Obesity Surgery最新文献

Aims: This study compares the effectiveness of sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) on the predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk and identifies key factors influencing postoperative (post-op) changes in ASCVD risk.

Methods: This prospective cohort study assessed the 10-year ASCVD risk in patients undergoing SG or OAGB between 2013 and 2023 using the ACC/AHA ASCVD Risk Estimator. In addition to the baseline assessment, the risk score was evaluated at 6, 12, 24, 36, and 48 months post-op. Longitudinal analysis tracked changes in ASCVD risk, and regression models identified individual and combined factors influencing these changes.

Results: The analysis enrolled 1397 individuals (mean age 50.1 years, 87.9% female), including 952 SG and 445 OAGB participants. Following adjustments, the 10-year ASCVD risk significantly reduced post-op with no observed differences between the surgical groups. Positive associations with risk reduction were found for baseline risk, total cholesterol (TC), type 2 diabetes mellitus (T2DM), triglycerides (TG), systolic blood pressure (SBP), fasting plasma glucose (FPG), and estimated glomerular filtration rate (eGFR). In contrast, age, triglyceride-glucose (TyG) index, hemoglobin A1c (HbA1c), male sex, smoking, and high-density lipoprotein cholesterol (HDL-C) demonstrated negative associations with ASCVD risk reduction.

Conclusion: Metabolic and bariatric surgery significantly reduced the 10-year ASCVD risk, with comparable outcomes between SG and OAGB. Key determinants influencing the 10-year ASCVD risk reduction included baseline risk score, age, TC, T2DM, TyG index, TG, HbA1c, SBP, sex, FPG, smoking, HDL-C, and eGFR.

Background: Although metabolic and bariatric surgery (MBS) is an established treatment for obesity, its effects on cardiac electrophysiology remain poorly characterized. This study investigated whether MBS was associated with a reduced risk of QTc interval prolongation in female patients with severe obesity.

Methods: This retrospective cohort study utilized the TriNetX database to identify female adults with body mass index ≥ 40 kg/m² who underwent laparoscopic surgery between 2010 and 2023. Patients were stratified into MBS (sleeve gastrectomy or gastric bypass) and control groups (other laparoscopic procedures). We performed 1:1 propensity score matching based on demographics, comorbidities, and laboratory parameters. The primary outcome was the incidence of QTc prolongation (≥ 460 ms) at one-year follow-up. Secondary analyses assessed outcomes at three months and three years to evaluate temporal trends. A prespecified subgroup analysis examined whether the effects differed by surgical technique.

Results: Among 79,796 matched female patients (39,898 per group), MBS was associated with a significantly reduced QTc prolongation cumulative incidence within one year (0.33% vs. 0.77%; Hazard ratio [HR]: 0.41, 95% confidence interval [CI]: 0.33-0.50, p < 0.001). This association remained consistent across follow-up (HRs 0.47 at three months; 0.39 at three years). The association between procedure type and QTc prolongation differed in magnitude, with sleeve gastrectomy showing a lower HR than gastric bypass (0.34 vs. 0.61, p for subgroup difference = 0.005).

Conclusion: MBS confers a sustained three-year reduction in QTc prolongation risk in female patients with severe obesity, likely reflecting the cardiovascular benefits of weight loss and metabolic recovery, though individual contributions cannot be separated.

Introduction: The 2022 updates from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) have revised the indications for metabolic and bariatric surgery (MBS). This study investigated the association between a history of MBS and micronutrient status in a nationally representative U.S. adult population.

Methods: The study included 2,970 adults aged ≥ 18 years from the National Health and Nutrition Examination Survey (2015-2018). Participants were categorized into three groups: (1) individuals with a BMI within the normal weight range (18.5-24.9 kg/m²); (2) individuals with a history of MBS; and (3) individuals who met the eligibility criteria for MBS but had not undergone the procedure. Weighted logistic regression models were used to compare between-group differences in the prevalence of micronutrient abnormalities.

Results: Compared to the individuals with normal weight group, individuals eligible for MBS but without a history of surgery exhibited an increased likelihood of hyperferritinemia (OR, 1.779; 95% CI: 1.168-2.709), high transferrin receptor levels (OR, 2.145; 95% CI: 1.175-3.917), hypocalcemia (OR, 3.415; 95% CI: 1.306-8.929), and vitamin D deficiency (OR, 2.126; 95% CI: 1.522-2.969). In contrast, no statistically significant differences in the prevalence of these conditions were observed between the group with a history of MBS and the individuals with normal weight group.

Conclusion: In this cross-sectional analysis, individuals eligible for MBS who had not undergone surgery showed a higher prevalence of several micronutrient abnormalities compared to individuals with normal weight. This pattern was not observed in individuals with a history of MBS, suggesting that postoperative management, including micronutrient supplementation, may mitigate these deficiencies. However, these findings should be interpreted with caution due to the study's limitations.

Recurrent weight gain after metabolic bariatric surgery (MBS) threatens the durability of metabolic and renal benefits, yet its intricate relationship with kidney function remains underexplored. This review synthesizes evidence that weight regain (≥ 20% from nadir weight) reactivates obesity-driven kidney injury pathways, including glomerular hyperfiltration, lipotoxicity (toxic damage from lipid overload), and NOD-like receptor protein 3 (NLRP3) inflammasome activation (an immune complex driving inflammation). Consequently, albuminuria recurs in 20-35% of patients and eGFR decline accelerates. Procedure-specific dynamics modulate outcomes. Roux-en-Y gastric bypass (RYGB) offers superior kidney protection despite moderate regain (5.3-37% at 7 years). In contrast, sleeve gastrectomy (SG) shows higher regain (26.3-76% at 6 years) and weaker renal improvements. Critically, weight recurrence reactivates transforming growth factor-beta (TGF-β)/mothers against decapentaplegic homolog (SMAD) and Wnt/β-catenin fibrotic signaling, driving ectopic renal fat reaccumulation and tubular injury. Emerging strategies, including glucagon-like peptide-1 (GLP-1) agonists (27% albuminuria reduction) and endoscopic revisions, show promise in mitigating renal sequelae. However, definitional heterogeneity in weight regain and insufficient phenotyping of kidney-specific biomarkers impede clinical translation. This review underscores the urgency of personalized interventions to preserve kidney health in the context of post-bariatric weight recurrence, advocating for multidisciplinary approaches and future research into novel antifibrotic therapies.

Objective: The objective of this study was to evaluate the incidence of and risk factors for surgery-related pressure injuries (PIs) in bariatric surgery patients and to assess the effect of postoperative mobility on PI development.

Methods: This prospective, correlational, monocentric study included 279 individuals who underwent bariatric surgery. Patients were assessed for PIs every 8 hours during the first 48 hours postoperatively. Mobility status was evaluated via the Observer Mobility scale, and PI risk was measured via the Munro and Braden scales.

Results: The incidence of surgery-related PIs was 19%, with most patients classified as stage 1, predominantly affecting the knees, coccyx, and abdominal region. Independent risk factors for PI development included abnormal skin (p = 0.015), higher Munro scale scores (p < 0.001), increased postoperative pain (p < 0.001), and reduced mobility (p = 0.006).

Conclusions: In bariatric surgery patients, the use of surgery-specific risk assessment tools, effective pain management, early mobilization, and proper device placement play critical roles in reducing the risk of surgery-related PIs.