Obesity Surgery最新文献

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.

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.