A global obesity pandemic is one of the most significant health threats worldwide owing to its close association with numerous comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, heart failure, cancer and many others. Obesity and its comorbidities lead to a higher rate of cardiovascular complications, heart failure and increased cardiovascular and overall mortality. Bariatric surgery is at present the most potent therapy for obesity, inducing a significant weight loss in the majority of patients. In the long-term, a substantial proportion of patients after bariatric surgery experience a gradual weight regain that may, in some, reach up to a presurgical body weight. As a result, anti-obesity pharmacotherapy may be needed in some patients after bariatric surgery to prevent the weight regain or to further potentiate weight loss. This article provides an overview of the use of anti-obesity medications as an augmentation to bariatric surgery for obesity. Despite relatively limited published data, it can be concluded that anti-obesity medication can serve as an effective adjunct therapy to bariatric surgery to help boost post-bariatric weight loss or prevent weight regain.

• MeSH
• bariatrická chirurgie * metody   MeSH
• hmotnostní přírůstek účinky léků   MeSH
• hmotnostní úbytek * účinky léků   MeSH
• kombinovaná terapie MeSH
• látky proti obezitě * terapeutické užití   MeSH
• lidé MeSH
• obezita * chirurgie   farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• látky proti obezitě * MeSH

INTRODUCTION: Pancreatic steatosis (PS) has both metabolic consequences and local effects on the pancreas itself. Magnetic resonance imaging (MRI) is the most reliable non-invasive method for diagnosing PS. We investigated the impact of metabolic syndrome (MS) on the presence of PS, differences in individuals with and without PS, and the metabolic effects of bariatric procedures. METHODS: Changes in anthropometric and basic biochemistry values and MS occurrence were evaluated in 34 patients with obesity who underwent a bariatric procedure. After the procedure, patients underwent MRI with manual 3D segmentation mask creation to determine the pancreatic fat content (PFC). We compared the differences in the PFC and the presence of PS in individuals with and without MS and compared patients with and without PS. RESULTS: We found no significant difference in the PFC between the groups with and without MS or in the occurrence of PS. There were significant differences in patients with and without PS, especially in body mass index (BMI), fat mass, visceral adipose tissue (VAT), select adipocytokines, and lipid spectrum with no difference in glycemia levels. Significant metabolic effects of bariatric procedures were observed. CONCLUSIONS: Bariatric procedures can be considered effective in the treatment of obesity, MS, and some of its components. Measuring PFC using MRI did not show any difference in relation to MS, but patients who lost weight to BMI < 30 did not suffer from PS and had lower overall fat mass and VAT. Glycemia levels did not have an impact on the presence of PS.

• Klíčová slova
• Bariatric surgery, Metabolic syndrome, Obesity, Pancreatic steatosis,
• MeSH
• bariatrická chirurgie * MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• metabolický syndrom * diagnostické zobrazování   metabolismus   MeSH
• morbidní obezita * chirurgie   MeSH
• nitrobřišní tuk metabolismus   MeSH
• obezita metabolismus   MeSH
• pankreas diagnostické zobrazování   metabolismus   MeSH
• retrospektivní studie MeSH
• ztučnělá játra * patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVE: To compare the effects of biliopancreatic diversion (BPD) and laparoscopic gastric banding (LAGB) on insulin sensitivity and secretion with the effects of laparoscopic gastric plication (P). METHODS: A total of 52 obese women (age 30-66 years) suffering from type 2 diabetes mellitus (T2DM) were prospectively recruited into three study groups: 16 BPD; 16 LAGB, and 20 P. Euglycemic clamps and mixed meal tolerance tests were performed before, at 1 month and at 6 months after bariatric surgery. Beta cell function derived from the meal test parameters was evaluated using mathematical modeling. RESULTS: Glucose disposal per kilogram of fat free mass (a marker of peripheral insulin sensitivity) increased significantly in all groups, especially after 1 month. Basal insulin secretion decreased significantly after all three types of operations, with the most marked decrease after BPD compared with P and LAGB. Total insulin secretion decreased significantly only following the BPD. Beta cell glucose sensitivity did not change significantly post-surgery in any of the study groups. CONCLUSION: We documented similar improvement in insulin sensitivity in obese T2DM women after all three study operations during the 6-month postoperative follow-up. Notably, only BPD led to decreased demand on beta cells (decreased integrated insulin secretion), but without increasing the beta cell glucose sensitivity.

