Presurgery Body Mass Index Research Articles

Testosterone levels increase following bariatric surgery - validation of preceding literature in a large-scale population analysis.

The effects of bariatric surgery on testosterone levels in men with obesity and hypogonadism have not been thoroughly explored yet. To investigate the possible effects of bariatric surgery on T levels in obese hypogonadal men by comparing T levels before and after surgery using a comprehensive claims database. The TriNetX US Collaborative Network database was used to identify men ages 18-80 who underwent a bariatric procedure and had a serum T value of<350ng/dL prior to surgery. Men who received testosterone therapy before/or after surgery were excluded. We conducted a retrospective self-matched cohort analysis to examine the difference in serum T levels before and after bariatric surgery. A sub-analysis was carried out to explore differences between men who reached eugonadal status or maintained low T levels following surgery. Descriptive statistics detailed sociodemographic and clinical characteristics, with continuous and categorical data compared using unpaired t-tests and chi-square analysis, respectively. Changes in T levels and body mass index (BMI) before and after surgery were compared using an unpaired t-test with a<0.05 set for significance. All analyses were conducted using the TriNetX platform which utilizes both Python and R software. The study analyzed 69 hypogonadal men who underwent bariatric surgery and had T levels assessed before and after the procedure. The mean (standard deviation) pre-surgery serum T level was 208±79ng/dL, which post-surgery increased to 371±164ng/dL, marking an average increase of 163±164ng/dL. Likewise, the mean (standard deviation) body mass index decreased from 42.9±9.0 to 38.8±5.7kg/m2. Post-surgery, 45% (31 men) achieved eugonadal status, while 55% (38 men) continued to have low T levels. A comparison between the post-surgery eugonadal cohort and the persistent low T cohort revealed that the former had higher pre-surgery serum T levels (235±71ng/dL vs. 184±80.4ng/dL, p=0.007), a higher pre-surgery body mass index (45.5±4.5kg/m2 vs. 41.1±11.5kg/m2, p=0.041), and a significantly greater reduction in body mass index post-surgery (7.3±7.2kg/m2 vs. 2.0±12.8kg/m2, p=0.04). Notably, the increase in T was significantly higher in the eugonadal cohort compared to the persistent low testosterone cohort (257±143ng/dL vs. 95±178ng/dL, p<0.0001). This study provides evidence of bariatric surgery's positive effect on serum T levels in obese men with baseline low T. Almost one out of two men with low T reached normal T levels after bariatric surgery. As the most comprehensive study to date, it validates and substantiates previous work suggesting that weight loss can improve T levels physiologically.

Body mass index and sex and their effect on patient-reported outcomes following cartilage repair: an insight from the International Cartilage Regeneration and Joint Preservation Society Patient Registry

IntroductionChondral injuries in the knee, whether isolated or accompanying other injuries are found in as many as 60% of arthroscopic examinations. Although current research has identified negative outcomes for patients with a body mass index (BMI) >30kg/m2 undergoing chondral repair, our understanding of the relationship between presurgery BMI and postoperative patient-reported outcomes across all BMI categories remains lacking. ObjectivesThrough the International Cartilage Regeneration and Joint Preservation Society (ICRS) Patient Registry, this study aimed to explore this relationship, taking into account sex variations. MethodsThe ICRS Patient Registry was used to extract the data for this study. The outcomes in focus were the Knee Osteoarthritis Outcome Score (KOOS) and EQ-5D scores. Pearson and Spearman correlation methods were applied and the level of significance was set as α= 0.05. ResultsOf 3194 Registry patients at the time of data extraction, 1757 had undergone a surgical procedure, and 336 of these had complete KOOS or EQ-5D scores available for 6-week, 6-month, and 1-year postoperation. Analyses revealed that neither male (average BMI – 28.2 kg/m2) nor female (average BMI – 25.3 kg/m2) data sets indicated a correlation between BMI and the patient-reported outcomes. ConclusionsBMI, irrespective of sex, is not correlated with patient-reported outcomes in patients enrolled in the ICRS Registry with a BMI <30 kg/m2. Although BMIs in the overweight classification were not associated with poorer outcomes than BMIs in the normal classification, the current literature continues to support the notion that a BMI >30 kg/m2 is linked to poor cartilage repair and failure.

