Obesity impairs vasodilatation and blood flow increase mediated by endothelial nitric oxide: An overview

Journal of Clinical Pharmacology

Volumn 53, Issue 12, 2013, Pages 1228-1239

  Toda, Noboru ^a,b   Okamura, Tomio ^b  

^a Toyama Institute for Cardiovascular Pharmacology Research   (Japan)

^b SHIGA UNIVERSITY OF MEDICAL SCIENCE   (Japan)

Author keywords

Adipokine; Endothelium dependent vasodilatation; Nitric oxide; Obesity; Pharmacological treatment

Indexed keywords

ADIPONECTIN; ENDOTHELIAL NITRIC OXIDE SYNTHASE; GHRELIN; LEPTIN; NIFEDIPINE; REDUCED NICOTINAMIDE ADENINE DINUCLEOTIDE PHOSPHATE OXIDASE; RESVERATROL;

BARIATRIC SURGERY; BLOOD FLOW; BODY WEIGHT; DIABETES MELLITUS; DIETARY INTAKE; ENDOTHELIAL DYSFUNCTION; ENDOTHELIUM CELL; ENZYME ACTIVITY; ENZYME DEGRADATION; ENZYME SYNTHESIS; EXERCISE; EXPERIMENTAL ANIMAL; HUMAN; IN VIVO STUDY; NONHUMAN; OBESITY; REVIEW; VASODILATATION; WEIGHT CONTROL;

ADIPOKINE; ENDOTHELIUM-DEPENDENT VASODILATATION; NITRIC OXIDE; OBESITY; PHARMACOLOGICAL TREATMENT;

ANIMALS; ENDOTHELIUM, VASCULAR; HUMANS; NITRIC OXIDE; OBESITY; VASODILATION;

EID: 84893024972     PISSN: 00912700     EISSN: 15524604     Source Type: Journal    
DOI: 10.1002/jcph.179     Document Type: Review

References (115)

