Obesity Surgery最新文献

Background: Metabolic bariatric surgery leads to improved life expectancy in younger individuals, but whether older (> 60 years) individuals benefit from metabolic bariatric surgery is uncertain. This study examined mortality and causes of death in patients with metabolic bariatric surgery at age 60 years or older.

Materials and methods: This was a population-based matched cohort study based on all healthcare in Denmark, Finland, and Sweden between 1996 and 2024. All patients who had primary metabolic bariatric surgery at age > 60 years were included and exactly matched 1:5 to comparison individuals of the same age, sex, country, and calendar year with non-operative treatment for obesity. Cox regression provided hazard ratios with 95% confidence intervals for mortality adjusted for multiple obesity-related diseases and frailty.

Results: In total, 3879 (16.7%) patients with metabolic bariatric surgery and 19395 (83.3%) patients with non-operative treatment for obesity were included and followed for 176632 person-years. The cumulative mortality was 17.5% (n = 677) among operated patients compared to 23.5% (n = 4536) in the non-operated. In adjusted analyses, metabolic bariatric surgery was associated with 32% decreased mortality (HR 0.68, 95% CI 0.63-0.73). The results were consistent in patients of age > 60-70 years at the time of surgery, but there was no apparent benefit in patients operated at age > 70 years (HR 1.14, 95% CI 0.89-1.47). Operated patients were less likely to die from cardiovascular disease (57.6% versus 65.8%, p < 0.001), but other causes of death were similarly distributed between the groups.

Conclusion: Metabolic bariatric surgery may decrease mortality in older patients with severe obesity.

Background: Vitamin D deficiency is common in people with obesity and can worsen after bariatric surgery. As the reproductive years and post-menopausal status can place additional demands on vitamin D requirements, we studied vitamin D status after bariatric surgery in women under 45 years of age compared with women over 45.

Methods: We conducted an observational cohort study of 305 women undergoing primary bariatric surgery at a university teaching hospital in North West England. Participants were stratified by age into women under 45 years (Wu45, n = 123) and over 45 years (Wo45, n = 182). Patients were routinely prescribed daily calcium and vitamin D supplementation after bariatric surgery. Serum 25-hydroxyvitamin D, adjusted calcium, parathyroid hormone (PTH) and metabolic parameters were measured preoperatively and at intervals over 24 months postoperatively.

Results: After bariatric surgery, vitamin D levels rose significantly within 4 months but were lower in Wu45 at 12 and 24 months (p < 0.05). Adjusted calcium levels declined over time, with Wu45 showing significantly lower levels at 12 and 24 months. PTH levels, initially lower in Wu45, increased and equalized with Wo45's levels by 12 months.

Conclusions: Women under 45 are at increased risk of vitamin D and calcium deficiencies after bariatric surgery. This may reflect higher physiological demands and variable adherence to supplementation. Patient education and tailored supplementation strategies may be required to prevent long-term micronutrient complications.

Background: Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity; however, a significant subset of patients do not achieve the expected weight loss or experience substantial weight recurrence over time. While intestinal energy absorption potentially influences weight loss outcomes, this phenomenon has not been investigated in post-MBS patients. Therefore, we assessed the relationship between diet, intestinal energy absorption, and weight outcomes in individuals post-MBS.

Methods: Caloric intake, determined via dietary questionnaires, and fecal energy density, determined via bomb calorimetry, were used as a proxy to assess calorie absorption before and after gastric bypass or sleeve gastrectomy. Within a total of 67 patients, fecal energy density was measured at 0, 1, 6, 12, 18, and 24 months. A dynamic linear mixed-effects model was used to examine the longitudinal association between intestinal energy harvest and subsequent weight loss following MBS. Multivariate regression was developed to identify potential weight loss predictors, and random forest algorithms were employed to forecast weight results based on intestinal energy absorption.

Results: Intestinal energy absorption changed over the pre- and post-MBS periods. Random forest models indicated that intestinal energy absorption enhanced the predictability of patient weight loss outcomes.Fecal energy density was modestly but significantly associated with weight loss at later postoperative time points (p = 0.04), suggesting that reduced intestinal energy absorption contributes to more sustained weight reduction post-MBS. Associations between diet and energy absorption were not significant.

Conclusion: MBS changes energy absorption capacity post-surgery. A higher relative fecal energy content (lower energy absorption) at early timepoints are associated with better weight loss outcomes at later timepoints post-MBS. Findings may guide the development of diagnostic tools and treatment guidelines for patients at risk of suboptimal weight loss outcomes.

Background: Bariatric surgery results in body composition changes, but direct assessment is often unavailable in clinical settings. Prediction equations offer an alternative but remain unvalidated, especially in people with obesity. This study evaluated the accuracy of anthropometric-based equations for estimating fat mass (FM)%, FM, and lean soft tissue (LST) in females awaiting bariatric surgery.

Methods: Females with class II or III obesity underwent body composition assessment via dual X-ray absorptiometry. The accuracy of 16 body composition equations was determined using Bland-Altman analyses, assessing group-level (bias: mean difference, via paired t-test) and individual-level (limits of agreement [LOA]; bias ± 2 standard deviations) agreement. Pearson's or Spearman's correlation assessed proportional bias and the relationship between equation error and age, weight, waist circumference, and waist-to-height ratio.