Analysis of Factors Associated with Outcomes of Bariatric Surgery: rs1800497 ANKK1, rs1799732 DRD2 Genetic Polymorphisms, Eating Behavior, Hedonic Hunger, and Depressive Symptoms

IntroductionA therapeutic approach to severe obesity is bariatric surgery (BS), which is considered an effective intervention for ameliorating comorbidities such as T2DM, hypertension, dyslipidemia, and cardiovascular diseases. Some polymorphisms are considered markers for addictive disorders and hedonic hunger. We analyzed factors associated with the outcomes of BS, including rs1800497 ANKK1 and rs1799732 DRD2 polymorphisms, eating behavior, hedonic hunger, and depressive symptoms. MethodsWe retrospectively selected 101 patients who underwent BS and agreed to participate. The previous conditions to BS, such as body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and comorbidities, were registered; the scholarship value was evaluated as the total number of years of scholarly education. To evaluate the post-surgery conditions of the participants, we took blood samples, anthropometric measures, and 3 questionnaires to evaluate eating behavior (TFEQ-R18), hedonic hunger (PFS), and depressive symptoms (PHQ-9). The ANKK1 rs1800497 and rs1799732 DRD2 polymorphisms were genotyped. ResultsThe median total weight loss (TWL) was 34.7 kg, with a BMI of 33.8 kg/m2, 6 (4–8) years after BS. The TWL was positively associated with the TFEQ-R18 score (p = 0.006) and negatively associated with triglycerides (p = 0.011). rs1800497 ANKK1 was associated with TFEQ-R18 (OR = 1.13 (1.02–1.25), p = 0.009). We also found a negative correlation of pre-surgery BMI with scholarship (r = − 0.27, p < 0.05). ConclusionThe patients showed an improvement in metabolic and anthropometric parameters post-surgery. Interestingly, the ANKK1 Taq1A polymorphism was associated with eating behavior and scholarship with pre-surgery BMI, which may be considered predictors of BS outcomes.

Gestational Weight Gain in Pregnancies Following Bariatric Surgery

IntroductionTo compare the gestational weight gain (GWG) between women with previous bariatric surgery and those without and investigate whether GWG correlates with birthweight (BW) or delivery of a small-for-gestational-age (SGA) neonate.Materials and MethodsProspective, longitudinal study, include 100 pregnant women with previous bariatric surgery and 100 without weight loss surgery, but with similar early-pregnancy body mass index (BMI). In a sub-study, 50 of the post-bariatric women were also matched to 50 women without surgery, but early-pregnancy BMI similar to the pre-surgery BMI of the post-bariatric ones. All women had their weight/BMI measured at 11–14 and 35–37 weeks of gestation, and the difference in maternal weight/BMI between the two time points was expressed as GWG/BMI gain. Associations between maternal GWG/BMI gain and birthweight (BW) were examined.ResultsCompared to no bariatric women with similar early-pregnancy BMI, post-bariatric women had similar GWG (p = 0.46), and the number of women with appropriate, insufficient, and excessive weight gain was comparable between groups (p = 0.76). However, post-bariatric women delivered smaller babies (p < 0.001), and GWG was not a significant predictor of BW or of delivering a SGA neonate. Compared to no bariatric women with similar pre-surgery BMI, post-bariatric ones had higher GWG (p < 0.01) but still delivered smaller neonates (p = 0.001).ConclusionsPost-bariatric women seem to have similar or greater GWG compared to women without surgery matched for early-pregnancy or pre-surgery BMI, respectively. Maternal GWG was not associated with BW or higher prevalence of SGA neonates seen in women with previous bariatric surgery.Graphical

A Hub and Spoke Learning Program in Bariatric Surgery in a Small Region of Italy.

