Benefits Of Bariatric Surgery Research Articles

B-140 Use of the metabolic health index for correlation with comorbidity reduction for patients undergoing bariatric surgery

Abstract Background Bariatric surgery is a commonly performed procedure aimed at addressing obesity and its associated health issues. However, while weight loss is often a primary focus, the broader improvements in metabolic health, including reductions in conditions such as type 2 diabetes mellitus (T2DM) and dyslipidemia, are not consistently quantified. The recent development of the Metabolic Health Index (MHI) by van Loon et al. provides a potential laboratory index that encompasses various metabolic parameters to predict improvements in comorbidities post-surgery. Our study aimed to assess the utility of MHI in correlating with changes in metabolic health status among patients undergoing bariatric surgery at a U.S. medical center. Methods In our current study, we conducted a retrospective analysis of 300 patients who had undergone bariatric surgery between 2012 and 2019 at the University of Minnesota. We selected patients who had both baseline and one-year post-surgery laboratory values available, including age, hemoglobin A1C (HbA1c), triglycerides, potassium, and creatinine for estimated glomerular filtration rate (eGFR), which were necessary for calculating MHI using the equation of van Loon et al. Thirty patients met the inclusion criteria and their eGFRs were calculated using the 2021 CKD-EPI equation. Using the published formulae, we calculated the MHI for each patient before and after surgery. Patients were stratified based on improvements in diabetic (T2DM) and dyslipidemic status, with lower stratification numbers indicating better outcomes. We then conducted correlation analyses to examine the relationship between changes in MHI, individual components of MHI, BMI, and the reduction in the two comorbidities. We also examined if any of the initial values of MHI, its components and BMI correlated with the magnitude of reduction in the two comorbidities. Results In the patient cohort examined, initially 46.7% of the population were non-diabetic and this changed to 53.3% one year after surgery. The number of patients with diabetes decreased from 33.3% to 13.3%, indicating a benefit of bariatric surgery in alleviating type 2 diabetes mellitus (T2DM). Dyslipidemia decreased from 36.7% to 13.3% post-surgery. Most of the patients had reductions in both the BMI and MHI scales and a linear relationship between the two values was observed. A Spearman correlation analysis revealed that the values of HbA1c (rho= 0.56, p = 0.0014)) and MHI (rho = 0.5, p = 0.005) had a correlation with the reduction in T2DM and the reduction in triglycerides (rho= 0.73, p= 0.0) correlated with reduction in dyslipidemia. On the other hand, the reduction in BMI did not correlate with the improvement in the comorbidities examined. It was determined that the initial values of MHI, its components, and BMI had no correlation to the degree of reduction in comorbidities. Conclusions Our findings suggest that MHI and HbA1C may serve as valuable indicators of metabolic health improvements following bariatric surgery, while BMI changes alone may not fully capture these improvements. Laboratory-based measurements such as MHI offer a promising approach for assessing and monitoring metabolic health outcomes in bariatric surgery patients, providing insights beyond traditional weight-based metrics.

Postoperative pulmonary complications in patients with chronic obstructive pulmonary disease undergoing primary laparoscopic bariatric surgery: an MBSAQIP analysis

BackgroundRecent research has shown beneficial effects of bariatric surgery (BaS) on the risk of developing acute exacerbations of chronic obstructive pulmonary disease (COPD). However, this patient population may be at increased risk of complications, especially postoperative pulmonary complications (PPC). ObjectivesTo analyze the incidence of PPC in patients with COPD undergoing BaS. SettingAcademic Hospital, United States. MethodsWe performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass during 2015–2019. The primary outcome of the study was any PPC, defined as a composite variable including postoperative pneumonia, mechanical ventilation >48 hours and unplanned endotracheal intubation. A univariate analysis was performed to compare patients with and without COPD, and a multivariate logistic regression was performed to adjust for confounders. A subgroup analysis was performed to compare endpoints in patients with COPD with or without home oxygen requirements. ResultsA total of 752,722 patients were included in our analysis (laparoscopic sleeve gastrectomy = 73.2%, Roux-en-Y gastric bypass = 26.8%). PPC occurred in 2390 patients, 0.3% without COPD versus 1.3% with COPD (P < .001). Multivariable analysis confirmed that COPD independently increases the risk of PPC (OR = 1.7, CI = 1.4–2.1). Subgroup analysis showed that patients who are oxygen dependent had a much higher risk for PPC (2.4% versus 1.1%, P < .001). ConclusionPPC are higher among patients with obesity and concomitant COPD. Oxygen dependency confers an even higher complication rate. The risk and benefits of BaS in this population must be carefully addressed.