1. Aronne LJ, Isoldi KK. Overweight and obesity: Key components of cariometabolic risk. Clin Cornerstone 2007;8:29-37.
2. Belin de Chantemele EJ, Stepp DW. Influence of obesity and metabolic dysfunction on the endothelial control in the coronary circulation. J Mol Cell Cardiol 2012;52:840-847.
3. Montero D, Walther G, PerezMartin A, et al. Endothelial dysfunction, inflammation, and oxidative stress in obese children and adolescents: Markers and effect of lifestyle intervention. Obes Rev 2012;13:441-455.
4. Furchgott RF, Zawadzki JV. Obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 1980;288:373-376.
5. Furchgott RF. Studies on relaxation of rabbit aorta by sodium nitrite: The basis for the proposal that the acidactivatable inhibitory factor from retractor penis is inorganic nitrite and the endotheliumderived relaxing factor is nitric oxide. In: Vanhoutte PM, ed. Vasodilatation: Vascular Smooth Muscle, Peptides, Autonomic Nerve and Endothelium New York: Raven Press; 1988: 401-414
6. Palmer RM, Ferrige AG, Moncada S. Nitric oxide release accounts for the biological activity of endotheliumderived relaxing factor. Nature 1987;327:524-526.
7. Dimmeler S, Fleming I, Fisslthaler B, et al. Activation of nitric oxide synthase in endothelial cells by Aktdependent phosphorylation. Nature (Lond) 1999;399:601-605.
8. Moncada S, Palmer RM, Higgs EA. Nitric oxide: Physiology, pathophysiology, and pharmacology. Pharmacol Rev 1991;43: 109-142.
9. Sturm W, Sandhofer A, Engl J, et al. Influence of visceral obesity and liver fat on vascular structure and function on obese subjects. Obesity (Silver Spring) 2009;17:1783-1788.
10. Parikh NI, Keyes MJ, Larson MG, et al. Visceral and subcutaneous adiposity and brachial artery vasodilator function. Obesity (Silver Spring) 2009;17:2054-2059.
11. Gupta AK, Comelissen G, Greenway FL, et al. Abnormalities in circadian blood pressure variability and endothelial function: Pragmatic markers for adverse cardiometabolic profiles in asymptomatic obese adults. Cardiovasc Diabetol 2010;9:58.
12. RomeroCorral A, SentKuniyoshi FH, SierraJohnson J, et al. Modest visceral fat gain causes endothelial dysfunction in healthy humans. J Am Coll Cardiol 2010;56:662-666.
13. Georgescu A, Popov D, Constantin A, et al. Dysfunction of human subcutaneous fat arterioles in obesity alone or obesity associated with Type 2 diabetes. Clin Sci 2011;120:463-472.
14. Grassi G, Seravalle G, Scopelliti F, et al. Structural and functional alterations of subcutaneous small resistance arteries in severe human obesity. Obesity (Silver Spring) 2010;18:92-98.
15. Van Guilder GP, Stauffer BL, Greiner JJ, et al. Impaired endotheliumdependent vasodilatation in overweight and obese adult humans is not limited to muscarinic receptor agonists. Am J Physiol 2008;294:H1685-H1692.
16. Weil BR, Westby CM, Van Guilder GP, et al. Enhanced endothelin1 system activity with overweight and obesity. Am J Physiol 2011;301:H689-H695.
17. Lambert E, Sari CI, Dawood T, et al. Sympathetic nervous system activity is associated with obesityinduced subclinical organ damage in young adults. Hypertension 2010;56:351-358.
18. Andersson J, Sjöström LG, Karlsson M, et al. Dysregulation of subcutaneous adipose tissue blood flow in overweight postmenopausal women. Menopause 2010;17:365-371.
19. MiâdiMessaoud H, Chouchane A, Abderrazek E, et al. Obesityinduced impairment of endotheliumdependent vasodilation in Tunisian women. Int J Obes 2010;34:273-279.
20. Keymel S, Kalka C, Rassaf T, et al. Impaired endothelial progenitor cell function predicts agedependent carotid intimal thickening. Basic Res Cardiol 2008;103:582-586.
21. Toda N. Agerelated changed in endothelial function and blood flow regulation. Pharmacol Ther 2012;133:159-176.
22. Westerweel PE, Visseren FL, Hajer GR, et al. Endothelial progenitor cell levels in obese men with the metabolic syndrome and the effect of simvastatin monotherapy vs. simvastatin/ezetimibe combination therapy. Eur Heart J 2008;29:2808- 2817.
23. Tobler K, Freudenthaler A, BaumgartnerParzer SM, et al. Reduction of both number and proliferative activity of human endothelial progenitor cells in obesity. Int J Obes 2010;34:687- 700.