BackgroundMetabolic and bariatric surgery (BS) are considered life-changing and life-saving treatments for obese patients. The Italian Society of Obesity Surgery (SICOB) requires at least 25 operations per year to achieve the standard of care in the field. Despite the increasing need to treat obese patients, some small southern regions of Italy, such as Molise, do not have enough experience in bariatric procedures to be allowed to perform them. Therefore, our aim was to run a Hub and Spoke Program with a referral center in BS to treat obese patients and provide a proper learning curve in BS in Molise.MethodsIn 2020, the “A. Cardarelli Hospital” in Campobasso, Molise, started a formal “Learning Model of Hub and Spoke Collaboration” with the Hub center “Ospedale Del Mare”, Naples. A multidisciplinary approach was achieved. Patients were supervised and operated under the supervision and tutoring of the referral center. We retrospectively reviewed our prospectively collected database from February 2020 to August 2021 in order to analyze the safety and effectiveness of our learning program.ResultsIn total, 13 (3 men and 10 women) patients underwent BS with the mean age of 47.08 years and a presurgery BMI of 41.79. Seven (53.84%) patients were the American Society of Anesthesiologist (ASA) II, and 6 (46.16%) patients were ASA III. Twelve (92.31%) procedures were laparoscopic sleeve gastrectomies, 1 (7.69%) patient underwent endoscopic BioEnterics Intragastric Balloon (BIB) placement. One (8.33%) sleeve gastrectomy was associated to gastric band removal. Mean surgical time was 110.14 ± 23.54 min. The mean length of stay was 4.07 ± 2.40 days. No Clavien-Dindo ≥ III and mortality were reported. The follow-up program showed a mean decrease of 11.82 in terms of body mass index (BMI) value. The last 5 procedures were performed by the whole equips from “A. Cardarelli” under external tutoring without any impact on complication rate.ConclusionThe setup of a proper Hub and Spoke Program may allow to perform BS to provide the standard of care. This approach may reduce health costs and related patient migration.

Confinement During the COVID-19 Pandemic After Metabolic and Bariatric Surgery-Associations Between Emotional Distress, Energy-Dense Foods, and Body Mass Index.

PurposeTo estimate the association of emotional distress with both consumption of energy-dense micronutrient-poor foods (EDF) and body mass index (BMI) and the association between EDF consumption and change in BMI, during COVID-19 pandemic in patients with prior bariatric surgery.Materials and MethodsThis cross-sectional study applied an online structured questionnaire to 75 postoperative bariatric patients during the first Portuguese lockdown. Emotional distress was assessed trough the Hospital Anxiety and Depression Scale (HADS) and dietary intake was evaluated by Food Frequency Questionnaire (FFQ). Self-reported BMI prior to and at the end of confinement was used to compute BMI change. Pre-surgery BMI was computed from measured height and weight from clinical records.ResultsAfter adjustment for education, sex, time since surgery, pre-surgery BMI, and exercise practice, moderate/severe scores in HADS were significantly positively associated with consumption of EDF (ẞ = 0.799; 95% CI: 0.051, 1.546), but not with BMI. Daily EDF consumption significantly increased the odds of maintaining/increasing BMI (OR = 3.34; 95% CI: 1.18, 9.45), instead of decreasing it (reference). Sweets consumption was the only subcategory of EDF significantly positively associated with the odds of a worse outcome in BMI change (OR = 4.01; 95% CI: 1.13, 14.22).ConclusionsAmong postoperative bariatric patients, higher reported levels of emotional distress during confinement are associated with increased EDF consumption. Increased EDF consumption during confinement, particularly sweets, is associated with higher odds of bariatric patients not decreasing their BMI. Additional effort is needed to address inadequate lifestyle behaviors among these patients in the context of the COVID-19 pandemic.Graphical abstract Supplementary InformationThe online version contains supplementary material available at10.1007/s11695-021-05608-2.

Weight Regain Outcomes After Bariatric Surgery in the Long-term Follow-up: Role of Preoperative Factors.

Weight regain (WR) compromises the effectiveness of bariatric surgery. The objective of this study was to determine differences in long-term WR prevalence using different definitions and analyze possible preoperative predictors involved. Single-center retrospective cohort study including 445 adults who underwent 3 modalities of bariatric surgery between 2009 and 2014. age, gender, ethnicity, body mass index (BMI), type 2 diabetes (T2D), hypertension (HTN), and type of surgery. WR at year 6 assessed by 4 definitions and 6 multivariate models based on common thresholds. Our cohort (71.1% female) had a mean age of 44.78 ± 11.94 years, and mean presurgery BMI of 44.94 ± 6.88 kg/m2, with a median follow-up of 6 years (IQR=5-8). The prevalences of T2D and HTN were 36.0% and 46.7% respectively. WR rates over thresholds ranged from 25.4 to 68.1%, with significant differences between groups in the WR measured as the percentage of maximum weight loss (MWL) and the increase in excess weight loss (EWL). Presurgery BMI was a significant predictor in 3 models; restrictive techniques were associated with WR in all the models except for those considering WR over 10 kg and WR over 15% from nadir as dependent variables. In this long-term study, WR defined as percentage of MWL and increase in EWL from nadir had the greatest significance in logistic regression models with preoperative BMI and type of surgery as independent variables. These findings could serve to establish a standardized outcome reporting WR in other longitudinal studies. • Lack of standardized outcome to measure weight regain after bariatric surgery. • Lowest rates of weight regain in malabsorptive techniques in all definitions applied. • Weight regain measured as percentage of maximum weight lost.

Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study

ObjectiveThe study aimed to investigate the heterogeneity of weight loss 5 years after Roux-en-Y gastric bypass (RYGB) and the association with cardiometabolic health as well as to model prediction estimates...

Fecal metagenomics and metabolomics reveal gut microbial changes after bariatric surgery.

Evidence from longitudinal patient studies regarding gut microbial changes after bariatric surgery is limited. To examine intraindividual changes in fecal microbiome and metabolites among patients undergoing Roux-en-Y gastric bypass or vertical sleeve gastrectomy. Observational study. Twenty patients were enrolled and provided stool samples before and 1 week, 1 month, and/or 3 months after surgery. Shallow shotgun metagenomics and untargeted fecal metabolomics were performed. Zero-inflated generalized additive models and linear mixed models were applied to identify fecal microbiome and metabolites changes, with adjustment for potential confounders and correction for multiple testing. We enrolled 16 women and 4 men, including 16 white and 4 black participants (median age = 45 years; presurgery body mass index = 47.7 kg/m2). Ten patients had Roux-en-Y gastric bypass, 10 had vertical sleeve gastrectomy, and 14 patients provided postsurgery stool samples. Of 47 samples, median sequencing depth was 6.3 million reads and 1073 metabolites were identified. Microbiome alpha-diversity increased after surgery, especially at 3 months. Significant genus-level changes included increases in Odoribacter, Streptococcus, Anaerotruncus, Alistipes, Klebsiella, and Bifidobacterium, while decreases in Bacteroides, Coprocosccus, Dorea, and Faecalibacterium. Large increases in Streptococcus, Akkermansia, and Prevotella were observed at 3 months. Beta-diversity and fecal metabolites were also changed, including reduced caffeine metabolites, indoles, and butyrate. Despite small sample size and missing repeated samples in some participants, our pilot study showed significant postsurgery changes in fecal microbiome and metabolites among bariatric surgery patients. Future large-scale, longitudinal studies are warranted to investigate gut microbial changes and their associations with metabolic outcomes after bariatric surgery.

Leveraging Digital Infrastructure for Data Analysis: An Example in Bariatric Surgery.

The digitalization of healthcare information provides hospitals with the ability to gain insight into patterns and associations pertaining to disease and management. Using bariatric patient data as an example provided an opportunity to explore the potential of electronic medical record (EMR) data to generate insights. The aim of this study was to extract EMR data pertaining to bariatric patient information as a means to explore predictive factors of weight loss post-bariatric surgery. We conducted a retrospective cohort study of patients undergoing bariatric surgery between January 1, 2018, and April 30, 2019, at Humber River Hospital. Multiple linear regression was used to examine whether age, pre-surgery body mass index (BMI), comorbidities and mental health disorders predicted higher weight loss 6 months following bariatric surgery. A total of 502 patients were included in the final analysis. Age (ß = 0.04 [95% CI 0.01, 0.06], p = 0.005), baseline BMI (ß = -0.16 [95% CI -0.19, -0.13], p = <0.0001) and diabetes (ß = 0.82 [95% CI 0.23, 1.42], p = 0.007) were associated with weight loss six months post-bariatric surgery. EMRs are a rich source of data with the potential to generate insights that can lead to improved care.

Outcomes of pregnancy after bariatric surgery: results of a French matched-cohort study

