Effect of Bariatric Surgery on The Relation Between RBP 4 And Vitamin D Plasma Levels in Male Obese Subject

        Main risk factor about the metabolic disorders is supposed due to the obesity like the low grade for the chronic inflammation, atherosclerosis, and arterial hypertension. In eth systemic concentration the changes for the server peptides in known as the adipokines that is secreted through the adipose tissue and the very implicated for the development of the obesity which is belong to the metabolic alterations (Broch and et al).

        RBP 4 is stand for “Retinol-binding protein- 4” is also known as the carrier of the vitamin A is a blood in the different tissues for the liver along with the adipose tissue (AT). When the protein levels of the RBP-4 is evaluated in the AT for the circulatory systems during the specific glucose of the adipocytes for the 4 knockout mouse. In the obese of men when the RBP-4 is analyzed previously then the weight reduction that is followed through the improvement for the obese which is related the metabolic disorder for the systematic concentration as the RBP-4 is very lower in the different studies. However the insulin sensitivity improvement indices where the loss weight of occurs and it is found the positively because it is connected by the reduction of the systemic RBP-4 for the vitamin D plasma the levels.

        From the small randomized controlled trials which is suggested for the Vitamin D, along with the supplementation that increased the production of the obese in men. In the trial of 54 healthy men which means have the plasma levels in a deficiency range approximately in  during the placebo group along with the 32.5 nmol/l in the vitamin D for the group, and it is convert to the nmol/l to the ng/ml which is divided by the 2.5 and it received either  for the vitamin D in the daily year where the  along with the placebo . Now there is some biological support for the reasonable relationship among a vitamin D along with the RBP-4 in the obese of the men after the effects of the Bariatric Surgery. VDR is stand for “Vitamin D receptors” along with the Vitamin D metabolizing enzymes that is widely expressed involving the male reproductive of the obesity. The purpose of the search is that investigate the cross sectional gate of relationship of RBP-4 and the Vitamin D status which is reflected by the plasma levels concentration (Nimptsch and et al).

        The OS “Obese subject” study that is the knowledge for the first prospective and it is the controlled intervention through the investigators that effects the long term of the weight loss, on the death rate plus the disease that is presented in the Bariatric Surgery and it is connected with the relationship of the RBP-4 and the Vitamin D for the obesity in the men. However the relationship of the RBP-4 and the Vitamin D is very significant which cause the obese in the men after the surgery effects. Therefore the aim of this research is that the present study which investigate the Effect of Bariatric Surgery is associated with the relationship of the Vitamin D, and the RBP-4 to reduce the obesity in the plasma levels of men (Lars Sjöström and et al).

        Weight loss before a conception of the optimum method to remove the risk of the medical along with the obstetric complication in the obese men for the productive age. Whereas the medical therapy along with the variation of the lifestyles verify the limited success to maintain the long term weight loss, where the Bariatric Surgery is very popular solution for the obese in men in the relationship of the Vitamin D along with the RBP-4 (Weintraub and et al). The use of the Bariatric Surgery which is increased the dramatically in the last years not more than 100,000 procedures that is performed in the US during 2003. On the other side the long term obese in men is induced by the effects of the Bariatric Surgery which is very favorable effect in the relationship of the RBP-4 and the Vitamin D. To determine the decisively effects of obese in men is controlled by the prospective of the interventional trails; that is needed. In the study of the OS the use of the Bariatric Surgery to obtain the reduction in obese in men like the Surgery is the obtainable technique which is established for the long term effects on the reduction of the obese. This research study is examines   whether the Bariatric Surgery is connected with the relationship of Vitamin D  plus the RBP-4 and compare with the  plasma level of obese in men (Sjöström). Vitamin A which is very significant and  paly the key role in the growth of cell  as compare to Vitamin D might be increase the obese in the plasma level of the obese subjects in Men .

Hypotheses of Effect of Bariatric Surgery on the relation between RBP 4 and Vitamin D Plasma levels in Male Obese Subject

H₁: There is positive significant relation among the Vitamin D plasma levels and RBP-4 plasma levels after Bariatric surgery in obese males.