24. Biasucci LM, Graziani F, Rizzello V, et al. Paradoxical preservation of vascular function in severe obesity. Am J Med 2010;123:727-734.
25. Jonk AM, Houben AJ, Schaper NC, et al. Obesity is associated with impaired endothelial function in the postprandial state. Microvasc Res 2011;82:423-429.
26. Han KA, Patel Y, Lteif AA, et al. Contributions of dysglycemia, obesity, and insulin resistance to impaired endotheliumdependent vasodilatation in humans. Diabetes Metab Res Rev 2011;27: 354-361.
27. Beltowski J. Leptin and atherosclerosis. Atherosclerosis 2006;189:47-60.
28. Sweeney G. Cardiovascular effects of leptin. Nat Rev Cardiol 2010;7:22-29.
29. Kundson JD, Payne GA, Bortbouse L, et al. Leptin and mechanisms of endothelial dysfunction and cardiovascular disease. Curr Hypertens Rep 2008;10:434-439.
30. Fortuo A, Bidegain J, Baltanás A, et al. Is leptin involved in phagocytic NADPH oxidase overactivity in obesity Potential clinical implications. J Hypertens 2010;28:1944-1950.
31. Korda M, Kubant R, Patton S, et al. Leptininduced endothelial dysfunction in obesity. Am J Physiol 2008;295:H1514-H1521.
32. RuedaClausen CF, Lahera V, Calderón J, et al. The presence of abdominal obesity is associated with changes in vascular function independently of other cardiovascular risk factors. Int J Cardiol 2010;139:32-41.
33. Lin YH, Ho YL, Lee JK, et al. Plasma leptin levels and digital pulse volume in obese patients without metabolic syndrome-a pilot study. Clin Chim Acta 2011;412:730-734.
34. Beltowski J. Leptin and the regulation of endothelial function in physiological and pathological conditions. Clin Exp Pharmacol Physiol 2012;39:168-178.
35. Payne GA, Kohr MC, Tune JD. Epicardial perivascular adipose tissue as a therapeutic target in obesityrelated coronary artery disease. Br J Pharmacol 2012;165:659-669.
36. Li FY, Cheng KK, Lam KS, et al. Crosstalk between adipose tissue and vasculature: Role of adiponectin. Acta Physiol 2011;203:167-180.
37. Saarikoski LA, Huupponen RK, Viikari JS, et al. Adiponectin is related with carotid artery intimameida thickness and brachial flowmediated dilatation in young adults-the Cardiovascular Risk in Young Finns Study. Ann Med 2010;42:603-611.
38. Del Turco S, Navarra T, Gastaldelli A, et al. Protective role of adiponectin on endothelial dysfunction induced by AGEs: A clinical and experimental approach. Microvasc Res 2011;82: 73-76.
39. Mori T, Shinohara K, Wakatsuki A, et al. Adipocytokines and endothelial function in preeclamptic women. Hypertesns Res 2010;33:250-254.
40. Isgaard J, Granata R. Ghrelin in cardiovascular disease and atherogenesis. Mol Cell Endocrinol 2011;340:59-64.
41. Wiley KE, Davenport AP. Comparison of vasodilators in human internal mammary artery: Ghrelin is a potent physiological antagonist of endothelin1. Br J Pharmacol 2002;136:1146-1152.
42. Tesauro M, Schinzari F, Rovella V, et al. Ghrelin restores the endothelin 1/nitric oxide balance in patients with obesityrelated metabolic syndrome. Hypertension 2009;54:995-1000.
43. Pepene CE. Evidence for visfatin as an independent predictor of endothelial dysfunction in polycystic ovary syndrome. Clin Endocrinol 2012;76:119-125.
44. Cirillo P, Di Palma V, Maresca F, et al. The adipokine visfatin induces tissue factor expression in human coronary artery endothelial cells: Another piece in the adipokines puzzle. Thromb Res 2012;130:403-408.
45. Bhattacharjee R, Alotaibi WH, KheirandishGozal L, et al. Endothelial dysfunction in obese nonhypertensive children without evidence of sleep disordered breathing. BMC Pediatr 2010;10:8.
46. Ciccone MM, Miniello V, Marchioli R, et al. Morphological and functional vascular changes induced by childhood obesity. Eur J Cardiovasc Prev Rehabil 2011;18:831-835.
47. Bhattacharjee R, Kim J, Alotaibi WH, et al. Endothelial dysfunction in children without hypertension: Potential contributions of obesity and obstructive sleep apnea. Chest 2012;141: 682-691.
48. Mahmud FH, Hill DJ, Cuerden MS, et al. Impaired vascular function in obese adolescents with insulin resistance. J Pediatr 2009;155:678-682.
