Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery最新文献

Background: Globally, many surgeons perform varying revisional procedures to convert either a primary sleeve gastrectomy (SG) or laparoscopic adjustable gastric band (LAGB) for the management of recurrent weight gain. There is no consensus on efficacious revision surgery in terms of long-term weight loss and comorbidity management. Nationally, the most common revision procedure is to a Roux-en-Y gastric bypass (RYGB). Internationally, there are other options in frequent use. This includes the one-anastomosis gastric bypass (OAGB). Both RYGB and OAGB have different potential complications and issues but have been very successful in many patients.

Objectives: To assess OAGB and RYGB as revision surgery, differences in weight loss, and nutritional status at approximately 1 year.

Setting: Single university hospital system.

Methods: Patients who underwent OAGB as a revision of SG or LAGB were case matched by age, sex, and primary bariatric procedure to patients who underwent RYGB during January 2019 to October 2022.

Results: This study looked at 113 patients with either a primary SG or LAGB. Fifty-eight patients were converted to OAGB, and 55 patients were converted to RYGB. The OAGB cohort had a greater total body weight loss compared with the RYGB. There were no significant differences in postoperative nutritional values between the groups, except for decreased vitamin B12 levels in the RYGB cohort.

Conclusion: Patients who underwent conversion from either SG or LAGB to OAGB experienced a greater TBWL at 1-year postoperatively compared with those who underwent conversion to RYGB, without difference in nutritional deficiencies.

Social media (SM) use among individuals before and after metabolic and bariatric surgery (MBS) has dramatically increased in recent years, yet the benefits and risks to patients remain unclear. This systematic review sought to synthesize the literature on SM use among individuals pre- and post-MBS. Objectives were to: 1) explore the patterns of SM use in this population, 2) identify the benefits and risks of MBS-focused SM use, and 3) inform clinicians and patients about strategies to more effectively engage with MBS-focused SM. This systematic review was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analysis and was registered with PROSPERO (CRD42023473191). Studies which included a retrospective or prospective examination of SM and MBS were included. A comprehensive search was performed and published scientific articles were examined by three independent reviewers, resulting in 24 full text articles meeting inclusion criteria based on prespecified selection criteria. Results are reported by SM platform including Facebook, YouTube, Online Forums/Websites, X (formerly "Twitter"), Instagram, and TikTok. Findings indicate that SM use among individuals pre- and post-MBS is high and Facebook is the preferred platform. Several benefits of SM use were identified including easier access to large peer support communities, inspiration and encouragement, and easy access to health information. Possible downsides to SM use include problems with the accuracy of MBS content on SM. Given these findings, MBS clinicians can use this information to inform their patients about strategies to promote benefits and reduce potential risks of SM use.

Background: Morbid obesity is associated with aging of the immune system, a phenomenon known as "inflammaging," characterized by increased numbers of various immune cell subsets.

Objectives: To evaluate the long-term effects of bariatric surgery on immune cell subsets in patients with obesity and to determine the impact of metabolic syndrome on these changes.

Setting: High-volume bariatric center, Netherlands.

Methods: This prospective cohort study included patients with obesity, with and without metabolic syndrome, as well as lean controls. Peripheral blood samples were collected preoperatively (T0) and at various time points up to 18 months postoperatively (T18). Flow cytometry was used to measure absolute numbers of T cells, B cells, natural killer (NK) cells, and monocyte subsets, with adjustments for age and cytomegalovirus (CMV) serostatus.

Results: At T0, patients with obesity had elevated numbers of CD4+ CD31 naïve T cells, CD8+ terminally differentiated effector memory RA T cells, double-negative B cells, plasmablasts, NK cells, and monocytes compared with lean controls. CD8+ central memory T cells were decreased in patients with obesity. While most immune cell subsets gradually normalized by T18, some subsets, including T cells, B cells, and NK cells, that were initially elevated, decreased during follow-up and ultimately ended up lower than those in lean controls at T12 or T18. Metabolic syndrome did not affect these outcomes. COVID-19-related disruptions reduced the number of patients assessed over time.