H₀: There is not positive significant relation among the Vitamin D plasma levels and RBP-4 plasma levels after Bariatric surgery in obese males.

Methods of Effect of Bariatric Surgery on the relation between RBP 4 and Vitamin D Plasma levels in Male Obese Subject

        The research design is explained about the whole of the design of the research which is used for conducting the research study. Particularly, it explains about the approach and philosophy of the research study. The philosophy of the research study leads toward the supporting the hypothesis as well as the effects of the whole study either it positive or negative.

        The process is contains on the source of the information which is usually known as the data collection. This is the good source for providing the information according to the sources and time scales which is usually used for data collection. Two types of the data collection is used for conducting this research study as the secondary and primary.

        Data is collected by using the both sources of the data as; primary and secondary.  The secondary data leads towards the previously existing that are conducted to measure the effect of bariatric surgery in the various perspectives. In the secondary source of the data all parameters needed for this study have been obtained in previously approved studies by the Institutional Review Board at King Saud University College of Medicine (Ref. No. 17/0969/IRB).

        It contains various types of the Theories and perceptions of the existing research on the related topics. The particular attentions is based upon the literature of the study which the good parts for discussing different view of the various authors on the particular topic. It is referred as the way of the data collection for attaining the objectives and aims of the research by using the skills knowledge and abilities on the particular topic. It also includes the all the information that is related to the effect of bariatric surgery on the relation between RBP-4 and Vitamin D plasma levels in male obese subjects

        The primary source of the data collection is referred as the information which is collected by the researcher to achieving the objectives of the research in effective manners. It is also referred as the first hand source of the data collection by using the wide ranges of the sources which is based upon the research types along with the suitability of the topics.  It is used for understanding the concepts of the various respondents related to the role of the information technology in the supply chain managements for this presented research. It is consider as the effective ways which can resist the ineffective factors for getting the good results

        This is a retrospective study. This is conducted by using the both research methods as quantitative and qualitative research methods. The qualitative research methods refers to the interpritivism paradigm and a researcher whose follow an interpritivism paradigm can only uses a qualitative research approach. A qualitative research is conducted at high level and all the data is conducted in alphabets form rather than in numeric figures in quantitative method. Qualitative research is conducted on daily routines base of peoples and in own words of peoples and the big fact about this research is that this research is subjective and inductive in nature.

        The quantitative research methods are also used to conducting the research study because this study requires static analysis for providing the results in effective manners. In Quantitative method all the data is in the numeric form and in quantitative research large sampling can be used by the researcher and on that statistical data various tests like mean, mod and median will be applied to check the validity of the data and through quantitative method the relationship between the variables through the test correlation can be found. This approach is objective and deductive in nature.

        Simple random sampling techniques have been employed in this study and the data is collected from the 33 male patients. Who are involved in attending surgery clinic for bariatric surgery (gastric band or sleeve gastrostomy). The Consent of all participants have been obtained. For thirty-three male patients 25-50 years of age, will be enrolled in this study having BMI >35 Kg/m2 attending surgery clinic for bariatric surgery (gastric band or sleeve gastrostomy).

        All participants were healthy and were not taking any medication. Different parameters such as height, weight, BMI, WHR (waist-hip-ratio) were obtained. Blood samples were collected twice: right before surgery and 6 months after.  Plasma levels of glucose, lipids, insulin, GH, IGF-1, RBP-4, and vitamin D were analyzed.

        The levels of vitamin D and RBP-4 will be analyzed and the correlation will be assessed using Pearson correlation coefficient. Level of significance will be set at 0.05. The association between insulin sensitivity and both vitamin D and RBP-4 will be evaluated.  The other information of the respondents is given in the below given tables related to their demographic profile as well for measuring the effects of the bariatric surgery.

        As data is collected by the survey from the patients who are attending the bariatric surgery. For collecting data by survey the patients are not directly involved in this study because this study is not related to the observations or interviews of the patients. The biochemical analysis of the patients will be included in the survey by attempting the test in the lab to taking the blood sample of the patients.

