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Caci H, Chierici A, Iannelli A. Attention-deficit/hyperactivity disorder in adolescent and adult candidates for metabolic and bariatric surgery: A systematic review and meta-analysis. Obes Rev 2024:e13802. [PMID: 39040012 DOI: 10.1111/obr.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/13/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024]
Abstract
AIMS Attention-deficit with hyperactivity disorder (ADHD) is associated with obesity and impacts the outcome of metabolic and bariatric surgery (MBS). This study aimed at calculating the prevalence in candidates for MBS, which is yet unclear. METHODS We conducted a systematic review and meta-analysis, searching three databases from their respective inception to December 2022 for studies reporting the prevalence of ADHD in adolescents and adults assessed before undergoing MBS. The protocol was registered in PROSPERO (CRD42022384914). We adhered to Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines; the quality of studies was assessed with the JBI Critical Appraisal checklist. Random-effect meta-analyses were performed; confidence intervals were computed with a binomial exact method, and the pooled estimate was calculated after double arcsine transformation. FINDINGS Fourteen studies (24,455 adults) and three studies (299 adolescents) were selected. The quality of studies was moderate to poor; meta-analyses were performed on subgroups according to the case definition used. The prevalence is 8.94% and 9.90% in adults, and 28.73% in adolescents. CONCLUSIONS ADHD is three times more frequent in adults and six times more frequent in adolescents than in the general population. Recommendations are provided to improve the quality of future studies and obtain more reliable estimates of prevalence.
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Affiliation(s)
- Hervé Caci
- Hôpitaux Pédiatrique de Nice - CHU Lenval, Nice, France
- Centre de recherche en Épidémiologie et Santé des Populations, Psychiatrie du Développement et Trajectoires, Villejuif, France
| | - Andrea Chierici
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Nice, France
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Nice, France
- Université Côte d'Azur, Nice, France
- Team 8 "Hepatic Complications of Obesity and Alcohol", Nice, France
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2
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Canakis A, Wall-Wieler E, Liu Y, Zheng F, Sharaiha RZ. New-Onset Type 2 Diabetes after Bariatric Surgery: A Matched Cohort Study. Am J Prev Med 2024:S0749-3797(24)00176-4. [PMID: 38844144 DOI: 10.1016/j.amepre.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION The objective of this study is to determine the difference in rates of new-onset type 2 diabetes (T2D) for individuals who have had metabolic and bariatric surgery (MBS) and similar individuals who did not have MBS, and to determine whether differences in new-onset T2D differ depending on whether the individual had prediabetes at baseline. METHODS This study used data from a large United States employer-based retrospective claims database from 2016 to 2021 (analysis completed in 2023). Individuals who did and did not have MBS were matched 1:1 on index year, sex, age, health plan type, region, body mass index, baseline healthcare costs, other obesity-related comorbidities, prediabetes diagnosis, and inpatient admissions in the year before the index date. New-onset T2D was examined at 1 (18,752 matches) and 3 (5,416 matches) years after the index date and stratified by baseline prediabetes. RESULTS Among the full cohort of individuals with and without prediabetes at baseline, 0.1% and 2.7% of individuals who had did and did not have MBS developed T2D within 1 year after the index date, respectively (difference=2.6, 95% CI 2.4-2.8), and 0.3% and 8.4% of individuals who did and did not have MBS developed T2D within 3 years after the index date, respectively (difference=8.1, 95% CI 7.3-8.8). The difference in new-onset T2D was greatest among individuals with prediabetes at baseline. CONCLUSIONS This study demonstrated patients with obesity and without T2D who undergo MBS are significantly less likely to develop new-onset T2D compared to matched non-MBS patients.
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Affiliation(s)
- Andrew Canakis
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elizabeth Wall-Wieler
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, California
| | - Yuki Liu
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, California
| | - Feibi Zheng
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, California; DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Reem Z Sharaiha
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York.
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Gershuni V, Wall-Wieler E, Liu Y, Zheng F, Altieri MS. Observational cohort investigating health outcomes and healthcare costs after metabolic and bariatric surgery: a study protocol. BMJ Open 2024; 14:e077143. [PMID: 38272560 PMCID: PMC10824029 DOI: 10.1136/bmjopen-2023-077143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/08/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION As the rate of obesity increases, so does the incidence of obesity-related comorbidities. Metabolic and bariatric surgery (MBS) is the most effective treatment for obesity, yet this treatment is severely underused. MBS can improve, resolve, and prevent the development of obesity-related comorbidities; this improvement in health also results in lower healthcare costs. The studies that have examined these outcomes are often limited by small sample sizes, reliance on outdated data, inconsistent definitions of outcomes, and the use of simulated data. Using recent real-world data, we will identify characteristics of individuals who qualify for MBS but have not had MBS and address the gaps in knowledge around the impact of MBS on health outcomes and healthcare costs. METHODS AND ANALYSIS Using a large US employer-based retrospective claims database (Merative), we will identify all obese adults (21+) who have had a primary MBS from 2016 to 2021 and compare their characteristics and outcomes with obese adults who did not have an MBS from 2016 to 2021. Baseline demographics, health outcomes, and costs will be examined in the year before the index date, remission and new-onset comorbidities, and healthcare costs will be examined at 1 and 3 years after the index date. ETHICS AND DISSEMINATION As this was an observational study of deidentified patients in the Merative database, Institutional Review Board approval and consent were exempt (in accordance with the Health Insurance Portability and Accountability Act Privacy Rule). An IRB exemption was approved by the wcg IRB (#13931684). Knowledge dissemination will include presenting results at national and international conferences, sharing findings with specialty societies, and publishing results in peer-reviewed journals. All data management and analytic code will be made available publicly to enable others to leverage our methods to verify and extend our findings.
