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Demirpolat MT, İslam MM. Development and Validation of the GAASThyriC Model for Predicting Patients with Suboptimal Clinical Response After Laparoscopic Sleeve Gastrectomy and a Practical Calculator: A Retrospective Cohort Study. Surg Laparosc Endosc Percutan Tech 2024; 34:424-431. [PMID: 38898798 DOI: 10.1097/sle.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND It might not be possible to achieve the desired outcome in every patient following bariatric surgery, even though every patient is thoroughly examined before surgery. This study aimed to develop a regression model based on parameters that affect weight loss success in patients scheduled for laparoscopic sleeve gastrectomy (LSG) and thus preoperatively predict whether the patients will have an optimal clinical response in terms of weight loss at the end of the first year. MATERIALS AND METHODS Between January 2018 and August 2022, patients who underwent LSG were analyzed retrospectively. Age, sex, comorbidities, smoking status, alcohol use status, preoperative weight, preoperative body mass index (BMI), preoperative laboratory data, weight, and total weight loss (TWL)% values at the end of the first year were recorded. At the end of the first year following LSG, patients with TWL% above 20% were defined as having an optimal clinical response in terms of weight loss. This study is designed, conducted, and reported regarding the "transparent reporting of a multivariable prediction model for individual prognosis or diagnosis" (TRIPOD) statement. The final model was used to construct an Excel-based calculator. RESULTS Four hundred thirty-eight patients underwent the sleeve gastrectomy procedure, and 38 of them were excluded from the study because of a lack of 1-year follow-up information, resulting in 400 eligible patients for our study. Age, glucose, thyroid stimulating hormone (TSH), alcohol consumption, systemic immune inflammation index (SII), and tobacco were the independent predictors of optimal clinical response ( P <0.001, P <0.001, P <0.001, P =0.011, P =0.039, P =0.045, respectively). The model was called the GAASThyriC score. When the final model was tested in the validation cohort, the AUC was 0.875 (95% CI, 0.742-0.999), the sensitivity was 83.3% (95% CI, 51.6-97.9), specificity was 86.4% (95% CI, 77.4-92.8), negative likelihood ratio was 0.19 (95% CI, 0.05-0.68), and accuracy was 86% (95% CI, 77.6-92.1) when the cutoff value was set to the optimal threshold (logit = 0.8451). CONCLUSION The GAASThyriC score can be used as an effective auxiliary tool to predict the patient population with suboptimal clinical response in terms of TWL% at the end of the first year after LSG.
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Affiliation(s)
| | - Mehmet Muzaffer İslam
- Department of Emergency Medicine, University of Health Sciences, Umraniye Education and Research Hospital, Istanbul, Turkey
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Ochs V, Tobler A, Wolleb J, Bieder F, Saad B, Enodien B, Fischer LE, Honaker MD, Drews S, Rosenblum I, Stoll R, Probst P, Müller MK, Lavanchy JL, Taha-Mehlitz S, Müller BP, Rosenberg R, Frey DM, Cattin PC, Taha A. Development of predictive model for predicting postoperative BMI and optimize bariatric surgery: a single center pilot study. Surg Obes Relat Dis 2024:S1550-7289(24)00680-4. [PMID: 39117560 DOI: 10.1016/j.soard.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/04/2024] [Accepted: 06/30/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The pilot study addresses the challenge of predicting postoperative outcomes, particularly body mass index (BMI) trajectories, following bariatric surgery. The complexity of this task makes preoperative personalized obesity treatment challenging. OBJECTIVES To develop and validate sophisticated machine learning (ML) algorithms capable of accurately forecasting BMI reductions up to 5 years following bariatric surgery aiming to enhance planning and postoperative care. The secondary goal involves the creation of an accessible web-based calculator for healthcare professionals. This is the first article that compares these methods in BMI prediction. SETTING The study was carried out from January 2012 to December 2021 at GZOAdipositas Surgery Center, Switzerland. Preoperatively, data for 1004 patients were available. Six months postoperatively, data for 1098 patients were available. For the time points 12 months, 18 months, 2 years, 3 years, 4 years, and 5 years the following number of follow-ups were available: 971, 898, 829, 693, 589, and 453. METHODS We conducted a comprehensive retrospective review of adult patients who underwent bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy), focusing on individuals with preoperative and postoperative data. Patients with certain preoperative conditions and those lacking complete data sets were excluded. Additional exclusion criteria were patients with incomplete data or follow-up, pregnancy during the follow-up period, or preoperative BMI ≤30 kg/m2. RESULTS This study analyzed 1104 patients, with 883 used for model training and 221 for final evaluation, the study achieved reliable predictive capabilities, as measured by root mean square error (RMSE). The RMSE values for three tasks were 2.17 (predicting next BMI value), 1.71 (predicting BMI at any future time point), and 3.49 (predicting the 5-year postoperative BMI curve). These results were showcased through a web application, enhancing clinical accessibility and decision-making. CONCLUSION This study highlights the potential of ML to significantly improve bariatric surgical outcomes and overall healthcare efficiency through precise BMI predictions and personalized intervention strategies.
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Affiliation(s)
- Vincent Ochs
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Anja Tobler
- Department of Surgery, GZO-Hospital, Wetzikon, Switzerland
| | - Julia Wolleb
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Florentin Bieder
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Baraa Saad
- Faculty of Medicine, St. George's University of London, London, UK
| | - Bassey Enodien
- Department of Surgery, GZO-Hospital, Wetzikon, Switzerland
| | - Laura E Fischer
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael D Honaker
- Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, North Carolina
| | - Susanne Drews
- Department of Surgery, Centre for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, Liestal, Switzerland
| | - Ilan Rosenblum
- Department of Surgery, Centre for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, Liestal, Switzerland
| | - Reinhard Stoll
- Department of Surgery, Centre for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, Liestal, Switzerland
| | - Pascal Probst
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland
| | - Markus K Müller
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland
| | - Joël L Lavanchy
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland; Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Stephanie Taha-Mehlitz
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Beat P Müller
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Robert Rosenberg
- Department of Surgery, Centre for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, Liestal, Switzerland
| | - Daniel M Frey
- Department of Surgery, GZO-Hospital, Wetzikon, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Anas Taha
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland; Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, North Carolina; Department of Surgery, Centre for Gastrointestinal Diseases, Cantonal Hospital Basel-Landschaft, Liestal, Switzerland.
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Chen G, Li Z, Wang L, Wuyun Q, Sang Q, Wang J, Wang Z, Tian C, Yu C, Amin B, Zhang N, Fan Q. Analysis of correlation between BMI and TWL% outcome following metabolic and bariatric surgery: a retrospective study using restricted cubic spline. BMC Surg 2024; 24:178. [PMID: 38849774 PMCID: PMC11157919 DOI: 10.1186/s12893-024-02455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE This study aimed to examine the correlation between preoperative body mass index (BMI) and adequate percentage of total weight loss (TWL%) outcome and present evidence of tiered treatment for patients with obesity in different preoperative BMI. METHODS We included patients with complete follow-up data who underwent metabolic and bariatric surgery (BMS). We termed optimal clinical response as TWL% >20% at one year following MBS. To investigate dose-response association between preoperative BMI and optimal clinical response, preoperative BMI was analyzed in three ways: (1) as quartiles; (2) per 2.5 kg/m2 units (3) using RCS, with 3 knots as recommended. RESULTS A total of 291 patients with obesity were included in our study. The corresponding quartile odds ratios associated with optimal clinical response and adjusted for potential confounders were 1.00 (reference), 1.434 [95% confidence interval (95%CI) = 0.589-3.495], 4.926 (95%CI = 1.538-15.772), and 2.084 (95%CI = 0.941-1.005), respectively. RCS analysis showed a non-linear inverted U-shaped association between preoperative BMI and optimal clinical response (Nonlinear P = 0.009). In spline analysis, when preoperative BMI was no less than 42.9 kg/m2, the possibility of optimal clinical response raised as preoperative BMI increased. When preoperative BMI was greater than 42.9 kg/m2, the possibility of optimal clinical response had a tendency to decline as preoperative BMI increased. CONCLUSION Our research indicated the non-linear inverted U-shaped correlation between preoperative BMI and adequate weight loss. Setting a preoperative BMI threshold of 42.9 is critical to predicting optimal clinical outcomes.
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Affiliation(s)
- Guanyang Chen
- Department of General Surgery, Peking University Ninth School of Clinical Medicine, Beijing, China
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Zhehong Li
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Liang Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qiqige Wuyun
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qing Sang
- Department of General Surgery, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Jing Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chenxu Tian
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chengyuan Yu
- Department of General Surgery, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Buhe Amin
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Nengwei Zhang
- Department of General Surgery, Peking University Ninth School of Clinical Medicine, Beijing, China.
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Qing Fan
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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Nadal E, Benito E, Ródenas-Navarro AM, Palanca A, Martinez-Hervas S, Civera M, Ortega J, Alabadi B, Piqueras L, Ródenas JJ, Real JT. Machine Learning Model in Obesity to Predict Weight Loss One Year after Bariatric Surgery: A Pilot Study. Biomedicines 2024; 12:1175. [PMID: 38927382 PMCID: PMC11200726 DOI: 10.3390/biomedicines12061175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
Roux-en-Y gastric bypass (RYGB) is a treatment for severe obesity. However, many patients have insufficient total weight loss (TWL) after RYGB. Although multiple factors have been involved, their influence is incompletely known. The aim of this exploratory study was to evaluate the feasibility and reliability of the use of machine learning (ML) techniques to estimate the success in weight loss after RYGP, based on clinical, anthropometric and biochemical data, in order to identify morbidly obese patients with poor weight responses. We retrospectively analyzed 118 patients, who underwent RYGB at the Hospital Clínico Universitario of Valencia (Spain) between 2013 and 2017. We applied a ML approach using local linear embedding (LLE) as a tool for the evaluation and classification of the main parameters in conjunction with evolutionary algorithms for the optimization and adjustment of the parameter model. The variables associated with one-year postoperative %TWL were obstructive sleep apnea, osteoarthritis, insulin treatment, preoperative weight, insulin resistance index, apolipoprotein A, uric acid, complement component 3, and vitamin B12. The model correctly classified 71.4% of subjects with TWL < 30% although 36.4% with TWL ≥ 30% were incorrectly classified as "unsuccessful procedures". The ML-model processed moderate discriminatory precision in the validation set. Thus, in severe obesity, ML-models can be useful to assist in the selection of patients before bariatric surgery.
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Affiliation(s)
- Enrique Nadal
- Instituto Universitario de Ingeniería Mecánica y Biomecánica (I2MB), Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Esther Benito
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain; (E.B.); (B.A.); (L.P.); (J.T.R.)
| | - Ana María Ródenas-Navarro
- Endocrinology and Nutrition Service, Clinical University Hospital of Valencia, 46010 Valencia, Spain; (A.M.R.-N.); (A.P.); (M.C.)
| | - Ana Palanca
- Endocrinology and Nutrition Service, Clinical University Hospital of Valencia, 46010 Valencia, Spain; (A.M.R.-N.); (A.P.); (M.C.)
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
| | - Sergio Martinez-Hervas
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain; (E.B.); (B.A.); (L.P.); (J.T.R.)
- Endocrinology and Nutrition Service, Clinical University Hospital of Valencia, 46010 Valencia, Spain; (A.M.R.-N.); (A.P.); (M.C.)
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Miguel Civera
- Endocrinology and Nutrition Service, Clinical University Hospital of Valencia, 46010 Valencia, Spain; (A.M.R.-N.); (A.P.); (M.C.)