While the benefits of bariatric surgery (BS) on pregnancy outcomes have been demonstrated for women compared with matched controls on presurgery body mass index (pB-BMI), data are lacking and those benefits are uncertain compared with matched controls on prepregnancy BMI (pP-BMI). Our study aimed to evaluate outcomes (obstetrical and neonatal) of single pregnancy in women previously exposed to BS compared with women unexposed to BS matched on pB-BMI and pP-BMI. Retrospective matched cohort study from 2 observational studies of pregnant women conducted in a French administrative county (Finistère). From April 1, 2015 to January 31, 2019, pregnant women with previous BS (n = 52) were included and compared with 2 different control groups as follows: group A (n = 104), matched for pB-BMI, age, and parity; and group B (n = 104), matched for pP-BMI, age, and parity. In women exposed to BS, mean age was 27.1 (±4.9) years and pB-BMI was 46.0 (±4.6) kg/m2. Operated women differed significantly from group A but not from group B for pP-BMI (29.4 ± 6.1 versus 45.3 ± 4.5 group A versus 28.6 ± 6.6 group B) and gestational diabetes (12.0% versus 44.0% group A versus 17.0% group B), respectively. In the group of women exposed to BS, birth weight (g) was significantly lower (2960 ± 545 versus 3381 ± 735 group A versus 3310 ± 645 group B) and large-for-gestational-age infants less frequent (0% versus 13% group A versus 8% group B). Bariatric surgery reduced risks of excessive fetal growth and gestational diabetes with a trend for a higher risk of small-for-gestational-age, despite matching on pP-BMI suggesting a risk associated to BS and solely to previous surgery-induced weight loss.

Pre-Disease and Pre-Surgery BMI, Weight Loss and Sarcopenia Impact Survival of Resected Lung Cancer Independently of Tumor Stage.

Lower pre-surgery Body Mass Index (BMI) and low muscle mass impact negatively long-term survival of non-small cell lung cancer (NSCLC). We investigated their influence on survival after major lung resection for NSCLC. Methods: A retrospective analysis of a prospectively collected database was made on 304 consecutive patients. Results: Underweight, normal, overweight and obese patients represented 7.6%, 51.6%, 28.6%, and 12.6% of the pre-disease population. Weight loss and gain were recorded in 44.4% and 5% of patients, respectively. Low muscle mass was more frequently associated with BMI < 25 kg/m2 (p < 0.000001). Overall survival was positively affected by pre-disease (p = 0.036) and pre-surgery (p = 0.017) BMI > 25 kg/m2, and, even more, in case of BMI > 25 kg/m2 and increasing weight (p = 0.012). Long-term outcome was negatively influenced by low muscle mass (p = 0.042) and weight loss (p = 0.0052) as well as age (p = 0.017), ASA categories (p = 0.025), extent of resection (p = 0.0001), pleural invasion (p = 0.0012) and higher pathologic stage (p < 0.0001). Three stepwise multivariable models confirmed the independent favorable prognostic value of higher pre-disease (RR 0.66[0.49–0.89], p = 0.006) and pre-surgery BMI (RR 0.72[0.54–0.98], p = 0.034), and the absence of low muscle mass (RR 0.56[0.37–0.87], p = 0.0091). Conclusions: Body reserves assessed by simple clinical markers impact survival of surgically treated NSCLC. Strategies improving body fat and muscular mass before surgery should be considered.

Risk of Operative and Nonoperative Interventions Up to 4 Years After Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in a Nationwide US Commercial Insurance Claims Database

There are few nationwide studies comparing the risk of reintervention after contemporary bariatric procedures. To compare the risk of intervention after Roux-en-Y gastric bypass (RYGB) vs vertical sleeve gastrectomy (VSG). This cohort study used a nationwide US commercial insurance claims database. Adults aged 18 to 64 years who underwent a first RYGB or VSG procedure between January 1, 2010, and June 30, 2017, were matched on US region, year of surgery, most recent presurgery body mass index (BMI) category (based on diagnosis codes), and baseline type 2 diabetes. The prematch pool included 4496 patients undergoing RYGB and 8627 patients undergoing VSG, and the final weighted matched sample included 4476 patients undergoing RYGB and 8551 patients undergoing VSG. Bariatric surgery procedure type (RYGB vs VSG). The primary outcome was any abdominal operative intervention after the index procedure. Secondary outcomes included the following subtypes of operative intervention: biliary procedures, abdominal wall hernia repair, bariatric conversion or revision, and other abdominal operations. Nonoperative outcomes included endoscopy and enteral access. Time to first event was compared using multivariable Cox proportional hazards regression modeling. Among 13 027 patients, the mean (SD) age was 44.4 (10.3) years, and 74.1% were female; 13.7% had a preoperative BMI between 30 and 39.9, 45.8% had a preoperative BMI between 40 and 49.9, and 24.2% had a preoperative BMI of at least 50. Patients were followed up for up to 4 years after surgery (median, 1.6 years; interquartile range, 0.7-3.2 years), with 41.9% having at least 2 years of follow-up and 16.3% having at least 4 years of follow-up. Patients undergoing VSG were less likely to have any subsequent operative intervention than matched patients undergoing RYGB (adjusted hazard ratio [aHR], 0.80; 95% CI, 0.72-0.89) and similarly were less likely to undergo biliary procedures (aHR, 0.77; 95% CI, 0.67-0.90), abdominal wall hernia repair (aHR, 0.60; 95% CI, 0.47-0.75), other abdominal operations (aHR, 0.71; 95% CI, 0.61-0.82), and endoscopy (aHR, 0.54; 95% CI, 0.49-0.59) or have enteral access placed (aHR, 0.58; 95% CI, 0.39-0.86). Patients undergoing VSG were more likely to undergo bariatric conversion or revision (aHR, 1.83; 95% CI, 1.19-2.80). In this nationwide study, patients undergoing VSG appeared to be less likely than matched patients undergoing RYGB to experience subsequent abdominal operative interventions, except for bariatric conversion or revision procedures. Patients considering bariatric surgery should be aware of the increased risk of subsequent procedures associated with RYGB vs VSG as part of shared decision-making around procedure choice.