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Affiliation(s)
- Victoria Gershuni
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Yuki Liu
- Intuitive Surgical, Sunnyvale, California, USA
| | - Feibi Zheng
- Intuitive Surgical, Sunnyvale, California, USA
- DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Drai C, Chierici A, Schiavo L, Amor IB, Schneider S, Iannelli A. Long-Term Results of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Individuals Older Than 60 Years with Morbid Obesity. Obes Surg 2023; 33:3850-3859. [PMID: 37840091 DOI: 10.1007/s11695-023-06851-5] [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: 05/22/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE An increasing Pnumber of individuals with obesity over the age of 60 years require bariatric surgery to treat obesity and its related medical problems. Sleeve gastrectomy and Roux-en-Y gastric bypass have already proven their efficacy in this population, but literature lacks reports of long-term results. The aim of this study is to compare long-term results of sleeve gastrectomy and Roux-en-Y gastric bypass in individuals older than 60 years old. MATERIALS AND METHODS This is a single-center, retrospective, comparative study of 204 patients undergoing either sleeve gastrectomy (123, 60.3%) or Roux-en-Y gastric bypass (81, 39.7%) for morbid obesity with a mean follow-up of 44.5 ± 19.1 months and 54.6 ± 17.9 months, respectively. RESULTS Total weight loss was significantly increased for patients who underwent Roux-en-Y gastric bypass compared to sleeve gastrectomy from 12 to 48 months after surgery, while no significant difference was found after 60 (30.39% vs. 27.63%) and 72 (27.36% vs. 23.61%) months. Roux-en-Y gastric bypass was associated to a significant increased rate of early postoperative complications (22.2% vs. 4%; p < 0.0001), but no difference was found concerning late postoperative morbidity (6.2% vs. 1.6%). Both procedures were effective in obesity related medical problems. CONCLUSION Roux-en-Y gastric bypass confers an increased weight loss than sleeve gastrectomy in patients over the age of 60 in the mid-term, but it is associated with more early postoperative complications. Sleeve gastrectomy can be considered a valid alternative as long-term weight loss results are superposable to those ensured by Roux-en-Y gastric bypass.
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Affiliation(s)
- Céline Drai
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, Nice, France
- Université Côte d'Azur, Nice, France
| | - Andrea Chierici
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, Nice, France
| | - Luigi Schiavo
- Unit of General and Emergency Surgery, University Hospital San Giovanni Di Dio E Ruggi d'Aragona, Mercato San Severino, Salerno, Italy
| | - Imed Ben Amor
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, Nice, France
| | - Stéphane Schneider
- Université Côte d'Azur, Nice, France
- Department of Gastroenterology and Clinical Nutrition, CHU de Nice, University Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 Hospital, Nice, France.
- Université Côte d'Azur, Nice, France.
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", Nice, France.
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Maki KC, Kirkpatrick CF, Allison DB, Gadde KM. Pharmacotherapy for obesity: recent evolution and implications for cardiovascular risk reduction. Expert Rev Endocrinol Metab 2023; 18:307-319. [PMID: 37199542 DOI: 10.1080/17446651.2023.2209176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Obesity is highly prevalent in the U.S. and is associated with an increased risk of major adverse cardiovascular events (MACE). Modalities for the management of obesity include lifestyle intervention, pharmacotherapy, and bariatric surgery. AREAS COVERED This review describes the evidence on the effects of weight loss therapies on MACE risk. Lifestyle interventions and older antiobesity pharmacotherapies have been associated with <12% body weight reduction and no clear benefit to reduce MACE risk. Bariatric surgery is associated with substantial weight reduction (20-30%) and markedly lower subsequent risk for MACE. Newer antiobesity pharmacotherapies, particularly semaglutide and tirzepatide, have shown greater efficacy for weight reduction compared with older medications and are being evaluated in cardiovascular outcomes trials. EXPERT OPINION Current practice for cardiovascular risk reduction in patients with obesity is lifestyle intervention for weight loss, combined with the treatment of obesity-related cardiometabolic risk factors individually. The use of medications to treat obesity is relatively rare. In part, this reflects concerns about long-term safety and weight loss effectiveness, possible provider bias, as well as lack of clear evidence of MACE risk reduction. If ongoing outcomes trials demonstrate the efficacy of newer agents in reducing MACE risk, this will likely lead to expanded use in obesity management.
