There is an association of the Gly482Ser polymorphism with type 2 diabetes and obesity. No previous study has evaluated the association of this polymorphism with the outcomes of bariatric surgery. We tested the hypothesis that Gly482Ser polymorphism could predict clinical, laboratorial and structural atherosclerotic marker [carotid intima-media thickness (C-IMT)] outomes. Patients (n=55) were submitted to Roux-en-Y gastric bypass (RYGB) and evaluated for anthropometric, C-IMT, metabolic and infl ammatory parameters at baseline, 1, 6 and 12 mo after RYGB. The polymerase chain reaction- restriction fragment length polymorphism was performed. Serum IL-6, adiponectin, leptin, insulin and MCP-1 were determined. An euglycemic-hyperinsulinemic clamp was performed. C-IMT was measured 1.0 cm distal to the bulbus over a length of 1.0 cm of carotid arteries. At baseline, all parameters were similar between groups. At 1-year after surgery, BMI dropped from 45 to 28 in the Gly/Gly group, and from 44 to 28 in Gly/Ser+Ser/Ser group. There was a signifi cant reduction in the waist/ hip ratio only in the Gly/Ser+Ser/Ser group. Lipid profi le improved after 12 mo similarly in both groups. Fasting blood glucose dropped signifi cantly only in the Gly/Ser+Ser/Ser. Insulin, HOMA-IR and clamp results, and adipokines (leptin, adiponectin) presented signifi cant changes similarly in both groups. Both Gly/Gly and Gly/Ser+Ser/Ser groups presented reductions of us-CRP, MCP-1 and IL-6. Signifi cant inter-group differences were detected for us-CRP, blood leukocyte counts and IL-6. Both Gly/Gly and Gly/Ser+Ser/Ser patients presented signifi cant reductions at 12 mo (0.20 mm, and 0.27 mm, respectively, p
Integrated Physiology/ Obesity POSTERS 1918-P Prevalence-Adjusted Cost of Comorbidities in Overweight/Obese Patients with a Body Mass Index 25-34.9 vs ≥35 DIANA I. BRIXNER, MORGAN BRON, BRANDON BELLOWS, XIANGYANG YE, VENKATESH HARIKRISHNAN, GARY M. ODERDA, Salt Lake City, UT, Deerfi eld, IL Obesity is associated with an increased prevalence of comorbidities. This study looked at prevalence and cost of comorbidities in 2 categories of overweight/obese patients based on BMI. Prevalence of 25 comorbidities in patients with BMI 25-34.9 and ≥35 was calculated and ranked based on data from the GE Centricity EMR research database. Patients whose BMI was within NHLBI guideline categories for overweight (25-29.9), class I obesity (30-34.9) and class II or III obesity (≥35) between 3/1/05 and 6/30/09 were included. BMI index date was defi ned as date of either only BMI on record, or latest BMI for patients with 2 or more BMI readings. Prevalence of comorbidities was based on presence of ICD- 9 code within 2 y prior to BMI index date. Annual comorbidity-associated costs were based on an ICD-9 code for overweight or obesity and patient activity for 1 y post comorbidity index date in Thomson Reuters MedStat MarketScan database. Prevalence-adjusted cost of comorbidities was determined by multiplying annual comorbidity-associated cost per patient from MarketScan by comorbidity prevalence rate ratio from 2 BMI groups of the EMR database. The GE EMR database identifi ed 109,885 patients with BMI ≥25 and 2 y EMR activity before BMI index date. The 3 comorbidities with highest prevalence (BMI 25-34.9, ≥35) were hyperlipidemia (14.6%, 16.3%), hypertension (10.2%, 17.7%), and back pain (7.5%, 8.3%). Annual comorbidity-associated cost per overweight/ obese patient was $1136 for hyperlipidemia, $1511 for hypertension, and $2081 for back pain. Prevalence-adjusted per patient cost increased from BMI 25-34.9 to BMI ≥35 in hyperlipidemia ($166 to $185), hypertension ($154 to $268), and back pain ($156 to $173). As an example, a plan with 1,000 members with BMI 25-34.9 would have hyperlipidemia-associated cost of $166,000 vs $185,000 for a plan with 1,000 members with BMI ≥35. This study confi rmed the incremental impact of weight on prevalence and cost of selected comorbidities in overweight or obese patients. Management or therapies that can lower patients’ BMI have the potential to decrease comorbidity rates and may lower costs for health plans. 