Benefits of bariatric surgery on glycemic control in patients with type 2 diabetes mellitus. A narrative review.

Benefits of bariatric surgery on glycemic control in patients with type 2 diabetes mellitus. A narrative review.

Sex-differential testosterone response to long-term weight loss

ObjectivesObesity-associated gonadal dysfunction is a common comorbidity in patients seeking weight loss interventions. We examined the incremental effect of weight loss on gonadal axes in men and women over 3 years. Changes in sex hormones were compared between dietary intervention (Diet) and bariatric procedures: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and laparoscopic adjustable gastric banding (LAGB). Additional analysis assessed changes in corticotropic, somatotropic and thyroid axes after weight loss interventions.MethodsThis prospective, observational study included 61 adults with Body Mass Index >30 kg/m2, mean age 51 (SD = 11) years. Endocrine parameters were measured at baseline and at 6 timepoints over 36-months.ResultsFor each 1 kg of weight lost, between baseline and 36 months, total testosterone increased by 0.6% (95% CI: 0.2%, 1.0%, p = 0.002) in males and decreased by 0.8% (95% CI: −1.4%, −0.3%, p = 0.003) in females. These changes remained statistically significant when controlled for age and for menopausal status in females. At 36 months, in comparison with Diet, RYGB women had lower total testosterone by 54% (95% CI: −90%, −17%, p = 0.004), reduced free androgen index (FAI) by 65% (95% CI; −114%, −17%, p = 0.009) while SG had reduced FAI by 39% (95% CI; −77%, 0%, p = 0.05). No such differences between groups were noted for male subjects. Adrenocorticotropic hormone declined by 0.3% (95% CI: 0.0, −0.5%, p = 0.05), insulin-like growth factor-1 increased by 0.4% (95% CI; 0.2%, 0.7%, p = 0.005), without such thyrotrophin change for each 1 kg of weight loss, for entire cohort, over 36 months.ConclusionsThe testosterone changes observed in this study were proportional to the amount of weight loss. In females, reduction in androgens was independent of age and menopausal status and more pronounced after bariatric procedures. This study finding warrants further clinical research to explore an impact of androgen reduction on functional and cognitive status in postmenopausal women. The observed changes in pituitary hormones may contribute to the metabolic benefits of bariatric surgery.

Various aspects of bariatric surgery - a review

Introduction and purpose Obesity is a complex, chronic disease that has recently reached epidemic proportions. According to the World Health Organization, the prevalence of this disease tripled since 1975, reaching 13% of the global population in 2016. A body mass index (BMI) &gt; 30 kg/m² is typically the reference point for obesity in adults, and the mortality risk associated with obesity increases by 100% at BMI &gt; 40 kg/ m² compared to individuals with normal body weight. The aim of the article is to present the benefits of bariatric surgery, encompassing not only weight loss but also a range of other advantages for obese patients undergoing the procedure. Materials and methods The literature included in the PubMed databases is searched through the words such as obesity, bariatric surgery. Description of the state of knowledge: The literature review shows the breadth of the issue. Obesity constitutes a public health crisis and a significant risk factor for many diseases, including cardiovascular diseases, diabetes, cancer, and numerous others. Since in most cases, lifestyle optimization and low-calorie diet alone are not sufficient, pharmacological interventions as well as surgical interventions are often necessary. Bariatric surgery remains the most effective treatment option, as it has been demonstrated to not only reduce body weight but also decrease mortality from cardiovascular diseases and extend overall life expectancy. Conclusions The benefits, complications, and selection of the best surgical method for treating obesity are still under investigation. However, research demonstrates the long-term effectiveness of bariatric surgery in weight loss and the remission of comorbidities such as type 2 diabetes, as well as in preventing obesity-related cancers.