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
| | - Joaquín Ortega
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
- General Surgery Service, University Hospital of Valencia, 46010 Valencia, Spain
- Department of Surgery, University of Valencia, 46010 Valencia, Spain
| | - Blanca Alabadi
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain; (E.B.); (B.A.); (L.P.); (J.T.R.)
- Endocrinology and Nutrition Service, Clinical University Hospital of Valencia, 46010 Valencia, Spain; (A.M.R.-N.); (A.P.); (M.C.)
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
| | - Laura Piqueras
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain; (E.B.); (B.A.); (L.P.); (J.T.R.)
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
- Department of Pharmacology, University of Valencia, 46010 Valencia, Spain
| | - Juan José Ródenas
- Instituto Universitario de Ingeniería Mecánica y Biomecánica (I2MB), Universitat Politècnica de València, 46022 Valencia, Spain;
| | - José T. Real
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28040 Madrid, Spain; (E.B.); (B.A.); (L.P.); (J.T.R.)
- Endocrinology and Nutrition Service, Clinical University Hospital of Valencia, 46010 Valencia, Spain; (A.M.R.-N.); (A.P.); (M.C.)
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
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Sobutay E, Bilgiç Ç, Kabaoğlu B, Yavuz Y. Can Weight of The Resected Stomach Predict Weight Loss Results After Laparoscopic Sleeve Gastrectomy? Surg Laparosc Endosc Percutan Tech 2024; 34:29-34. [PMID: 38306493 DOI: 10.1097/sle.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/11/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Many factors have been investigated in the literature to predict weight loss outcomes after LSG. However, insufficient data regarding the resected stomach weight (RGW) exists. This retrospective study aimed to investigate the association between RGW and weight loss outcomes 1 year after LSG. MATERIALS AND METHODS Fifty-four patients who underwent LSG in a tertiary care center were evaluated retrospectively. The statistical analyses were performed to investigate the correlation between preoperative demographics, RGW, and the excess weight loss percentage (%EWL) and percent total weight loss (%TWL). RESULTS The mean RGW was 169.7±40.1, ranging from 101 to 295 grams. The RGW was significantly correlated with preoperative weight (r=0.486; P<0.001), body mass index (r=0.420; P=0.002), and age (r=0.327; P=0.01). However, RGW did not predict postoperative weight loss, as measured by percent total weight loss (%TWL) and percent excess weight loss (%EWL), respectively (r=0.044; P=0.75 and r=-0.216; P=0.11). Multiple linear regression analysis identified age as a negative predictor for both %TWL (β=-0.351, P=0.005) and %EWL (β=-0.265, P=0.03), while preoperative body mass index was a negative predictor for %EWL (β=-0.469, P<0.001). CONCLUSION The RGW, although correlated with patient characteristics, does not serve as a reliable predictor of postoperative weight loss in the first year after LSG. Further research is needed to improve predictive models and patient care in bariatric surgery.
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Affiliation(s)
- Erman Sobutay
- Department of General Surgery, Koç Foundation American Hospital
| | - Çağri Bilgiç
- Department of General Surgery, Koç Foundation American Hospital
| | - Burçak Kabaoğlu
- Department of General Surgery, Koç Foundation American Hospital
| | - Yunus Yavuz
- Department of General Surgery, Koç Foundation American Hospital
- Department of General Surgery, Obesity and Metabolic Surgery Center, Koç University, School of Medicine, Istanbul, Turkey
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Cao Y, Luo P, Tang H, Li P, Wang G, Li W, Song Z, Su Z, Sun X, Yi X, Fu Z, Cui B, Zhu S, Zhu L. Insulin resistance levels predicted metabolic improvement and weight loss after metabolic surgery in Chinese patients with type 2 diabetes. Surg Obes Relat Dis 2024; 20:80-90. [PMID: 37739868 DOI: 10.1016/j.soard.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/12/2023] [Accepted: 08/05/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND The causes for failure of metabolic improvement and inadequate weight loss after metabolic surgery (MS) in Chinese patients with type 2 diabetes (T2D) have not been fully elucidated. The effect of insulin resistance (IR) on the outcome of T2D, hypertension, hyperlipidemia, and obesity after MS in Chinese patients with T2D and a body mass index (BMI) of 25-32.5 kg/m2 warrants further study. OBJECTIVES Patients with T2D and a BMI of 25-32.5 kg/m2 who underwent MS between July 2019 and June 2021 were included. SETTING University hospital, China. METHODS IR levels were evaluated with the glucose disposal rate (GDR). Improvement of T2D, hypertension, and hyperlipidemia was assessed with the composite triple endpoint (CTEP), and weight loss was assessed with the percent of total weight loss (%TWL). Partial correlation analysis, binary logistic regression analysis, multiple linear regression analysis, receiver operating characteristic curve (ROC) analysis, and subgroup analysis were used to analyze the relationship between the CTEP, %TWL at 1 year postoperative, and GDR preoperative. RESULTS This study analyzed the data of 51 patients with T2D and a BMI of 25-32.5 kg/m2 (30 men and 21 women) with a mean preoperative GDR of 3.72 ± 1.48 mg/kg/min. Partial correlation coefficients between CTEP, %TWL, and GDR were .303 (P = .041) and .449 (P = .001), respectively. The preoperative GDR was significantly positively correlated with CTEP (OR = 1.610, P = .024) and %TWL (β = 1.38, P = .003). The preoperative GDR predicted cutoff values of 4.36 and 5.35 mg/kg/min for CTEP attainment and %TWL ≥ 20%, respectively. CONCLUSION IR levels predicted metabolic improvement and weight loss 1 year after MS in Chinese patients with T2D and a BMI of 25-32.5 kg/m2.
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Affiliation(s)
- Yaoquan Cao
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ping Luo
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Guohui Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Song
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhihong Su
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xianhao Yi
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhibing Fu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Beibei Cui
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China.
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Osorio-Conles Ó, Jiménez A, Ibarzabal A, Balibrea JM, de Hollanda A, Vidal J. Limited Bariatric Surgery-induced Weight Loss in Subjects With Type 2 Diabetes: Predictor Variables in Adipose Tissue. J Clin Endocrinol Metab 2023; 108:e1205-e1213. [PMID: 37249080 DOI: 10.1210/clinem/dgad271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Indexed: 05/31/2023]
Abstract
CONTEXT The impact of type 2 diabetes mellitus (T2D) at baseline on limited weight loss (WL) after bariatric surgery (BS) remains controversial, and the potential underlying mechanisms incompletely understood. OBJECTIVE We aimed at gaining further insight on this relationship and identifying novel associations between adipose tissue (AT) parameters and short-term WL outcomes in subjects with or without T2D undergoing BS. METHODS Mid-term WL trajectories after BS have been evaluated in a cohort of 1659 subjects (cohort 1) with (n = 543) and without T2D (n = 1116). Paired subcutaneous and visceral AT samples were obtained from a cohort of 48 pairs of subjects with and without T2D matched for age, sex, BMI, and type of BS (cohort 2). Differences in AT parameters between groups were evaluated and potential associations with WL response explored. RESULTS T2D was independently associated with a 5% lesser mid-term WL in cohort 1, while HbA1c, insulin treatment, and number of T2D medications prior to BS were only related to short-term WL outcomes. In cohort 2, a number of differentially expressed genes in AT were identified between groups, while fat cell size and fibrosis were comparable. Subcutaneous ATG7 expression was found as an independent predictor of limited WL 1 year after surgery (β: -12.21 ± 4.41, P = .008) and its addition to a clinical model significantly improved the amount of WL variability explained (R2 = 0.131 vs R2 = 0.248, F change P = .009). CONCLUSION Our results highlight the importance of T2D as determinant of limited WL following BS and suggest that dysregulated macroautophagy in subcutaneous AT may contribute to this association.
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Affiliation(s)
- Óscar Osorio-Conles
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Amanda Jiménez
- Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Ainitze Ibarzabal
- Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - José María Balibrea
- Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Ana de Hollanda
- Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Josep Vidal
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
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Noria SF, Shelby RD, Atkins KD, Nguyen NT, Gadde KM. Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment. Curr Diab Rep 2023; 23:31-42. [PMID: 36752995 PMCID: PMC9906605 DOI: 10.1007/s11892-023-01498-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE OF REVIEW Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain. RECENT FINDINGS Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy. Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.
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Affiliation(s)
- Sabrena F Noria
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University, N718 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA.
| | - Rita D Shelby
- Department of Plastic and Reconstructive Surgery, University of Miami, Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Katelyn D Atkins
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA, 70808, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine, 3800 W Chapman Ave, Orange, CA, 92868, USA
| | - Kishore M Gadde
- Department of Surgery, University of California Irvine, 3800 W Chapman Ave, Orange, CA, 92868, USA
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9
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Decreased Weight Loss Following Bariatric Surgery in Patients with Type 2 Diabetes. Obes Surg 2023; 33:179-187. [PMID: 36322345 PMCID: PMC9834097 DOI: 10.1007/s11695-022-06350-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bariatric surgery represents the most effective treatment for achieving significant and sustained weight loss. We aimed to assess whether presence of type 2 diabetes (T2D) at baseline, and T2D remission following bariatric surgery affect the weight loss outcome. METHODS Data of 312 consecutive morbidly obese subjects who underwent bariatric surgery were analysed. Patients underwent either RYGB (77%), or sleeve gastrectomy (23%), and their body weight was followed-up for 1, 2, 3, 4, and 5 years at regular ambulatory visits (N = 269, 312, 210, 151, 105, at each year, respectively). T2D remission was assessed according to the ADA criteria. RESULTS In the whole dataset, 92 patients were affected by T2D. Patients with T2D were older than patients without T2D (52 ± 9 vs 45 ± 11 years, p < 0.0001), but there were no differences in baseline BMI, sex, and type of intervention received. We found that presence of T2D at baseline was associated with smaller weight loss at 1, 2, 3, 4, and 5 years following bariatric surgery (δ BMI at 2 years: - 13.7 [7.7] vs - 16.4 [7.3] kg/m2; at 5 years - 12.9 [8.8] vs - 16.3 [8.7] kg/m2 in patients with T2D vs patients without T2D respectively, all p < 0.05). When dividing the patients with T2D in remitters and non-remitters, non-remitters had significantly smaller weight loss compared to remitters (δ BMI at 2 years: - 11.8 [6.3] vs - 15.4 [7.8] kg/m2; at 5 years: - 8.0 [7.1] vs - 15.0 [7.2] kg/m2, non-remitters vs remitters respectively, all p < 0.05). CONCLUSIONS T2D is independently associated to smaller weight loss following bariatric surgery, especially in subjects not achieving diabetes remission. • Patients with T2D achieve smaller weight loss following bariatric surgery • When dividing the T2D patients in remitters and non-remitters, non-remitters achieve significantly smaller weight loss compared to remitters.
