Nonsurgical Weight Loss Research Articles

Echocardiographic Assessment of Cardiac Remodeling According to Obesity Class

Evidence supports the existence of cardiac remodeling in obesity, but no standard diagnostic criteria has been proposed or validated.The objective of this study was to identify echocardiographic features of cardiac remodeling according to obesity class and assess the effect of non-surgical weight loss on cardiac structure and function.A total of 120 patients were divided according to their obesity class (Group 1: BMI 18.5-24.9; Group 2: 25-29.9; Group 3: 30-39.9; Group 4: >40) and underwent cross-sectional transthoracic echocardiography. Echocardiographic parameters of cardiac chamber quantification and function were compared between the 4 groups. Echocardiographic parameters were compared pre- and post-non-surgical weight loss in a subgroup of patients. Overall, there was an incremental increase in left ventricular (LV), left atrial (LA), and right ventricular dimensions, LV mass and LV stroke volume (all p<0.0001) across obesity classes. There was no significant difference in LV ejection fraction or right ventricular systolic function as assessed by tricuspid annular plane systolic excursion (TAPSE) but a significant decrease in global longitudinal strain (BMI 18.5-24.9: 22.8%±1.7%; BMI 25-29.9: 22.0%±1.4%; BMI 30-39.9: 20.8%±1.1%; BMI >40: 20.6%±1.3%, p<0.0001) and left atrial strain (BMI 18.5-24.9: 37.7%±2.3%; BMI 25-29.9: 32.8%±2.1%; BMI 30-39.9: 31.5%±1.8%; BMI >40: 29.0%±2.8%, p<0.0001). Allometric height-indexed LV and LA dimensions increased with increasing BMI class (p<0.0001). Echocardiographic parameters did not change significantly after non-surgical weight loss.In conclusion, echocardiographic features can be described according to obesity class. Allometric height indexation may better reflect cardiac remodeling in obesity in comparison to BSA indexation. Non-surgical weight loss was not associated with significant changes in cardiac chamber dimensions and function.

Impact of surgical and non-surgical weight loss on echocardiographic and strain parameters in Asian patients

Surgical weight loss (SWL) improves myocardial mechanics as measured by speckle-tracking imaging. However non-surgical versus SWL and the subsequent impact on myocardial function in overweight Asian subjects has not been evaluated. 66 patients underwent a 16-week lifestyle intervention (LSI) programme consisting of dietary interventions and exercise prescription. Echocardiography with speckle tracking was performed at baseline and post-intervention. This group was compared against a group of 12 subjects who had undergone bariatric surgery and a control group of 10 lean Asian subjects. A generalised structural equation model (gSEM) was constructed to ascertain the effect of modality of weight loss on strain parameters, adjusting for BMI. Participants attained significant weight loss after LSI (28.2 ± 2.66 kg/m2 vs. 25.8 ± 2.84 kg/m2, p = 0.001). This was associated with a non-significant trend towards improvement in strain parameters. SWL participants had significant improvement in the left ventricular global longitudinal strain (− 20.52 ± 3.34 vs. − 16.68 ± 4.15, p < 0.01) and left atrium reservoir strain (44.32 ± 14.23 vs. 34.3 ± 19.31, p = 0.02). Lean subjects had significantly higher strain parameters than overweight subjects. The gSEM model demonstrated surgical modality of weight loss as an independent predictor of improvement in strain parameters. Significant improvement in echocardiographic parameters were documented in patients who underwent bariatric surgery.

Gut-muscle communication links FGF19 levels to the loss of lean muscle mass following rapid weight loss

ObjectiveOptimal weight loss involves decreasing adipose tissue while preserving lean muscle mass. Identifying molecular mediators that preserve lean muscle mass is therefore a clinically important goal. We have shown that circulating, postprandial FGF19 levels are lower in patients with obesity and decrease further with comorbidities such as type 2 diabetes and MASLD. Preclinical studies have shown that FGF15 (mouse ortholog of human FGF19) is necessary to protect against lean muscle mass loss following metabolic surgery-induced weight loss in a mouse model of diet-induced obesity. We evaluated if non-surgical weight loss interventions also lead to increased systemic levels of FGF19 and whether FGF19 levels are predictive of lean muscle mass following rapid weight loss in human subjects with obesity. Research design and methodsWeight loss was induced in 176 subjects with obesity via a very low-energy diet, VLED (800 kcal/d) in the form of total liquid meal replacement for 3-4 months. We measured plasma FGF19 levels at baseline and following VLED-induced weight loss. Multiple linear regression was performed to assess if FGF19 levels were predictive of lean mass at baseline (obesity) and following VLED. ResultsPostprandial levels of FGF19 increased significantly following VLED-weight loss. Multiple linear regression analysis showed that baseline (obesity) FGF19 levels, but not post VLED FGF19 levels, significantly predicted the percent of lean muscle mass after VLED-induced weight loss, while controlling for age, sex, and the baseline percent lean mass. ConclusionThese data identify gut-muscle communication and FGF19 as a potentially important mediator of the preservation of lean muscle mass during rapid weight loss.