        All the parameters and scales are decided before conducting the test of the respondents in the lab. These scales are included as; demographic parameters of the respondents as; age, Pre-operative weight, Pre-operative BMI , Pre-op plasma level of RBP-4 (ng/ml), Pre-op plasma level of Vit-D (ng/ml),Pre-op  RBP/Vit-D ratio and  biochemical data of male obese patients. After collecting the data from the respondents or sample of the respondents in the lab the test are applied on this data for measuring the co0rrelation among the both variables study and outcome variables.

        SPSS software is used to analyzing the data or testing the variables for getting the good and accurate results. SPSS is the good software that is used to minimizing the chances of the data manipulation. It also used to generating the tables, charts and graphs for qualitative research methods. SPSS is considered as the best tool for conducting the analysis as well as calculating the averages results for the various constructs. Data is analyzed in to analysis descriptive and inferential analysis. Descriptive analysis discusses about the averages of the respondents meanwhile inferential analysis discusses about the correlation of the dependent and independent variables.

Study variables of Effect of Bariatric Surgery on the relation between RBP 4 and Vitamin D Plasma levels in Male Obese Subject

Patient weight:

quantitative continuous variable measured in Kg

Patient BMI:

  quantitative continuous variable measured in Kg/m2

Plasma level of RBP-4:

quantitative continuous variable measured in

Plasma levels of vitamin D:

quantitative continuous variable measured in

Ratio of pre-operative plasma levels of RBP-4 to Plasma levels of preoperative vitamin D:

a quantitative continuous variable without a measure.

Outcome variables of Effect of Bariatric Surgery on the relation between RBP 4 and Vitamin D Plasma levels in Male Obese Subject

Baseline average plasma levels of RBP-4 and Vit-D in obese males

Correlation coefficient between male BMI and  pre-operative plasma levels of RBP-4 and Vit-D

Correlation coefficient between change in male BMI and peri-operative change in plasma levels of RBP-4 and Vit-D.

Correlation between changes occur in plasma levels of RBP-4 and changes in plasma levels of Vit-D.

Limitations and Research Ethics of Effect of Bariatric Surgery on the relation between RBP 4 and Vitamin D Plasma levels in Male Obese Subject

Although this analysis was precisely set active, it will still attentive of its limitations and insufficiencies.

This research is conducted only in one country.

The data is collected from only 1 hospital.

For this research only 33 questionnaires are received in filled form with the approval of doctors and help of medical staff. .

Method, procedure, or point of view for choosing acceptable behavior and for observing complex questions and problems.

The reason for this analysis is clarified and easy to be effectively understood by the followers and in addition the respondents to stay away from any uncertainty at any end.

All the information kept confidential which is collected from the respondents.

Interpretation of Effect of Bariatric Surgery on the relation between RBP 4 and Vitamin D Plasma levels in Male Obese Subject

        The above given table is representing the correlation among pre and post-operative system of the plasma levels of RBP-4 and plasma levels of Vitamin-D. There is not find any statistically significant correlation between levels of RBP-4 and Vit-D plasma levels either pre- (p = 0.56) or post-operative (p = 0.52), it was noticed that the direction of these minor relation was different pre from post the operation. Pre-operatively, RBP-4 and vitamin-D were in direct relation, while after bariatric surgery they were inversely related

Discussion of Effect of Bariatric Surgery on the relation between RBP 4 and Vitamin D Plasma levels in Male Obese Subject

        It is discusses in this study the metabolic disorders is supposed due to the obesity like the low grade for the chronic inflammation, atherosclerosis, and arterial hypertension. RBP 4 is stand for “Retinol-binding protein- 4” is also known as the carrier of the vitamin A is a blood in the different tissues for the liver along with the adipose tissue (AT). When the protein levels of the RBP-4 is evaluated in the AT for the circulatory systems during the specific glucose of the adipocytes for the 4 knockout mouse.