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10
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Richter LR, Albert BI, Zhang L, Ostropolets A, Zitsman JL, Fennoy I, Albers DJ, Hripcsak G. Data assimilation on mechanistic models of glucose metabolism predicts glycemic states in adolescents following bariatric surgery. Front Physiol 2022; 13:923704. [PMID: 36518108 PMCID: PMC9744230 DOI: 10.3389/fphys.2022.923704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Type 2 diabetes mellitus is a complex and under-treated disorder closely intertwined with obesity. Adolescents with severe obesity and type 2 diabetes have a more aggressive disease compared to adults, with a rapid decline in pancreatic β cell function and increased incidence of comorbidities. Given the relative paucity of pharmacotherapies, bariatric surgery has become increasingly used as a therapeutic option. However, subsets of this population have sub-optimal outcomes with either inadequate weight loss or little improvement in disease. Predicting which patients will benefit from surgery is a difficult task and detailed physiological characteristics of patients who do not respond to treatment are generally unknown. Identifying physiological predictors of surgical response therefore has the potential to reveal both novel phenotypes of disease as well as therapeutic targets. We leverage data assimilation paired with mechanistic models of glucose metabolism to estimate pre-operative physiological states of bariatric surgery patients, thereby identifying latent phenotypes of impaired glucose metabolism. Specifically, maximal insulin secretion capacity, σ, and insulin sensitivity, SI, differentiate aberrations in glucose metabolism underlying an individual's disease. Using multivariable logistic regression, we combine clinical data with data assimilation to predict post-operative glycemic outcomes at 12 months. Models using data assimilation sans insulin had comparable performance to models using oral glucose tolerance test glucose and insulin. Our best performing models used data assimilation and had an area under the receiver operating characteristic curve of 0.77 (95% confidence interval 0.7665, 0.7734) and mean average precision of 0.6258 (0.6206, 0.6311). We show that data assimilation extracts knowledge from mechanistic models of glucose metabolism to infer future glycemic states from limited clinical data. This method can provide a pathway to predict long-term, post-surgical glycemic states by estimating the contributions of insulin resistance and limitations of insulin secretion to pre-operative glucose metabolism.
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Affiliation(s)
- Lauren R. Richter
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Benjamin I. Albert
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Linying Zhang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Jeffrey L. Zitsman
- Division of Pediatric Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Metabolism, and Diabetes, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - David J. Albers
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States,Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States,*Correspondence: George Hripcsak,
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11
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Pajares L, Seguí J, Alguacil L. A History of Adjustment Disorder Predicts Greater Weight Loss After Sleeve Gastrectomy. Surg Obes Relat Dis 2022; 18:1269-1276. [DOI: 10.1016/j.soard.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022]
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12
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Coleman KJ, Paz SR, Bhakta BB, Taylor B, Liu J, Yoon TK, Macias M, Arterburn DE, Crawford CL, Drewnowksi A, Figueroa Gray MS, Hansell LD, Ji M, Lewis KH, Moore DD, Murali SB, Young DR. Cohort profile: The Bariatric Experience Long Term (BELONG): a long-term prospective study to understand the psychosocial, environmental, health and behavioural predictors of weight loss and regain in patients who have bariatric surgery. BMJ Open 2022; 12:e059611. [PMID: 35613770 PMCID: PMC9125764 DOI: 10.1136/bmjopen-2021-059611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The Bariatric Experience Long Term (BELONG) prospective study cohort was created to address limitations in the literature regarding the relationship between surgical weight loss and psychosocial, health, behaviour and environmental factors. The BELONG cohort is unique because it contains 70% gastric sleeve and 64% patients with non-white race/ethnicity and was developed with strong stakeholder engagement including patients and providers. PARTICIPANTS The BELONG cohort study included 1975 patients preparing to have bariatric surgery who completed a baseline survey in a large integrated health system in Southern California. Patients were primarily women (84%), either black or Hispanic (59%), with a body mass index (BMI) of 45.1±7.4 kg/m2, age 43.3±11.5 years old, and 32% had at least one comorbidity. FINDINGS TO DATE A total of 5552 patients were approached before surgery between February 2016 and May 2017, and 1975 (42%) completed a baseline survey. A total of 1203 (73%) patients completed the year 1 and 1033 (74%) patients completed the year 3 postoperative survey. Of these survey respondents, 1341 at baseline, 999 at year 1, and 951 at year 3 were included in the analyses of all survey and weight outcome data. A total of 803 (60% of eligible patients) had survey data for all time points. Data collected were self-reported constructs to support the proposed theoretical model. Height, weight and BMI were abstracted from the electronic medical record to obtain the main outcomes of the study: weight loss and regain. FUTURE PLANS We will collect self-reported constructs and obtain height, weight and BMI from the electronic medical record 5 years after bariatric surgery between April 2022 and January 2023. We will also collect patient experiences using focus groups of 8-12 patients each throughout 2022.
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Affiliation(s)
- Karen J Coleman
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Silvia R Paz
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bhumi B Bhakta
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Brianna Taylor
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jialuo Liu
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Tae K Yoon
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Mayra Macias
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - David E Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Cecelia L Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Adam Drewnowksi
- Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| | | | - Laurel D Hansell
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Kristina H Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Darren D Moore
- Marriage and Family Therapy Program, The Family Institute, Northwestern University, Evanston, Illinois, USA
| | - Sameer B Murali
- Center for Obesity Medicine & Metabolic Performance, Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Deborah R Young
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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13
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Appetite Changes in Weight Regain and Weight Maintenance After Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:1-12. [PMID: 35441332 DOI: 10.1007/s11695-022-06061-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) surgery produces significant weight loss. However, a number of patients experience weight regain years after surgery. Factors driving weight regain after surgical interventions are currently being explored. Our objective was to investigate appetite-related measures associated with weight regain after RYGB surgery. MATERIALS AND METHODS Using a cross-sectional design, 29 participants (49.6 ± 9.1 years of age; current BMI 32.4 ± 4.7 kg/m2, 43.6 ± 8.9 months post-RYGB) were stratified into tertiles according to weight regain per month after nadir (weight maintenance (WM), n = 9; low weight regain (LWR), n = 10; and high weight regain (HWR), n = 10). The average weight regain was, by design, significantly different between the groups (WM = 2.2 ± 2.5 kg; LWR = 10.0 ± 3.4 kg; HWR = 14.9 ± 6.3 kg regained, p < 0.05). Appetite (visual analog scales), olfactory performance ("sniffin sticks"), eating behaviors (Three Factor Eating Questionnaire), food reward (Leeds Food Preference Questionnaire), and appetite-related hormones (ghrelin, PYY, GLP-1 and leptin) were measured fasting and in response to a standardized test meal. RESULTS Dietary restraint was significantly higher than clinical cutoffs in WM and LWR (p < 0.05). As expected, significant time effects were noted for ghrelin, PYY, and GLP-1, but there were no group differences. CONCLUSION The results suggest that appetite-related outcomes are similar across individuals who have maintained weight loss and experienced regain following RYGB.
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14
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Can We Benefit from the Preoperative Psychometric Test with Symptom Checklist-90-Revised (SCL-90-R) to Predict Weight Loss After Sleeve Gastrectomy? Obes Surg 2022; 32:1531-1538. [PMID: 35146601 DOI: 10.1007/s11695-022-05951-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The psychological assessment is crucial before bariatric surgery. Derogatis' Symptom Checklist-90-Revised (SCL-90-R) is one of the most widely used measures of psychological symptoms and distress in both clinical and research settings. We aimed to investigate the predictive value of SCL-90-R subscale scores on postoperative excess weight loss percentage (EWLP) after laparoscopic sleeve gastrectomy (LSG). METHODS Patients who underwent primary LSG for morbid obesity and fully completed preoperative SCL-90-R between January 2016 and July 2019 were retrospectively examined. A multiple linear regression analysis was performed to investigate the relationship between descriptive and psychological variables associated with EWLP percentage at the 12th-month. RESULTS One hundred six patients who met the inclusion criteria were analyzed. The adequate weight loss (EWLP ˃ 50%) was achieved in 90% of patients after 12 months. The multiple linear regression analysis indicated that younger patients (β = - 0.695; 95% CI - 1.056, - 0.333; p < 0.001), and patients with preoperative lower BMI (β = - 1.524; 95% CI - 1.974, - 1.075; p < 0.001) achieved higher EWLP at 12th-month. High somatization score (β = 11.975; 95% CI 3.653, 20.296; p = 0.005) and a low Global Severity Index (GSI) score (β = - 24.276; 95% CI - 41.457, - 7.095; p = 0.006) had a positive effect on EWLP at 12th-month. CONCLUSIONS Preoperative psychological testing can help predict surgical outcomes in the bariatric population. More intense lifestyle and behavioral support can be applied by targeting patients who are expected to lose less weight after surgery, and patients' weight loss potential can be increased.
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15
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Li N, Xu B, Zeng J, Lei S, Gu L, Feng L, Zhu B, Huang Y, Wang L, Su L, Qu S, Cheng X, Bu L. Development of a New Index Based on Preoperative Serum Lipocalin 2 to Predict Post-LSG Weight Reduction. Obes Surg 2022; 32:1184-1192. [PMID: 35138515 PMCID: PMC8933383 DOI: 10.1007/s11695-022-05916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/03/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
Background Bariatric surgery is the most effective therapy for obesity, but targeted weight reduction is not always achieved. Serum lipocalin-2 (LCN2) is closely associated with obesity, but its impact on weight loss after surgery is unknown. We aimed to access the reliability of LCN2 levels and other parameters as effective predictors of excellent weight loss (≥ 75% excess weight loss (EWL)) 1 year after bariatric surgery. Methods This retrospective study evaluated 450 patients (aged 18–65 years) with obesity at 3 months and 1 year after laparoscopic sleeve gastrectomy (LSG) surgery. Seventy-four patients who underwent LSG surgery and met the inclusion and exclusion criteria were included in this study. Serum LCN2, thyroid function, and metabolic and anthropometric parameters were assessed. Weight reduction was expressed as %EWL and percent total weight loss (%TWL) at 3 months and 1 year post surgery. Multivariable logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to evaluate predictors of ≥ 75%EWL. Results In our cohort, %EWL and %TWL were both strongly associated with preoperative serum LCN2 levels. The binary logistic regression analysis showed that preoperative LCN2, waist circumference, and glycated hemoglobin were independent predictors of excellent weight loss. Conclusions Based on these results, we determined a new P index with better predictive value for excellent weight reduction (≥ 75%EWL) 1 year after LSG surgery. Graphical abstract ![]()
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Affiliation(s)
- Nannan Li
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Bei Xu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Jiangping Zeng
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Shihui Lei
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Lei Gu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Lijin Feng
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Bing Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Yueye Huang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Lu Wang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Lili Su
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Xiaoyun Cheng
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.
| | - Le Bu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China.
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16
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Lodewijks Y, Akpinar E, van Montfort G, Nienhuijs S. Impact of Preoperative Weight Loss on Postoperative Weight Loss Revealed from a Large Nationwide Quality Registry. Obes Surg 2022; 32:26-32. [PMID: 34713382 DOI: 10.1007/s11695-021-05760-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Weight loss before bariatric surgery is not mandatory, but questions remain as to whether preoperative weight loss has an impact on weight loss after surgery. Most studies have small sample sizes. The objective was to evaluate the relationship between preoperative and successful postoperative weight loss defined as ≥25% total weight loss (TWL) at 1 and 2 years after primary bariatric surgery with regard to the obesity-related comorbidities. MATERIALS AND METHODS Data were extracted from a large nationwide quality registry of patients who underwent a sleeve gastrectomy (SG) or gastric bypass (GBP) between January 2015 and January 2018. Patients with completed screening and preoperative and postoperative data were included. A multivariate logistic regression analysis was performed for each technique and follow-up years separately. RESULTS In total, 8751 were included in the analysis. Patients with preoperative weight loss were more likely to achieve ≥25% postoperative TWL in both procedures. Patients with higher preoperative weight loss of 5-10% had an increased likelihood for achieving 25% TWL compared to 0-5%, OR 1.79 (CI (1.42-2.25), p < 0.001) vs 1.25 (CI (1.08-1.46), p < 0.004) for the GBP group for year 2 postoperative. This was the same for the SG group at year 2, OR 1.30 (CI (1.03-1.64), p < 0.029) vs 1.14 (CI (0.94-1.38), p < 0.198). CONCLUSION Patients with preoperative weight loss were more likely to achieve ≥25% postoperative TWL at 1 and 2 years after surgery in both procedures; moreover, the extent of preoperative weight loss contributes to the significance and odds of this success.
