Ockham's razor and the metabolic syndrome

Metabolic Surgery and Chronic Traumatic Encephalopathy: Perceptions of Former NFL Players

PURPOSE

Chronic traumatic encephalopathy (CTE) has been diagnosed in 91.7% of retired United States National Football League (NFL) players at postmortem. There is no treatment or cure for CTE. Most living former NFL athletes with probable CTE suffer from obesity and its comorbidities. Our previous reviews document the improvement in cognition following metabolic/bariatric surgery (MBS) (e.g., gastric bypass, sleeve gastrectomy). These operations might reduce microglial maladaptive states, thereby attenuating neurodegeneration and CTE-like neurocognitive impairment. The study evaluated former NFL players' views on metabolic surgery in relation to reduction of obesity and CTE risk.

MATERIALS AND METHODS

An online multiple-choice questionnaire (30 items, 125 response options, 10-min completion) developed in the Research Electronic Data Capture (REDCap) system was sent to 1,014 athletes screened in 2017-2022 by the Living Heart Foundation.

RESULTS

From 2/2022 to 7/2023, of 700 surveys opened, 72 (10.3%) of the retired players responded. Mean age was 61.6 ± 12.6 years; 45.0% had the disease of obesity with a mean BMI 35.5 ± 4.6 kg/m2. Thirty-three percent reported ≥ 2 obesity-related comorbidities; 40.3% memory-related TBI symptoms; 66.7% ≥ 1 cognitive symptom; 85.0% believed MBS was safe and effective but were unlikely to elect MBS for weight management. Yet, 57.0% of the entire cohort, and 68.8% of players with obesity were more likely to elect MBS if it could also reduce CTE risk.

CONCLUSIONS

Results of the study bode well for future research recruitment. Most surveyed retired NFL players with obesity believed MBS to be effective and would be more likely to undergo MBS if it also reduced CTE risk.

Foam rolling and stretching do not provide superior acute flexibility and stiffness improvements compared to any other warm-up intervention: A systematic review with meta-analysis

BACKGROUND

Acute improvement in range of motion (ROM) is a widely reported effect of stretching and foam rolling, which is commonly explained by changes in pain threshold and/or musculotendinous stiffness. Interestingly, these effects were also reported in response to various other active and passive interventions that induce responses such as enhanced muscle temperature. Therefore, we hypothesized that acute ROM enhancements could be induced by a wide variety of interventions other than stretching or foam rolling that promote an increase in muscle temperature.

METHODS

After a systematic search in PubMed, Web of Science, and SPORTDiscus databases, 38 studies comparing the effects of stretching and foam rolling with several other interventions on ROM and passive properties were included. These studies had 1134 participants in total, and the data analysis resulted in 140 effect sizes (ESs). ES calculations were performed using robust variance estimation model with R-package.

RESULTS

Study quality of the included studies was classified as fair (PEDro score = 4.58) with low to moderate certainty of evidence. Results showed no significant differences in ROM (ES = 0.01, p = 0.88), stiffness (ES = 0.09, p = 0.67), or passive peak torque (ES = -0.30, p = 0.14) between stretching or foam rolling and the other identified activities. Funnel plots revealed no publication bias.

CONCLUSION

Based on current literature, our results challenge the established view on stretching and foam rolling as a recommended component of warm-up programs. The lack of significant difference between interventions suggests there is no need to emphasize stretching or foam rolling to induce acute ROM, passive peak torque increases, or stiffness reductions.

Body mass index and risk of mortality in patients undergoing bariatric surgery

BACKGROUND

Prior literature has demonstrated that bariatric surgery is a safe approach for patients with morbid obesity. However, the relationship between body mass index (BMI) and risk of mortality in these patients has not been fully elucidated. Primary objective of this study was to evaluate the relationship between BMI and risk of mortality using data obtained from a national database, with a special focus on patients with BMI ≥ 70.0 kg/m².

METHODS

A retrospective cohort study of patients with morbid obesity (BMI ≥ 40 kg/m²) undergoing first-time bariatric surgery between 2015 and 2018 was performed using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Primary outcome was intra-operative death or death within 30 days post-operatively. Patients were categorized into quartiles according to BMI. Multivariable analysis was performed to evaluate the association of BMI with risk of mortality. Relative risk (RR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively.

RESULTS

A total of 463, 436 patients were included with a 30-day mortality rate of 0.11%. Mean BMI (SD) was 48.2 (7.3) kg/m²; 1.5% of patients had BMI ≥ 70.0 kg/m². On multivariable analysis, highest quartile patients had a significantly higher risk of mortality than lowest quartile patients. For patients with BMI ≥ 70.0 kg/m², the risk of mortality was more pronounced with an eightfold increase compared to the lowest quartile. In patients with BMI ≥ 70.0 kg/m², although sleeve gastrectomy (SG) was the most common procedure, the risk of mortality was significantly higher in patients undergoing Roux-en-Y gastric bypass (RYGB).

CONCLUSIONS

BMI is associated with increased risk of 30-day mortality. The effect of BMI is more pronounced in patients with BMI ≥ 70.0 kg/m². In these patients, RYGB is associated with increased risk of mortality compared to SG.