1694-P: Subphenotype-Dependent Benefits of Bariatric Surgery in Data-Driven Clusters of Individuals at Risk for Type 2 Diabetes

1694-P: Subphenotype-Dependent Benefits of Bariatric Surgery in Data-Driven Clusters of Individuals at Risk for Type 2 Diabetes

Obesity management for the treatment of type 2 diabetes: emerging evidence and therapeutic approaches.

Excess adiposity can contribute to metabolic complications, such as type 2 diabetes mellitus (T2DM), which poses a significant global health burden. Traditionally viewed as a chronic and irreversible condition, T2DM management has evolved and new approaches emphasizing reversal and remission are emerging. Bariatric surgery demonstrates significant improvements in body weight and glucose homeostasis. However, its complexity limits widespread implementation as a population-wide intervention. The identification of glucagon-like peptide 1 (GLP-1) and the development of GLP-1 receptor agonists (GLP-1RAs) have improved T2DM management and offer promising outcomes in terms of weight loss. Innovative treatment approaches combining GLP-1RA with other gut and pancreatic-derived hormone receptor agonists, such as glucose-dependant insulinotropic peptide (GIP) and glucagon (GCG) receptor agonists, or coadministered with amylin analogues, are demonstrating enhanced efficacy in both weight loss and glycemic control. This review aims to explore the benefits of bariatric surgery and emerging pharmacological therapies such as GLP-1RAs, and dual and triple agonists in managing obesity and T2DM while highlighting the caveats and evolving landscape of treatment options.

Bariatric Surgery as a Bridge to a Successful Kidney Transplantation: A Case Report

BackgroundSevere obesity impairs renal function and outcomes in kidney transplant recipients. Bariatric surgery benefits those unresponsive to medical treatments. Limited case reports exist on its efficacy and long-term prognosis for transplant candidates. Thus, this study aims to present a case in which laparoscopic sleeve gastrectomy was safely performed on a patient with severe obesity awaiting kidney transplantation. Case PresentationThis study included a dialysis patient with a body mass index of 47 kg/m2. Living-donor kidney transplantation using his younger sister as a donor was considered, but it was determined that the risk of complications during and after surgery was high. Medical treatment was first performed, but the obesity did not improve; therefore, a laparoscopic sleeve gastrectomy was performed. Although postoperative bleeding occurred, the patient was discharged from the hospital on the 14th postoperative day. Subsequently, his weight steadily decreased, and living-donor kidney transplantation was performed 13 months after laparoscopic sleeve gastrectomy was performed. Furthermore, the patient's progress after kidney transplantation was good, and he was freed from hemodialysis. ConclusionImproving severe obesity before kidney transplantation is effective in improving prognosis, and bariatric surgery should be considered when medical treatment is ineffective. Future research are needed to determine the optimal time between the performance of this procedure and kidney transplantation, as well as the long-term prognosis after kidney transplantation.