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Affiliation(s)
- Yentl Lodewijks
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Erman Akpinar
- Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333, AA, Leiden, The Netherlands
| | - Gust van Montfort
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Simon Nienhuijs
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Qureshi FG, Wiegand JG, O'Neill G, Allen B, Wools G, Klement J, Franklin EV, Messiah SE, Gupta OT. Longitudinal Outcomes in Adolescents After Referral for Metabolic and Bariatric Surgery. J Pediatr Gastroenterol Nutr 2021; 73:677-683. [PMID: 34433784 DOI: 10.1097/mpg.0000000000003290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) can be a well tolerated and effective treatment option for severe obesity in adolescents. We compared outcomes for adolescents that did and did not proceed to surgery. METHODS A single-center longitudinal study (2015-2020). Patients were identified as LSG if they completed laparoscopic sleeve gastrectomy within 6 months of initial visit and NoLSG if they did not. Chi-square, Fisher exact, nonparametric Kruskal-Wallis tests, and Linear Mixed Models (LMM) were used to compare outcomes over 2 years. RESULTS Three hundred fifty-two adolescents were referred with a mean age of 15.6 ± 1.4, 69% girls, 38% Hispanic, and 78% had noncommercial insurance. The median baseline weight was 135 kg and body mass index (BMI) was 48 kg/m2; 42% had a BMI >50. Seventy-nine (22%) underwent LSG whereas 273 (78%) did not complete MBS primarily because of lack of interest. LSG patients had 21% total weight loss and 22% total BMI loss at 24 months whereas NoLSG patients had 4% total weight gain and 3% BMI gain (P < 0.01). Obesity-associated conditions improved in the LSG group (P < 0.01). Follow-up in both groups was poor (≤30% at 24 months). Patients with public insurance and those with BMI from 50 to 59.9 kg/m2 were high performing LSG patients. CONCLUSIONS A minority (22%) of adolescents referred for MBS proceeded to surgery, despite its demonstrated efficacy and safety in adolescence. Those that did not undergo surgery continued to gain weight. Further research is needed to understand patient preferences or concerns related to MBS utilization during adolescence.
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Affiliation(s)
- Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center
- Childrens Health System of Texas
| | - Jared G Wiegand
- University of Texas Health Science Center, School of Public Health, Dallas
| | | | | | | | | | | | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas
| | - Olga T Gupta
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
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El Moussaoui I, Van Vyve E, Johanet H, Dabrowski A, Piquard A, Delaunay T, Navez B, Hauters P, Sirisier F, Loi P, Closset J. Laparoscopic sleeve gastrectomy for morbid obesity in a Belgian-French prospective multicenter study: outcomes and predictors weight loss failure. Acta Chir Belg 2021; 121:413-419. [PMID: 33086992 DOI: 10.1080/00015458.2020.1841485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) became the most frequently performed bariatric procedure worldwide, gaining rapidly popularity thanks to its technical simplicity and the relatively good results. The aim of this Belgian-French study was to evaluate postoperative complications, weight loss, and resolution of obesity-related comorbidities after LSG, and identify predictive factors of weight loss failure. PATIENTS AND METHODS A prospective multicenter study was conducted on all LSG performed during 2014 in 7 centers. Their demographic, preoperative, and postoperative data were prospectively collected and analyzed statistically. RESULTS Overall 529 patients underwent LSG, with a mean preoperative weight and body mass index (BMI) of 118.9 ± 19.9 kg and 42.9 ± 5.5 kg/m2, respectively. Postoperative mortality was null and early postoperative morbidity was 6%, including 2.5% of gastric leakage. BMI significantly decreased to 31.1 kg/m2 and 30.0 kg/m2 at 1 and 3 years, respectively (p < .001). The mean %EWL was 77.2 and 74.6% at 1 and 3 years. A significant reduction in dyslipidemia (28.0-16.8%), obstructive sleep apnea (OSAS) (34.6-23.3%) and arterial hypertension (HTN) (30.4-20.2%) was observed after 3 years, but it does not concern diabetes and gastroesophageal reflux disease (GERD). At multivariate analysis, age > 50 years old, BMI >50 kg/m2 and previous laparoscopic adjustable gastric banding (LAGB) remained independent predictors of weight loss failure. CONCLUSIONS LSG for morbid obesity is safe and effective. Satisfactory outcome after 3 years can be achieved regarding %EWL and some comorbidities such as dyslipidemia, OSAS, and HTN, but not diabetes and GERD. Age > 50 years old, BMI > 50 kg/m2 and previous LAGB were independent predictors of weight loss failure.
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Affiliation(s)
| | | | | | | | | | | | - Benoît Navez
- Cliniques universitaires Saint Luc, Brussels, Belgium
| | | | | | - Patrizia Loi
- Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | - Jean Closset
- Erasmus Hospital, Free University of Brussels, Brussels, Belgium
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Athanasiadis DI, Hernandez E, Monfared S, Kubicki N, Ninad N, Karim A, Selzer D, Stefanidis D, Banerjee A. Bariatric surgery outcomes: is age just a number? Surg Endosc 2021; 35:3139-3146. [PMID: 32601760 DOI: 10.1007/s00464-020-07752-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Obesity and its associated comorbidities represent a pervasive problem in the United States across all age groups. There are conflicting data regarding the effectiveness and postoperative recovery of bariatric surgery in elderly patients. The aim of this study was to compare outcomes of bariatric surgery across age groups. MATERIALS AND METHODS After obtaining institutional review board approval, patients with morbid obesity who underwent non-revisional laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) at our institution between 2011 and 2015 were included in this retrospective study. Patients were subdivided into five age groups: < 30, 30-39, 40-49, 50-59, and ≥ 60 years. Patient baseline demographics and comorbidities were collected. Postoperative outcomes including reinterventions/reoperations, 30-day-readmissions, 90-day-mortality, comorbidities' resolution, and change in BMI (ΔBMI) up to 4 years were recorded and compared. The groups were compared with ANOVA and chi-square tests and multivariable analyses. RESULTS LRYGB was performed in 74.7% of the 1026 study patients. Patients ≥ 60 years old demonstrated lower preoperative BMI than patients < 50 years (p < 0.001). Patients 50-59 years old had increased length of stay compared to 30-39 (p = 0.003) and a higher prevalence of all comorbidities was found in older patients (p < 0.001). There was no significant difference in 30-day-readmissions; 90-day-mortality; reoperations; and reinterventions among the study groups. The ΔBMI was higher in younger patients and comorbidity resolution was more likely in younger patients with the exception of obstructive sleep apnea. CONCLUSION Bariatric surgery can be accomplished safely across all age groups with satisfiable postoperative weight loss. However, older age had higher hospital stay and convalescence and lower comorbidity resolution compared to younger patients. Thus, bariatric surgery should be offered earlier in life to allow the patients to reap its benefits.
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Affiliation(s)
- Dimitrios I Athanasiadis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
| | - Edward Hernandez
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
| | - Sara Monfared
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
| | - Natalia Kubicki
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, University of Maryland Medical Systems, Baltimore, MD, USA
| | - Nehal Ninad
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amani Karim
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Don Selzer
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
- Indiana University Health North Hospital, Indianapolis, IN, USA
| | - Dimitrios Stefanidis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA
- Indiana University Health North Hospital, Indianapolis, IN, USA
| | - Ambar Banerjee
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine Indiana, 11725 N Illinois St, Suite 350, Carmel, Indianapolis, IN, 46032, USA.
- Indiana University Health North Hospital, Indianapolis, IN, USA.
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20
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Zetu C, Popa S, Munteanu R. Postbariatric Surgery Hypoglycemia and Nutritional Deficiencies: Long-Term Follow-Up. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cornelia Zetu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy “Carol Davila,” Bucharest, Romania
| | - Simona Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Rubin Munteanu
- Department of Surgery, Euroclinic-Regina Maria Hospital Bucharest, Bucharest, Romania
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21
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Zetu C, Popa S, Golli AL, Condurache A, Munteanu R. Long-term improvement of dyslipidaemia, hyperuricemia and metabolic syndrome in patients undergoing laparoscopic sleeve gastrectomy. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:704-709. [PMID: 34033279 PMCID: PMC10528615 DOI: 10.20945/2359-3997000000273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to assess the long-term impact of laparoscopic sleeve gastrectomy (LSG) on lipid profile, uric acid level and metabolic syndrome. METHODS A prospective study was performed between 2009-2014, evaluating long-term percentage of excesso body mass index loss (%EBMIL), lipid profile, uric acid level and metabolic syndrome. RESULTS Overall sixty subjects were followed-up. %EBMIL increased significantly, reaching a maximum (86,9 ± 6,3%) at 5 years post-LSG. Therapeutic success rate (%EBMIL ≥ 60%) was 80% at 5 years. The triglyceride level decreased significantly (148 ± 72.1 mg/dL baseline vs 130.7 ± 57.5 mg/dL at 1 month vs 110.7 ± 42.6 mg/dL at 3 months vs 92.5 ± 35.2 mg/dL at 1 year vs 84.2 ± 32.3 mg/dL at 5 years; p < 0.05 for all). HDL-cholesterol increased and uric acid decreased significantly in the first year postoperatively, remaining stable afterwards (46.9 ± 12.3 mg/dL baseline vs 47.4 ± 10 mg/dL at 1 month vs 49.8 ± 9.3 mg/dL at 3 months vs 55.4 ± 10.2 mg/dL at 1 year; p < 0.05 for all for HDL-cholesterol and 6.4 ± 2 mg/dL baseline vs 6 ± 1.7 mg/dL at 1 month vs 5.2 ± 1.3 mg/dL at 3 months vs 4.8 ± 1 mg/dL at 1 year; p < 0.05 for all for uric acid). The prevalence of metabolic syndrome decreased from 66.7% baseline to 8.3% at 5 years postoperatively (p < 0.01). CONCLUSION LSG was effective in terms of %EBMIL and metabolic traits improvement for Romanian patients.
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Affiliation(s)
- Cornelia Zetu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Simona Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, Craiova, Romania,
| | - Andreea-Loredana Golli
- Department of Public Health and Healthcare Management, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Ancuta Condurache
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Rubin Munteanu
- Department of Surgery, Euroclinic - Regina Maria Hospital Bucharest, Bucharest, Romania
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22
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Coleman KJ, Schlundt DG, Bonnet KR, Holmquist KJ, Dunne J, Crull E, Hanaoka BY, Lent MR, Nadglowski J, Sylvia L, Venkatachalam S, Xanthakos SA, Zeiger R, Arterburn D, Williams N, Courcoulas A, Anau J, McTigue KM, Blalock C, Malanga E, McClay J, McBride CL, Schlundt D, Emiliano A, Nemr R, McTigue K, Courcoulas A, Xanthakos SA, Michalsky M, Coleman KJ, Murali S, Tavakkoli A, Desai N, Apovian C, Clark J, Nauman E, Cirielli E, Nadglowski J, St Clair T, Tice J, Vitello J, Zeiger R, Arterburn D, Anau J, Janning C, Williams N. Understanding the Bariatric Patient Perspective in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study. Obes Surg 2021; 30:1837-1847. [PMID: 31965490 DOI: 10.1007/s11695-020-04404-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2016, the Patient-Centered Outcomes Research Institute funded the National Patient Centered Clinical Research Network (PCORnet) Bariatric Study (PBS). Understanding the experience of postoperative patients was a key component of this study. METHODS Nine focus groups were conducted in Southern California, Louisiana, Pennsylvania, and Ohio and in a national advocacy conference for patients with obesity. Participants were identified and recruited in both clinical and community settings. Focus group transcripts were analyzed using an iterative inductive-deductive approach to identify global overarching themes. RESULTS There were 76 focus group participants. Participants were mostly women (81.4%), had primarily undergone gastric sleeve (47.0%), were non-Hispanic white (51.4%), had some college education (44.3%), and made $100,000 annual income or less (65.7%). Qualitative findings included negative reactions patients received from friends, family, and co-workers once they disclosed that they had bariatric surgery to lose weight; and barriers to follow-up care included insurance coverage, emotional and situational challenges, and physical pain limiting mobility. CONCLUSIONS These findings confirm the other qualitative findings in this area. The approach to bariatric surgery should be expanded to provide long-term comprehensive care that includes in-depth postoperative lifetime monitoring of emotional and physical health.