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Affiliation(s)
- Kevin C Maki
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
- Midwest Biomedical Research, Addison, IL, USA
| | - Carol F Kirkpatrick
- Midwest Biomedical Research, Addison, IL, USA
- Idaho State University, Pocatello, ID, USA
| | - David B Allison
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
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Santos CA, Carvalho M, Gregório J. Design and evaluation of a new nurse-led case management intervention for bariatric surgery patients. MethodsX 2023; 10:102049. [PMID: 36824996 PMCID: PMC9941129 DOI: 10.1016/j.mex.2023.102049] [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: 10/07/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
This paper provides a new management about the treatment of obesity, that have a growing incidence worldwide. A management centered on the patients' needs during the bariatric surgery is necessary. In this context, patient monitoring and follow-up by a case manager, who guides the provision of specialized care focused on patient's adaptation to the new reality, can prove to be essential to achieve better outcomes. This study, guided by the Design Science Research Methodology (DSRM), will have as main objective to design a new intervention (Case-managing program) aimed at patients undergoing bariatric surgery. As secondary objectives, we intend to analyze the influence of the new intervention in the perioperative period and impact on several clinical and humanistic endpoints. In the evaluation phase, an experimental, controlled, and randomized study (RCT) will be developed, with an intervention group (IG) and a control group (CG). The CG will receive the usual care and the IG, will receive the intervention for an expected period of one year. This project aims to be the first study to investigate the effect of a long-term specialized case-management intervention (face-to-face and e-health) in patients who are candidates for bariatric surgery during all the perioperative periods. This method presents: • The results will be reported the patients related outcomes measures for bariatric surgery • The results are expected to provide an overview of the most effective case management interventions for long-term better results on bariatric surgery • Allowing researchers to design and propose a new case management for bariatric surgery.
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Affiliation(s)
- Cláudia Amaro Santos
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal,CRI.COM – Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal,CBIOS – Universidade Lusófona's Research Center for Biosciences & Health Technologies Lisbon, Portugal,Corresponding author
| | - Manuel Carvalho
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal,CRI.COM – Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
| | - João Gregório
- CBIOS – Universidade Lusófona's Research Center for Biosciences & Health Technologies Lisbon, Portugal
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7
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Frankel A, Thomson I, Shah A, Chen C, Zahir SF, Barbour A, Holtmann G, Mark Smithers B. Laparoscopic fundoplication versus laparoscopic Roux-en-Y gastric bypass for gastro-oesophageal reflux disease in obese patients: protocol for a randomized clinical trial. BJS Open 2022; 6:6849402. [PMID: 36440813 PMCID: PMC9703586 DOI: 10.1093/bjsopen/zrac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Laparoscopic fundoplication (LF) is the standard surgical procedure for the treatment of gastro-oesophageal reflux disease (GORD). Laparoscopic Roux-en-Y gastric bypass (LRYGB) is commonly performed to achieve weight loss in obese patients, but it also has anti-reflux properties. Hence, in the obese population suffering from GORD, LRYGB could be an alternative to LF. The aim of this trial will be to compare LF and LRYGB in an obese population presenting with GORD and being considered for surgery. METHODS This will be an investigator-initiated randomized clinical trial. The research population will be obese patients (BMI 30-34.9 with waist circumference more than 88 cm (women) or more than 102 cm (men), or BMI 35-40 with any waist circumference) referred to a public hospital for consideration of anti-reflux surgery. The primary aim of the study will be to determine the efficacy of LF compared with LRYGB on subjective and objective control of GORD. Secondary aims include determining early and late surgical morbidity and the side-effect profile of LF compared with LRYGB and to quantify any non-reflux benefits of LRYGB (including overall quality of life) compared with LF. CONCLUSION This trial will determine whether LRYGB is effective and acceptable as an alternative to LF for the surgical treatment of GORD in obese patients Registration number: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000636752p (https://www.anzctr.org.au/).
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Affiliation(s)
- Adam Frankel
- Correspondence to: Adam Frankel, Princess Alexandra Hospital, Upper GI Surgery, Ward 4D, 199 Ipswich Rd, Woolloongabba, Brisbane, Queensland, Australia 4102 (e-mail: )
| | - Iain Thomson
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Ayesha Shah
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Chen Chen
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Syeda Farah Zahir
- Queensland Facility for Advanced Bioinformatics, Queensland Cyber Infrastructure Foundation, Queensland, Australia
| | - Andrew Barbour
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerald Holtmann
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - B Mark Smithers
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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Ebadinejad A, Barzin M, Abiri B, Mahdavi M, Khalaj A, Ebrahimi D, Hosseinpanah F, Valizadeh M. The effect of bariatric surgery in comparison with the control group on the prevention of comorbidities in people with severe obesity: a prospective cohort study. BMC Surg 2022; 22:290. [PMID: 35902855 PMCID: PMC9331579 DOI: 10.1186/s12893-022-01740-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Obesity is a global health priority, particularly in developing countries. The preventive effect of bariatric surgery against obesity-related diseases in the developing countries of the Middle East and North Africa region, where type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia prevail, has not been examined. Method Severely obese participants who underwent bariatric surgery were compared with their counterparts who underwent no intervention. These patients had been followed up in two prospective cohort studies for three years. We here determined the incidence of new-onset T2DM, HTN, and dyslipidemia and reported absolute and relative risks for the incidence of these comorbidities in the two groups. Results In this study, 612 participants in the bariatric surgery group were compared with 593 participants in the control group. During the follow-up period, T2DM developed in eight (2.9%) people in the surgery group and 66 (15.0%) people in the control group (P < 0.001). New-onset HTN and dyslipidemia showed significantly lower frequencies in the surgery group compared to the control group (4 (1.8%) vs. 70 (20.4%) and 33 (14.3%) vs. 93 (31.5%), respectively). Regarding a less favorable metabolic profile in the surgery group at the baseline, the relative risk reductions associated with bariatric surgery were 94, 93, and 55% for the development of T2DM, HTN, and dyslipidemia, respectively. Conclusion The risk reduction of obesity-related comorbidities after bariatric surgery should be considered in the decision-making process for public health in the region, which bariatric surgery could result in the prevention of comorbidities. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01740-7.