Do patients with osteoarthritis lose weight prior to elective joint replacement?

Obesity is a known risk factor for the development of osteoarthritis and the subsequent need for joint replacement. Weight loss has been shown to reduce pain, disability, and the need for joint replacement, particularly in patients with knee osteoarthritis. The aim of this study was to investigate pre-operative weight change in patients with hip, knee, and shoulder osteoarthritis at a regional, public hospital in Australia, to identify opportunities for pre-operative weight-loss intervention. A retrospective review of patients who underwent elective primary total hip (THR), knee (TKR), and shoulder (TSR) replacement for osteoarthritis was conducted between December 2019 and December 2022. BMI data were collected at three time points: (1) general practitioner (GP) referral; (2) orthopaedic clinic review; and (3) pre-admission clinic (PAC) assessment. A total of 496 patients were included in the study, of which 205 underwent THR, 251 underwent TKR, and 40 underwent TSR. The mean patient age was 67 years, and 46.4% were female. At the time of GP referral, the mean body mass index (BMI) was 31.4 kg/m2. Across the study period, only 2% of patients experienced clinically significant weight loss pre-operatively (≥5% of total body weight). This study has demonstrated that very few patients lose weight prior to undergoing joint replacement in the public sector in Australia. This highlights the need for targeted non-surgical weight loss interventions for patients currently awaiting joint replacement.

Protocol for a prospective longitudinal cohort study on the effects of non-surgical weight loss on pelvic floor dysfunction

IntroductionRecent studies have recommended non-surgical weight loss and pelvic floor muscle training as first-line treatment for obese patients with urinary incontinence. However, limited studies are detecting the effect of weight...

Bodily sensations and bariatric surgery: Links between interoceptive sensibility, intuitive and disordered eating behaviour in obesity and obesity surgery.

This study evaluated interoceptive sensibility, intuitive and disordered eating among bariatric candidates, operated individuals and individuals with obesity seeking non-surgical treatment. We recruited 57 individuals with obesity seeking nonsurgical weight-loss (IOB), 84 bariatric candidates (Pre) and 22 individuals post-bariatric surgery (Post) who responded to questionnaires: Multidimensional Assessment of Interoceptive Awareness, Intuitive Eating Scale-2 (IES-2), Dutch Eating Behaviour Questionnaire, Binge Eating Scale, State-Trait Anxiety Inventory, Beck's Depression Inventory. Overall, the Post group manifested higher scores on 'Body-Listening' (F=4.95, p=0.01), 'Emotional Awareness' (F=8.83, p<0.001) and 'Trusting' (F=6.71, p=0.002) interoceptive dimensions, on the IES-2 total score (F=5.48, p=0.007) and 'Reliance on hunger and satiety cues' (F=31.3, p<0.001) when age was controlled. The IOB group presented higher scores on emotional (F=3.23, p=0.047) and binge eating (F=5.99, p=0.004). Among operated individuals, intuitive eating mediated the relationship between interoceptive sensibility dimensions and binge eating: 'Attention regulation' (54%) 'Self-regulation' (75.1%), 'Body listening' (94.09%) and 'Trusting' (84.9%). Our results suggest the therapeutic potential of interoceptive sensibility and intuitive eating in obesity management in/beyond the bariatric context.

Comparison of Histological Skin Changes After Massive Weight Loss in Post-bariatric and Non-bariatric Patients.