49. Tavares AC, Bocchi EA, Guimaräes GV. Endothelial function in prepubertal children at risk of developing cardiomyopathy: A new frontier. Clinics 2012;67:273-278.
50. Friedemann C, Heneghan C, Mahtani K, et al. Cardiovascular disease risk in healthy children and its association with body mass index: Systematic review and metaanalysis. BMJ 2012;345: E4759, doi: 10.1136/bmj.e4759
51. Galili O, Versari D, Sattler KJ, et al. Early experimental obesity is associated with coronary endothelial dysfunction and oxidative stress. Am J Physiol 2007;292:H904-H911.
52. Bourgoin F, Bachelard H, Badeau M, et al. Endothelial and vascular dysfunction and insulin resistance in rats fed a highfat, highsucrose diet. Am J Physiol 2008;295:H1044-H1055.
53. Kume T, Kawamoto T, Okura H, et al. Evaluation of coronary endothelial function by cathetertype NO sensor in highfatdietinduced obese dogs. Circ J 2009;73:562-567.
54. Gilbert EL, Ryan MJ. High dietary fat promotes visceral obesity and impaired endothelial function in female mice with systemic lupus erythematosus. Gend Med 2011;8:150-155.
55. Tsai TH, Chai HT, Sun CK, et al. Obesity suppresses circulating level and function of endothelial progenitor cells and heart function. J Transl Med 2012;10:137, doi: 10.1186/1479587610 137.
56. Ma L, Ma S, He H, et al. Perivascular fatmediated vascular dysfunction and remodeling through the AMPK/mTOR pathway in highfat dietinduced obese rats. Hypertens Res 2010;33: 446-453.
57. Wang H, Luo W, Wang J, et al. Obesityinduced endothelial dysfunction is prevented by deficiency of Pselectin Glycoprotein Ligand1. Diabetes 2012;61:3219-3227.
58. Kobayashi R, Akamine EH, Davel AP, et al. Oxidative stress and inflammatory mediators contribute to endothelial dysfunction in highfat dietinduced obesity in mice. J Hypertens 2010;28:2111- 2119.
59. Belin de Chantemèle EJ, Ali MI, Mintz J, Stepp DW. Obesityinduced insulin resistance causes endothelial dysfunction without reducing the vascular response to hindlimb ischemia. Basic Res Cardiol 2009;104:707-717.
60. Toque HA, da Silva FH, Calixto MC, et al. Highfat diet associated with obesity induces impairment of mouse corpus cavernosum responses. BJU Int 2011;107:1628-1634.
61. Grayson TH, Chadha PS, Bertrand PP, et al. Increased caveolae density and caveolin1 expression accompany impaired NOmediated vasorelaxation in dietinduced obesity. Histochem Cell Biol 2012;139:309-312.
62. Ketonen J, Pilvi T, Mervaala E. Caloric restriction reverses highfat dietinduced endothelial dysfunction and vascular superoxide production in C57BI/6 mice. Heart Vessels 2010;25:254-262.
63. Lobato NS, Filgueira FP, Akamine EH, et al. Obesity induced by neonatal treatment with monosodium glutamate impairs microvascular reactivity in adult rats: Role of NO and prostanoids. Nutr Metab Cardiovasc Dis 2011;21:808-816.
64. Kagota S, Fukushima K, Umetani K, et al. Coronary vascular dysfunction promoted by oxidativenitrative stress in SHRSP.ZL epr(fa)/lzmDmcr rats with metabolic syndrome. Clin Exp Pharmacol Physiol 2010;37:1035-1043.
65. Villalba N, Martinez P, Briones AM, et al. Differential structural and functional changes in penile and coronary arteries from obese Zucher rats. Am J Physiol 297: 2009; H696-H707.
66. Wang Y, Cheng KK, Lam KS, et al. APPL1 counteracts obesityinduced vascular insulin resistance and endothelial dysfunction by modulating the endothelial production of nitric oxide and endothelin1 in mice. Diabetes 2011;60:3044-3054.
67. Tian XY, Wong WT, Xu A, et al. Uncoupling protein2 protects endothelial function in dietinduced obsess mice. Circ Res 2012;110:1211-1216.
68. Kagota S, Chia E, McGuire JJ. Preserved arterial vasodilatation via endothelial proteaseactivated receptor2 in obese type 2 diabetic mice. Br J Pharmacol 2011;164:358-371.
69. Vecchione C, Maffei A, Colella S, et al. Leptin effect on endothelial nitric oxide is mediated through Aktendothelial nitric oxide synthase phosphorylation pathway. Diabetes 2002;51: 168-173.
70. Beltowski J, Wójcika G, JamrozWiniewska A, et al. Resistance to acute NOmimetic and EDHFmimetic effects of leptin in the metabolic syndrome. Life Sci 2009;85:557-567.
