Surgical and Nonsurgical Interventions for Obesity in Service of Preserving Cognitive Function

Anti-Obesity Effects of Leuconostoc mesenteroides 4-Fermented Lemon Peel Filtrate on HFD-Induced Obese Mice via NFκB/ PPAR-γ Pathway

Obesity is a major health problem associated with Type 2 diabetes, non-alcohol fatty liver disease (NAFLD), and atherosclerosis. Functional lactic acid bacteria-fermented products have been reported to have potential anti-obese effect. The present results revealed that Leuconostoc mesenteroides 4 (LMSS4)-fermented lemon peel filtrate slowed down the increase of body weight, and decreased liver and epididymal fat indices; it also decreased serum levels of TC (total cholesterol), TG (triglyceride), LDL-C (low-density lipoprotein cholesterol), ALT (alanine transaminase), AST (aspartate transaminase), and AKP (alkaline phosphatase), TNF-α (tumor necrosis factor-α), IFN-γ (interferon gamma), IL-1β (interleukin-1β), IL-6 (interleukin-6), and IL-10 (interleukin-10), increased the levels of HDL-C (high-density lipoprotein cholesterol), IL-4 (interleukin-4), and IL-10 (interleukin-10). Furthermore, the mRNA expression of NFκB-p65 (nuclear factor-κB p65), PPAR-γ (eroxisome proliferator-activated receptor γ), TNF-α, IL-1β, leptin, SREBP-1c (sterol regulatory element binding protein-1c), FAS (fatty acid synthase), and CEBP/α (CCAAT/enhancer binding protein α) were down-regulated, while the expression of IL-4, IκB-α (inhibitory subunit of NF Kappa B alpha), and IL-10 were upregulated after the mice were treated with LMSS4-fermented lemon filtrate; the filtrate also downregulated the protein expression of NFκB-p65 and PPAR-γ but increased the expression of IκB-α. The HPLC results found that rutin and hesperidin were the predominant constituents in both the unfermented and LMSS4-fermented lemon filtrates among the 15 constituents analyzed. In addition, chlorogenic acid, umbelliferone, byakangelicin, and oxypeucedanin hydrate were increased in the fermented lemon filtrate, in which chlorogenic acid showed the highest increase rate (83.51%). In conclusion, the anti-obesity effect of LMSS 4-fermented lemon peel filtrate was mediated via the regulation of the NFκB/PPAR-γ signaling pathway. These results could provide an experimental basis for developing new functional lemon beverages for obesity intervention.

Safety of Non-steroidal Anti-inflammatory Drugs as Part of Enhanced Recovery After Laparoscopic Sleeve Gastrectomy-A Systematic Review and Meta-Analysis

Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery option for managing extreme obesity in most patients. While non-steroidal anti-inflammatory drugs (NSAIDs) promise postoperative pain management after bariatric surgeries, their safety in LSG remains unexplored. In this systematic review, we studied the safety of NSAIDs following LSG reported by six studies involving 588 patients. Our study demonstrated that NSAIDs effectively alleviated the postoperative pain after LSG without major safety concerns. Most reported (>20% incidence) adverse events included postoperative nausea and vomiting (PONV, 21%). For patients undergoing LSG, NSAIDs offer a valuable option for pain management and improved care, potentially reducing opioid consumption. However, additional research is required to optimize NSAID usage and ensure safety, especially concerning renal and gastrointestinal issues.

The changes in cognitive function following bariatric surgery considering the function of gut microbiome

Background

There is a correlation between gut microbiota and cognitive function. The mechanisms and pathways explain why the incidence of Alzheimer's disease in subjects undergoing bariatric surgery is lower than in other people with obesity.

Methods

In this review article, we aim to discuss the association of obesity, cognitive impairment, and physiological changes after bariatric surgery.

Results

Bariatric surgery has a series of physiological benefits which may lead to an improvement in cognitive functions in individuals who are prone to later developing Alzheimer's disease. Also, taxonomical change in the gut microbiome profile provides a healthy condition for living with better levels of cognition without neuropathological damages in older ages.

Conclusion

It can be concluded that there is a possible correlation between cognitive dysfunction and increased risk of cognitive dysfunction in people with a BMI higher than 40 kg/m2. Bariatric surgery may increase neurotransmitters and improve the gut bacteria, leading to a significant reduction in the risk of Alzheimer's disease.