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Affiliation(s)
- Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Behnaz Abiri
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mahdavi
- 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
| | - Danial Ebrahimi
- Department of Surgery, Faculty of Medicine, Shiraz University, Shiraz, Iran
| | - Farhad Hosseinpanah
- 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.
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9
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Iannelli A, Bouam S, Schneck AS, Alifano M. Esophageal Cancer in Patients Undergoing Bariatric Surgery: What Is the Real Burden? Obes Surg 2022; 32:567-568. [PMID: 35000067 DOI: 10.1007/s11695-021-05826-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Antonio Iannelli
- Université Côte d'Azur, 06103, Nice, France. .,Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 06200 Nice, 151 Route Saint Antoine de Ginestière, BP 3079, 06200, Nice Cedex 3, France. .,Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", 06200, Nice, France.
| | - Samir Bouam
- Unité d'Information Médicale, Hôpitaux Universitaires Paris Centre, AP-HP, 75004, Paris, France
| | - Anne-Sophie Schneck
- Centre Hospitalier Universitaire de Guadeloupe-Digestive Surgery Unit, 97159, Pointe à Pitre, Guadeloupe
| | - Marco Alifano
- Thoracic Surgery Department, Cochin Hospital, AP-HP Centre, 75004, Paris, France.,INSERM U1138 Team "Cancer, Immune Control, and Escape," Cordeliers Research Center, University of Paris, 75006, Paris, France
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García-Delgado Y, López-Madrazo-Hernández MJ, Alvarado-Martel D, Miranda-Calderín G, Ugarte-Lopetegui A, González-Medina RA, Hernández-Lázaro A, Zamora G, Pérez-Martín N, Sánchez-Hernández RM, Ibarra-González A, Bengoa-Dolón M, Mendoza-Vega CT, Appelvik-González SM, Caballero-Díaz Y, Hernández-Hernández JR, Wägner AM. Prehabilitation for Bariatric Surgery: A Randomized, Controlled Trial Protocol and Pilot Study. Nutrients 2021; 13:2903. [PMID: 34578781 PMCID: PMC8465022 DOI: 10.3390/nu13092903] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery is the most efficacious treatment for obesity, though it is not free from complications. Preoperative conditioning has proved beneficial in various clinical contexts, but the evidence is scarce on the role of prehabilitation in bariatric surgery. We describe the protocol and pilot study of a randomized (ratio 1:1), parallel, controlled trial assessing the effect of a physical conditioning and respiratory muscle training programme, added to a standard 8-week group intervention based on therapeutical education and cognitive-behavioural therapy, in patients awaiting bariatric surgery. The primary outcome is preoperative weight-loss. Secondary outcomes include associated comorbidity, eating behaviour, physical activity, quality of life, and short-term postoperative complications. A pilot sample of 15 participants has been randomized to the intervention or control groups and their baseline features and results are described. Only 5 patients completed the group programme and returned for assessment. Measures to improve adherence will be implemented and once the COVID-19 pandemic allows, the clinical trial will start. This is the first randomized, clinical trial assessing the effect of physical and respiratory prehabilitation, added to standard group education and cognitive-behavioural intervention in obese patients on the waiting list for bariatric surgery. Clinical Trial Registration: NCT0404636.
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Affiliation(s)
- Yaiza García-Delgado
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - María José López-Madrazo-Hernández
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Dácil Alvarado-Martel
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Guillermo Miranda-Calderín
- Department of Rehabilitation and Physical Medicine, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (G.M.-C.); (A.U.-L.); (C.T.M.-V.); (S.M.A.-G.)
| | - Arantza Ugarte-Lopetegui
- Department of Rehabilitation and Physical Medicine, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (G.M.-C.); (A.U.-L.); (C.T.M.-V.); (S.M.A.-G.)
| | - Raúl Alberto González-Medina
- Internal Medicine Nursing 8th North Wing, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain;
| | - Alba Hernández-Lázaro
- Department of Endocrinology and Nutrition, Hospital Universitario Dr. Negrín, 35010 Gran Canaria, Spain;
| | - Garlene Zamora
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Nuria Pérez-Martín
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
| | - Rosa María Sánchez-Hernández
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Adriana Ibarra-González
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Mónica Bengoa-Dolón
- Department of Pneumology, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain;
| | - Carmen Teresa Mendoza-Vega
- Department of Rehabilitation and Physical Medicine, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (G.M.-C.); (A.U.-L.); (C.T.M.-V.); (S.M.A.-G.)
| | - Svein Mikael Appelvik-González
- Department of Rehabilitation and Physical Medicine, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (G.M.-C.); (A.U.-L.); (C.T.M.-V.); (S.M.A.-G.)
| | - Yurena Caballero-Díaz
- Department of General and Digestive Surgery, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.C.-D.); (J.R.H.-H.)
| | - Juan Ramón Hernández-Hernández
- Department of General and Digestive Surgery, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.C.-D.); (J.R.H.-H.)