Changes in the skin structure, including the collagen and elastin content, have been reported with massive weight loss (MWL) following bariatric metabolic surgery (BMS) and have been correlated to a higher risk of complications after body-contouring surgery (BCS). This study aimed at comparing the histological characteristics of the skin of patients having surgical MWL (SMWL) post-BMS to those with non-surgical massive weight loss (NSMWL). This prospective study compared the epidermal thickness, and collagen and elastin fibers content in 80 skin biopsies obtained from BCS procedures performed to patients who experienced MWL defined more than 50% of excess weight loss (%EWL) either SMWL (40 biopsies) or NSMWL (40 biopsies). Twenty biopsies in each group were obtained from abdominoplasties and 20 from breast reductions. Epidermal thickness was measured in H&E-stained sections, collagen fibers were assessed using Masson trichrome-stained sections, and elastin fibers were assessed using Modified Verhoeff's stained sections. Image analysis software was used to calculate the fractions of collagen and elastin fibers. This study included 77 patients, 38 SMWL patients, and 39 NSMWL patients. The SMWL group had a significantly higher age (p < 0.001), a longer time interval from intervention (p < 0.001), higher initial weight (p < 0.001), higher initial BMI (p < 0.001), lower current weight (p = 0.005), lower current BMI (p < 0.001), and significantly higher %EWL than NSMWL group (p < 0.001). No significant differences were detected between the two groups regarding complications after abdominoplasty (p = 1.000). The elastic fibers content in the dermis was significantly higher in the abdominal region of the NSMWL group than SMWL (p = 0.029). All other parameters showed non-significant differences between NSMWL and SMWL in the skin of abdomen and breast. The SMWL group had a significant reduction in elastic fiber content in the skin of the abdomen compared to the NSMWL group. The collagen content was equally reduced in both groups with non-significant differences in both breast and abdomen regions in both groups.

Awareness About the Benefits of Post-bariatric Surgery in Diabetic Patients in Makkah Almukarramah, Saudi Arabia.

To measure awareness about the benefits of post-bariatric surgery, which is a shortening of the gut in order to lose weight in diabetic patients in the Makkah region, Saudi Arabia. A cross-sectional survey was conducted among diabetic patients aged 18-65 from February to July 2023. An online questionnaire via Google Forms was distributed and used to assess the participants' awareness of the benefits of post-bariatric surgery for diabetic patients. Overall, 388 participants (56.40% female, 43.60% male) were surveyed. Most participants (91.5%) showed awareness of gastric sleeve surgery, while a significant proportion (85.8%) recognized obesity as a disease. A majority of participants (80.90%) showed awareness of the association between obesity, diabetes, and high blood pressure. However, only 46.10% of participants showed awareness of eligibility criteria associated with bariatric surgery. The majority recognized the effectiveness of bariatric surgery for weight loss but did not consider it the first choice, emphasizing a preference for non-surgical weight loss strategies. Participants demonstrated good knowledge about obesity and its implications for health. They also demonstrated good knowledge about bariatric surgery as an effective weight reduction method but expressed a preference for non-surgical methods, which reflects their awareness of the complications of bariatric surgery. However, the results showed a lack of awareness of postoperative indications and lifestyle changes, thus highlighting the need for comprehensive patient education and counseling.

Expression characteristics of peripheral lymphocyte programmed death 1 and FoxP3+ Tregs in gastric cancer during surgery and chemotherapy.

Programmed death 1 (PD-1) and CD4+CD25+FoxP3+ expression in peripheral blood T-cells has been previously reported in various types of cancer. However, the specific variation tendency during surgery and chemotherapy, as well as their relationship in gastric cancer patients, still remain unclear. Understanding this aspect may provide some novel insights for future studies on tumor recurrence and tumor immune escape, and also serve as a reference for determining the optimal timing and dose of clinical anti-PD-1 antibodies. To observe and analyze the expression characteristics of peripheral lymphocyte PD-1 and FoxP3+ regulatory T cells (FoxP3+ Tregs) before and after surgery or chemotherapy in gastric cancer patients. Twenty-nine stomach cancer patients undergoing chemotherapy after a D2 gastrectomy provided 10 mL peripheral blood samples at each phase of the perioperative period and during chemotherapy. This study also included 29 age-matched healthy donors as a control group. PD-1 expression was detected on lymphocytes, including CD4+CD8+CD45RO+, CD4+CD45RO+, and CD8+CD45RO+ lymphocytes as well as regulatory T cells. We observed a significant increase of PD-1 expression on immune subsets and a larger number of FoxP3+ Tregs in gastric cancer patients (P < 0.05). Following D2 gastrectomy, peripheral lymphocytes PD-1 expression and the number of FoxP3+ Tregs notably decrease (P < 0.05). However, during postoperative chemotherapy, we only observed a decrease in PD-1 expression on lymphocytes in the CD8+CD45RO+ and CD8+CD45RO+ populations. Additionally, linear correlation analysis indicated a positive correlation between PD-1 expression and the number of CD4+CD45RO+FoxP3high activated Tregs (aTregs) on the total peripheral lymphocytes (r = 0.5622, P < 0.0001). The observed alterations in PD-1 expression and the activation of regulatory T cells during gastric cancer treatment may offer novel insights for future investigations into tumor immune evasion and the clinical application of anti-PD-1 antibodies in gastric cancer.

Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by the tumor microenvironment.

Comprehensive genomic analysis has shown that small bowel adenocarcinoma (SBA) has different genomic profiles from gastric and colorectal cancers. Hence, it is essential to establish chemotherapeutic regimens based on SBA characteristics. The expression of programmed cell death-ligand 1 (PD-L1) and programmed cell death-ligand 2 (PD-L2) in SBA is not fully understood. Anti-PD-L1/PD-1 therapy uses tumor-infiltrating lymphocytes (TILs); therefore, the status of TILs in the tumor microenvironment (TME) may influence their efficacy. The ratio of FoxP3+ to CD8+ T cells has been reported to be useful in predicting the prognosis of digestive system cancers. To investigate the clinicopathological significance of PD-L1/2 expression according to the status of TILs in SBA tissues. We performed immunohistochemical analysis for PD-L1, PD-L2, CD8, FoxP3, and DNA mismatch repair (MMR) proteins using formalin-fixed, paraffin-embedded tissues from 50 patients diagnosed with primary SBA. The immunoreactivities of PD-L1 and PD-L2 were determined separately in tumor cells and tumor-infiltrating immune cells throughout the tumor center and invasive margins, and finally evaluated using the combined positive score (CPS). We assessed CD8+ and FoxP3+ T cells in the intratumoral and tumor-surrounding stroma. Subsequently, we calculated and summed the ratio of FoxP3 to CD8+ T cell counts. Immune-related cell densities were graded as low or high. Immunohistochemical results were compared with clinicopathological factors and patient prognosis. The distribution of cancer-specific survival (CSS) was estimated using the Kaplan-Meier method, and the log-rank test was used to test for significant differences in CSS. A Cox proportional hazard model was also used to assess the effect of tumor variables on CSS. PD-L1 expression was positive in 34% in tumor cells (T-PD-L1) and 54% in tumor-infiltrating immune cells (I-PD-L1) of the cases examined. T-PD-L2 was positive in 34% and I-PD-L2 was positive in 42% of the cases. PD-L1 CPS ≥ 10 and PD-L2 CPS ≥ 10 were observed in 50% and 56% of the cases, respectively. Deficient MMR (dMMR) was 14% of the cases. T-PD-L1, I-PD-L1 and PD-L1 CPS ≥ 10 were all significantly associated with dMMR (P = 0.037, P = 0.009, and P = 0.005, respectively). T-PD-L1, I-PD-L1, and PD-L1 CPS ≥ 10 were all associated with deeper depth of invasion (P = 0.001, P = 0.024, and P = 0.002, respectively). I-PD-L2 expression and PD-L2 CPS ≥ 10 were significantly higher in the differentiated histological type (P = 0.015 and P = 0.030, respectively). The I-PD-L1 and I-PD-L2 levels were significantly associated with better CSS (P = 0.037 and P = 0.015, respectively). CD8-high was significantly associated with less lymph node metastasis (P = 0.047), less distant metastasis (P = 0.024), less peritoneal dissemination (P = 0.034), and earlier TNM stage (P = 0.047). The CD8-high group had better prognosis than the CD8-low group (P = 0.018). FoxP3 expression was not associated with any clinicopathological factors or prognosis. We found that patients with PD-L2 CPS ≥ 10 tended to have worse prognosis in the FoxP3/CD8-low group (P = 0.088). The clinicopathological significance of PD-L1/2 expression may differ depending on the TME status. Immune checkpoint inhibitors may improve the prognosis of SBA patients with low FoxP3/CD8 ratio and PD-L2 expression.

Roles of phosphatidylinositol-3-kinases signaling pathway in inflammation-related cancer: Impact of rs10889677 variant and buparlisib in colitis-associated cancer.