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Affiliation(s)
- Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
| | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Kimberly J Holmquist
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | | | - Michelle R Lent
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | | | - Louisa Sylvia
- Massachusetts General Hospital, Boston, MA and Harvard Medical School, Cambridge, MA, USA
| | | | | | | | - David Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | | | | | - Jane Anau
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | | | - Cynthia Blalock
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Elisha Malanga
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - James McClay
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Corrigan L McBride
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Ana Emiliano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Rabih Nemr
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | | | - Marc Michalsky
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Sameer Murali
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ali Tavakkoli
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Nirav Desai
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Caroline Apovian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jeanne Clark
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Elizabeth Nauman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Elizabeth Cirielli
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Tammy St Clair
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Julie Tice
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Joseph Vitello
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - David Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Jane Anau
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Cheri Janning
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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23
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Barzin M, Mousapour P, Khalaj A, Mahdavi M, Valizadeh M, Hosseinpanah F. The Relationship Between Preoperative Kidney Function and Weight Loss After Bariatric Surgery in Patients with Estimated Glomerular Filtration Rate ≥ 30 mL/min: Tehran Obesity Treatment Study. Obes Surg 2021; 30:1859-1865. [PMID: 31953746 DOI: 10.1007/s11695-020-04407-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Severe obesity can lead to progressive kidney injury and chronic kidney disease (CKD). The current study aimed at determining whether preoperative kidney function level in patients with estimated glomerular filtration rate (eGFR) ≥30 mL/min affects weight loss after bariatric surgery. METHODS A total of 1958 bariatric patients underwent laparoscopic sleeve gastrectomy and gastric bypass from March 2013 to March 2017. The patients were categorized according to preoperative eGFR (30-59, 60-89, 90-124, and ≥ 125 mL/min). Changes in body mass index (BMI), percentage of total weight loss (TWL%), and percentage of excess weight loss (EWL%) were compared across the eGFR categories. Moreover, multivariable logistic regression analysis was used to evaluate the relationship between eGFR and insufficient weight loss (defined as not achieving 50% EWL at 12 months after surgery). RESULTS Preoperative eGFR was positively associated with unadjusted ΔBMI (P trend < 0.001), TWL% (P trend < 0.001), and EWL% (P trend = 0.007) after 12 months of surgery. However, these associations were no longer significant after multivariable adjustment. Further, univariate analysis demonstrated a positive relationship between preoperative eGFR and insufficient weight loss (odds ratio [OR] 1.38; 95% confidence interval [CI] 1.11-1.71; P = 0.004). By contrast, preoperative eGFR was not a predictor of insufficient weight loss in multivariable logistic regression analysis (OR 0.98; 95% CI 0.46-1.24; P = 0.886). CONCLUSION Although patients with lower preoperative eGFR experience less weight loss after bariatric surgery, preoperative kidney function does not appear to have an independent impact on postoperative weight loss in patients with eGFR ≥ 30 mL/min.
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Affiliation(s)
- Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pouria Mousapour
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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24
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Yang PJ, Chen CL, Chen CN, Lin MT, Wang W. Early weight loss as a predictor of 3-year weight loss and weight regain in patients with good compliance after sleeve gastrectomy. Surg Obes Relat Dis 2021; 17:1418-1423. [PMID: 33962874 DOI: 10.1016/j.soard.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/12/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most common surgery for severe obesity. Patients lose weight post SG and regain some weight in the following years. Early weight loss predicts weight loss after SG. However, etiologies of weight loss and regain after SG remain unclear. OBJECTIVES To investigate the effects of early weight loss on medium-term weight regain post SG. SETTING Two university hospitals in Taiwan. METHODS Patients with records within 1 and at 3 years after SG were enrolled retrospectively. Preoperative clinical variables and percentage of total weight loss (%TWL) were analyzed. Weight regain was defined as a weight increase from 1 year postoperatively of >25% of the lost weight. Linear and multiple logistic regression were applied to examine the associations of early weight loss, weight loss, and weight regain. RESULTS A total of 363 patients were included. Body mass indexes before and 1, 3, 6, 12, and 36 months postoperatively were 40.7 ± 6.8 kg/m2, 36.6 ± 6.2 kg/m2, 33.5 ± 5.8 kg/m2, 30.9 ± 5.5 kg/m2, 28.4 ± 5.2, and 29.3 ± 5.4 kg/m2, respectively. At 3 years after SG, 73 patients (20.1%) had weight regain. In multivariate linear analyses, initial age, waist circumference, type 2 diabetes, and %TWL at 1 or 3 months were associated with either 1-year or 3-year %TWL. Multiple logistic regression revealed %TWL at 3 months to be a predictor for 3-year weight regain after SG (odds ratio, .927; P = .02). CONCLUSION Early weight loss predicted weight loss and regain 3 years after SG. Early lifestyle and behavioral interventions are suggested in patients at high risk of poor weight loss and weight regain outcomes after SG.
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Affiliation(s)
- Po-Jen Yang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Center for Obesity, Life Style, and Metabolic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Ling Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chiung-Nien Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Center for Obesity, Life Style, and Metabolic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Weu Wang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
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25
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El Moussaoui I, Van Vyve E, Johanet H, Dabrowski A, Piquard A, Delaunay T, Navez B, Hauters P, Sirisier F, Loi P, Closset J. Five-year Outcomes of Sleeve Gastrectomy: A Prospective Multicenter study. Am Surg 2021; 88:1224-1229. [PMID: 33605784 DOI: 10.1177/0003134821991984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure in the world. Our purpose was to evaluate the percentage of excess weight loss (%EWL), resolution of obesity-related comorbidities after SG, and identify predictive factors of weight loss failure. METHODS A prospective cohort study of adults who underwent SG during 2014 in 7 Belgian-French centers. Their demographic, preoperative, and postoperative data were prospectively collected and analyzed statistically. RESULTS Overall, 529 patients underwent SG, with a mean preoperative weight and body mass index (BMI) of 118.9 ± 19.9 kg and 42.9 ± 5.5 kg/m2, respectively. Body mass index significantly decreased to 32.2 kg/m2 at 5 years (P < .001). The mean %EWL was 63.6% at 5 years. A significant reduction in dyslipidemia (28.0%-18.2%), obstructive sleep apnea (OSAS) (34.6%-25.1%), and arterial hypertension (HTN) (30.4%-21.5%) was observed after 5 years, but not for diabetes and gastroesophageal reflux disease (GERD). At multivariate analysis, age >50 years old, BMI >50 kg/m2, and previous laparoscopic adjustable gastric banding (LAGB) remained independent predictors of weight loss failure. CONCLUSIONS Five years after SG, weight loss was satisfactory; the reduction of comorbidities was significant for dyslipidemia, OSAS, and HTN, but not diabetes and GERD. Age >50 years old, BMI >50 kg/m2, and previous LAGB were independent predictors of weight loss failure.
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Affiliation(s)
- Imad El Moussaoui
- 70496Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | | | | | | | | | | | - Benoît Navez
- 70492Cliniques Universitaires Saint Luc, Brussels, Belgium
| | | | | | - Patrizia Loi
- 70496Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | - Jean Closset
- 70496Erasmus Hospital, Free University of Brussels, Brussels, Belgium
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26
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Gerken ALH, Rohr-Kräutle KK, Weiss C, Seyfried S, Reissfelder C, Vassilev G, Otto M. Handgrip Strength and Phase Angle Predict Outcome After Bariatric Surgery. Obes Surg 2021; 31:200-206. [PMID: 32803706 PMCID: PMC7808965 DOI: 10.1007/s11695-020-04869-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The amount of postoperative weight loss after bariatric surgery varies interindividually. The quality of the pre- and postoperative body composition is an important predictor of success. The aim of this study was to investigate the role of preoperative handgrip strength and phase angle (PhA) as predictors of sustained postoperative weight loss in order to assess the influence of body composition on the postoperative outcome after bariatric surgery. METHOD In a prospective cohort study, bioelectrical impedance and follow-up data of 198 patients after laparoscopic sleeve gastrectomy (SG; n = 68) and Roux-en-Y gastric bypass (GB; n = 130) were analyzed for a period of 36 months postoperatively. RESULTS The mean preoperative handgrip strength (31.48 kg, SD 9.97) correlates significantly with the postoperative body composition up to 24 months after surgery. Preoperative PhA, gender, size, and body weight influenced postoperative weight loss significantly. A significant correlation between preoperative PhA (mean 6.18°, SD 0.89°) and total weight loss (%TWL) was observed up to 3 months after SG (r = 0.31444, p = 0.0218) and up to 12 months after GB (r = 0.19184, p = 0.0467). The optimum cutoff for the prediction of a response of less than 50% excess weight loss was a preoperative PhA of 6.0°. CONCLUSIONS The preoperative handgrip strength confirmed its suitability for use as a predictor of postoperative body composition, whereas the preoperative PhA predicts postoperative weight loss after bariatric surgery. Further research is necessary to identify the role of these parameters for preconditioning.
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Affiliation(s)
- A L H Gerken
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - K-K Rohr-Kräutle
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - C Weiss
- Department of Biometry and Statistics, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - S Seyfried
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - C Reissfelder
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - G Vassilev
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M Otto
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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27
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Vennapusa A, Panchangam RB, Kesara C, Chivukula T. Response: Factors Predicting Weight Loss after "Sleeve Gastrectomy with Loop Duodenojejunal Bypass" Surgery for Obesity (J Obes Metab Syndr 2020;29:208-14). J Obes Metab Syndr 2020; 29:327-329. [PMID: 33380578 PMCID: PMC7789021 DOI: 10.7570/jomes20132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Amar Vennapusa
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
| | | | - Charita Kesara
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
| | - Tejaswi Chivukula
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
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Patel K, Askari A, Mamidanna R, Jain V, Adil T. Long-term BAROS scores and independent obesity-related co-morbidity predictors of failure after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2020; 16:1954-1960. [PMID: 32958371 DOI: 10.1016/j.soard.2020.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/05/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term (>5 yr) studies assessing outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) using the Bariatric Analysis and Reporting Outcome System (BAROS) are limited. Evidence of predictors of failure long-term after LRYGB is also lacking. OBJECTIVES To compare BAROS scores at 5 and 10 years post LRYGB and to establish whether individual obesity-related co-morbidities are associated with suboptimal outcomes at these time points. SETTING Single bariatric unit. METHODS BAROS scores were analyzed in patients who were 5 years (group A) and 10 years (group B) post LRYGB. Obesity-related co-morbidities as predictors of failure of surgery (defined by % excess weight loss [%EWL] <50% or BAROS total score ≤1) were examined. Intergroup comparative analysis of outcomes and logistic regression modeling to determine predictors of weight loss failure were conducted. RESULTS A total of 88 patients were 5 years post LRYGB (group A), and 91 patients were 10 years post LRYGB (group B). A total of 52.3% (46/88) in group A and 54.9% (50/91) in group B had failure of weight loss defined by %EWL <50%. There were no significant differences in percentage of total weight loss, %EWL, or BAROS scores between the 2 groups (21.8% versus 22.0%, P = .897; 48.5% versus 47.1%, P = .993; and 3.7 versus 3.3, P = .332, respectively). No individual obesity-related co-morbidity at time of surgery was associated with suboptimal outcomes (%EWL <50% or BAROS total score ≤1) at 5 years or 10 years after LRYGB. CONCLUSIONS Long-term outcomes assessed by the BAROS score appear sustainable between 5 and 10 years after LRYGB surgery, and weight loss achieved at 5 years is maintained at 10 years. Preoperative presence of specific obesity-related co-morbidities was not associated with failure of surgery long-term.
