, even in obesity, a metabolically benign fat distribution phenotype may exist.

Methods  In 314 subjects, we measured total body, visceral, and subcutaneous fat with magnetic resonance (MR) tomography and fat in the liver and skeletal muscle with proton MR spectroscopy. Insulin sensitivity was estimated from oral glucose tolerance test results. Subjects were divided into 4 groups: normal weight (body mass index [BMI] [calculated as weight in kilograms divided by height in meters squared], <25.0), overweight (BMI, 25.0-29.9), obese–insulin sensitive (IS) (BMI, ≥30.0 and placement in the upper quartile of insulin sensitivity), and obese–insulin resistant (IR) (BMI, ≥30.0 and placement in the lower 3 quartiles of insulin sensitivity).

Results  Total body and visceral fat were higher in the overweight and obese groups compared with the normal-weight group (P < .05); however, no differences were observed between the obese groups. In contrast, ectopic fat in skeletal muscle (P < .001) and particularly the liver (4.3% ± 0.6% vs 9.5% ± 0.8%) and the intima-media thickness of the common carotid artery (0.54 ± 0.02 vs 0.59 ± 0.01 mm) were lower and insulin sensitivity was higher (17.4 ± 0.9 vs 7.3 ± 0.3 arbitrary units) in the obese-IS vs the obese-IR group (P < .05). Unexpectedly, the obese-IS group had almost identical insulin sensitivity and the intima-media thickness was not statistically different compared with the normal-weight group (18.2 ± 0.9 AU and 0.51 ± 0.02 mm, respectively).

Conclusions  A metabolically benign obesity that is not accompanied by insulin resistance and early atherosclerosis exists in humans. Furthermore, ectopic fat in the liver may be more important than visceral fat in the determination of such a beneficial phenotype in obesity.