Lipid metabolic reprogramming mediated by circulating Nrg4 alleviates metabolic dysfunction-associated steatotic liver disease during the early recovery phase after sleeve gastrectomy

BackgroundThe metabolic benefits of bariatric surgery that contribute to the alleviation of metabolic dysfunction-associated steatotic liver disease (MASLD) have been reported. However, the processes and mechanisms underlying the contribution of lipid metabolic reprogramming after bariatric surgery to attenuating MASLD remain elusive.MethodsA case–control study was designed to evaluate the impact of three of the most common adipokines (Nrg4, leptin, and adiponectin) on hepatic steatosis in the early recovery phase following sleeve gastrectomy (SG). A series of rodent and cell line experiments were subsequently used to determine the role and mechanism of secreted adipokines following SG in the alleviation of MASLD.ResultsIn morbidly obese patients, an increase in circulating Nrg4 levels is associated with the alleviation of hepatic steatosis in the early recovery phase following SG before remarkable weight loss. The temporal parameters of the mice confirmed that an increase in circulating Nrg4 levels was initially stimulated by SG and contributed to the beneficial effect of SG on hepatic lipid deposition. Moreover, this occurred early following bariatric surgery. Mechanistically, gain- and loss-of-function studies in mice or cell lines revealed that circulating Nrg4 activates ErbB4, which could positively regulate fatty acid oxidation in hepatocytes to reduce intracellular lipid deposition.ConclusionsThis study demonstrated that the rapid effect of SG on hepatic lipid metabolic reprogramming mediated by circulating Nrg4 alleviates MASLD.

'Surgery is my only hope': A qualitative study exploring perceptions of living with obesity and the prospect of having bariatric surgery.

The health benefits of bariatric surgery are well documented; however, the occurrence of weight-regain after surgery, along with the development of mental health difficulties poses a question of how contemporary psychology could assist to prepare people living with obesity prior to undergoing bariatric surgery. This research explored individuals' (in the immediate pre-operative and post-operative population) attitudes, beliefs and experiences towards obesity and their journey to bariatric surgery. Seventeen adult participants (males n = 4; age range: 26-64 years) were recruited and participated in a semi-structured interview. Twelve individuals participated prior to undergoing bariatric surgery. Five individuals participated in the early post-operative period (<3 months post-surgery). People living with obesity displayed high optimism for positive outcomes, with participants hoping that bariatric surgery would be different to previous attempts at weight regulation, with there being a clear shift in the locus of control for weight management from self to healthcare professionals. Whilst this is adaptive, there was the presence of seemingly unrealistic optimism, with many pre-surgery participants not relaying the realistic possibility of post-surgery weight-regain. Despite the optimism individuals feel about bariatric surgery, participants felt that the psychological factors influencing eating behaviours are not being addressed by healthcare. These findings suggest that mindfulness, mindful eating, and self-compassion approaches should be incorporated into clinical practice to support weight regulation and adaption to physiological changes after bariatric surgery.

Bariatric surgery, through beneficial effects on underlying mechanisms, improves cardiorenal and liver metabolic risk over an average of ten years of observation: A longitudinal and a case-control study

BackgroundBariatric surgery has long-term beneficial effects on body weight and metabolic status, but there is an apparent lack of comprehensive cardiometabolic, renal, liver, and metabolomic/lipidomic panels, whereas the underlying mechanisms driving the observed postoperative ameliorations are still poorly investigated. We aimed to study the long-term effects of bariatric surgery on metabolic profile, cardiorenal and liver outcomes in association with underlying postoperative gut hormone adaptations. Methods28 individuals who underwent bariatric surgery [17 sleeve gastrectomy (SG), 11 Roux-en-Y gastric bypass (RYGB)] were followed up 3, 6 and 12 and at 10 years following surgery. Participants at 10 years were cross-sectionally compared with an age-, sex- and adiposity-matched group of non-operated individuals (n = 9) and an age-matched pilot group of normal-weight individuals (n = 4). ResultsThere were durable effects of surgery on body weight and composition, with an increase of lean mass percentage persisting despite some weight regain 10 years postoperatively. The improvements in metabolic and lipoprotein profiles, cardiometabolic risk markers, echocardiographic and cardiorenal outcomes persisted over the ten-year observation period. The robust improvements in insulin resistance, adipokines, activin/follistatin components and postprandial gastrointestinal peptide levels persisted 10 years postoperatively. These effects were largely independent of surgery type, except for a lasting reduction of ghrelin in the SG subgroup, and more pronounced increases in proglucagon products, mainly glicentin and oxyntomodulin, and in the cardiovascular risk marker Trimethylamine-N-oxide (TMAO) within the RYGB subgroup. Despite similar demographic and clinical features, participants 10 years after surgery showed a more favorable metabolic profile compared with the control group, in conjunction with a dramatic increase of postprandial proglucagon product secretion. ConclusionsWe demonstrate that cardiorenal and metabolic benefits of bariatric surgery remain robust and largely unchanged ten years postoperatively and are associated with durable effects on gastrointestinal- muscle- and adipose tissue-secreted hormones. Trial registrationClinicalTrials.gov: NCT04170010.