Visual, Verbal and Everyday Memory 2 Years After Bariatric Surgery: Poorer Memory Performance at 1-Year Follow-Up

Severe obesity has been associated with reduced performance on tests of verbal memory in bariatric surgery candidates. There is also some evidence that bariatric surgery leads to improved verbal memory, yet these findings need further elucidation. Little is known regarding postoperative memory changes in the visual domain and how patients subjectively experience their everyday memory after surgery. The aim of the current study was to repeat and extend prior findings on postoperative memory by investigating visual, verbal, and self-reported everyday memory following surgery, and to examine whether weight loss and somatic comorbidity predict memory performance. The study was a prospective, observational study in which participants (n = 48) underwent cognitive testing at baseline, 1 and 2 years after bariatric surgery. Repeated measures analyses of variance revealed significantly poorer visual and verbal memory performance at the 1-year follow-up, with performance subsequently returning to baseline levels after 2 years. Verbal learning and self-reported everyday memory did not show significant postoperative changes. Memory performance at 1 year was not significantly predicted by weight loss, changes in C-reactive protein levels or postoperative somatic comorbidity (Type 2 diabetes, sleep apnea, and hypertension). The study demonstrated poorer visual and verbal memory performance at 1-year follow-up that returned to baseline levels after 2 years. These findings are in contrast to most previous studies and require further replication, however, the results indicate that postoperative memory improvements following bariatric surgery are not universal. Findings suggest that treatment providers should also be aware of patients potentially having poorer memory at 1 year following surgery.

Phenotypic heterogeneity of obesity-related brain vulnerability: one-size interventions will not fit all

Intact memory and problem solving are key to functional independence and quality of life in older age. Considering the unprecedented demographic shift toward a greater number of older adults than children in the United States in the next few decades, it is critically important for older adults to maintain work productivity and functional independence for as long as possible. Implementing early interventions focused on modifiable risk factors for cognitive decline at midlife is a strategy with the highest chance of success at present, bearing in mind the current lack of dementia cures. We present a selective, narrative review of evidence linking nutrition, body composition, vascular health, and brain function in midlife to highlight the phenotypic heterogeneity of obesity-related brain vulnerability and to endorse the development of individually tailored lifestyle modification plans for primary prevention of cognitive decline.

Changes in Cognitive Function Following Bariatric Surgery: a Systematic Review

Increased body mass is directly associated with reduced cognitive function. The aim of this study was to systematically review the effect of bariatric weight loss surgery on cognitive function. A comprehensive and unrestricted literature search was conducted using the following databases: MEDLINE, EMBASE, PubMed, Scopus, Web of Sciences, and the Cochrane Library. A total of 414 publications were identified, of which 18 were included in the final review. Cognitive function as measured by a number of different assessment tools was shown to improve following surgically induced weight loss in most studies. Significant and rapid weight loss resulting from bariatric surgery is associated with prompt and sustained improvements in cognitive function including memory, executive function, and cognitive control.

Diabetes, Obesity, and the Brain: New Developments in Biobehavioral Medicine

Diabetes and obesity, two major public health concerns, are associated with increased risk for problems in multiple organ systems, including the central nervous system. The adverse effects of diabetes and obesity on cognitive functioning are increasingly well recognized. This special issue of Psychosomatic Medicine features the latest research linking diabetes, obesity, and brain structure, function, and metabolism and follows a special meeting on this topic organized by the American Psychosomatic Society in October 2013. Evidence for the increased prevalence of diabetes and obesity is reviewed as it relates to cognitive decline. These articles indicate that the age of onset of Type 1 diabetes may be relevant to future cognitive function and that disease duration of Type 2 diabetes and sociocultural factors are related to cognitive decline during the aging process. The hypothalamus and other neural circuits, notably the dopaminergic system that underlies feeding and reward-related aspects of food intake, are among the key factors involved in obesity. Research on the associations between obesity and cognitive function is described using the positive effects of weight reduction following bariatric surgery or behavioral methods. This special issue concludes with a conceptual framework for linking obesity and diabetes with accelerated cognitive decline as related to the aging process. The collection of articles highlights the importance of using a life span perspective to understand the influence of both Type 1 and Type 2 diabetes on brain metabolism, function, and structure. Moreover, these studies show that distressing environmental circumstances can adversely influence neurocognitive dysfunction associated with obesity and diabetes.