71. GilOrtega M, Stucchi P, GuzmánRuiz R, et al. Adaptive nitric oxide overproduction in perivascular adipose tissue during early dietinduced obesity. Endocrinology 2010;151:3299-3306.
72. Payne GA, Borbouse L, Kumar S, et al. Epicardial perivascular adiposederived leptin exacerbates coronary endothelial dysfunction in metabolic syndrome via a protein kinase Cb pathway. Arterioscler Thromb Vasc Biol 2010;30:1711-1717.
73. Chen JX, Stinnett A. Critical role of the NADPH oxidase subunit p47phox on vascular TLR expression and neointimal lesion formation in highfat dietinduced obesity. Lab Invest 2008;88:1316-1328.
74. Deng G, Long Y, Yu YR, et al. Adiponectin directly improves endothelial dysfunction in obese rats through the AMPKeNOS pathway. Int J Obes 2010;34:165-171.
75. Li R, Xu M, Wang X, et al. Reduced vascular responsiveness to adiponectin in hyperlipidemic rats-mechanisms and significance. J Mol Cell Cardiol 2010;49:508-515.
76. Bussey CT, Kolka CM, Rattigan S, et al. Adiponectin opposes endothelin1mediated vasoconstriction in the perfused rat hindlimb. Am J Physiol 2011;301:H79-H86.
77. Iantorno M, Chen H, Kim J, et al. Ghrelin has novel vascular actions that mimic PI3kinasedependent actions of insulin to stimulate production of NO from endothelial cells. Am J Physiol 2006;292:E756-E764.
78. Yamawaki H, Tsubaki N, Mukohda M, et al. Omentin, a novel adipokine, induces vasodilation in rat isolated blood vessels. Biochem Biopys Res Commun 2010;393:668-672.
79. Xia M, Zhang C, Boini KM, et al. Membrane raftlysosome redox signaling platforms in coronary endothelial dysfunction induced by adipokine visfatin. Cardiovasc Res 2011;89:401-409.
80. Lim SY, Davidson SM, Paramanthan AJ, et al. The novel adipocytokine visfatin exerts direct cardioprotective effects. J Cell Mol Med 2008;12:1395-1403.
81. Kerr SM, Livingstone MB, McCrorie TA, et al. Endothelial dysfunction associated with obesity and the effect of weight loss interventions. Proc Nutr Soc 2011;70:418-425.
82. Miyaki A, Maeda S, YoshizawaM, et al. Effect of habitual aerobic exercise on body weight and arterial function in overweight and obese men. Am J Cardiol 2009;104:823-828.
83. Zhu W, Zeng J, Yin J, et al. Both flowmediated vasodilation procedures and acute exercise improve endothelial function in obese young men. Eur J Appl Physiol 2010;108:727-732.
84. Mestek ML, Westby CM, Van Guilder GP, et al. Regular aerobic exercise, without weight loss, improves endotheliumdependent vasodilatation in overweight and obese adults. Obesity (Silver Spring) 2010;18:1667-1669.
85. Vinet A, Karpoff L, Walther G, et al. Vascular reactivity at rest and during exercise in middleaged obese men: Effects of shortterm, lowintensity, exercise training. Int J Obes 2011;35:820-828.
86. MiâdiMessaoud H, Chouchane A, Ben Saad H, et al. Sixminute walk test improved forearm skin blood flow in Tunisian obese women. Obesity (Silver Spring) 2012;20:1773-1779.
87. Murphy EC, Carson L, Neal W, et al. Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. Int J Pediatr Obes 2009;4:205-214.
88. Hopkins ND, Stratton G, Tinken TM, et al. Relationships between measures of fitness, physical activity, body composition and vascular function in children. Atherosclerosis 2009;204:244-249.
89. Bunker AK, ArceEsquivel AA. Rector RS, et al. Physical activity maintains aortic endotheliumdependent relaxation in the obese type 2 diabetic OLETF rat. Am J Physiol 2010;298:H1889- H1901.
90. Touati S, Meziri F, Devaux S, et al. Exercise reverses metabolic syndrome in highfat dietinduced obese rats. Med Sci Sports Exerc 2011;43:398-407.
91. Miyaki A, Maeda S, Yoshizawa M, et al. Effect of weight reduction with dietary intervention on arterial distensibility and endothelial function in obese men. Angiology 2009;60:351-357.
92. Rallidis LS, Lekakis J, Kolomvotsou A, et al. Close adherence to Mediterranean diet improves endothelial function in subjects with abdominal obesity. Am J Clin Nutr 2009;90:263-268.
93. Wycherley TP, Brinkworth GD, Keogh JB, et al. Longterm effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients. J Intern Med 2010;267:452-461.
