Journal watch 09/03/2022

Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including outcomes from the ENGAGE CVD (comparing vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) operations), the impact of bariatric surgery on pregnancy and post-partum outcomes, body composition changes at 12 months following different bariatric procedures, the evaluation for hypoglycaemia-related symptoms after bariatric surgery the pre-surgical role of Dapagliflozin plus exenatide for type 2 diabetic and the sociodemographic characteristics of post-bariatric contouring patients (please note, log-in maybe required to access the full paper).


Comparative Effectiveness of Gastric Bypass and Sleeve Gastrectomy on Predicted 10-Year Risk of Cardiovascular Disease 5 Years Following Surgery

US researchers have revealed the outcomes from the Effectiveness of Gastric Bypass vs. Gastric Sleeve for Cardiovascular Disease (ENGAGE CVD) study, which compared the effectiveness of vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) operations in reducting the American College of Cardiology (ACA) and the American Heart Association (AHA) predicted ten-year atherosclerotic cardiovascular disease (ASCVD) risk five years after surgery.


The ENGAGE CVD cohort included 22,095 patients who underwent VSG or RYGB from 2009-2016. The VSG and RYGB were compared using a local instrumental variable (LIV) approach to address observed and unobserved confounding, as well as to conduct heterogeneity of treatment effects for patients of different age groups, baseline predicted ten-year CVD risk using the ASCVD risk score, and those who had T2DM at the time of surgery.


The outcomes showed that the predicted ten-year ASCVD risk at surgery was 4.1% for VSG and 5.1% for RYGB, decreasing to 2.6% for VSG and 2.8% for RYGB one-year post-operatively. Five years after surgery, patients remained with relatively low risk levels (3.0% for VSG and 3.3% for RYGB) and there were no significant differences in predicted ten-year ASCVD risk between VSG and RYGB at any time.


The authors concluded that the predicted ten-year ASCVD risk was low in this population and remained low up to five years for those with diabetes, Black and Hispanic patients, and older adults.

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Pregnancy and post-partum outcomes of obese women after bariatric surgery: A case-control study

Investigators from the University of Rome, Rome, Italy, have reported bariatric surgery has a positive impact on several obstetric outcomes, but with a higher frequency of small for gestational age (SGA) and increase in late preterm delivery (PTD).


Writing in the European Journal of Obstetrics and Gynecology and Reproductive Biology, the researchers examined the impact of restrictive bariatric surgery on several pregnancy outcomes in comparison with different grades of obesity. The study included 90 women: 30 underwent surgery and 60 were living with obesity.


The mean pre-pregnancy BMI was 31.0±4.2 kg/m2 in the surgical group and 38.1±4.3 kg/m2 in the control group (p<0.001). The control group experienced higher rate of foetal macrosomia (25% vs 6.7%; p=0.049), gestational hypertension (23.3% vs 3.3%; p=0.04), preeclampsia (23.3% vs 0%; p=0.04), gestational diabetes (33.3% vs 6.7%; p=0.01) and caesarean section (68.3% vs 20%; p<0.0001).


The surgical group showed higher frequency of small for gestational age (SGA) (46.7% vs 18.3%; p=0.006), late preterm delivery (PTD) (33.3% vs 10%; p=0.009), cholestasis (13.3% vs 1.7%; p=0.049). Breastfeeding ≥6 months was higher among BS mothers (36.7% vs 11.7%; p=0.007).


Mothers in the surgical group more frequently achieved the recommended goal of breastfeeding for 6 months compared to women with obesity.


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Body composition changes at 12 months following different surgical weight loss interventions in adults with obesity: A systematic review and meta-analysis of randomized control trials

Researchers from Monash University, Clayton, Victoria, Australia, writing in Obesity Reviews, have found that Meta-analysis revealed that, relative to gastric banding, Roux-en-Y gastric bypass (RYGB) led to greater total body mass loss and greater fat mass loss but similar lean mass loss RYGB also led to similar changes in total body mass, fat mass, and lean mass compared with sleeve gastrectomy.


They conducted a systematic review and meta-analysis to determine relative lean mass and fat mass changes in adults with obesity following surgical weight loss interventions.