The Impact of Bariatric Surgery on Social Support, Resilience and Quality of Life: A Prospective Cohort Study

Introduction: Obesity has become a global health concern, with significant health risks and psychological consequences. Bariatric surgery has gained popularity as an effective treatment for morbid obesity. Therefore, with the increase in these diseases, it becomes crucial for people to manage their health and quality of life better. This study was planned to focus on the impact of bariatric surgery on quality of life, with a specific emphasis on social support and resilience. Aim: To investigate the impact of bariatric surgery on quality of life, with a focus on social support and resilience. Materials and Methods: This prospective cohort study was conducted at the Ckosmic Surgical Center in Moga, India, from June 01, 2022, to July 30, 2023. It included sixty participants who underwent pre- and post-assessments, comprising demographic data and psychological surveys. The inclusion criteria for this study were patients who had undergone bariatric surgery, had a BMI over 40 Kg/m2 or BMI over 35 kg/m2 , were obese, and were aged between 18-65 years. By utilising the World Health Organisation (WHO) quality of life survey, this study compared pre and post-surgery results. The Statistical Package for Social Sciences (SPSS) analysis was employed to provide a more comprehensive evaluation of the results derived from complex datasets. Results: The results indicated significant improvements in quality of life and resilience following surgery, with a p-value of 0.01. However, social support remained stable, with no significant changes in scores. These findings contribute to the evidence supporting the benefits of bariatric surgery in treating morbid obesity. Conclusion: Bariatric surgery can enhance social support and resilience among obese patients. Therefore, the utilisation of surgeries such as One-Anastomosis Gastric Bypass (OAGB), Roux-en-Y Gastric Bypass (RYGB), and Sleeve Gastrectomy (SG) can offer substantial benefits in terms of both health outcomes and social support or resilience.

Recent advances in bariatric surgery: a narrative review of weight loss procedures

Bariatric surgery has emerged as a highly effective option for individuals with obesity, offering significant and sustainable weight loss outcomes. This surgical approach involves various procedures that alter the anatomy of the gastrointestinal tract, leading to reduced food intake and nutrient absorption. Established procedures such as sleeve gastrectomy, gastric bypass, adjustable gastric banding, and biliopancreatic diversion with duodenal switch have proven track records. In contrast, emerging options like intragastric balloons, AspireAssist devices, and endoscopic sleeve gastroplasty show promise but require further investigation. Numerous studies have highlighted the remarkable benefits of bariatric surgery, not only in weight loss but also in the resolution of obesity-related comorbidities and significant improvements in quality of life. However, successful outcomes rely on a multidisciplinary approach, encompassing preoperative evaluation, patient selection, comprehensive postoperative care, nutritional support, and psychological counseling. Regular follow-up and adherence to postsurgical recommendations are crucial for sustained weight loss and positive long-term results. As bariatric surgery continues to evolve, tailored procedures based on individual needs and ongoing research hold the potential for even more refined and effective approaches. Through this ongoing advancement, bariatric surgery is poised to offer improved patient outcomes, transforming lives for those grappling with the challenges of obesity.