Proximal Roux-en-Y gastric bypass: Addressing the myth of limb length

BackgroundSome studies suggest that changes in weight or metabolic outcomes are affected by the lengths of the gastrointestinal limbs in the Roux-en-Y gastric bypass. MethodsParticipants (N = 1,770) underwent primary Roux-en-Y gastric bypass and were followed ≤7 years in the Longitudinal Assessment of Bariatric Surgery-2, a multicenter US cohort study. Alimentary limb and biliopancreatic limb lengths were measured according to research protocol; common channel was measured in a subsample (N = 547). Aimentary limb, biliopancreatic limb, and common channel ratio to total small bowel length were calculated. ResultsMedian presurgery body mass index was 46 (25th–75th percentile: 43–51) kg/m2. Medians (25th–75th percentiles) for alimentary limb length were 125 cm (100–150), for biliopancreatic limb length were 50 cm (50–60), and common channel length were 410 cm (322–520). Statistics for ratios to the small bowel length were 0.23 (0.18–0.27) for alimentary limb, 0.09 (0.07–0.10) for biliopancreatic limb, and 0.69 (0.63–0.73) for common length. There were no significant associations between alimentary limb, biliopancreatic limb, common channel, alimentary limb ratio, biliopancreatic limb ratio or common channel ratio, and either weight loss or improvement in cardiometabolic outcomes. ConclusionThe common channel length in Roux-en-Y gastric bypass is highly variable between individuals. None of the limb lengths in this study, nor alimentary limb, biliopancreatic limb, or common channel ratios, seem to be related to weight loss or metabolic improvements >7 years.

Patient factors associated with weight gain and weight loss after knee or hip arthroplasty

ObjectivesFollowing total knee or total hip arthroplasty (TKA, THA), up to 31% of recipients experience significant weight gain while up to 14% experience significant weight loss. Factors associated with significant weight change (≥5% of baseline weight) have not been comprehensively explored. This study aimed to identify pre- and post-surgical (including current) patient factors associated with significant weight change three years after surgery. MethodsA pre-existing nationally-acquired cohort who underwent TKA or THA for osteoarthritis participated in 3-year telephone follow-up. Updated weight, comorbidity, and complication data were collected along with ongoing index joint problems and other patient-reported outcomes including global improvement. These data, along with body mass index (BMI) pre-surgery and post-surgery rehabilitation received, were incorporated into two multivariable logistic regression models to determine separately the factors associated with ≥5% weight gain and ≥5% loss at 3-years post-surgery. Results73.4% (1289/1757) participated in the follow-up; 1191 (n = 663 TKA) provided updated weight data. Patterns of weight change were similar for both surgeries (TKA: 16.1% gained ≥5%, 19.6% lost ≥5%; THA: 15.8% gained ≥5%, 17.8% lost ≥5%). In multivariable modelling, younger age and lower pre-surgery BMI were significantly associated with weight gain; female gender and an absence of ongoing index joint issues were associated with weight loss. ConclusionDifferent mechanisms are likely associated with significant weight gain or loss at 3-years post-surgery. Cogent weight management entails consideration of both outcomes. Many post-surgical factors appear not to be importantly associated with weight change.