| | - Ana María Wägner
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
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Yu CW, Park LJ, Pinto A, Ma ON, Lee Y, Gupta R, Chaudhary V, Doumouras AG, Hong D. The Impact of Bariatric Surgery on Diabetic Retinopathy: A Systematic Review and Meta-Analysis. Am J Ophthalmol 2021; 225:117-127. [PMID: 33428884 DOI: 10.1016/j.ajo.2020.12.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE While bariatric surgery induces remission of type 2 diabetes mellitus and reduces other microvascular complications, its impact on diabetic retinopathy (DR) is unclear. Some trials suggest early worsening of DR postsurgery because of rapid improvements in hyperglycemia. This meta-analysis sought to estimate the impact of bariatric surgery on DR for obese patients compared with medical treatment. DESIGN Systematic review and meta-analysis. METHODS The Medline, Embase, and PubMed Central databases were searched to March 2020. Primary studies comparing DR in patients undergoing bariatric surgery with those undergoing medical management were included. Results were meta-analyzed using a random-effects model. Primary outcomes included prevalence of all DR and sight-threatening DR after surgery. Secondary outcomes included worsening of DR within and beyond 12 months. RESULTS Overall, 14 studies comprised of 110,300 surgical patients and 252,289 control subjects were included. Surgical patients had a statistically significantly lower postoperative prevalence of all DR (relative risk [RR] 0.17 [95% confidence interval {CI} 0.13-0.22]) and sight-threatening DR (RR 0.47 [95% CI 0.27-0.82]). Early worsening of DR and progression to sight-threatening DR had occurred more often in those with more severe DR initially. However, beyond 12 months, bariatric surgery resulted in significantly fewer patients with worsened DR (RR 0.29 [95% CI 0.16-0.54]). The overall risk of bias was low; estimates of relative effects had low to moderate certainty of evidence. CONCLUSION While bariatric surgery was associated with fewer cases of all and sight-threatening DR, early worsening was more severe in patients with existing sight-threatening DR. These findings argue for frequent monitoring during the first postoperative year.
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12
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Bailly L, Fabre R, Pradier C, Iannelli A. Colorectal Cancer Risk Following Bariatric Surgery in a Nationwide Study of French Individuals With Obesity. JAMA Surg 2021; 155:395-402. [PMID: 32159744 DOI: 10.1001/jamasurg.2020.0089] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Although bariatric surgery is effective against morbid obesity, the association of this surgery with the risk of colorectal cancer remains controversial. Objective To assess whether bariatric surgery is associated with altered risk of colorectal cancer among individuals with obesity. Design, Setting, and Participants This retrospective, population-based, multicenter, cohort study based on French electronic health data included 1 045 348 individuals with obesity, aged 50 to 75 years, and free of colorectal cancer at baseline. All inpatients with obesity having data recorded during a hospital stay between 2009 and 2018 by the French national health insurance information system database were followed up for a mean (SD) of 5.3 (2.1) years for those who did not undergo bariatric surgery and 5.7 (2.2) years for those who underwent bariatric surgery. Two groups of patients comparable in terms of age, sex, body mass index, follow-up, comorbidities, and conditions who did or did not undergo surgery were also obtained by propensity score matching. Exposures Bariatric surgery (n = 74 131), including adjustable gastric banding, sleeve gastrectomy, gastric bypass; or no bariatric surgery (n = 971 217). Main Outcomes and Measures Primary outcome was incident colorectal cancer. Standardized incidence ratios were calculated using age-, sex-, and calendar year-matched colorectal cancer incidence among the general French population during the corresponding years. Secondary outcome was incident colorectal benign polyps. Results Among a total of 1 045 348 patients, the mean (SD) age was 57.3 (5.5) years for the 74 131 patients in the surgical cohort vs 63.4 (7.0) years for the 971 217 patients in the nonsurgical cohort. The mean (SD) follow-up was 6.2 (2.1) years for patients who underwent adjustable gastric banding, 5.5 (2.1) years for patients who underwent sleeve gastrectomy, and 5.7 (2.2) years for patients who underwent gastric bypass. In total, 13 052 incident colorectal cancers (1.2%) and 63 649 colorectal benign polyps were diagnosed. The rate of colorectal cancer was 0.6% in the bariatric surgery cohort and 1.3% in the cohort without bariatric surgery. In the latter cohort, 9417 cases were expected vs 12 629 observed, a standardized incidence ratio of 1.34 (95% CI, 1.32-1.36). In the bariatric surgery cohort, 428 cases were expected and 423 observed, a standardized incidence ratio of 1.0 (95% CI, 0.90-1.09). Propensity score-matched hazard ratios in comparable operated vs nonoperated groups were 0.68 (95% CI, 0.60-0.77) for colorectal cancer and 0.56 (95% CI, 0.53-0.59) for colorectal benign polyp. There were fewer new diagnoses of colorectal cancer after gastric bypass (123 of 22 343 [0.5%]) and sleeve gastrectomy (185 of 35 328 [0.5%]) than after adjustable gastric banding (115 of 16 460 [0.7%]), and more colorectal benign polyps after adjustable gastric banding (775 of 15 647 [5.0%]) than after gastric bypass (639 of 20 863 [3.1%]) or sleeve gastrectomy (1005 of 32 680 [3.1%]). Conclusion and Relevance The results of this nationwide cohort study suggested that following bariatric surgery, patients with obesity share the same risk of colorectal cancer as the general population, whereas for patients with obesity who do not undergo bariatric surgery, the risk is 34% above that of the general population.