Results: One hundred twenty-nine females (body mass index: 43.4 ± 6.2 kg/m²; age: 44 ± 12 years) were included. Most equations (12/16; 75%) differed from measured values on a group level, and individual-level agreement was generally poor. Equations from Woolcott et al. (FM% LOA: -7.7, 8.3%) and Lee et al. (equation 2: FM LOA: -9.1, 10.1; LST LOA: -6.9, 10.7 kg) showed the narrowest LOA. Proportional bias was present in most equations (12/16; 75%), with biases in FM% and LST often correlated with body weight, waist circumference, and waist-to-height ratio.

Conclusions: No equation provided accurate individual-level body composition estimates, though some performed reasonably well at the group level. Improved prediction models or accessible measurement methods are needed for accurate body composition evaluation before and after bariatric surgery.

Background: Sleeve gastrectomy (SG) is an effective bariatric procedure but often results in rapid fat-free mass (FFM) loss during the early postoperative period, which may impair recovery and metabolic stability. This study evaluated the effects of different protein supplements low-BCAA soy peptide-based (LBP), whey protein-based (WP), and compound protein-based (CP) on FFM preservation one month after SG.

Methods: A retrospective cohort study was conducted on 200 SG patients categorized by postoperative protein supplementation strategy. Body composition was assessed using bioelectrical impedance analysis before and one month after surgery. Primary outcomes included changes in total and regional FFM, with subgroup analyses based on age, sex, and baseline FFM. Covariate-adjusted comparisons controlled for age, sex, and baseline BMI.

Results: At one month postoperatively, the LBP group demonstrated significantly lower percentage FFM loss from total weight loss (%FFML/WL) and smaller reductions in absolute FFM compared to the CP and WP groups (p < 0.05). These differences remained significant after adjustment. Subgroup analysis indicated greater FFM preservation in female patients, those under 30 years of age, and patients with baseline FFM ≤ 50 kg.

Conclusions: Low-BCAA soy peptide supplementation was associated with superior early FFM preservation after SG, particularly in younger and leaner patients. These findings suggest that LBP may be an effective component of early postoperative nutritional care to minimize muscle loss and highlight the combined importance of adequate protein intake and physical activity in optimizing lean mass preservation.

Introduction: Preoperative weight loss has been suggested as a predictor of postoperative weight loss outcomes after Metabolic Bariatric Surgery (MBS). While previous studies focused on outcomes up to 3 years, longer-term results remain limited. This study evaluates the association between preoperative weight loss and total weight loss (%TWL) up to five years postoperatively.

Methods: This single-center retrospective study included 765 patients who underwent primary MBS between June 2017 and august 2019. Patients were stratified into quartiles based on preoperative weight loss. Follow-up data on %TWL were analyzed at 3 and 6 months and 1 through 5 years postoperatively.

Results: The median age was 45 (35-52) and the majority were female (76.6%). Most patients underwent ring augmented Roux-en-Y Gastric Bypass (91.1%). Follow-up was 99.6% at 1 year and 65.9% at 5 years. Quartiles were defined as Q1: <4.4%, Q2:4.4-6.2%, Q3: 6.2-8.2% and Q4: > 8.2% preoperative weight loss. After 5 years %TWL was 32.4 (Q1), 32 (Q2), 32 (Q3) and 31.6 (Q4).

Conclusion: Greater preoperative weight loss was associated with significant higher %TWL up to two years (quartiles) and four years (low vs high) after MBS, but no significant differences were found after five years of follow up. The impact of preoperative weight loss on long-term outcomes was consistent across subgroups. Female sex, RYGB procedure and younger age were general predictors for greater %TWL.

Background: Duodenal switch (DS) can be performed as a direct one-stage procedure or as a planned/revisional two-step approach after sleeve gastrectomy. Consistent head-to-head evidence on long-term disease-free time is limited.

Objectives: To compare disease-free time and safety between direct (one-stage) and two-step DS.

Setting: Spanish tertiary bariatric center.

Methods: Propensity-score matched analysis (1:1) of patients undergoing DS, comparing direct versus two-step procedures. Matching variables were age, sex, and baseline body mass index (BMI). From 429 DS cases, 75 direct DS patients were matched to 75 two-step patients. Outcomes included short- and long-term complications, mortality, severe diarrhea or malnutrition, follow-up completeness at 3 and 5 years, weight loss, BMI < 35 kg/m², and disease-free status operationalized as the absence of metabolic diseases across follow-up.

Results: Mean initial BMI was 55.9 kg/m². Safety was comparable: short-term complications 14% (6% Clavien-Dindo ≥ III) and long-term 5.3%, with no between-group differences; no mortality, severe diarrhea, or malnutrition.Follow-up was 94.6% at 3 years and 80.7% at 5 years. Direct DS showed superior disease-free status at 5 years (absence of metabolic diseases 66.7% vs 57.1%; p<0.001) and greater durability of weight control (BMI < 35 kg/m² 88.2% vs 71.4%; p<0.001), along with higher total weight loss (45.4% vs 42.0%; p<0.05).

Conclusions: In patients with BMI > 50 kg/m², direct DS achieves longer high-risk disease-free status while maintaining a safety profile comparable to two-step DS.