Phosphatidylinositol-3-kinases (PI3K) is a well-known route in inflammation-related cancer. Recent discovery on PI3K-related genes revealed a potential variant that links ulcerative colitis (UC) and colorectal cancer (CRC) with colitis-associated cancer (CAC). PI3K/AKT pathway has been recommended as a potential additional therapeutic option for CRC due to its substantial role in modifying cellular processes. Buparlisib is a pan-class I PI3K inhibitor previously shown to reduce tumor growth. To investigate the regulation of rs10889677 and the role of buparlisib in the PI3K signaling pathway in CAC pathogenesis. Genomic DNA from 32 colonic samples, including CAC (n = 7), UC (n = 10) and CRC (n = 15), was sequenced for the rs10889677 mutation. The mutant and wildtype fragments were amplified and cloned in the pmirGLO vector. The luciferase activity of cloned vectors was assessed after transfection into the HT29 cell line. CAC mice were induced by a mixture of a single azoxymethane injection and three cycles of dextran sulphate sodium, then buparlisib was administered after 14 d. The excised colon was subjected to immunohistochemistry for Ki67 and Cleaved-caspase-3 markers and quantitative real-time polymerase chain reaction analysis for Pdk1 and Sgk2. Luciferase activity decreased by 2.07-fold in the rs10889677 mutant, confirming the hypothesis that the variant disrupted miRNA binding sites, which led to an increase in IL23R expression and the activation of the PI3K signaling pathway. Furthermore, CAC-induced mice had a significantly higher disease activity index (P < 0.05). Buparlisib treatment significantly decreased mean weight loss in CAC-induced mice (P < 0.05), reduced the percentage of proliferating cells by 5%, and increased the number of apoptotic cells. The treatment also caused a downward trend of Pdk1 expression and significantly decreased Sgk2 expression. Our findings suggested that the rs10889677 variant as a critical initiator of the PI3K signaling pathway, and buparlisib had the ability to prevent PI3K-non-AKT activation in the pathophysiology of CAC.

SAT655 Modifying Effects Of Dash Diet On Food Addiction Two Years After Sleeve Gastrostomy: A Randomized Controlled Clinical Trial

Abstract Disclosure: S. Ariyanfar: None. M. Tabesh: None. M. Noormohammadi: None. S. Razeghi Jahromi: None. E. Rashidbeigi: None. In morbid obese individuals, bariatric surgery is considered an effective intervention due to failure of non-surgical weight management strategies. Sleeve gastrostomy (LSG) accounts for over half of bariatric surgeries. The prevalence of weight regains is 76% over 2-6 years after LSG due to binge eating disorder and food addiction. In our previous study, one-fifth of patients with LSG fulfilled the criteria for food addiction (FA). Various dietary patterns have been studied for their potential benefits in controlling FA in non-surgical weight loss programs. Among them, DASH diet attracted our attention, because, besides its effect on FA, the nature of this diet fully addresses other prevalent complications of patients with morbid obesity who undergoes LSG more than two years ago, i.e., vascular problems and gut microbiota changes. To study the effect of the DASH diet on food addiction after LSG we recruited 100 individuals with LSG two years prior to the study who had mild to moderate FA according to DSM-IV criteria and Yale Food Addiction Scale (YFAS) and weight regain of more than 25% of excess weight loss. Participants were randomly assigned to a calorie-restricted DASH diet (1000-1200 calories, containing 2-3 servings of whole grain, 3-4 servings of vegetables, 3 servings of fruit, 2 servings of skim or low-fat dairy products, 1-2 servings of meat, poultry, and fish, 3 servings of nuts, seeds, and legumes, 2 servings of oil) or a calorie-restricted diet (1000-1200 calories, 3-4 servings of whole grain, 3-4 servings of vegetables, 2 servings of fruit, 2 servings of skim or low-fat dairy products, 2-3 servings of meat, poultry, and fish, 1 serving of nuts, seeds, and legumes, 2 servings of oil, and 1 serving of sugar.) for 16 weeks. Food addiction, serum levels of FBS and insulin were assessed. No significant differences in calorie and macronutrient intake, BMI, amount of excess weight before surgery, physical activity level, depression, anxiety level, and YFAS mean were observed between to studied groups After 16 weeks, individuals in DASH diet group reported a significant reduction in YFAS (from3.64±0.63 to 2.66±0.63, P.Value &amp;lt; 0.001), also Insulin levels and FBS decreased from 12.22±3.13 to 10.12±2.3 mcU/ml (P.Value&amp;lt; 0.001) and from 91.92±8.9 to 86.98±6.8 mg/dl (P.Value&amp;lt; 0.001), respectively. A significant reduction of insulin (13.21±2.97 to11.15±2.18 mcU/ml, P.Vaue&amp;lt; 0.001) and FBS level (92.31±7.5 to 87.63±5.9 mg/dl) was observed among controls. A significantly higher reduction of insulin levels in DASH group was noticed at the endpoint (P.Value: 0.026). It could be concluded that adherence to DASH diet, 2 years after SLG, can combat food addiction by modifying serum insulin levels. Presentation: Saturday, June 17, 2023

Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table.