Weight Loss Through Bariatric Surgery Is Associated With Lower Rates of Hepatic Decompensation

Introduction: The obesity epidemic has not spared patients with cirrhosis. Obesity has been shown to increase the probability of clinical decompensation independent of portal pressure or hepatic synthetic function. Various modalities of weight reduction have emerged as therapeutic targets in the management of cirrhosis regardless of etiology. Bariatric surgery has become the gold standard treatment for morbid obesity, with data suggesting bariatric surgery is safe and effective in patients with compensated cirrhosis. This study aimed to explore the relationship between weight reduction surgery and the development of hepatic decompensation. Methods: Fourteen biopsy-proven patients with cirrhosis who underwent bariatric surgery (cases) at our institution from 1/1/2000-6/31/2017 were identified using diagnosis and procedural codes. A retrospective chart review was utilized to validate coded diagnoses. Twenty-eight controls were selected from a database of patients with cirrhosis and obesity and matched for body mass index (BMI), age, and metabolic syndrome components. The prevalence of hepatic decompensation in relation to BMI was compared between groups. Results: There were no statistically significant differences in demographic characteristics between the groups including age, sex, race, metabolic syndrome components, or etiology of cirrhosis; though 93% of cases had NASH cirrhosis (Table 1). All cases (n=14) had compensated cirrhosis at the time of surgery, and no cases developed hepatic decompensation. Average pre-surgery BMI was 50.4 kg/m2compared to 38.7 kg/m2at the end of follow-up (average decrease in BMI of 12.1 kg/m2in cases). In contrast, 54% of controls were diagnosed with decompensated cirrhosis. Average BMI at the time of clinical decompensation in controls was 44.6 kg/m2. The difference in BMI between cases (38.7 kg/m2)and all controls (45.3 kg/m2) reached statistical significance (p=0.01), as did the difference in BMI between cases (38.7 kg/m2) and controls with decompensation (44.6 kg/m2; p=0.04). Conclusion: Bariatric surgery in patients with cirrhosis resulted in a decrease in BMI without clinical decompensation. In a control group of obese patients with cirrhosis matched for age and metabolic syndrome components, decompensation was diagnosed in 54% during the study period. These results support prior data suggesting weight loss may be associated with decreased rates of clinical decompensation in patients with cirrhosis.958 Figure 1 No Caption available.

Postoperative outcomes based on patient participation in a presurgery education and weight management program

BackgroundThe benefits of presurgery weight management programs (WMPs) for bariatric patients are mixed; some show a positive impact on percent excess weight loss (%EWL) at 12 months postsurgery, while others show no effect. ObjectivesThe purpose of this study was to compare pre- and postoperative 6- and 12-month outcomes between patients who attended a 12-week presurgery WMP and patients who did not participate. SettingOhio State Wexner Medical Center, University Hospital, United States. MethodsA retrospective medical record analysis was conducted to compare preoperative and 6- and 12-month postoperative outcomes for patients who attend the presurgery WMP (n = 56) and patients who did not (n = 441) within a 2-year time period (N = 497). Descriptive statistics and independent t tests were conducted to determine mean differences between groups, while controlling for surgery type, for weight status outcomes (%EWL, change in body mass index) preoperatively and 6 and 12 months postsurgery, and length of stay and readmission rate. ResultsPatients who attended the preoperative WMP had significantly higher %EWL at 12 months postsurgery compared with patients who did not attend the WMP. Additional findings indicated a positive, but nonsignificant effect, from the WMP on presurgery body mass index, and postsurgery %EWL at 6 months and body mass index change at 6 and 12 months postsurgery. ConclusionsPatients attending the WMP had better 12-month %EWL and outcomes compared with those who did not attend the WMP, though this was not true for 6-month outcomes and differed based on surgery type.