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Affiliation(s)
- Laurent Bailly
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Roxane Fabre
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,EA Cobtek, Université Côte d'Azur, Nice, France
| | - Christian Pradier
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity," Université Côte d'Azur, Nice, France
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13
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Koch TR, Shope TR. Laparoscopic Vertical Sleeve Gastrectomy as a Treatment Option for Adults with Diabetes Mellitus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1307:299-320. [PMID: 32072474 DOI: 10.1007/5584_2020_487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity is a major factor in the worldwide rise in the prevalence of type 2 diabetes mellitus. The obesity "epidemic" will require novel, effective interventions to permit both the prevention and treatment of diabetes caused by obesity. Laparoscopic vertical sleeve gastrectomy is a newer bariatric surgical procedure with a lower risk of complications (compared to Roux-en-Y gastric bypass surgery). Based in part on restriction of daily caloric intake, sleeve gastrectomy has a major role in inducing significant weight loss and weight loss is maintained for at least 10 years. Prior studies have supported the utility of the vertical sleeve gastrectomy for the treatment and management of subgroups of individuals with diabetes mellitus. There are reports of 11% to 76.9% of obese individuals discontinuing use of diabetic medications in studies lasting up to 8 years after vertical sleeve gastrectomy. Major ongoing issues include the preoperative determination of the suitability of diabetic patients to undergo this bariatric surgical procedure. Understanding how this surgical procedure is performed and the resulting anatomy is important when vertical sleeve gastrectomy is being considered as a treatment option for diabetes. In the postoperative periods, specific macronutrient goals and micronutrient supplements are important for successful and safer clinical results. An understanding of immediate- and long term- potential complications is important for reducing the potential risks of vertical sleeve gastrectomy. This includes the recognition and treatment of postoperative nutritional deficiencies and disorders. Vertical sleeve gastrectomy is a component of a long term, organized program directed at treating diabetes related to obesity. This approach may result in improved patient outcomes when vertical sleeve gastrectomy is performed to treat type 2 diabetes in obese individuals.
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Affiliation(s)
- Timothy R Koch
- Center for Advanced Laparoscopic General & Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, USA.
| | - Timothy R Shope
- Center for Advanced Laparoscopic General & Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, USA
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14
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Ferri FA, Frieder JS, Blanco DG, Funes DR, Gomez CO, Lo Menzo E, Szomstein S, Rosenthal RJ. Short-term multiorgan metabolic benefits of rapid weight loss after sleeve gastrectomy in severely obese patients. Surg Obes Relat Dis 2020; 17:284-291. [PMID: 33191164 DOI: 10.1016/j.soard.2020.10.003] [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: 09/14/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) has become the most prevalent bariatric-metabolic surgical approach in the United States. Its popularity among surgeons and patients is mainly due to a better safety profile and less overall morbidity, with broad benefits from a systemic and metabolic perspective. OBJECTIVE Comprehensively describe the short-term multiorgan metabolic effects of rapid weight loss after SG. SETTING Academic hospital, United States. METHODS We retrospectively reviewed the charts of patients that underwent SG at our institution between 2012 and 2016. We analyzed the required variables to calculate multiple risk scores, such as cardiovascular, hypertension, and diabetes risk scores. Furthermore, the renal and hepatic functions and the metabolic and hematologic profiles were assessed at 12 months of follow-up. RESULTS A total of 1002 patients were included in the analysis. The percentage of excess body mass index loss was, on average, 65% at 12 months of follow-up. We observed a positive cardio-renal-hepatic improvement, demonstrated by a substantial reduction of the 10-year cardiovascular risk. We noticed an improvement of renal function, which was more significant in chronic kidney disease (stage ≥2), and a significant improvement on liver function tests (measured by decreased aspartate aminotransferase and alanine transaminase) at 12 months of follow-up. Our data also show a positive impact on decreasing the risk of developing hypertension and type 2 diabetes. There was a positive impact on the lipid profile, with the exception of low-density lipoprotein. CONCLUSION There are significant short-term benefits on multiorgan metabolic parameters after rapid weight loss in severely obese patients undergoing sleeve gastrectomy.
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Affiliation(s)
- Francisco A Ferri
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Joel S Frieder
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Gutierrez Blanco
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Romero Funes
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Camila Ortiz Gomez
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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15
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Abstract
PURPOSE OF REVIEW To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery. RECENT FINDINGS The basic principles of the mechanism for the metabolic effects of bariatric surgery can be categorized into calorie restriction, deviation of nutrients, and reduced amounts of adipose tissue. Recent findings suggest the importance of early changes following deviation of nutrients to more distal parts of the small bowel resulting in altered release of gastrointestinal hormones, altered gut microbiota, and weight-reduction. In the long-term, loss of adipose tissue results in reduced inflammation and improved insulin sensitivity. From a clinical perspective these changes are associated with remission of diabetes in patients with morbid obesity and type 2 diabetes, prevention of diabetes in patients with insulin resistance without overt type 2 diabetes and prevention of both microvascular and macrovascular complications for all patients with morbid obesity. SUMMARY At present, bariatric surgery remains the most effective treatment option to improve glucose control and long-term complications associated with hyperglycemia in patients with obesity.Although the mechanisms behind these metabolic effects remain only partially understood, further knowledge on these complex mechanisms may help identifying durable treatment options for morbid obesity and important metabolic comorbidities.