Inclusion criteria included randomized controlled trials (RCTs) performed in populations with obesity (body mass index ≥30 kg/m2) aged over 18 years, who underwent any type of bariatric surgery and reported body composition measures via dual-energy X-ray absorptiometry or bio-electrical impedance analysis. Authors conducted full text screening and determined that there were six RCTs eligible for inclusion, with data extracted at 12 months post-surgery.


They noted that additional RCTs comparing body composition changes following different bariatric surgery procedures are required.


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Evaluation and Management of Patients Referred for Post-Bariatric Surgery Hypoglycemia at a Tertiary Care Center

Investigators from the Mayo Clinic, Rochester, MN, have examined diagnostic evaluation and therapeutic interventions of patients referred for post-bariatric surgery hypoglycaemia. Writing in Obesity Surgery, they evaluated patients who were treated for post-bariatric surgery hypoglycaemia in a tertiary referral center from 2008 to 2017.


A total of 60/2450 (2.4%) patients who underwent bariatric surgery were evaluated for hypoglycaemia-related symptoms. The majority were middle-aged women without type 2 diabetes who had undergone Roux-en-Y gastric bypass. Thirty-nine patients (65%) completed a biochemical assessment for hypoglycaemia episodes. Six (10%) patients had confirmed hypoglycaemia by Whipple’s triad, and four (6.7%) met the criteria for post-bariatric surgery hypoglycaemia based on clinical and biochemical criteria.


All patients were recommended dietary modification as the initial line of treatment, and this intervention resulted in most patients reporting at least some improvement in their symptoms. Eight patients (13%) were prescribed pharmacotherapy, and two patients required additional interventions for symptom control.


They concluded that evaluation for hypoglycaemia-related symptoms after bariatric surgery was rare. Even without establishing a diagnosis of hypoglycaemia, dietary changes were a helpful strategy for symptom management for most patients.


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Dapagliflozin plus exenatide on patients with type 2 diabetes awaiting bariatric surgery in the DEXBASU study

Researchers from the Institut de Recerca Biomèdica de Lleida (IRBLleida), University of Lleida, Lleida, Spain, have reported the impact of dapagliflozin as a strategic option to reduce the waiting list for bariatric surgery, especially in those patients with type 2 diabetes.


Writing in Scientific Reports, their 24-week non-blinded, randomised pilot study assessed the efficacy of subcutaneous exenatide 2.0mg once weekly plus oral dapagliflozin 10mg once daily (Group A) compared to a control group (Group B) in 56 patients with type 2 diabetes awaiting bariatric surgery was conducted.


The proportion of patients who ran off the criteria for bariatric surgery was larger in Group A than in the control group (45.8% vs. 12.0%, p=0.010). Participants in Group A exhibited an absolute decrease in body weight and BMI of 8.1kg and 3.3kg/m2, respectively (p<0.001 for both in comparison with Group B). A higher percentage of participants in Group A reached a BMI<35kg/m2 (45.8 vs 12.0%) and lost > 10% of their initial body weight (20.8 vs 0%) compared to Group B.


The researchers concluded that the combination of exenatide plus dapagliflozin appears as a strategic option to reduce the waiting list for bariatric surgery, especially in those patients with type 2 diabetes.


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Sociodemographic characteristics of patients and their use of post-bariatric contouring surgery in the US

Authors from the Royal Victoria Hospital, Belfast, UK, have found that the insurance status of bariatric surgery patients and their sex were strongly associated with receipt of a range of contouring procedures.


Their study examined the relationship between the use of contouring procedures on post-bariatric surgery patients, clinical need and sociodemographic factors. Using data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Ambulatory Surgery Sample (NASS) in the US, a total of 66,368 weighted episodes of care received by patients who had had bariatric surgery were extracted (54,684 female [82.4%]) and 6219 episodes had contouring surgeries (9.37%).


Panniculectomy was the most common post-bariatric contouring procedure (3.68%). Compared to Medicare insured patients, the odds of receiving contouring surgery among self-payers were 1.82 for panniculectomy, 14.79 for abdominoplasty and 47.97 for mastopexy.


Writing in BMC Health Services Research, they concluded that insurance status of bariatric surgery patients and their sex were strongly associated with receipt of a range of contouring procedures. Self-payments were associated with a doubling of the odds of having panniculectomy and an increase in the odds to approximately 14 times for abdominoplasty and 48 times for mastopexy.


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