Metabolic comorbidities are common in patients with cardiorenal disease; they can cause atherosclerotic cardiovascular disease (ASCVD), speed progression, and adversely affect prognosis. Common comorbidities are Type 2 diabetes mellitus (T2DM), obesity/overweight, chronic kidney disease (CKD), and chronic liver disease. The cardiovascular system, kidneys, and liver are linked to many of the same risk factors (e.g. dyslipidaemia, hypertension, tobacco use, diabetes, and central/truncal obesity), and shared metabolic and functional abnormalities lead to damage throughout these organs via overlapping pathophysiological pathways. The COVID-19 pandemic has further complicated the management of cardiometabolic diseases. Obesity, T2DM, CKD, and liver disease are associated with increased risk of poor outcomes of COVID-19 infection, and conversely, COVID-19 can lead to worsening of pre-existing ASCVD. The high rates of these comorbidities highlight the need to improve recognition and treatment of ASCVD in patients with obesity, insulin resistance or T2DM, chronic liver diseases, and CKD and equally, to improve recognition and treatment of these diseases in patients with ASCVD. Strategies to prevent and manage cardiometabolic diseases include lifestyle modification, pharmacotherapy, and surgery. There is a need for more programmes at the societal level to encourage a healthy diet and physical activity. Many pharmacotherapies offer mechanism-based approaches that can target multiple pathophysiological pathways across diseases. These include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, selective mineralocorticoid receptor antagonists, and combined glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist. Non-surgical and surgical weight loss strategies can improve cardiometabolic disorders in individuals living with obesity. New biomarkers under investigation may help in the early identification of individuals at risk and reveal new treatment targets.

Body Image and Weight Loss Outcome After Bariatric Metabolic Surgery: a Mixed Model Analysis.

As in nonsurgical weight loss populations, body image may partly explain differences in weight loss outcomes after surgery. The aim of this study was to determine the prospective association between body image and weight loss in a longitudinal cohort of patients up to 3 years after bariatric metabolic surgery. The BODY-Q self-report questionnaire was used to assess body image. Linear mixed models evaluated associations of baseline body image with weight loss in the first year as well as associations of body image at 12 months and first-year change in body image with weight loss 12 to 36 months after surgery. Available body image data included 400 (100%), 371 (93%), 306 (77%), 289 (72%), and 218 (55%) patients at baseline and 4, 12, 24, and 36 months, respectively. Body image scores improved significantly until 12 months, followed by a gradual decline. Scores remained improved in comparison to baseline (β = 31.49, 95% CI [27.8, 35.2], p < .001). Higher baseline body image was associated with less weight loss during the first year, and the effect size was trivial (ß = -0.05, 95% CI [-0.09, -0.01], p = .009). Body image and change in body image were not associated with weight loss 12 to 36 months after surgery. Body image improved after bariatric metabolic surgery. Although no clinically relevant associations of body image with weight loss were demonstrated, the gradual decline in body image scores underlines the importance of long-term follow-up with regular assessment of this aspect of quality of life.

Preoperative Optimization Before Ventral Hernia Repair: A Systematic Review and Meta-analysis.

Obesity is associated with an increased risk of ventral hernia development and recurrence rates after ventral hernia repair (VHR). The metabolic derangements caused by obesity can also lead to many postoperative complications. Therefore, it is a common practice to attempt weight loss before VHR. However, there is still no consensus on optimal preoperative management for obese patients with a ventral hernia. This study aims to perform a meta-analysis to evaluate the effect of preoperative weight optimization on VHR outcomes. We performed a literature search of PubMed, Scopus, and Cochrane Library databases to identify studies comparing obese patients who underwent surgical or non-surgical weight loss interventions before undergoing hernia repair surgery to obese patients who underwent hernia repair surgery without prehabilitation. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. One thousand six hundred nine studies were screened and 13 were thoroughly reviewed. Five studies comprising 465 patients undergoing hernia repair surgery were included. No differences in hernia recurrence [odds ratio (OR) 0.66; 95% CI 0.23-1.89; P=0.44; I2=20%], seroma (OR 0.70; 95% CI 0.25-1.95; P=0.50; I2=5%), hematoma (OR 2.00; 95% CI 0.5-7.94; P=0.45; I2=0%), surgical site infection (OR 1.96; 95% CI 0.52-7.40; P=0.32; I2=0%), and overall complication (OR 0.80; 95% CI 0.37-1.74; P=0.58; I2=40%) rates were noted when comparing patients who underwent a preoperative weight loss intervention (prehabilitation or bariatric surgery) versus those who did not. In the subgroup analysis of patients who underwent bariatric surgery, we found no difference in hernia recurrence (OR 0.64; 95% CI 0.12-3.33; P= 0.59; I2=41%) or overall complications (OR 1.14; 95% CI 0.36-3.64; P=0.82; I2=64%). In the subgroup analysis of patients who lost weight versus patients who did not, there was no significant difference in overall complication rates (OR 0.86; 95% CI 0.34-2.21; P=0.76; I2=55%). We found similar hernia recurrence, seroma, hematoma, and surgical site infection rates in patients who underwent preoperative optimization. These findings underline the need for prospective studies to define the optimal role of preoperative optimization and weight loss in obese patients undergoing ventral hernia repair.