1919-P Short-Term Evolution of the Insulin Resistance Depending on the Type of Bariatric Surgery LOURDES GARRIDO-SANCHEZ, MORA MURRI, JOSE RIVAS-BECERRA, DIEGO FERNANDEZ-GARCIA, JUAN ALCAIDE, EDUARDO GARCIA-FUENTES, FRANCISCO TINAHONES, Tarragona, Spain, Malaga, Spain Obesity is very often accompanied by other diseases, the most common being type 2 diabetes mellitus and cardiovascular complications. Bariatric surgery is almost the only effective strategy for treating morbidly obese patients. The aims of this study was evaluate the metabolic changes that occur in the early stage after two types of bariatric surgery, biliopancreatic diversión of Scopinaro (BPD) and Sleeve gastrectomy (SG), in morbidly obese persons. The study was undertaken in 31 morbidly obese persons (7 men and 24 women) 15 days before and 15, 30, 45 y 90 days after bariatric surgery (times 0, 1, 2, 3, and 4, respectively). There is a signifi cant improvement in anthropometric variables as result of the two types of bariatric surgery, without signifi cant differences between both types of interventions. In patients undergoing BPD, serum glucose, cholesterol, triglycerides, HDL-cholesterol and FFA were signifi cantly reduced. The changes that occur in these biochemical variables following the SG were not signifi cant. Insulin resistance decreased signifi cantly over the 90 days after surgery, showing the highest decrease at 15 days. Meanwhile, in patients undergoing SG, insulin resistance worsened at 15 days and later diminished. In conclusion, this study shows that the surgical technique that excludes the duodenum (BPD) has immediate postoperative changes in the degree of insulin resistance in morbidly obese patients compared to those techniques that do not exclude (SG). Supported by: JCI-2009-04086, CP04/00133, PS09/01060, PS09/00997 1920-P Small Decrements in Glucose Increase Hunger in the Presence of Visual Food Cues RENATA BELFORT DE AGUIAR, SARITA NAIK, DONGJU SEO, RAJITA SINHA, ROBERT SHERWIN, New Haven, CT Hypoglycemia is associated with increased hunger, triggering increased food consumption. The mechanism for how circulating glucose infl uence food-seeking behavior is unclear. In this study, we evaluated the effects of small changes in glucose within the physiological range on measurements For author disclosure information, see page 785. OBESITY—HUMAN CATEGORY A518 of food motivation in response to visual food cues. Ten healthy subjects (mean age 31±8, A1c 5.4±0.4) underwent a 2mU/kg.min hyperinsulinemic euglycemic clamp (goal=plasma glucose ∼90mg/dl) while viewing high fat, low fat food and non-food pictures, 2 hours after receiving a standardized meal. Liking and wanting ratings were collected for each picture. Hunger ratings were collected at baseline, 60, 85min and at 2 hrs. Initially plasma glucose rose from 83±9 mg/dL at baseline to 98±11 mg/dL after 10mins. During the interval between 10 and 60 min plasma glucose showed more variability, although mean levels decreased slightly to 93±7mg/dL (it decreased by 14+/-4 mg/dL in 6 subjects and increased by 11+/-5 mg/dL in 4 subjects). Subsequently, plasma glucose stabilized at 95±9mg/dL until the end of the clamp. Hunger ratings, after subjects viewed food and non-food images, signifi cantly increased from 1.7±0.7 at baseline to 4.0±0.8 at 60min (p=0.01) and 5.2±2.9 at 2 hrs. (p=0.004). Hunger levels at the end of the clamp were associated with glucose at 10min (r=0.816,p=0.004) and 60min (r=-0.702,p=0.02) and the drop in glucose between 10 and 60mins (r=0.848,p=0.002). The changes in glucose were not associated with signifi cant increases in plasma glucagon, cortisol, FFA, or ghrelin from baseline levels. In addition, leptin levels increased (p
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