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Affiliation(s)
- Krashna Patel
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom.
| | - Alan Askari
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Ravikrishna Mamidanna
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Vigyan Jain
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Tanveer Adil
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
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Stenberg E, Mohseni S, Cao Y, Näslund E. Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery. Obes Surg 2020; 30:139-145. [PMID: 31346982 DOI: 10.1007/s11695-019-04108-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery. METHODS Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss. RESULTS In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002). CONCLUSIONS Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden.
| | - Shahin Mohseni
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery. Int J Obes (Lond) 2020; 44:2279-2290. [PMID: 32651450 PMCID: PMC7577856 DOI: 10.1038/s41366-020-0637-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/04/2020] [Accepted: 07/01/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Patients with low socioeconomic status have been reported to have poorer outcome than those with a high socioeconomic status after several types of surgery. The influence of socioeconomic factors on weight loss after bariatric surgery remains unclear. The aim of the present study was to evaluate the association between socioeconomic factors and postoperative weight loss. MATERIALS AND METHODS This was a retrospective, nationwide cohort study with 5-year follow-up data for 13,275 patients operated with primary gastric bypass in Sweden between January 2007 and December 2012 (n = 13,275), linking data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, the Swedish National Patient Register, and the Swedish Prescribed Drugs Register. The assessed socioeconomic variables were education, profession, disposable income, place of residence, marital status, financial aid and heritage. The main outcome was weight loss 5 years after surgery, measured as total weight loss (TWL). Linear regression models, adjusted for age, preoperative body mass index (BMI), sex and comorbid diseases were constructed. RESULTS The mean TWL 5 years after surgery was 28.3 ± 9.86%. In the adjusted model, first-generation immigrants (%TWL, B -2.4 [95% CI -2.9 to -1.9], p < 0.0001) lost significantly less weight than the mean, while residents in medium-sized (B 0.8 [95% CI 0.4-1.2], p = 0.0001) or small towns (B 0.8 [95% CI 0.4-1.2], p < 0.0001) lost significantly more weight. CONCLUSIONS All socioeconomic groups experienced improvements in weight after bariatric surgery. However, as first-generation immigrants and patients residing in larger towns (>200,000 inhabitants) tend to have inferior weight loss compared to other groups, increased support in the pre- and postoperative setting for these two groups could be of value. The remaining socioeconomic factors appear to have a weaker association with postoperative weight loss.
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Pinto SL, Juvanhol LL, Bressan J. Increase in Protein Intake After 3 Months of RYGB Is an Independent Predictor for the Remission of Obesity in the First Year of Surgery. Obes Surg 2020; 29:3780-3785. [PMID: 31376133 DOI: 10.1007/s11695-019-04124-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although bariatric surgery promotes dietary changes, many questions regarding their effect on weight loss remain unanswered. OBJECTIVE The aim of this study was to evaluate changes in dietary intake and predictive factors of obesity remission in the first 12 months after RYGB. METHODS Fifty-one patients (mean 39.34 ± 9.38 years, 68.7% women) who underwent RYGB were included in this study. Dietary intake was evaluated through a 24-h dietary recall and subsequently classified by NOVA, macronutrients and calories. The predictive factors for obesity remission within 12 months after RYGB were evaluated by Cox regression. RESULTS At baseline, 62.7% of the patients presented severe obesity; mean excess weight loss was greater than 80% after 1 year of surgery and about 70% of the patients were no longer diagnosed with obesity. An increase in percentage of calories from protein was observed at 3 and 12 months after surgery. The caloric contribution of ultra-processed foods was low at 3 months after surgery while that of unprocessed or minimally processed foods was high at 3 and 12 months after surgery. From the Cox regression analysis, preoperative BMI (HR, 0.78; 95% CI, 0.69-0.88) and age (HR, 0.94; 95% CI, 0.89-0.99) showed an inverse association with obesity remission. Also, Δ protein (at 3 months-baseline) showed a positive association with obesity remission (HR, 1.06; 95% CI, 1.01-1.12). CONCLUSION Lower preoperative BMI, lower age, and higher protein intake at 3 months after surgery may favor remission of obesity in up to 12 months compared with baseline.
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Affiliation(s)
- Sônia Lopes Pinto
- Nutrition Course, Federal University of Tocantins, Quadra 109 North, NS-15 Avenue, ALCNO-14, Block Bala2, North Director Plan, Palmas, Tocantins, 77001-090, Brazil. .,Federal University of Viçosa, Viçosa, Minas Gerais, Brazil.
| | - Leidjaira Lopes Juvanhol
- Department of Nutrition and Health, Federal University of Viçosa, University Campus, Viçosa, Minas Gerais, 36570-900, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Federal University of Viçosa, University Campus, Viçosa, Minas Gerais, 36570-900, Brazil
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Lima RLS, Oliveira EJSGD, Pereira EC, Costa LDS, Dourado TS, Valadão JA, Lima RC, Campelo GP, Brito RMD, Oliveira CMBD, Moura ECR, Leal PDC. Comparative analysis between patients undergoing Gastric Bypass and Sleeve Gastroplasty in a private hospital in Sao Luis-MA. Acta Cir Bras 2020; 35:e202000307. [PMID: 32692798 PMCID: PMC7251972 DOI: 10.1590/s0102-865020200030000007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/01/2020] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To compare the satisfaction levels about the surgery and anesthesia management, and to analyze the postoperative outcomes of patients undergoing Gastric Bypass and Sleeve Gastroplasty surgeries in a private hospital in Sao Luís-MA. METHODS The sample consisted of patients undergoing Bypass and Sleeve bariatric surgeries from August 2018 to August 2019, who were in the range of 18 and 70 years old and had not used drugs or presented cardiac arrhythmias, dilated cardiomyopathy, and conduction disorder heart. Data were collected from the evaluation forms and recorded in a form with closed questions. RESULTS Most patients were female (Bypass - 56% and Sleeve - 67.4%) and aged between 30 and 39 years old (Bypass - 32% and Sleeve - 55.8%). Information (Bypass - 92% and Sleeve - 86.1%) was the highest satisfaction index found. Sleepiness in the immediate postoperative period (Bypass - 92% and Sleeve - 93%) was the main side effect. There were no postoperative complications in patients between the two types of surgery. CONCLUSIONS Patients submitted to Bypass and Sleeve were completely satisfied with the perioperative management. There was no statistically significant difference when comparing adverse effects between the techniques.
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A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy. Obes Surg 2020; 29:3165-3173. [PMID: 31388962 DOI: 10.1007/s11695-019-03917-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified. PURPOSE We present the mid-term outcomes of SADI bypass surgery after SG. METHOD A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50 kg/m2). Incidence of complications was divided into < 30 days and > 30 days. RESULT Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3 years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24 months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient's population at 24 months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication. CONCLUSION The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.
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Tankel J, Shlezinger O, Neuman M, Ahuva Hershko Moshe A, Ben Nachum N, Hurvitz N, Spira R. Predicting Weight Loss and Comorbidity Improvement 7 Years Following Laparoscopic Sleeve Gastrectomy: Does Early Weight Loss Matter? Obes Surg 2020; 30:2505-2510. [DOI: 10.1007/s11695-020-04462-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Assakran BS, Alromaih AH, Alashkar AH, AlGhasham FS, Alqunai MS. Is routine post-sleeve gastrografin needed? Profile of 98 cases. BMC Res Notes 2020; 13:219. [PMID: 32299510 PMCID: PMC7164338 DOI: 10.1186/s13104-020-05060-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/06/2020] [Indexed: 01/19/2023] Open
Abstract
Objective Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures. Some surgeons still perform routine post-sleeve gastrografin (RSG) study believing that it would detect post-LSG complications, especially leak. In this study, we aimed to evaluate the cost-effectiveness of RSG by considering the cost of the study, length of hospital stay and complications-related costs RSG could prevent. Results A total of 98 eligible patients were included. Of them, 54 patients underwent RSG and 44 did not. Excluding the cost of LSG procedure, the average cost for those who underwent RSG and those who did not in Saudi Riyal (£) was 5193.15 (1054.77) and 4222.27 (857.58), respectively. The average length of stay (ALOS) was practically the same regardless of whether or not the patient underwent RSG. 90.8% (n = 89) of all patients stayed for 3 days. None of the patients developed postoperative bleeding, stenosis or leak. The mean weight, body mass index (BMI) and percentage weight loss (PWL) 6 months postoperatively were found to be 87.71 kg (SD = 17.51), 33.89 kg/m2 (SD = 7.29) and 26.41% (SD = 9.79), respectively. The PWL 6 months postoperatively was 23.99% (SD = 8.47) for females and 30.57 (SD = 10.6) for males (p = 0.01).
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Affiliation(s)
- Bandar Saad Assakran
- Surgical Department, King Fahd Specialist Hospital, P.O. Box 2290, Alnaziyah, Buraidah, 52366, Saudi Arabia.
| | - Abdullah Homood Alromaih
- Surgical Department, King Fahd Specialist Hospital, P.O. Box 2290, Alnaziyah, Buraidah, 52366, Saudi Arabia
| | | | | | - Mansur Suliman Alqunai
- Surgical Department, King Fahd Specialist Hospital, P.O. Box 2290, Alnaziyah, Buraidah, 52366, Saudi Arabia
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Male gender is an independent risk factor for patients undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass: an MBSAQIP® database analysis. Surg Endosc 2020; 34:3574-3583. [PMID: 32072290 PMCID: PMC7224103 DOI: 10.1007/s00464-019-07106-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/23/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Male patients undergoing bariatric surgery have (historically) been considered higher risk than females. The aim of this study was to examine the disparity between genders undergoing laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB) procedures and assess gender as an independent risk factor. METHODS The MBSAQIP® Data Registry Participant User Files for 2015-2017 was reviewed for patients having primary SG and RYGB. Patients were divided into groups based on gender and procedure. Variables for major complications were grouped together, including but not limited to PE, stroke, and MI. Univariate and propensity matching analyses were performed. RESULTS Of 429,664 cases, 20.58% were male. Univariate analysis demonstrated males were older (46.48 ± 11.96 vs. 43.71 ± 11.89 years, p < 0.0001), had higher BMI (46.58 ± 8.46 vs. 45.05 ± 7.75 kg/m2, p < 0.0001), and had higher incidence of comorbidities. Males had higher rates of major complications (1.72 vs. 1.05%; p < 0.0001) and 30-day mortality (0.18 vs. 0.07%, p < 0.0001). Significance was maintained after subgroup analysis of SG and RYGB. Propensity matched analysis demonstrated male gender was an independent risk factor for RYGB and SG, major complications [2.21 vs. 1.7%, p < 0.0001 (RYGB), 1.12 vs. 0.89%, p < 0.0001 (SG)], and mortality [0.23 vs. 0.12%, p < 0.0001 (RYGB), 0.10 vs. 0.05%; p < 0.0001 (SG)]. CONCLUSION Males continue to represent a disproportionately small percentage of bariatric surgery patients despite having no difference in obesity rates compared to females. Male gender is an independent risk factor for major post-operative complications and 30-day mortality, even after controlling for comorbidities.