Conclusions: Bariatric surgery restores the harmful effects of morbid obesity on the composition of innate and adaptive immune cell subsets in the long-term for patients with obesity, both with and without metabolic syndrome.

Background: Earlier evidence indicated that metabolic and bariatric surgery (MBS) may adversely affect neonatal outcomes among patients conceiving soon after MBS, but recent studies demonstrated conflicting results, especially for new surgical techniques.

Objectives: The aim of this study was to assess the effects of MBS types and surgery to birth interval on maternal, birth, and nonbirth outcomes in women with severe obesity.

Setting: New York State's all-payer hospital discharge database (2008-2019).

Methods: We identified women with severe obesity who underwent MBS (Post-MBS, n = 5001) or did not undergo MBS (No-MBS, n = 74,515), and examined maternal, neonatal, and nonbirth outcomes by MBS type and time since surgery in a propensity score-matched sample.

Results: Compared with No-MBS mothers, Post-MBS mothers had a lower incidence of stillbirths, ectopic pregnancies, and miscarriages (nonoverlapping confidence intervals). Post-MBS mothers were also significantly less likely to have pregnancy hypertension, gestational diabetes, and cesarean deliveries, but were more likely to experience vaginal bleeding during early pregnancy and deliver low birthweight newborns compared with No-MBS mothers (P < .05). Among Post-MBS mothers, deliveries within 18 months after surgery were associated with higher rate of cesarean sections and neonatal deaths compared with deliveries 18+ months after MBS (P < .05). Pregnancies after gastric bypass (RYGB) were more likely to result in cesarean deliveries compared with pregnancies after sleeve gastrectomy (P < .01).

Conclusions: Although weight loss surgery in women with obesity may reduce the rates of adverse maternal nonbirth outcomes and pregnancy complications, neonates born to women who conceived during the first year after MBS, especially RYGB, may be at higher risk for adverse outcomes.

Background: Roux-en-Y gastric bypass (RYGB) surgery is effective in ameliorating type 2 diabetes mellitus (T2DM); but its mechanism remains incompletely understood.

Objectives: This study aimed to investigate whether RYGB improves glucose metabolism by upregulating hepatic trefoil factor family 3 (TFF3) and thereby activating the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway.

Setting: Affiliated Hospital of North Sichuan Medical college in Nanchong city, China.

Methods: Zucker diabetic fatty (ZDF) rats underwent RYGB or sham surgery (SHAM), and Zucker lean (ZL) rats served as controls (CON). TFF3 expression and PI3K/Akt pathway activity were compared between groups using western blot, immunofluorescence, and RT-qPCR. Adeno-associated virus (AAV) was used to specifically overexpress and interfere with hepatic TFF3. Liver fibrosis and steatosis were assessed using Masson trichrome and Oil Red O staining. HepG2 cells overexpressing or knocking out TFF3 were constructed using lentiviral transfection and CRISPR/Cas9 technology. After verifying the activity of the PI3K/Akt pathway by western blot, rescue experiments were performed on HepG2 cell overexpressing and knocking out TFF3 using LY294002 and 740Y-P, respectively. The activities of gluconeogenic enzymes and glucose uptake capacity in different HepG2 cells were evaluated using qPCR and flow cytometry.