The Impact of Bariatric Surgery on Weight Loss and Glycemic Control in Patients With Obesity and Type 2 Diabetes: A Systematic Review.

Obesity and type 2 diabetes mellitus (T2DM) are global health challenges. Bariatric surgery has emerged as a potential intervention for managing these conditions, but its efficacy and impact need comprehensive evaluation.This systematic review aimed to assess the impact of bariatric surgery on weight loss and glycemic control in patients with obesity and T2DM. FollowingPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted in October 2023, primarily using PubMed. Studies were selected based on specific inclusion and exclusion criteria, focusing on bariatric surgery's relationship with weight loss and glycemic control. The quality of the included studies was assessed using the ROBINS-I (risk of bias in non-randomized studies of interventions) risk of bias assessment approach. Out of 272 initially identified studies, nine met the inclusion criteria. These studies, encompassing 10,445 participants from various global locations, predominantly targeted middle-aged participants. The findings consistently highlighted the benefits of bariatric surgery in weight reduction and improved glycemic control. However, the degree of benefits varied based on the type of surgical procedure, patient's BMI, and other individual factors. Bariatric surgery offers significant advantages in managing obesity and T2DM. While it consistently aids in weight reduction and glycemic control, individualized treatment approaches considering various patient and procedural factors are crucial for optimal outcomes. When applied to the right patient, bariatric surgery can offer significantly better glycemic control and weight reduction when compared to only medication control and lifestyle adjustments. However, future research should focus on long-term outcomes and the integration of surgical interventions with lifestyle and medical management.

Bariatric Surgery and COVID-19: a Change of Perspective in a New Phase of the Pandemic.

The protective role of bariatric surgery (BS) against COVID-19 has been reported by several studies, showing, in the first pandemic waves, better outcome of the infection in patients that had undergone BS. With the virus progressive endemicity, BS benefits on COVID-19 clinical course could appear less evident, while COVID-19 effects on BS outcomes must be investigated. In this national multicentric cross-sectional study, we compared COVID-19 incidence and clinical course between a cohort of patients that had undergone BS (OP) and a cohort of candidates to BS (WS); moreover, we analyzed BS outcomes based on SARS-CoV-2 positivity/negativity. From June to December 2021, 522 patients from five Italian referral centers were administered an 87-item telephonic questionnaire completing the analysis of electronic medical records. Demographics, COVID-19 "tested" incidence, suggestive symptoms and clinical outcome parameters of OP and WS were compared. BS outcomes parameters were compared between OP that developed the disease or not. COVID-19 incidence was the same in OP and WS, while symptoms and clinical course seemed milder in OP, with no data individually reaching statistical significance. OP who developed SARS-CoV-2 infection had higher excess weight loss than negative OP (66.8% ± 22.1 vs. 57.7% ± 22.8, p = 0.029). Positive OP had had gastric-bypass (RYGB/OAGB) more frequently than negative ones (38.4% vs. 18.2%, p = 0.025). With the disease becoming endemic, BS protective role against COVID-19 seems clinically less relevant. BS outcomes can be affected by COVID-19, thus imposing careful follow-up for positive patients, especially if undergoing gastric-bypass.

Racial Differences in Psychiatric Symptoms, Maladaptive Eating, and Lifestyle Behaviors After Bariatric Surgery.

