A quick look at the noteworthy articles in bariatric and metabolic research
Assessment of two different diagnostic guidelines criteria (National Cholesterol Education Adult Treatment Panel III [ATP III] and International Diabetes Federation [IDF]) for the evaluation of metabolic syndrome remission in a longitudinal cohort of patients undergoing Roux-en-Y gastric bypass.
Rodríguez-Ortiz D, Reyes-Pérez A, León P, et al. Surgery. 2015 Dec 31. [Epub ahead of print]
Synopsis: The authors conducted a study to assess the value of two different diagnostic guidelines criteria (National Cholesterol Education Adult Treatment Panel III [ATP III] and International Diabetes Federation [IDF]) for the evaluation of remission of metabolic syndrome after Roux-en-Y gastric bypass (RYGB). Weight loss and metabolic syndrome remission were analyzed among 381 patients 6 and 12 months after primary RYGB by ATP III and IDF criteria. They found that with the use of the IDF definition, the remission rate of metabolic syndromewas 10 percent more rigorous than with use of the ATP-III criteria. They concluded that this feature is attributable to a greater discrimination of patients with high blood pressure, glycemia, and dyslipidemia and that the IDF criteria seem more accurate to evaluate metabolic syndrome remission.
Does BMI influence clinical outcomes after total knee arthroplasty?
Daniilidis K, Yao D, Gosheger G, et al. Technol Health Care. 2015 Dec 21. [Epub ahead of print].
Synopsis: The researchers conducted a retrospective study to evaluate clinical outcomes of German patients with obesity after total knee arthroplasty (TKA). The study included a total 199 patients with 230 TKA between 2001 and 2009. The collective was divided into four groups in relation to their body mass index (BMI):
• group 1: BMI < 25kg/m2, n= 24
• group 2: BMI 25–30kg/m2, n= 80
• group 3: BMI 30–40kg/m2, n= 109
• group 4: BMI> 4 kg/m2, n = 17.
Clinical outcome measurement was scored postoperatively using the knee society score (KSS), hospital for special surgery score (HSS) and the visual analogue scale (VAS). Furthermore complications and subjective patient satisfaction were noted.
The researchers did not detect any significant differences in the clinical scores between the BMI-subgroups; however, they measured statistically significantly worse results in case of infection and instability in all BMI subgroups (p> 0.01).
Laparoscopic sleeve gastrectomy versus gastric bypass in late adolescents: What is the optimal surgical strategy for morbid obesity?
van Mil SR, Biter LU, Grotenhuis BA, Zengerink JF, Mannaerts GH. Eur J Pediatr Surg. 2016 Jan 8. [Epub ahead of print]
Synopsis: To define the preferred procedure in adolescents, this study compares outcomes of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bybass (LRYGB)in late adolescents in the authors’ clinic. Data on baseline characteristics, operative details, and follow-up were collected retrospectively in all patients (age 18–20 years) who underwent LSG or LRYGB. A total 65 adolescents (54 females; median age 19 years) were included in the study. Among them, 45 patients underwent LSG, and 20 underwent LRYGB. The authors observed significant differences in percent excess weight loss (%EWL) at two-year follow-up; 81.0% in LRYGB (n=11) versus 96.8% in LSG (n=23), p=0.007. No differences were observed in postoperative mortality, complication rate, and resolution of comorbidities between both procedures. The authors concluded that LSG may be an appropriate bariatric technique to perform in adolescents with morbid obesity.
Metabolic changes after Roux-en-Y bariatric surgery in Hispanics.
Hernández-Gil de Lamadrid J, Nieves-Rivera JJ, Mora L, et al. Bol Asoc Med P R. 2015;107(3):66–69.
Synopsis: In this article, the researchers describe the metabolic outcomes 12 months after bariatric surgery (Roux-en-Y gastric bypass [RYGB]) in Hispanic patients with morbid obesity and evaluate the correlation between weight loss and the observed changes. Medical records from 102 Hispanic patients with morbid obesity who underwent RYGB were identified at the University of Puerto Rico (UPR) Hospital. The following variables were obtained before and 12 months after surgery: body mass index (BMI), body weight, total cholesterol (TC), triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), and fasting blood sugar (FBS). Of the 102 patients, 97 percent underwent RYGB; 79.4 percent were women and 44 percent had diabetes. The researchers observed statistically significant reductions (p<0.05) 12 months after surgery in: BMI, weight, TC, triglycerides, LDL, and FBS. They found that HDL increased. They concluded that RYGB significantly improves the lipid profile and FBS levels in Hispanic patients with obesity and that the poor correlation factor between weight loss and these variables suggests that other mechanisms, independent from weight loss, are responsible for these changes.
Results of more than 11,800 sleeve gastrectomies: Data analysis of the German Bariatric Surgery Registry.
Stroh C1, Köckerling F, Volker L, et al. Ann Surg. 2015 Dec 31. [Epub ahead of print]
Synopsis: Since 2005 data from patients undergoing bariatric procedures in Germany have been prospectively registered in an online database and analyzed. All patients who had undergone primary sleeve gastrectomy (SG) within a seven-year period were considered for analysis.
