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Journal Watch—February 2016

| February 1, 2016

A quick look at the noteworthy articles in bariatric and metabolic research


Health-related quality of life after laparoscopic sleeve gastrectomy.
Amichaud R, Donatini G, Barussaud ML, Charalambous C, Ingrand I, Faure JP. Minerva Chir. 2016 Feb 4. [Epub ahead of print]
Synopsis: BACKGROUND: Obesity has an impact on health-related quality of life (HRQoL) and bariatric surgery may improve HRQoL in addition to severe obesity-related comorbidities. Aim of the study was to evaluate HRQoL following sleeve gastrectomy and the sensitivity of two HRQoL questionnaires: the Impact of Weight on Quality Of Life-Lite (IWQOL-Lite) and the World Health Organization-Quality Of Life-Bref (WHOQOL-Bref) scales.
METHODS: Data were prospectively collected from 149 adult patients submitted to laparoscopic sleeve gastrectomy, before, at 6 and 12 months post-operatively. HRQoL was measured using both the WHOQOL-Bref and the IWQOL-Lite questionnaires.
RESULTS: Mean age was 40.5 ± 11.9 years, mean initial weight 118.7 ±30.3 kg and mean preoperative body mass index (BMI) was 44.1 ± 6.3 kg/m2. Excess weight loss (EWL) was 53.1 % and 68.8 % respectively at 6 and 12 months post-operatively. Both questionnaires showed significant improvement of HRQoL 12 months after the procedure. Two over 4 domains (physical and psychological health) of the WHOQOL-Bref improved at 6 months whereas all of the 5 domains of the IWQOL-Lite did. The IWQOL-Lite questionnaire pointed out a significant enhancement both at 6 and 12 months.
CONCLUSION: HRQoL is improved after sleeve gastrectomy. The specific obesity questionnaire IWQOL-Lite seems to be more sensitive than the generic WHOQOL-Bref to detect amelioration of HRQoL..
PMID: 26844610

Differential Effects of Bariatric Surgery Versus Exercise on Excessive Visceral Fat Deposits.
Wu FZ, Huang YL, Wu CC, Wang YC, Pan HJ, Huang CK, Yeh LR, Wu MT. Medicine (Baltimore). 2016 Feb;95(5):e2616.
Synopsis: The aim of the present study was to compare differential impacts of bariatric surgery and exercise-induced weight loss on excessive abdominal and cardiac fat deposition.Excessive fat accumulation around the heart may play an important role in the pathogenesis of cardiovascular disease. Recent evidences have suggested that bariatric surgery results in relatively less decrease in epicardial fat compared with abdominal visceral fat and paracardial fat.Sixty-four consecutive overweight or obese subjects were enrolled in the study. Clinical characteristics and metabolic profiles were recorded. The volumes of abdominal visceral adipose tissue (AVAT), abdominal subcutaneous adipose tissue (ASAT), epicardial (EAT), and paracardial adipose tissue (PAT) were measured by computed tomography in the bariatric surgery group (N = 25) and the exercise group (N = 39) at baseline and 3 months after intervention. Subjects in both the surgery and exercise groups showed significant reduction in body mass index (15.97%, 7.47%), AVAT (40.52%, 15.24%), ASAT (31.40, 17.34%), PAT (34.40%, 12.05%), and PAT + EAT (22.31%, 17.72%) (all P < 0.001) after intervention compared with baseline. In both the groups, the decrease in EAT was small compared with the other compartments (P < 0.01 in both groups). Compared with the exercise group, the surgery group had greater loss in abdominal and cardiac visceral adipose tissue (AVAT, ASAT, PAT, EAT+PAT) (P < 0.001), but lesser loss in EAT (P = 0.037).Compared with the exercise group, bariatric surgery results in significantly greater percentage loss of excessive fat deposits except for EAT. EAT, but not PAT, was relatively preserved despite weight reduction in both the groups. The physiological impact of persistent EAT deserves further investigation.
PMID: 26844473