There are several psychological and behavioral factors associated with poorer outcomes following bariatric surgery, yet it is unknown whether and how these factors may differ by race. In this cross-sectional study, individuals who underwent bariatric surgery from 2018 to 2021 and up to 4 years post-surgery were invited to complete an online survey. Psychiatric symptoms, maladaptive eating patterns, self-monitoring behaviors, and exercise frequency were examined. Participants (N = 733) were 87% women, 63% White, with a mean age of 44 years. Analyses of covariance demonstrated that White individuals endorsed greater anxiety symptoms (p =.01) and emotional eating due to depression (p = .01), whereas Black individuals endorsed greater depression severity (p = .02). Logistic regression analyses demonstrated that White individuals were more likely to experience loss of control eating (OR= 1.7, p = .002), grazing (OR= 2.53, p <.001), and regular self-weighing (OR= 1.41, p <.001) than Black individuals, and were less likely to skip meals (OR= .61, p = .04), or partake in nighttime eating (OR= .40, p <.001). There were no racial differences in binge eating, emotional eating due to anxiety or frustration, use of a food diary, or exercise. Thus, depressive symptoms, skipping meals, and nighttime eating may be important, modifiable intervention targets to optimize the benefits of bariatric surgery and promote equitable outcomes.

Postoperative micronutrient changes in bariatric surgery patients compliant with nutritional supplementation.

Bariatric surgery is commonly used in patients with body mass indexes over 35kg/m and obesity-related comorbidities. Despite the significant clinical benefits of bariatric surgery, nutritional deficiencies post-surgery remain a challenge for both patient and healthcare provider [Toninello et al. in Nutrients 13:1565, 2021, Gasmi et al. in Eur J Nutr 61:55-67, 2022]. Nutritional supplementation is a way of reducing the likelihood of postoperative deficiencies; however, prior studies have shown varying degrees of mostly poor to moderate patient adherence [Spetz et al. in Obes Res Clin Pract 16:407-412, 2022, Mahawar et al. in Obes Surg 29:1551-1556, 2019, Santonicola et al. in J Am Nutr Assoc 41:11-19, 2022, Sherf Dagan et al. in Obes Surg 27:2258-2271, 2017]. Our present study aims to provide insights into the micronutrient biochemical profile in patients previously found to be compliant with supplementation following roux-en-y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG). An 11-point outpatient survey was administered to consecutive patients ≥ 18years who had undergone either RYGB or VSG to determine adherence with nutritional supplementation. Medical records were retrospectively reviewed to determine preoperative and postoperative lab values, including vitamins A, B1, B12, and D, thyroid stimulating hormone (TSH), iron binding capacity, transferrin, ferritin, folate, iron, albumin, hemoglobin A1C, zinc, glomerular filtration rate (GFR, and liver function values. Values were classified as "abnormal" or "normal." Preoperative and postoperative values were compared for differences. Postoperative values were also compared between RYGB and VSG. There were no significant differences between preoperative and postoperative values for any nutritional marker aside from vitamin B12. A total of 51/60 patients (85.0%) had normal preoperative B12 measurements, compared with 40/65 (61.5%) patients postoperatively (P = 0.03). Notably, of 25 "abnormal" postoperative measurements, 20 (80%) were elevated values. There were no differences in postoperative deficiencies between RYGB and VSG. Patients in our sample did not have worsened micronutrient deficiencies following bariatric surgery, and there were no differences in micronutrient deficiencies between surgical technique.

Evidence of Bariatric Surgery Benefits Cardiac Function in Non-HFpEF Patients with Obesity: a Meta-Analysis.

Nowadays, increasing clinical evidence on metabolic and weight-loss effects of bariatric surgery on improving cardiac structure in obese patients, but its application in improving the cardiac function of HF (heart failure) patients remains controversial. The objective of this meta-analysis was to assess the effects of BS on cardiac function by quantifying the changes of LVEF (left ventricular ejection fraction) and NYHA (New York Heart Association classification) after operations in non-HFpEF (heart failure and preserved ejection fraction) patients. Articles were searched using PubMed and Embase from inception to December 9, 2022, and the Minors scale was used for quality assessments. The included patients should be non-HFpEF and clinically severely obese, and their pre-operative and post-operative values of LVEF or NYHA should be reported. Nine studies involving 146 patients were eventually included with a final result showing that the cardiac functional parameters were improved in non-HFpEF patients. After a weighted mean follow-up time of 15.8months, the mean NYHA decreased by 0.59 (I2 = 0; 95% CI 0.27 ~ 0.92; p = 0.003), and the mean LVEF increased by 7.49% (I2 = 0; 95% CI - 9.99 ~ - 4.99; p < 0.00001). Bariatric surgery offers beneficial cardiac effects on non-HFpEF patients with obesity but failed to show a significant improvement in the pooled analysis for the changes of cardiac parameters. The improving degree may be related to the baseline BMI, the extent of BMI loss, and the baseline age. Future studies should focus on finding out the influencing factors of effectivenesses and defining the suitable crowd.