Acute pancreatitis after intragastric balloon insertion: case report

The intragastric balloon (IGB) is a relatively recent non-surgical weight loss technique that is now widely used in the world to treat obesity. However, IGB causes a wide range of adverse effects that range from minor ones, such as nausea, stomach pain and gastroesophageal reflux, to serious ones, such as ulceration, perforation, intestinal blockage and compression of adjusting structures. A 22-year-old Saudi woman presented to the emergency department (ED) with a history of upper abdominal pain that started 1 day before admission. The patient's surgical background was unremarkable, and no other obvious pancreatitis risk factors were present. The patient underwent a minimally invasive treatment after being diagnosed with obesity (class 1), in which an IGB was inserted one and a half months prior to her ED presentation. She consequently began to lose weight (around 3kg). The hypothesis states that pancreatitis following IGB insertion can be caused either by stomach distention and pancreatic compression at the tail or body or by ampulla obstruction due to balloon catheter migration at the duodenum. Heavy meal consumption, which may cause an increase in pancreatic compression, is another potential cause of pancreatitis in such patients. We believe that the IGB-induced compression of the pancreas at its tail or body was the likely cause of pancreatitis in our case. This case was reported because it is the first one from our city as far as we know. A few cases from Saudi Arabia have also been reported, and reporting them will help to improve doctors' awareness of this complication, which can cause pancreatitis symptoms to be mistaken for something else because of the balloon-related effects on gastric distention.

Screening and Management of Malnutrition in Total Joint Arthroplasty.

Malnutrition is an increasingly prevalent problem in patients undergoing total joint arthroplasty (TJA). Increased risks associated with TJA in the setting of malnourishment have been well documented. Standardized scoring systems in addition to laboratory parameters such as albumin, prealbumin, transferrin, and total lymphocyte count have been developed to identify and evaluate malnourished patients. Despite an abundance of recent literature, there is no consensus on the best approach for screening TJA patients from a nutritional standpoint. Although there are a variety of treatment options, including nutritional supplements, nonsurgical weight loss therapies, bariatric surgery, and the involvement of dieticians and nutritionists, the effect of these interventions on TJA outcomes has not been well characterized. This overview of the most current literature aims to provide a clinical framework for approaching nutrition status in arthroplasty patients. A comprehensive understanding of the tools available for managing malnourishment will facilitate improved arthroplasty care.

Cost-Effectiveness of Weight-Loss Interventions Prior to Total Knee Replacement for Patients With Class III Obesity.

Class III obesity (body mass index >40 kg/m2 ) is associated with higher complications following total knee replacement (TKR), and weight loss is recommended. We aimed to establish the cost-effectiveness of Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and lifestyle nonsurgical weight loss (LNSWL) interventions in knee osteoarthritis patients with class III obesity considering TKR. Using the Osteoarthritis Policy model and data from published literature to derive model inputs for RYGB, LSG, LNSWL, and TKR, we assessed the long-term clinical benefits, costs, and cost-effectiveness of weight-loss interventions for patients with class III obesity considering TKR. We assessed the following strategies with a health care sector perspective: 1) no weight loss/no TKR, 2) immediate TKR, 3) LNSWL, 4) LSG, and 5) RYGB. Each weight-loss strategy was followed by annual TKR reevaluation. Primary outcomes were cost, quality-adjusted life expectancy (QALE), and incremental cost-effectiveness ratios (ICERs), discounted at 3% per year. We conducted deterministic and probabilistic sensitivity analyses to examine the robustness of conclusions to input uncertainty. LSG increased QALE by 1.64 quality-adjusted life-years (QALYs) and lifetime medical costs by $17,347 compared to no intervention, leading to an ICER of $10,600/QALY. RYGB increased QALE by 0.22 and costs by $4,607 beyond LSG, resulting in an ICER of $20,500/QALY. Relative to immediate TKR, LSG and RYGB delayed and decreased TKR utilization. In the probabilistic sensitivity analysis, RYGB was cost-effective in 67% of iterations at a willingness-to-pay threshold of $50,000/QALY. For patients with class III obesity considering TKR, RYGB provides good value while immediate TKR without weight loss is not economically efficient.