Bariatric Orthopaedics: Total Hip Arthroplasty in Super-Obese Patients (Those with a BMI of ≥50 kg/m2).
Issa K, Harwin SF, Malkani AL, Bonutti PM, Scillia A, Mont MA. J Bone Joint Surg Am. 2016 Feb 3;98(3):180-5.
Synopsis: The purpose of this study was to assess the clinical and patient-reported outcomes of primary total hip arthroplasty in super-obese patients (those with a body mass index [BMI] of ≥50 kg/m(2)) compared with a matched group of patients who had a normal BMI (<30 kg/m(2)). A secondary objective was to assess patients’ experiences in finding a treating surgeon.
METHODS: Forty-eight hips in forty-five patients who had a minimum BMI of 50 kg/m(2) and who had undergone a primary total hip arthroplasty at one of four high-volume institutions between 2001 and 2010 were reviewed. This included twenty-six women and nineteen men who had a mean age of fifty-four years (range, thirty-six to seventy-one years) and who were followed for a mean time of six years (range, four to twelve years). These patients were compared in a 1:3 ratio with a non-obese matched group (those with a BMI of <30 kg/m(2)) of 135 patients who had undergone total hip arthroplasty during the same time period by the same surgeons. The outcomes evaluated included implant survivorship, complication rates, Harris hip scores, 36-item Short-Form (SF)-36 questionnaires, University of California Los Angeles (UCLA) activity scores, and patient experience in finding a treating surgeon.
RESULTS: The super-obese group had a 4.5 times higher odds ratio of undergoing a revision when compared with the matching group (p = 0.06); the overall implant survivorship was 89.6% for the super-obese group and 97.8% for the matching group. The super-obese group also had a significantly higher odds ratio (7.7) of complications compared with the matching group (p = 0.017). The super-obese group also had significantly lower mean values for the Harris hip score (82 points for the super-obese group compared with 91 points for the matched group; p = 0.002), the SF-36 Physical Component Summary score (39 points for the super-obese group and 49 points for the matched group; p = 0.001), the SF-36 Mental Component Summary scores (46 points for the super-obese group and 58 points for the matched group; p = 0.001), and the UCLA activity score (3.9 points for the super-obese group compared with 6.2 points for the matched group; p = 0.001). Compared with the matched group, super-obese patients were evaluated by a larger number of orthopaedic surgeons prior to undergoing total hip arthroplasty.
CONCLUSIONS: The clinical and patient-reported outcomes of primary total hip arthroplasty were lower in the super-obese patients. These patients also faced challenges in finding surgeons who would perform their procedure. Super-obese patients may benefit from counseling with their treating surgeon to set realistic expectations with regard to the outcomes of their procedure.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
PMID: 26842407

From bariatric to metabolic surgery: Looking for a “disease modifier” surgery for type 2 diabetes.
Cordera R, Adami GF  World J Diabetes. 2016 Jan 25;7(2):27-33.
Synopsis: In this review the recent evolution of the comprehension of clinical and metabolic consequences of bariatric surgery is depicted. At the beginning bariatric surgery aim was a significant and durable weight loss. Later on, it became evident that bariatric surgery was associated with metabolic changes, activated by unknown pathways, partially or totally independent of weight loss. Paradigm of this “metabolic” surgery is its effects on type 2 diabetes mellitus (T2DM). In morbid obese subjects it was observed a dramatic metabolic response leading to decrease blood glucose, till diabetes remission, before the achievement of clinically significant weight loss, opening the avenue to search for putative anti-diabetic “intestinal” factors. Both proximal duodenal (still unknown) and distal (GLP1) signals have been suggested as hormonal effectors of surgery on blood glucose decrease. Despite these findings T2DM remission was never considered a primary indication for bariatric surgery but only a secondary one. Recently T2DM remission in obese subjects with body mass index (BMI) greater than 35 has become a primary aim for surgery. This change supports the idea that “metabolic surgery” definition could more appropriate than bariatric, allowing to explore the possibility that metabolic surgery could represent a “disease modifier” for T2DM. Therefore, several patients have undergone surgery with a primary aim of a definitive cure of T2DM and today this surgery can be proposed as an alternative therapy. How much surgery can be considered truly metabolic is still unknown. To be truly “metabolic” it should be demonstrated that surgery could cause T2DM remission not only in subjects with BMI > 35 but also with BMI < 35 or even < 30. Available evidence on this topic is discussed in this mini-review.
PMID: 26839653

Category: Journal Watch, Past Articles

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