• MeSH
• bariatrická chirurgie metody   MeSH
• beta-buňky fyziologie   MeSH
• biliopankreatická diverze metody   MeSH
• diabetes mellitus 2. typu komplikace   metabolismus   chirurgie   MeSH
• dospělí MeSH
• inzulin metabolismus   MeSH
• inzulinová rezistence * MeSH
• krevní glukóza metabolismus   MeSH
• laparoskopie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidní obezita komplikace   metabolismus   chirurgie   MeSH
• sekrece inzulinu MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• Názvy látek
• inzulin MeSH
• krevní glukóza MeSH

• MeSH
• léčba obezity * MeSH
• lidé MeSH
• morbidní obezita MeSH
• obezita MeSH
• žaludeční bypass * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

Worldwide obesity prevalence has nearly doubled since 1980. Due to numerous co-morbidities, obesity represents a serious health and socioeconomic problem worldwide. Pharmacotherapy should be an integral part of comprehensive obesity management. Drug therapy can assist in weight loss and its maintenance in those individuals who do not achieve appropriate weight loss through lifestyle interventions alone. After the withdrawal of sibutramine from the market in 2010, orlistat, a lipase inhibitor, was the only remaining prescription drug approved for the long-term treatment of obesity. In 2012, phentermine/topiramate extended-release (PHEN/TPM ER) combination and lorcaserin were approved by the US FDA as novel medications for long-term weight management. Three major phase III trials conducted with each drug confirmed their efficacy in terms of weight loss/maintenance and improvement of cardiometabolic risks. No head-to-head studies between the two new anti-obesity drugs have been carried out. However, in the existing studies PHEN/TPM ER had a superior weight loss profile to lorcaserin but the incidence of adverse effects was lower with lorcaserin. Both drugs were well-tolerated, and adverse events were modest in intensity, dose dependent, rather rare, and tended to decrease with the duration of treatment. Major safety concerns regarding PHEN/TPM ER include elevations in resting pulse rate, teratogenicity, mild metabolic acidosis, and psychiatric and cognitive adverse events. Valvulopathy, cognitive impairment, psychiatric disorders, and hypoglycemia represent major safety concerns for lorcaserin. Although existing trials have not demonstrated any significant issues with PHEN/TPM ER-induced heart rate elevation and lorcaserin-induced valvulopathy, all safety concerns should be seriously taken into account in patients treated with either of these novel anti-obesity medications.

• MeSH
• benzazepiny škodlivé účinky   MeSH
• benzoxaziny škodlivé účinky   MeSH
• bupropion škodlivé účinky   MeSH
• farmaceutická chemie MeSH
• fentermin aplikace a dávkování   škodlivé účinky   MeSH
• fruktosa aplikace a dávkování   škodlivé účinky   analogy a deriváty   MeSH
• glukagonu podobný peptid 1 škodlivé účinky   analogy a deriváty   MeSH
• látky proti obezitě aplikace a dávkování   škodlivé účinky   MeSH
• lidé MeSH
• liraglutid MeSH
• naltrexon škodlivé účinky   MeSH
• nežádoucí účinky léčiv MeSH
• obezita farmakoterapie   MeSH
• topiramat MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• benzazepiny MeSH
• benzoxaziny MeSH
• bupropion MeSH
• cetilistat MeSH Prohlížeč
• fentermin MeSH
• fruktosa MeSH
• glukagonu podobný peptid 1 MeSH
• látky proti obezitě MeSH
• liraglutid MeSH
• lorcaserin MeSH Prohlížeč
• naltrexon MeSH
• topiramat MeSH