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Affiliation(s)
- Erik Stenberg
- Faculty of Medicine and Health, Örebro University & Department of Surgery, Region Örebro County, Örebro, Sweden
| | - Anders Thorell
- Department of Clinical Science, Danderyds Hospital, Karolinska Institutet
- Department of Surgery, Ersta hospital, Stockholm, Sweden
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16
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Wiggins T, Guidozzi N, Welbourn R, Ahmed AR, Markar SR. Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003206. [PMID: 32722673 PMCID: PMC7386646 DOI: 10.1371/journal.pmed.1003206] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Previous clinical trials and institutional studies have demonstrated that surgery for the treatment of obesity (termed bariatric or metabolic surgery) reduces all-cause mortality and the development of obesity-related diseases such as type 2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia. The current study analysed large-scale population studies to assess the association of bariatric surgery with long-term mortality and incidence of new-onset obesity-related disease at a national level. METHODS AND FINDINGS A systematic literature search of Medline (via PubMed), Embase, and Web of Science was performed. Articles were included if they were national or regional administrative database cohort studies reporting comparative risk of long-term mortality or incident obesity-related diseases for patients who have undergone any form of bariatric surgery compared with an appropriate control group with a minimum follow-up period of 18 months. Meta-analysis of hazard ratios (HRs) was performed for mortality risk, and pooled odds ratios (PORs) were calculated for discrete variables relating to incident disease. Eighteen studies were identified as suitable for inclusion. There were 1,539,904 patients included in the analysis, with 269,818 receiving bariatric surgery and 1,270,086 control patients. Bariatric surgery was associated with a reduced rate of all-cause mortality (POR 0.62, 95% CI 0.55 to 0.69, p < 0.001) and cardiovascular mortality (POR 0.50, 95% CI 0.35 to 0.71, p < 0.001). Bariatric surgery was strongly associated with reduced incidence of T2DM (POR 0.39, 95% CI 0.18 to 0.83, p = 0.010), hypertension (POR 0.36, 95% CI 0.32 to 0.40, p < 0.001), dyslipidaemia (POR 0.33, 95% CI 0.14 to 0.80, p = 0.010), and ischemic heart disease (POR 0.46, 95% CI 0.29 to 0.73, p = 0.001). Limitations of the study include that it was not possible to account for unmeasured variables, which may not have been equally distributed between patient groups given the non-randomised design of the studies included. There was also heterogeneity between studies in the nature of the control group utilised, and potential adverse outcomes related to bariatric surgery were not specifically examined due to a lack of available data. CONCLUSIONS This pooled analysis suggests that bariatric surgery is associated with reduced long-term all-cause mortality and incidence of obesity-related disease in patients with obesity for the whole operated population. The results suggest that broader access to bariatric surgery for people with obesity may reduce the long-term sequelae of this disease and provide population-level benefits.
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Affiliation(s)
- Tom Wiggins
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - Nadia Guidozzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Richard Welbourn
- Department of Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - Ahmed R. Ahmed
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sheraz R. Markar
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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17
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Marinari GM, Anselmino M, Tascini C, Bernante P, Foletto M, Gentileschi P, Morino M, Olmi S, Toppino M, Silecchia G. Bariatric and metabolic surgery during COVID-19 outbreak phase 2 in Italy: why, when and how to restart. Surg Obes Relat Dis 2020; 16:1614-1618. [PMID: 32739265 PMCID: PMC7313526 DOI: 10.1016/j.soard.2020.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 01/21/2023]
Abstract
In Italy elective bariatric and metabolic surgery was cancelled on February 21,2020 at the beginning of the so-called phase 1 of the SARS-CoV-2 outbreak. Gradually it was restarted on May 4,2020 at the beginning of the so-called phase 2, when epidemiological data showed containment of the infection. Before the outbreak in eight high-volume bariatric centers 840 patients were surgically treated developing a Covid-19 infection, during phase 1, in only 5 cases (0.6%) without mortality. The post-operative complication rate was similar when compared to the 836 subjects submitted to bariatric surgery the year before. Since the high prevalence of infection in subjects with BMI > 30, it was argued that early intervention on obesity during phase 2 could help to minimize the effects of the disease in the event of a possible reversion to a SARS-CoV-2 outbreak phase 1. At the same time a prospective observational study from July 1 till the WHO declaration of the end of the pandemic has started in the eight high volume centers to monitor the post-operative outcome and its effect on SARS-CoV-2 infection.
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Affiliation(s)
| | - Marco Anselmino
- Bariatric & Metabolic Surgery Unit, Department of General Surgery, Pisa, Italy
| | - Carlo Tascini
- SOC Malattie infettive, Azienda Sanitaria Integrata, University of Udine Udine, Italy
| | - Paolo Bernante
- Bariatric & Metabolic Surgery Unit, Department of medical and surgical sciences, Azienda Ospedaliera Universitaria Policlinico di Sant'Orsola Bologna, Bologna, Italy
| | - Mirto Foletto
- Week Surgery - Bariatric Unit, Padova University Hospital, University of Padova, Padova, Italy
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, Tor Vergata University, Roma, Italy
| | - Mario Morino
- General Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Stefano Olmi
- General and Oncological Surgery, Center of Advanced Laparoscopy, Center of Bariatric and Metabolic Surgery, Zingonia, Italy
| | - Mauro Toppino
- General Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Gianfranco Silecchia
- Division of General Surgery & Bariatric Center of Excellence IFSO EC, Department of Medico-Surgical Sciences and Biothecnologies, Sapienza University of Rome, Latina, Italy.