Diverted Mini Gastric Bypass Surgery in Obese Population: Out-turn Over Hepatic and Nephrological Parameters

Introduction: Bariatric surgery is the best possible option for reducing weight when lifestyle changes and medication have not brought about lasting success and may reduce morbidity and mortality. Weight loss that may follow bariatric surgery in patients on calory restricted diet would result in reduced inflammation and therefore lowering inflammation-related organ damage, including that of the kidney and liver. The study aimed to observe the consequences of BMI change on Hepatic and Nephrological parameters in patients after One Anastomosis Gastric Bypass surgery. Method: This study was done at a bariatric center with 150 individuals (both male and female) aged 20 to 60 years with obesity grades II and III who were selected randomly. Hepatic and renal function tests were carried out at baseline visit, then 3 months and 6 months following surgically. Result: Bilirubin level significantly increased from baseline to visit 1; Serum glutamic-pyruvic transaminase (SGPT) levels significantly decreased at visits 1 and 2. The albumin to Globulin ratio was significantly increased at visit 2 . Blood Urea level and serum creatinine level reduced considerably at visit 1 and decreased more at visit 2 from baseline. Conclusion: Bariatric surgery may be related to improvement in both hepatic and renal function. The improvement may be attributed to reduced inflammatory organ damage related to obesity. More such studies must be performed to highlight the possible health benefits of bariatric surgery for obese patients whose lifestyle modification and medication have not aided in weight loss.&#x0D; Bangladesh Journal of Medical Science Vol. 22 No. 04 October’23 Page : 743-758

Benefits of bariatric surgery on microvascular outcomes in adult patients with type 2 diabetes: a systematic review and meta-analysis.

Microvascular diabetes complications impair patients' health-related quality of life. Bariatric surgery (BS) emerged as a compelling treatment that demonstrated to have beneficial effects on patients with diabetes and obesity. We aimed to synthesize the benefit of bariatric surgery on microvascular outcomes in adult patients with type 2 diabetes. 2011-2021. We included both cohort studies and randomized trials that evaluated bariatric surgery added to medical therapy compared with medical therapy alone in the treatment of adult patients with type 2 diabetes. Studies must have evaluated the incidence of any microvascular complication of the disease for a period of at least 6 months. We performed our search using PubMed, Scopus, EMBASE, Web of Science, and COCHRANE Central database which was performed from inception date until March 2021. PROSPERO (CRD42021243739). A total of 25 studies (160,072 participants) were included. Pooled analysis revealed bariatric surgery to reduce the incidence of any stage of retinopathy by 71% (odds ratio [OR] .29; 95% confidence interval [CI] .10-.91), nephropathy incidence by 59% (OR .41; 95% CI 17-96), and hemodialysis/end-stage renal disease by 69% (OR .31 95% CI .20-.48). Neuropathy incidence revealed no difference between groups (OR .11; 95% CI .01-1.37). Bariatric surgery increased the odds of albuminuria regression by 15.15 (95% CI 5.96-38.52); higher odds of retinopathy regression were not observed (OR 3.73; 95% CI .29-47.71). There were no statistically significant differences between groups regarding the change in surrogate outcomes. Bariatric surgery in adult patients with diabetes reduced the odds of any stage of retinopathy, hemodialysis/end-stage renal disease, and nephropathy composite outcome. However, its effect on many individual outcomes, both surrogates, and clinically significant, remains uncertain.