Results: Compared with the SHAM group, the blood glucose, body weight, insulin resistance, and lipid metabolism of ZDF rats in the RYGB group were significantly improved. The expression of TFF3 and PI3K/Akt phosphorylation in the liver of the RYGB group were higher than those of the rats that had undergone SHAM. In addition, compared with the SHAM group, the liver fibrosis and fatty degeneration of RYGB rats were milder, and the activity of gluconeogenic enzymes was lower. After tail vein injection of AAV that specifically overexpresses liver TTF3 in rats in the SHAM group, rats' insulin resistance, glucose tolerance, gluconeogenic enzymes, and other glucose metabolism indicators improved. After tail vein injection of AAV that interferes with liver TFF3 in rats in the RYGB group, rats' glucose metabolism indicators deteriorated. In in vitro experiments, the PI3K/Akt activity of TFF3-knocked-out HepG2 cells was lower than that of other groups. Lower glucose concentration were observed in TFF3-overexpressing cell lines. After rescue experiments, differences were found. The glucose metabolism level of the TFF3-expressing HepG2 cell line was positively correlated with the activity of the PI3K/Akt pathway.

Conclusions: RYGB regulates the expression of TFF3 in the liver of ZDF rats, thereby activating the PI3K/Akt pathway and improving T2DM.

Background: Existing studies are mainly focused on overall obesity or specific subpopulations, while the disease burden among patients with different characteristics of obesity progression remains uncertain.

Objectives: To conduct a descriptive analysis of the contemporary obesity/overweight associated economic burdens stratified by clinically meaningful features associated with obesity.

Settings: Utilizing Taiwan's 2013 National Health Interview Survey and the 2012-2019 National Health Insurance Research Database.

Methods: Six groups of adults with obesity and/or obesity-related conditions were targeted, including people receiving bariatric surgery (BS, n = 1679), having metabolic syndrome (MS, n = 1437), having body mass index (BMI) ≥27/30 kg/m² with obesity-related comorbidities (ORCs, n = 1428/552), and having BMI ≥27/30 kg/m² (n = 3235/1191). Healthcare utilization/expenditures (in 2022 USD) were measured.

Results: In the first year of follow-up, the BS group incurred the highest healthcare expenditures ($3494/person), followed by the MS group ($2852), the BMI ≥30/27 kg/m² with ORCs groups ($2025/$1920), and the BMI ≥30/27 kg/m² groups ($1160/$1032). In the years following BS, the prevalence and treatments for hypertension, diabetes, hyperlipidemia, and sleep apnea decreased significantly, and healthcare expenditures remained the lowest among the 6 groups but increased gradually. Heterogeneity of geographic distribution of obesity prevalence was observed.

Conclusions: Interventions tailored to patient characteristics, especially advanced obesity with high economic burden and obesity-associated geographic disparities, are needed. BS may curtail ORCs/MS, but the gradually increasing expenditures following BS would suggest a need of routine follow-ups.

Background: Obesity is associated with a higher incidence of fatty liver disease, intrahepatic triglyceride content, and hepatic fibrosis. These abnormalities could progress to severe liver disease.

Objectives: To evaluate the effects of bariatric surgery (BaS)-induced weight loss on liver volume, hepatic function tests, and lipid profile.

Setting: Academic Hospital, United States.

Methods: We conducted a retrospective review of an institutional review board (IRB)-approved database on patients who underwent BaS from 2006 to 2018. To determine changes in liver volume, we reviewed abdominal computed tomography scans before BaS (Group 1) and up to 18 months after (Group 2). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lipid profiles were collected before and after BaS.

Results: Seventy-three patients met the inclusion criteria. Patients were predominantly females 78.1% (57), with an average age of 51.29+12.54 years. The liver volume was 1870.73 + 638.5 mm³ before and 1555.15 + 464.8 after BaS (P = .004). ALT was 36.9 + 25.3 before versus 23.8 + 19.3 after BaS (P = .024).Triglyceride levels changed from 135.62 + 69.98 before to 97.50 + 47.33 after BaS (P = .009). Low-density lipoprotein decreased from 107.9 + 38.1 to 89.6 + 32.8 (P = .048).

Conclusions: BaS-induced weight loss determines significant liver shrinkage by reducing liver volume, and coincides with improvements in hepatic function tests and lipid profile. Our results suggest that BaS might contribute to reduction of the progression of fatty liver disease to fibrosis.