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Kitamura R, Chen R, Trickey A, Eisenberg D. Positive and Negative Independent Predictive Factors of Weight Loss After Bariatric Surgery in a Veteran Population. Obes Surg 2020; 30:2124-2130. [DOI: 10.1007/s11695-020-04428-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Casas-Tapia C, Araujo-Castillo RV, Saavedra-Tafur L, Bert-Dulanto A, Piscoya A, Casas-Lucich A. Higher HOMA-IR index is associated with increased excess weight loss in patients with BMI≥35kg/m 2 after vertical gastrectomy. Cir Esp 2020; 98:328-335. [PMID: 32000981 DOI: 10.1016/j.ciresp.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 11/22/2019] [Accepted: 12/01/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy. METHODS Retrospective cohort including patients ≥18 years old with BMI≥35kg/m2, who underwent primary sleeve gastrectomy between 2014-2017 at the Avendaño Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% ≥60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%. RESULTS Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed .29% less EWL% per each extra year of life (P=.019), and .93% more EWL% per each extra HOMA-IR point (P=.004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P=.050), and 2% more chance of success per each additional HOMA-IR point (P=.038). CONCLUSIONS There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes.
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Affiliation(s)
| | | | - Lil Saavedra-Tafur
- Cirugía General, Endoscópica y Bariátrica, Clínica de Día Avendaño, Lima, Perú
| | - Aimeé Bert-Dulanto
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Alejandro Piscoya
- Dirección de Investigación, Universidad San Ignacio de Loyola, Lima, Perú; Servicio de Gastroenterología, Hospital Guillermo Kaelin de la Fuente, Lima, Perú
| | - Alberto Casas-Lucich
- Facultad de Ciencias de la Salud, Universidad Privada San Juan Bautista, Lima, Perú
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Molero J, Olbeyra R, Vidal J, Torres F, Cañizares S, Andreu A, Ibarzabal A, Jiménez A, de Hollanda A, Moizé V, Flores L. A Propensity Score Cohort Study on the Long-Term Safety and Efficacy of Sleeve Gastrectomy in Patients Older Than Age 60. J Obes 2020; 2020:8783260. [PMID: 32802499 PMCID: PMC7416297 DOI: 10.1155/2020/8783260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bariatric surgery (BS) in older obese subjects (>60 years of age) has risen in the past decade and will continue to rise in the coming years due to ageing of the population. AIM To evaluate the short- (12 months) and long-term (60 months) results of laparoscopic sleeve gastroscopy (LSG) in patients older than age 60. METHODS We performed a retrospective review of patients prospectively included in a database from January 2007 to December 2013. All patients >60 [older group (OG)] who had undergone LSG were included. The control group (CG) included patients aged 50 to 59 years who had undergone LSG during the same period. RESULTS 116 (8.4 % of total surgery) and 145 patients were included in the OG and CG, respectively. BS in patients >60 years increased from 2.4% in 2003 to 14% in the last 2 years of the study. After inverse probability of treatment weighting (IPTW) analysis, all absolute standardized differences were <0.15. A 60-month follow-up was attained in 90% of patients in the OG and 74% in the CG. There were no significant differences in postoperative complications between the two groups. At 12 and 60 months after LSG, both groups achieved a similar body mass index. There was no statistical difference in the percentage of resolution of type 2 diabetes, hypertension, dyslipidemia, and SAHS between the two groups. In both groups, all the nutritional parameters evaluated remained within the normal range throughout the study. CONCLUSIONS LSG provides acceptable outcomes and is safe in older adults indicating that age should not be a limitation to perform BS in this population.
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Affiliation(s)
- Judith Molero
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios Office 9, Barcelona 08036, Spain
| | - Romina Olbeyra
- Institutd'Investigacions Biomèdiques August Pi Sunyer IDIBAPS, 180, Corcega Street, Barcelona 08036, Spain
| | - Josep Vidal
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios Office 9, Barcelona 08036, Spain
- Institutd'Investigacions Biomèdiques August Pi Sunyer IDIBAPS, 180, Corcega Street, Barcelona 08036, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Ferran Torres
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Medical Statistics Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona 08036, Spain
| | - Silvia Cañizares
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios Office 9, Barcelona 08036, Spain
- Psychiatry and Psychology Department, Hospital Clinic, Department of Clinical Psychology and Psychobiosslogy, University of Barcelona, Barcelona 08036, Spain
| | - Alba Andreu
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios Office 9, Barcelona 08036, Spain
| | - Ainitze Ibarzabal
- Department of Surgery, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain
- Gastrointestinal Surgery Department, Obesity Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Amanda Jiménez
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios Office 9, Barcelona 08036, Spain
- Institutd'Investigacions Biomèdiques August Pi Sunyer IDIBAPS, 180, Corcega Street, Barcelona 08036, Spain
| | - Ana de Hollanda
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios Office 9, Barcelona 08036, Spain
- Institutd'Investigacions Biomèdiques August Pi Sunyer IDIBAPS, 180, Corcega Street, Barcelona 08036, Spain
- Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
| | - Violeta Moizé
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios Office 9, Barcelona 08036, Spain
| | - Lilliam Flores
- Endocrinology and Nutrition Department, Obesity Unit, Hospital Clinic, 170, Villarroel Street, Helios Office 9, Barcelona 08036, Spain
- Institutd'Investigacions Biomèdiques August Pi Sunyer IDIBAPS, 180, Corcega Street, Barcelona 08036, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
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Lopez-Nava G, Asokkumar R, Rull A, Corbelle F, Beltran L, Bautista I. Bariatric endoscopy procedure type or follow-up: What predicted success at 1 year in 962 obese patients? Endosc Int Open 2019; 7:E1691-E1698. [PMID: 31803819 PMCID: PMC6887647 DOI: 10.1055/a-1007-1769] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023] Open
Abstract
Background and study aims It is uncertain if the difference in weight loss outcomes between different endoscopic bariatric therapies (EBTs) is technique-related or multidisciplinary team (MDT) follow-up-related. We hypothesized that at 1 year, the weight loss is determined more by adherence to MDT follow-up than by procedure type. We aimed to compare 1 year weight loss outcomes of four different EBTs at a single center with a standardized MDT follow-up. Patients and methods We prospectively collected and retrospectively analyzed outcomes in 962 patients (female-691, 71.2 %; mean age, 44.8 ± 10.6 years, mean BMI, 37.8 ± 5.9 Kg/m 2 ) treated with Intragastric balloons (IGBs) or endoscopic gastroplasty (EG) at HM Sanchinarro University Hospital between March 2012 to January 2017. The procedures were performed by the same endoscopist and followed up by the same MDT. We compared the percentage total body weight loss (%TWBL) at 1 year. We performed linear and logistic regression to identify predictive factors for weight loss and follow-up adherence at 1 year. Results Four hundred and eighty-one IGBs (Orbera-80.9 %; ReShape Duo-19.1 %), and 481 EG (Apollo ESG-51.3 %; Primary obesity surgery endoluminal-POSE-48.6 %) were performed. Only 480 patients (IGB- 45 %; EG- 55 %) completed 1 year follow-up. Among them, Apollo ESG achieved significantly higher TBWL (19.5 ± 13 %, P = 0.035), %TBWL (17.4 ± 10.2 %, P = 0.025), and ≥ 20 % TBWL (36.7 %, P = 0.032). However, in linear regression after adjusting for variables, only higher initial BMI (B = 0.31, P < 0.001) and higher percentage follow-up attendance (B = 0.24, P < 0.001) significantly predicted %TBWL at 1 year in the completion group but not the procedure type (B = 0.02, P = 0.72). In logistic regression, we observed female sex ( P = 0.01), high initial BMI ( P < 0.001), endoscopic gastroplasty ( P = 0.04), and high 1-month %TBWL ( P < 0.001) significantly predicted follow-up completion at 1 year. Conclusions Weight loss at 1 year is dependent on MDT follow-up rather than procedure type. Endoscopic gastroplasty promoted follow-up adherence more than IGBs.
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Affiliation(s)
- Gontrand Lopez-Nava
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Madrid, Spain.
| | - Ravishankar Asokkumar
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Madrid, Spain.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
| | - Angel Rull
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Madrid, Spain.
| | | | - Lucia Beltran
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Madrid, Spain.
| | - Inmaculada Bautista
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Madrid, Spain.,Ciber of Obesity and Nutrition Pathophysiology (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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Nickel F, de la Garza JR, Werthmann FS, Benner L, Tapking C, Karadza E, Wekerle AL, Billeter AT, Kenngott HG, Fischer L, Müller-Stich BP. Predictors of Risk and Success of Obesity Surgery. Obes Facts 2019; 12:427-439. [PMID: 31416073 PMCID: PMC6758709 DOI: 10.1159/000496939] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/14/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Obesity surgery has proven successful for weight loss and the resolution of comorbidities. There is, however, little evidence on its success and the risk of complications when considering age of onset of obesity (AOO), years of obesity (YOO), preoperative body mass index (BMI), Edmonton obesity staging system (EOSS) score, and age as possible predictors of weight loss, the resolution of comorbidities, and the risk of complications. METHODS Patients who underwent Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) from a prospective database were analyzed. Multiple regression analyses were used to predict comorbidities and their resolution, percentage excess weight loss (%EWL) and total weight loss (%TWL) 12 months after surgery, and the risk of complications using the predictors AOO, YOO, age, EOSS, and BMI. RESULTS 180 patients aged 46.8 ± 11.1 years with a preoperative BMI 49.5 ± 7.5 were included. The number of preoperative comorbidities was higher with older age (β = 0.054; p = 0.023) and a greater BMI (β = 0.040; p = 0.036) but was not related to AOO and YOO. Patients with AOO as a child or adolescent were more likely to have an EOSS score of ≥2. Greater preoperative BMI was negatively associated with %EWL (β = -1.236; p < 0.001) and older age was negatively associated with %TWL (β = -0.344; p = 0.020). Postoperative complications were positively associated with EOSS score (odds ratio [OR] 1.147; p = 0.042) and BMI (OR 1.010; p = 0.020), but not with age. AOO and YOO were not related to postoperative outcome. CONCLUSION Greater BMI was associated with a lower %EWL and age was associated with a low %TWL. YOO and AOO did not influence outcome. Age, BMI, and EOSS score were the most important predictors for risk and success after obesity surgery. Surgery should be performed early enough for optimal outcomes.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Javier R de la Garza
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Fabian S Werthmann
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Laura Benner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Christian Tapking
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Emir Karadza
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Anna-Laura Wekerle
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Adrian T Billeter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hannes G Kenngott
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lars Fischer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany,
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Hung KC, Ho CN, Chen JY, Liu WC, Sun CK, Soong TC. Association of preoperative hemoglobin with weight loss after bariatric surgery: a retrospective study. Surg Obes Relat Dis 2019; 15:1595-1603. [PMID: 31416688 DOI: 10.1016/j.soard.2019.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the known positive correlation between exercise and weight loss after bariatric surgery as well as the established association of hemoglobin level with maximal aerobic power and endurance performance, the correlation between preoperative hemoglobin concentration (pre-Hb) and postoperative weight loss remains unknown. OBJECTIVE This study aimed at assessing the association of pre-Hb with postoperative percentage weight loss (%WL) at 3, 6, 12, and 24 months after surgery. SETTING A single tertiary referral center. METHODS Outcomes of 282 patients undergoing laparoscopic sleeve gastrectomy at the 4 timepoints within a 24-month follow-up period were assessed. The primary study endpoint was the relationship between pre-Hb and postoperative %WL at 12-month follow-up. RESULTS The 282 patients had a mean preoperative body mass index of 39.0 ± 4.5 kg/m2 with a slight female predominance (57.4%). Follow-up data were available for 221 of 282 (78.4%) patients (mean %WL: 30.9% ± 6.6%) at 1 year. Pearson's correlation showed that pre-Hb correlated positively with post-Hb (r = 0.778, P < .001) and %WL (r = .237, P < .001) at 12-month follow-up but not at 24 months (r = .145, P = .331). Multiple linear regression analyses including baseline variables of age, sex, preoperative body mass index, and diabetes revealed that pre-Hb, age, and preoperative body mass index were independent predictors of %WL. There was no evidence of multicollinearity among these variables. CONCLUSION The present study showed a potential positive relationship between pre-Hb and postoperative weight loss. More well-designed, large-scale studies are warranted to clarify the effect of hemoglobin level on postoperative weight loss in this patient population.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Wei-Cheng Liu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tien-Chou Soong
- School of Medicine, I-Shou University, Kaohsiung, Taiwan; Weight loss and Health Management Center, E-Da Dachang Hospital, Kaohsiung, Taiwan.