94. Bigornia SJ, Mott MM, Apovian CM, et al. Longterm successful weight loss improves vascular endothelial function in severely obese individuals. Obesity (Silver Spring) 2010;18:754-759.
95. AlSolaiman Y, Jesri A, Mountford WK, et al. DASHlowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre. J Hum Hypertens 2010;24:237-246.
96. Mavri A, Poredoš P, Suran D, et al. Effect of dietinduced weight loss on endothelial dysfunction: Early improvement after the first week of dieting. Heart Vessels 2011;26:31-38.
97. Lindström J, Louheranta A, Mannelin M, et al. The Finnish diabetes prevention study (DPS): Lifestyle intervention and 3year results on diet and physical study. Diabetes Care 2003;26:3230- 3236.
98. Rittig K, Hieronimus A, Thamer C, et al. Reducing visceral adipose tissue mass is essential for improving endothelial function in type 2 diabetes prone individuals. Atherosclerosis 2010;212:575-579.
99. Gosmanov AR, Smiley DD, Robalino G, et al. Effects of oral and intravenous fat load on blood pressure, endothelial function, sympathetic activity, and oxidative stress in obese healthy subjects. Am J Physiol 2010;299:E953-E958.
100. Lavi T, Karasik A, KorenMorag N, et al. The acute effect of various glycemic index dietary carbohydrates on endothelial function in nondiabetic overweight and obese subjects. J Am Coll Cardiol 2009;53:2283-2287.
101. Martins MA, CattaPreta M, MandarimdeLacerda CA, et al. High fat diets modulate nitric oxide biosynthesis and antioxidant defense in red blood cells from C57BL/6 mice. Arch Biochem Biophys 2010;499:56-61.
102. Kasbi Chadli F, Andre A, Prieur X, et al. n3 PUFA prevent metabolic disturbances associated with obesity and improve endothelial function in golden Syrian hamsters fed with a highfat diet. Br J Nutr 2011;16:1-11.
103. Merchant N, Searles CD, Pandian A, et al. Nebivolol in highrisk, obese African Americans with stage 1 hypertension: Effects on blood pressure, vascular complicance, and endothelial function. J Clin Hypertens 2009;11:720-725.
104. Toda N. Vasodilating badrecenoceptor blockers as cardiovascular therapeutics. Pharmacol Ther 2003;100:215-234.
105. Wong RH, Howe PR, Buckley JD, et al. Acute resveratrol supplementation improves flowmediated dilatation in overweight/obese individuals with mildly elevated blood pressure. Nutr Metab Cardiovasc Dis 2011;21:851-856.
106. Liu J, Sun N, Yang S, et al. Effect of orlistatassociated weight loss on endotheliumdependent vasodilation in obese Chinese subjects with hypertension. Clin Exp Hypertens 2010;32:395-399.
107. Knight SF, Yuan J, Roy S, et al. Simvastatin and tempol protect against endothelial dysfunction and renal injury in a model of obesity and hypertension. Am J Physiol 2010;298:F86-F94.
108. Mendizábal Y, Llorens S, Nava E. Reactivity of the aorta and mesenteric resistance arteries from the obese spontaneously hypertensive rat: Effects of glitazones. Am J Physiol 2011;301: H1319-H1330.
109. Yamamoto E, Nakamura T, Kataoka K, et al. Nifedipine prevents vascular endothelial dysfunction in a mouse model of obesity and type 2 diabetes, by improving eNOS dysfunction and dephosphorylation. Biochem Biophys Res Commun 2010;403:258-263.
110. Frye M, McMurtry I, Orton EC, et al. Use of fatfed rats to study the metabolic and vascular sequelae of obesity and badrenergic antagonism. Comp Med 2009;59:242-248.
111. Agouni A, LagrueLakHal AH, Mostefai HA, et al. Red wine polyphenols prevent metabolic and cardiovascular alterations associated with obesity in Zucker fatty rats (Fa/Fa). PLoS ONE 2009;4:e5557.
112. Li Volti G, Salomone S, Sorrenti V, et al. Effect of silibinin on endothelial dysfunction and ADMA kevels in obese diabetic mice. Cardiovasc Diabetol 2011;10:62.
113. Sturm W, Tschoner A, Engl J, et al. Effect of bariatric surgery on both functional and structural measures of premature atherosclerosis. Eur Heart J 2009;30:2038-2043.
114. Sledzinski T, Sledzinski M, Smolenski RT, et al. Increased serum nitric oxide concentration after bariatric surgery-a potential mechanism for cardiovascular benefit. Obes Surg 2010;20: 204-210.
115. Sandoval D. Bariatric surgeries: Beyond restriction and malabsorption. Int J Obes 2011;35(Suppl. 3):S45-S49. Technology