Using the German Bariatric Surgery Registry, data from more than 11,800 SGs were collected between January 1, 2005 and December 31, 2013. The researchers found that staple line leak rate decreased from 6.5 to 1.4 percent. They also found that the following were associated with a significantly higher leakage rate compared with when using either buttresses or oversewing alone: male sex, higher body mass index, concomitant sleep apnea, conversion to laparotomy, longer operation time, a combination of buttresses and oversewing, and the occurrence of intraoperative complications. On multivariable analysis, operation time and year of procedure only had a significant impact on staple line leakage rate.
They concluded that the results of the study demonstrated that there are factors that increase the risk of leakage and which would enable surgeons to define risk groups, select patients more carefully, and offer closer follow-up during the postoperative course with early recognition and adequate treatment.
Objectively-measured sedentary time and cardiometabolic health in adults with severe obesity.
King WC, Chen JY, Courcoulas AP, et al. Prev Med. 2015;84:12-18. [Epub ahead of print]
Synopsis: A convenience sample of adults with severe obesity (N=927; 79% female, median age 45y, median body mass index (BMI) 46kg/m2) completed a research assessment at one of 10 US hospitals between 2006 and 2009 prior to bariatric surgery. Cardiometabolic health was assessed via physical measures, fasting blood samples and medication use. Indices of sedentary time (ST) were derived from StepWatch™ activity monitor data with minimum bout durations of 1 minute, 10 minutes, and 30 minutes. Cross-sectional associations were examined. Median (25th, 75th percentile) ST was as follows: 9.3hour per day (8.1, 10.5) in ≥1-minute bouts, 6.5 hours per day (5.2, 8.0) in ≥10-minute bouts, or 3.2 hours per day (2.1, 4.5) in ≥30min bouts. Associations with ST were generally strongest with the ≥10-minute bout duration. The researchers found that, independent of moderate-to-vigorous intensity physical activity, BMI and other potential confounders, 1 hour per day of ST in ≥10-minute bouts was associated with higher odds of diabetes by 15 percent (95%CI: 1.05-1.26), metabolic syndrome by 12 percent (95%CI: 1.01-1.24), and elevated blood pressure by 14 percent (95%CI: 1.02-1.26), and was associated with 1.4cm (95%CI: 0.9-1.9) larger waist circumference. They concluded that these findings indicate the importance of considering ST as a distinct health risk among adults with severe obesity, and suggest a 10-minute minimum duration may be preferable to 1 minute or 30 minutes for establishing ST from activity monitor data.
The role of bile acids in the metabolic regulations.
Vitek L, Haluzik M. J Endocrinol. 2016 Jan 5. [Epub ahead of print]
Synopsis: Bile acids (BA)affect multiple functions to control energy homeostasis, as well as glucose and lipid metabolism, predominantly by activating the nuclear farnesoid X receptor (FXR), and cytoplasmic G protein-coupled BA receptor TGR5 in a variety of tissues. However, BA also are aimed at many other cellular targets in a wide array of organs and cell compartments. In this article, the authors discuss BAs and their role in the pathogenesis of diabetes, obesity, and other “diseases of civilization.” They also discuss the effects of bariatric surgery BA cellular targets.
Self-determination and motivation for bariatric surgery: a qualitative study.
Park J. Psychol Health Med. 2015 Dec 28:1-6. [Epub ahead of print]
Synopsis: This study examined how individualswith obesity acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one’s motivation was internally regulated, related to one’s personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient’s pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients’ motivation, further helping to improve their long-term quality of life post-surgery.
Immunological evaluation of patients with type 2 diabetes mellitus submitted to metabolic surgery.
Borges Mde C, Terra GA, Takeuti TD, et al. Arq Bras Cir Dig. 2015;28(4):266–269. [Article in English, Portuguese]
Synopsis: The authors conducted a study to test a hypothesis that alterations in immunological parameters occur after duodenojejunal bypass surgery combined with ileal interposition without gastrectomy, and influences the insulin metabolism of betacells.
Seventeen patients with type 2 diabetes mellitus (T2DM) under clinical management were submitted to surgery and blood samples were collected before and six months after surgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α, IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometric measures, glucose levels and insulin use were evaluated in each patient.
No changes in the expression pattern of proinflammatory cytokines were observed before and after surgery. In contrast, there was a significant decrease in IL-10 expression, which coincided with a reduction in the daily insulin dose, glycemic index, and body mass index (BMI) of the patients. Early presentation of food to the ileum may have induced the production of incretins such as GLP-1 and PYY which, together with glycemic control, contributed to weight loss, diabetes remission and the consequent good surgical prognosis of these patients. In addition, the control of metabolic syndrome was responsible for the reduction of IL-10 expression in these patients.
The authors concluded that these findings suggest the presence of low-grade inflammation in this patient population during the postoperative period as a result of adequate glycemic control and absence of obesity, contributing to a good outcome of surgery.