            Therefore the insulin sensitivity improvement indices where the loss weight of occurs and it is found the positively because it is connected by the reduction of the systemic RBP-4 for the vitamin D plasma the levels. The small randomized controlled trials which is suggested for the Vitamin D, along with the supplementation that increased the production of the obese in men. There is some biological support for the reasonable relationship among a vitamin D along with the RBP-4 in the obese of the men after the effects of the Bariatric Surgery.

In the first chapter of the research paper the significance of the study is explained in extensive manner along with the objectives of the study. The research study is conducted to achieving the objectives as;

To evaluate plasma levels of RBP-4 and Vitamin D in obese male.

To correlate the levels of RBP-4 and Vitamin D in male obese people.

To assess the role of bariatric surgery in the relationship between RBP-4 and4 Vitamin D.

        The research study is significant for Understanding the change in the plasma levels of RBP-4 and Vitamin D will help in understanding the effect of bariatric surgery in which it will help in future research on the necessary nutritional supplements given to patients after bariatric surgery. It is also discusses in the introduction of the research paper. The relationship of the RBP-4 and the Vitamin D is very significant which cause the obese in the men after the surgery effects.

        The OS “Obese subject” study is the knowledge for the first prospective and it is the controlled intervention through the investigators that effects the long term of the weight loss, on the death rate plus the disease that is presented in the Bariatric Surgery. the medical therapy along with the variation of the lifestyles verify the limited success to maintain the long term weight loss, where the Bariatric Surgery is very popular solution for the obese in men in the relationship of the Vitamin D along with the RBP-4 (Weintraub and et al).

        To determine the decisively effects of obese in men is controlled by the prospective of the interventional trails; that is needed. In the study of the OS the use of the Bariatric Surgery to obtain the reduction in obese in men like the Surgery is the obtainable technique which is established for the long term effects on the reduction of the obese.

        It has been also observed in this research study that the Number of researches have been done previously to show if there is any association between obesity and vitamin d level, it appeared that obese individuals had low serum levels of 25 [OH] D compared to non- obese individuals and also a secondary high parathyroid hormone. It is also di9sdceesed in this study that the major cause behind this obesity and etiology is still unknown and it can find out correctly.

        The food treatment is not find out till now to reducing the obesity problem in the human beings but some type of the innovation is tried to be introduced in the medical sector with the passage time. Bariatric surgery is a common weight loss operation done routinely nowadays and it is associated with postoperative deficiency of many nutrients thus supplements are needed to maintain normal levels back (Richard D Bloomberg) . Vitamin D deficiency is well known to occur after bariatric surgery due to malabsorption since the ileum and jejunum parts of intestine which vitamin D is preferentially absorbed got by passed (Bell NH).

            In the third chapters of the research studies its dices the methods of the data collection and data analysis. The process is contains on the source of the information which is usually known as the data collection. This is the good source for providing the information according to the sources and time scales which is usually used for data collection. Two types of the data collection is used for conducting this research study as the secondary and primary.

            The research study is conducted by using the quantitative research method by conducting the survey from the patients who have got bariatric surgery. The simple random sampling technique is used to conducting the survey from the respondents. The data is collected from the 33 patients. In the chapter 4 of the research study the results are discuss for the variables which are obtained after analyzing the data by using the SPSS software. It has been analyzed that the Plasma level of RBP-4, Pre-op RBP/Vitamin-D ratio and Plasma level of Vitamin-D. It shows the coefficients for the variables value for the 0.082, 0.21 and -0.022 respectively.  These all value shows the negative relationship among the independent and dependent variables. It means the null hypothesis is accepted meanwhile the alternative hypothesis is rejected.

Conclusion on Effect of Bariatric Surgery on the relation between RBP 4 and Vitamin D Plasma levels in Male Obese Subject

            It is concluded the in obese Men and after the loss of substantial weight due to Bariatric Surgery, then Vitamin D, and RBP4 is related with the weight status along with the Vitamin D of plasma levels as compare to inflammatory markers. Bariatric Surgery is the server of the obesity which is connected by the long term weight loss through the reduction of plasma levels in men.  It has been concluded that there is negative correlation among the Plasma level of RBP-4and Plasma level of Vitamin-D.