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18
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Silveira EA, de Souza Rosa LP, de Carvalho Santos ASEA, de Souza Cardoso CK, Noll M. Type 2 Diabetes Mellitus in Class II and III Obesity: Prevalence, Associated Factors, and Correlation between Glycemic Parameters and Body Mass Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3930. [PMID: 32498226 PMCID: PMC7312992 DOI: 10.3390/ijerph17113930] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022]
Abstract
Despite the worldwide growth of class II and III obesity, the factors associated with type 2 diabetes mellitus (T2DM) in these obese individuals are not widely understood. Moreover, no study has investigated these associations in South America. Our study aimed to investigate the prevalence of T2DM and its associated factors, with an emphasis on biochemical parameters and eating habits, in class II and III obese individuals. We also aimed to analyze the correlation between glycemic parameters and body mass index (BMI). Baseline data from a randomized clinical trial (DieTBra Trial) of 150 class II and III obese individuals (BMI > 35 kg/m2) was used. An accelerometer, Food Frequency Questionnaire, and bioimpedance analysis were used to assess physical activity levels, eating habits, and body composition, respectively. Blood was collected after 12 h of fasting. Hierarchical multivariate Poisson regression was performed, and prevalence ratios (PRs) were calculated. Correlations between glycemic parameters (fasting blood glucose, glycosylated hemoglobin, homeostasis model assessment of insulin resistance (HOMA-IR), and insulin) and BMI were also analyzed. The prevalence of T2DM was 40.0% (95% CI, 32.1-48.3), high fasting blood glucose level was 19.33% (95% CI, 13.3-26.6), and high glycosylated hemoglobin was 32.67% (95% CI, 25.2-40.8). Age ≥ 50 years (PR = 3.17, 95% CI, 1.26-7.98) was significantly associated with T2DM; there was a positive linear trend between age and T2DM (p = 0.011). Multivariate analysis showed an association with educational level (PR = 1.49, 1.07-2.09, p = 0.018), nonconsumption of whole grains daily (PR = 1.67, 1.00-2.80, p = 0.049), and high HOMA-IR (PR = 1.54, 1.08-2.18, p = 0.016). We found a high prevalence of T2DM and no significant correlations between BMI and glycemic parameters.
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Affiliation(s)
- Erika Aparecida Silveira
- Post-Graduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiás 74605-050, Brazil; (L.P.d.S.R.); (A.S.e.A.d.C.S.); (C.K.d.S.C.); (M.N.)
| | - Lorena Pereira de Souza Rosa
- Post-Graduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiás 74605-050, Brazil; (L.P.d.S.R.); (A.S.e.A.d.C.S.); (C.K.d.S.C.); (M.N.)
- Federal Institute of Goiás, Goiânia Oeste Campus, Goiás 74270-040, Brazil
| | - Annelisa Silva e Alves de Carvalho Santos
- Post-Graduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiás 74605-050, Brazil; (L.P.d.S.R.); (A.S.e.A.d.C.S.); (C.K.d.S.C.); (M.N.)
- United College of Campinas, Goiás 74535-040, Brazil
| | - Camila Kellen de Souza Cardoso
- Post-Graduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiás 74605-050, Brazil; (L.P.d.S.R.); (A.S.e.A.d.C.S.); (C.K.d.S.C.); (M.N.)
- Nutrition Course, School of Social and Health Sciences, Pontifical Catholic University of Goiás, Goiás 74605-010, Brazil
| | - Matias Noll
- Post-Graduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiás 74605-050, Brazil; (L.P.d.S.R.); (A.S.e.A.d.C.S.); (C.K.d.S.C.); (M.N.)
- Instituto Federal Goiano, Ceres Campus, Goiás 76310-000, Brazil
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19
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Rosenzweig JL, Bakris GL, Berglund LF, Hivert MF, Horton ES, Kalyani RR, Murad MH, Vergès BL. Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104:3939-3985. [PMID: 31365087 DOI: 10.1210/jc.2019-01338] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop clinical practice guidelines for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM) in individuals at metabolic risk for developing these conditions. CONCLUSIONS Health care providers should incorporate regular screening and identification of individuals at metabolic risk (at higher risk for ASCVD and T2DM) with measurement of blood pressure, waist circumference, fasting lipid profile, and blood glucose. Individuals identified at metabolic risk should undergo 10-year global risk assessment for ASCVD or coronary heart disease to determine targets of therapy for reduction of apolipoprotein B-containing lipoproteins. Hypertension should be treated to targets outlined in this guideline. Individuals with prediabetes should be tested at least annually for progression to diabetes and referred to intensive diet and physical activity behavioral counseling programs. For the primary prevention of ASCVD and T2DM, the Writing Committee recommends lifestyle management be the first priority. Behavioral programs should include a heart-healthy dietary pattern and sodium restriction, as well as an active lifestyle with daily walking, limited sedentary time, and a structured program of physical activity, if appropriate. Individuals with excess weight should aim for loss of ≥5% of initial body weight in the first year. Behavior changes should be supported by a comprehensive program led by trained interventionists and reinforced by primary care providers. Pharmacological and medical therapy can be used in addition to lifestyle modification when recommended goals are not achieved.
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Affiliation(s)
| | | | | | - Marie-France Hivert
- Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Rita R Kalyani
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Bruno L Vergès
- Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
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