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Jongbloed F, Meijers RWJ, IJzermans JNM, Klaassen RA, Dollé MET, van den Berg S, Betjes MGH, de Bruin RWF, van der Harst E, Litjens NHR. Effects of bariatric surgery on telomere length and T-cell aging. Int J Obes (Lond) 2019; 43:2189-2199. [PMID: 30979972 DOI: 10.1038/s41366-019-0351-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obesity adversely affects health and is associated with subclinical systemic inflammation and features of accelerated aging, including the T-cell immune system. The presence of metabolic syndrome (MetS) may accelerate, while bariatric surgery might reverse these phenomena. To examine the effects of MetS and bariatric surgery on T-cell aging, we measured relative telomere length (RTL) and T-cell differentiation status in obese patients before and after bariatric surgery. METHODS WHO II/III classified obese patients scheduled for bariatric surgery were included: 41 without MetS and 67 with MetS. RTL and T-cell differentiation status were measured in circulating CD4+ and CD8+ T cells via flow cytometry. T-cell characteristics were compared between patients with and without MetS prior to and at 3, 6, and 12 months after surgery considering effects of age, cytomegalovirus-serostatus, and weight loss. RESULTS Thymic output, represented by numbers of CD31-expressing naive T cells, showed an age-related decline in patients with MetS. MetS significantly enhanced CD8+ T-cell differentiation. Patients with MetS had significant lower CD4+ RTL than patients without MetS. Within the first 6 months after bariatric surgery, RTL increased in CD4+ T cells after which it decreased at month 12. A decline in both thymic output and more differentiated T cells was seen following bariatric surgery, more pronounced in the MetS group and showing an association with percentage of body weight loss. CONCLUSIONS In obese patients, MetS results in attrition of RTL and accelerated T-cell differentiation. Bariatric surgery temporarily reverses these effects. These data suggest that MetS is a risk factor for accelerated aging of T cells and that MetS should be a more prominent factor in the decision making for eligibility for bariatric surgery.
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Affiliation(s)
- F Jongbloed
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.,Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - R W J Meijers
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J N M IJzermans
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R A Klaassen
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - M E T Dollé
- Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - S van den Berg
- Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - M G H Betjes
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R W F de Bruin
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - E van der Harst
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - N H R Litjens
- Department of Internal Medicine, Section Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, The Netherlands
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Stenberg E, Ottosson J, Szabo E, Näslund I. Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery—a Register-Based Cohort Study. Obes Surg 2019; 29:1229-1235. [DOI: 10.1007/s11695-018-03670-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Setting realistic expectations for weight loss after laparoscopic sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2019; 14:415-419. [PMID: 31534572 PMCID: PMC6748060 DOI: 10.5114/wiitm.2019.81661] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/05/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Despite the clinical benefits of bariatric surgery, some patients have experienced disappointment with their weight loss. Setting realistic expectations is the key to success. Aim To develop a specific prediction calculator to estimate the expected body mass index (BMI) at 1 year after laparoscopic sleeve gastrectomy (LSG). Material and methods A retrospective analysis was performed to study 211 patients after primary LSG. Nine baseline variables were analyzed. Least angle regression (LARS) was employed for variable selection and to build the predictive model. External validation was performed on a dataset of 184 patients. To test the accuracy of the model, a Wilcoxon signed-rank test was performed between BMI estimates and the observed BMI. A linear logistic equation was used to construct the online predictive calculator. Results The model included three variables – preoperative BMI (β = 0.023, p < 0.001), age (β = 0.005, p < 0.001), and female gender (β = 0.116, p = 0.001) – and demonstrated good discrimination (R2 = 0.672; adjusted R2 = 0.664) and good accuracy (root mean squared error of estimate, RMSE = 0.124). The difference between the observed BMI and the estimated BMI was not statistically significant (median = 0.737 (–2.676, 3.254); p = 0.223). External validation confirmed good performance of the model. Conclusions The study revealed a useful predictive model for estimating BMI at 1 year after LSG. The model was used for development of the PREDICT BMI calculator. This tool allows one to set realistic expectations of weight loss at one year after LSG.
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Subramaniam K, Low WY, Lau PC, Chin KF, Chinna K, Kosai NR, Taher MM, Rajan R. Eating Behaviour Predicts Weight Loss Six Months after Bariatric Surgery: A Longitudinal Study. Nutrients 2018; 10:nu10111616. [PMID: 30400129 PMCID: PMC6266615 DOI: 10.3390/nu10111616] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 01/17/2023] Open
Abstract
Bariatric surgery is currently the most durable weight loss solution for patients with morbid obesity. The extent of weight loss achieved, however, is subject to variation due to various factors, including patients' behaviour. In this study, we aimed to identify pre- and post-surgical predictors of weight loss following bariatric surgery. This prospective study included 57 participants who went through bariatric surgery (laparoscopic Roux-en-Y gastric bypass: n = 30; laparoscopic sleeve gastrectomy: n = 23; one anastomosis gastric bypass-mini gastric bypass: n = 4) in two tertiary referral hospitals. Consenting participants were assessed prior to surgery (T₀), and three months (T₁) and six months (T₂) after surgery. The assessment included interview and anthropometric measurements. The interview was done with the aid of instruments, including the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression screening and the Dutch Eating Behaviour Questionnaire (DEBQ) for eating behaviour assessment. Baseline comorbidity status was obtained from medical records. A Generalised Estimating Equation (GEE) was developed to determine predictors of weight loss. Participants in the study were mostly women (n = 37, 65%) with a mean age of 39.4 (SD = 10.01) years. The mean excess BMI loss (EBMIL) and total weight loss (TWL) at the sixth month was 63.31% and 23.83%, respectively. Anxiety, depression, and external eating scores reduced over time. Advancing age, high BMI, and higher scores for emotional and external eating emerged as significant negative predictors for TWL%. It can be concluded that the patients experienced substantial weight loss after surgery. Continuous monitoring of psychological well-being and eating behaviour are essential for optimal weight loss.
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Affiliation(s)
- Kavitha Subramaniam
- Medical Education, Research and Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Department of Physical and Mathematical Science, Faculty of Science, Tunku Abdul Rahman University, Kampar, Perak 31900, Malaysia.
| | - Wah-Yun Low
- Faculty of Medicine Dean's Office, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Peng-Choong Lau
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Kin-Fah Chin
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Karuthan Chinna
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Nik Ritza Kosai
- Minimally Invasive, Upper Gastrointestinal and Bariatric Surgery unit, Department of surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia.
| | - Mustafa Mohammed Taher
- Minimally Invasive, Upper Gastrointestinal and Bariatric Surgery unit, Department of surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia.
| | - Reynu Rajan
- Minimally Invasive, Upper Gastrointestinal and Bariatric Surgery unit, Department of surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia.
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Vargas GP, Mendes GA, Pinto RD. QUALITY OF LIFE AFTER VERTICAL GASTRECTOMY EVALUATED BY THE BAROS QUESTIONNAIRE. ACTA ACUST UNITED AC 2018; 30:248-251. [PMID: 29340547 PMCID: PMC5793141 DOI: 10.1590/0102-6720201700040005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life of the patients. AIM To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy. METHODS Was applied the questionnaire "Bariatric Analysis and Reporting Outcome System" (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy. RESULTS A total of 47 patients between 21-60 years old were evaluated. The total mean of the BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated. CONCLUSION BAROS showed excellent results in 36.17%, very good in 40.43%, good in 21.28% and reasonable in 2.13%. The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities.
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Cottam S, Cottam D, Cottam A, Zaveri H, Surve A, Richards C. The Use of Predictive Markers for the Development of a Model to Predict Weight Loss Following Vertical Sleeve Gastrectomy. Obes Surg 2018; 28:3769-3774. [DOI: 10.1007/s11695-018-3417-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Wee CC, Jones DB, Apovian C, Hess DT, Chiodi SN, Bourland AC, Davis RB, Schneider B, Blackburn GL, Marcantonio ER, Hamel MB. Weight Loss After Bariatric Surgery: Do Clinical and Behavioral Factors Explain Racial Differences? Obes Surg 2018; 27:2873-2884. [PMID: 28500418 DOI: 10.1007/s11695-017-2701-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prior studies have suggested less weight loss among African American compared to Caucasian patients; however, few studies have been able to simultaneously account for baseline differences in other demographic, clinical, or behavioral factors. METHODS We interviewed patients at two weight loss surgery (WLS) centers and conducted chart reviews before and after WLS. We compared weight loss post-WLS by race/ethnicity and examined baseline demographic, clinical (BMI, comorbidities, quality of life), and behavioral (eating behavior, physical activity level, alcohol intake) factors that might explain observed racial differences in weight loss at 1 and 2 years after WLS. RESULTS Of 537 participants who underwent either Roux-en-Y Gastric Bypass (54%) or gastric banding (46%), 85% completed 1-year follow-up and 73% completed 2-year follow-up. Patients lost a mean of 33.00% of initial weight at year 1 and 32.43% at year 2 after bypass and 16.07% and 17.56 % respectively after banding. After adjustment for other demographic characteristics and type of surgery, African Americans lost an absolute 5.93 ± 1.49% less weight than Caucasian patients after bypass (p < 0.001) and 4.72 ± 1.96% less weight after banding. Of the other demographic, clinical, behavioral factors considered, having diabetes and perceived difficulty making dietary changes at baseline were associated with less weight loss among gastric bypass patients whereas having a diagnosis of anxiety disorder was associated with less weight loss among gastric banding patients. The association between race and weight loss did not substantially attenuate with additional adjustment for these clinical and behavioral factors, however. CONCLUSION African American patients lost significantly less weight than Caucasian patients. Racial differences could not be explained by baseline demographic, clinical, or behavioral characteristics we examined.
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Affiliation(s)
- Christina C Wee
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Daniel B Jones
- Division of Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Caroline Apovian
- Evans Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Donald T Hess
- Department of Surgery, Boston Medical Center, Boston, MA, USA
| | - Sarah N Chiodi
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Ashley C Bourland
- Evans Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Roger B Davis
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Benjamin Schneider
- Division of Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - George L Blackburn
- Division of Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Edward R Marcantonio
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Mary Beth Hamel
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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50
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Kraus R, Stekhoven DJ, Leupold U, Marti WR. Linear Mixed Effects Analysis Reveals the Significant Impact of Preoperative Diet Success on Postoperative Weight Loss in Gastric Bypass Surgery. Obes Surg 2018; 28:2473-2480. [DOI: 10.1007/s11695-018-3189-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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