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.

To date, there is a lack of population-based studies assessing the prevalence and severity of steatosis and metabolic-associated steatohepatitis (MASH) in Egypt. CAP is widely used as a non-invasive tool for hepatic steatosis assessment, yet its reliability in obese populations remains unclear. We aimed to examine the prevalence and risk factors for steatosis and steatohepatitis in Egyptian patients undergoing laparoscopic sleeve gastrectomy and evaluate CAP's diagnostic accuracy against liver biopsy in detecting hepatic steatosis.

Methods: In this prospective cross-sectional study (2019-2023), 162 obese adults undergoing bariatric surgery were enrolled. CAP was performed prior to intraoperative wedge liver biopsy. Histological grading of steatosis and NAS scoring were conducted by blinded pathologists. Diagnostic accuracy of CAP was evaluated using AUROC, sensitivity, specificity, PPV, and NPV.

Results: Hepatic steatosis was present in 63.6% of patients by liver biopsy. CAP overestimated steatosis in 40% of biopsy-confirmed S0 cases, misclassifying them as S3. CAP cutoff of 286 dB/m for ≥ S1, sensitivity, specificity, PPV, and NPV were 57.7%, 65.0%, 76.3%, and 44.1%, respectively (AUROC = 0.577). Only 14.2% had steatohepatitis. Multivariate analysis identified albumin (p = 0.040) and hemoglobin (p = 0.018) as independent protective factors.

Conclusion: CAP significantly overestimated steatosis severity highlighting its limited reliability in obese populations.

Background: The fat mass and obesity-associated (FTO) and melanocortin-4 receptor (MC4R) genes have been implicated in the pathophysiology of obesity. However, their regulatory behavior in human gastric tissue and association with postoperative weight loss following metabolic and bariatric surgery (MBS) remain unclear.

Methods: In this prospective case-control study, gastric tissue from 50 patients with obesity undergoing laparoscopic sleeve gastrectomy and 48 non-obese controls was analyzed for FTO and MC4R mRNA expression using quantitative PCR. Adjusted Inverse propensity score weighting (IPSW-adjusted) and age-/sex-adjusted linear regression were applied. Receiver operating characteristic (ROC) curves were used to evaluate discriminatory thresholds. Correlation with 12-month percent total weight loss (%TWL) was assessed.

Results: FTO expression was significantly upregulated (mean fold-change: 4.68, p < 0.001) and MC4R downregulated (mean fold-change: - 0.91, p < 0.001) in patients with obesity. ROC analysis identified thresholds of > 1.515 for FTO (AUC = 1.00) and < 0.525 for MC4R (AUC = 1.00), both with high sensitivity and specificity. No significant correlation was observed between gene expression and %TWL at 12-month follow-up.

Conclusion: Gastric expression of FTO and MC4R accurately discriminates between individuals with and without obesity but does not predict postoperative weight loss outcomes after sleeve gastrectomy. These findings indicate diagnostic potential, whereas prognostic value remains unsubstantial.