Abstract IA046: Mechanistic targets and strategies to break the obesity-cancer link

Abstract Obesity promotes the incidence and progression of many cancers including breast cancer. Mechanisms underpinning obesity-driven breast cancer that could be harnessed to intercept this deleterious relationship are not completely understood. Here we apply multi-omics analysis of tumor and adipose to delineate candidate mediators underlying the procancer effects of obesity, and anticancer effects of weight loss, in a mouse model of obesity-driven breast cancer. We modeled bariatric surgery and nonsurgical weight loss in obese C57BL/6NCrl mice fed a high-fat diet (60 kcal% fat) using vertical sleeve gastrectomy or a sham surgery paired with (i) dietary weight loss via ad libitum low-fat diet (10 kcal% fat), (ii) 30% chronic calorie restriction, or (iii) intermittent calorie restriction. Once weight loss stabilized, mammary tumors were induced by orthotopic transplantation of E0771 cells, a model of triple negative breast cancer (TNBC). While bariatric surgery and a switch to low-fat diet were each moderately effective at reducing tumor mass, chronic and intermittent calorie restriction regimens were each highly effective in reducing tumor burden. Tumor transcriptomic analysis using gene set enrichment analysis revealed that weight loss interventions reversed obesity-associated immunosuppression. Mediation analysis identified weight loss and fat mass loss as significant mediators of the reduced tumor mass seen in all interventions. Integration of adipose transcriptomics and reduced-representation bisulfite sequencing identified NFKB1, FXR1, and BACH1 as regulators overrepresented in differentially methylated genes, and conserved with predicted regulators of transcriptional remodeling in human adipose tissue following bariatric surgery. These data indicate that weight loss through dietary and surgical means promotes antitumor immunity, in part via remodeling of tumor adjacent adipose tissue. We have identified several candidate mediators of adipose remodeling that may underpin the antitumor effects of bariatric surgery, and these mediators represent potential mechanism-based targets for future interventions. Citation Format: Michael F. Coleman. Mechanistic targets and strategies to break the obesity-cancer link [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA046.

Abstract 14721: Association of Non-Surgical Weight Loss With Speckle-Tracking Strain Parameters

Introduction Several studies have demonstrated that surgical weight loss improves myocardial mechanics as measured by speckle-tracking imaging. The studies, however, have mostly been conducted in morbidly obese Caucasian populations with an average body mass index (BMI) of around 40 kg/m2. To our knowledge, no study has examined whether non-surgical weight loss can improve myocardial mechanics in the less morbidly obese. Hypothesis We hypothesized that non-surgical weight loss would improve strain parameters in less morbidly obese patients. Methods 66 patients were recruited. Participants underwent a 16-week lifestyle intervention (LSI) programme. LSI consisted of a) dietary interventions involving regular consultations with the dietician and meal planning and b) exercise prescription with pedometers Echocardiography with speckle tracking was performed at baseline and post-intervention. Paired analysis using paired T-test evaluating changes in weight and strain parameters were conducted after intervention. Results The primary outcome was improvement in strain parameters after weight loss. Table 1 depicts the characteristics of the participants and the change in strain parameters. Participants attained significant weight loss after LSI ( 28.2 +/- 2.66 kg/m 2 vs 25.8 +/- 2.84 kg/m 2 , p =0.001). There was a significant reduction in waist and hip circumference (90.7 +/- 7.64 cm vs 83.62 +/- 7.13 cm, p =0.01) and (103.28 +/- 2.03 cm vs 97.74 +/- 6.24 cm, p=0.01) respectively. However this was not associated with improvement in strain parameters of the left atrium (51.456 +/- 11.24 vs 48.78 +/- 19.09, p =0.190) , left ventricle (-22.05 +/- 2.98 vs 22.77 +/- 3.21, p= 0.125) and right ventricle (-21.56 +/- 3.32 vs -22.02 +/- 3.59, p = 0.404). Conclusion Non-surgical weight loss was not associated with an improvement in echocardiographic speckle-tracking strain parameters.