Association of circulating proinflammatory marker, leucine‐rich‐α2‐glycoprotein (LRG1), following metabolic/bariatric surgery

Obesity confers substantial excess risk for morbidity and mortality, especially for type 2 diabetes (T2D). Leucine-rich-α2-glycoprotein 1 (LRG1), a novel proinflammatory factor, was recently reported to be higher in patients with T2D with complications of peripheral arterial disease. Association of LRG1, obesity, and weight loss is unknown. We examined whether plasma LRG1 is associated with obesity in health screening participants and if it predicts future weight loss in morbidly obese patients after metabolic/bariatric surgery. Cohort 1 was a cross-sectional study from a Health Screening program (n=616) in a tertiary hospital. Cohort 2 was a prospective study of morbidly obese patients (n=231) who underwent metabolic/bariatric surgery with follow-up weight measurements. Anthropometric data, baseline fasting glucose, plasma adiponectin, high sensitivity C-reactive protein (HsCRP), and LRG1 were measured. Postsurgery blood, after metabolic/bariatric surgery, were available for LRG1and HsCRP measurements in 57 patients. In the group with highest tertile of LRG1, body mass index (BMI), waist circumference, and HsCRP were significantly higher, while total cholesterol, high-density lipoprotein, low-density lipoprotein, and adiponectin were lower than tertiles 1 and 2. Generalized linear model analysis showed that female gender (P<.0001), non-Chinese ethnicity (P<.019), and higher HsCRP (P<.0001) levels were independent and significant determinants of higher plasma LRG1 levels. After adjustment for age, gender, ethnicity, and baseline BMI, female gender (P=.020), higher presurgery BMI (P=.001), and lower presurgery LRG1 (P=.002) remained statistically significant predictors for greater weight loss. Plasma LRG1 increased significantly [from 28.2 (21.9-36.8) to 34.9 (22.6-49.5)] μg/mL (P=.003) within 1.5months, after metabolic/bariatric surgery. Our study demonstrates that LRG1 level is positively associated with obesity and a lower level of plasma LRG1 predicts weight loss in metabolic/bariatric surgery. Our novel findings suggest LRG1, itself or in combination with other known factors, is a potential biomarker of inflammation and obesity.

Association of Obesity and Thyroid Cancer at a Tertiary Care Hospital in Pakistan.

ObjectiveThyroid cancer (TC) is one of the most common endocrine malignancies with a rapidly increasing worldwide presence. In Pakistan, it is more prevalent in females than males and has an incidence rate of 2.1%. Obesity and excess body mass index (BMI) has been linked to several cancers and is thought to be a risk factor for TC. We aim to investigate the incidence of TC in our population and understand it’s correlation with obesity.SubjectsThe study was a retrospective case series conducted in the years 2000 to 2014, at the Aga Khan University Hospital (AKUH), Karachi, Pakistan where 156 patients who had been diagnosed and treated for TC were analyzed. Clinicopathological data was collected from medical records of these patients and weight and height were measured, pre-surgery, post-surgery, and at follow up. The BMI was correlated with patient variables for any significant associations.ResultsThe patient set comprised of 38.5% males and 61.5% females with a mean age of 47.77 (SD ± 14.35). The BMI was significantly associated with age as 72.8% of participants were obese and >45 years old as compared to 27.2% who were under 45 years and obese (p-value <0.001). Upon comparison of the pre-surgery, post-surgery, and current mean BMI, Bonferroni pairwise comparisons showed no significant difference (p>0.999).Conclusion The majority of-of TC patients among the Pakistani population were obese and female. Age was significantly associated with the risk of having a higher BMI. Moreover, differences in BMI pre and post-surgery could not be statistically proven.

Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis.

The effectiveness of bariatric surgery has been well-studied. However, complications after bariatric surgery have been understudied. This review assesses <30-d major complications associated with bariatric procedures, including anastomotic leak, myocardial infarction and pulmonary embolism. This review included 71 studies conducted in the USA between 2003 and 2014 and 107,874 patients undergoing either gastric bypass, adjustable gastric banding or sleeve gastrectomy, with mean age of 44years and pre-surgery body mass index of 46.5kgm-2 . Less than 30-d anastomotic leak rate was 1.15%; myocardial infarction rate was 0.37%; pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction and pulmonary embolism was 0.12%, 0.37% and 0.18%, respectively. Among surgical procedures, <30-d after surgery, sleeve gastrectomy (1.21% [95% confidence interval, 0.23-2.19%]) had higher anastomotic leak rate than gastric bypass (1.14% [95% confidence interval, 0.84-1.43%]); gastric bypass had higher rates of myocardial infarction and pulmonary embolism than adjustable gastric banding or sleeve gastrectomy. During the review, we found that the quality of complication reporting is lower than the reporting of other outcomes. In summary, <30-d rates of the three major complications after either one of the procedures range from 0% to 1.55%. Mortality following these complications ranges from 0% to 0.64%. Future studies reporting complications after bariatric surgery should improve their reporting quality.