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 bariatric surgery reduced mortality vs. GLP-1RAs, renoprotective effects of metabolic surgery versus GLP1 for CKD, effect of bariatric surgery on patients with IBD, preoperative weight loss on 30-day complication rate after bariatric surgery, effects of bariatric surgery on muscle strength and tirzepatide impact on metabolic dysfunction–associated steatohepatitis (MASH), and more (please note, log-in maybe required to access the full paper).
Bariatric Metabolic Surgery vs Glucagon-Like Peptide-1 Receptor Agonists and Mortality
Bariatric metabolic surgery (BMS) was associated with greater reduced mortality compared with glucagon-like peptide-1 receptor agonists (GLP-1RAs) among individuals with a diabetes duration of ten years or less, mediated via greater weight loss, Israeli researchers have reported.
Writing in JAMA Network Open, the researchers compared all-cause mortality and nonfatal MACEs associated with BMS vs GLP-1RAs for adults with obesity and diabetes and without known cardiovascular disease. The study included 6070 members aged 24 years or older, who had diabetes and obesity and no prior history of ischemic heart disease, ischemic stroke or congestive heart failure. Patients who underwent BMS and patients who received GLP-1RAs from January 2008 to December 2021, were matched 1:1 by age, sex, and clinical characteristics.
The study included 3035 matched pairs of patients (total 6070). Among those with a diabetes duration of ten years or less (2371 pairs), mortality was lower for those who underwent BMS than for those treated with GLP-1RAs. This association became nonsignificant when weight loss during the follow-up period was also included in the model.
The investigators concluded that there were no differences in the risk for mortality between the treatment modalities among individuals with a longer duration of diabetes, nor in the occurrence of nonfatal MACEs among all patients.
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Renoprotective Effects of Metabolic Surgery Versus GLP1 Receptor Agonists on Progression of Kidney Impairment in Patients with Established Kidney Disease
Among patients with T2DM, obesity and established chronic kidney disease (CKD), metabolic surgery was significantly associated with a 60% lower risk of progression of kidney impairment and a 44% lower risk of kidney failure or death compared with glucagon-like peptide-1 receptor agonists (GLP-1RA), according to a study led by researchers from Cleveland Clinic, Cleveland, OH.
Reporting in the Annals of Surgery, they examined the renoprotective effects of metabolic surgery in 425 patients, including 183 patients in the metabolic surgery group and 242 patients in the GLP-1RA group with established CKD.
The cumulative incidence of the primary end point at eight-years was 21.7% in the surgical group and 45.1% in the nonsurgical group (p=0.006). The cumulative incidence of the secondary composite end point at eight-years was 24.0% in the surgical group and 43.8% in the nonsurgical group (p=0.048).
The researchers concluded that metabolic surgery should be considered as a therapeutic option for patients with CKD and obesity.
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Effect of Bariatric Surgery on Disease Outcomes in Patients With Inflammatory Bowel Disease
Sleeve gastrectomy but not Roux-en-Y gastric bypass (RYGB) is associated with improved disease-specific outcomes in patients with inflammatory bowel disease (IBD) and morbid obesity, according to a study led by Case Western Reserve University, Cleveland, OH.
Writing in the Journal of Clinical Gastroenterology, the primary aim of the study was to evaluate disease outcomes of IBD in patients after bariatric surgery. Patients with IBD and morbid obesity who underwent BS were compared with patients with IBD and morbid obesity without surgery in a retrospective, propensity-score matched cohort study using a multi-institutional database.
In all, 482 patients (3.4%) with IBD and morbid obesity underwent BS (mean age 46.9±11.2 y old, mean BMI 42.1±7.72 kg/m2, Crohn’s disease 60%). After propensity-score matching, the BS cohort had a lower risk (aOR 0.31, 95% CI 0.17-0.56) of a composite of IBD-related complications compared with the control cohort.
After propensity-score matching, the surgical cohort with sleeve gastrectomy had a decreased risk of a composite of IBD-related complications. There was no difference in the risk of a composite of IBD-related complications between the surgical cohort with RYGB compared with the control cohort.
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Impact of Preoperative Weight Loss on 30-Day Complication Rate after Bariatric Surgery
Preoperative weight loss does not lead to a consistent improvement in outcomes or operating room times for patients undergoing primary bariatric surgery, according to researchers from Harvard Medical School, Boston, MA.
Reporting in the Journal of the American College of Surgeons, they evaluate the impact of preoperative weight loss on surgical outcomes and OR times after primary laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (RYGB). This retrospective cohort study utilised the 2021 MBSAQIP dataset. Some 171,010 patients were then divided in to four groups: those with no weight loss, lost <0 to <5%, lost ≥5% to <10%, or lost ≥10% TWL preoperatively.
For BMI less than 50 kg/m2, they found preoperative weight loss led to no consistent improvement in surgical outcomes. Although >0% to <5% TWL led to a decrease in intra- and postoperative occurrences after RYGB and a decrease in reoperation rates after LSG, these observations were not seen in those with higher degree of weight loss. In patients with BMI 50 kg/m2 or more, preoperative weight loss showed a consistent improvement in reintervention rates after LSG, and readmission rates after RYGB. There was no improvement in other outcomes, however, irrespective of degree of preoperative weight loss.
The outcomes do not support a uniform policy of preoperative weight loss, although selective use in some high-risk patients may be appropriate, they researchers noted.
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Effects of bariatric surgery on muscle strength and quality: A systematic review and meta-analysis
Bariatric surgery-induced weight loss can reduce the strength of appendicular muscles in the short term, which should be addressed in management these subjects, researchers form Universidad de Chile, Santiago, Chile, have reported.
Writing in Obesity Reviews, they examined postoperative changes in muscle strength and quality and their relationship with BMI changes among adults undergoing surgery.
The meta-analyses included 24 articles (666 participants) and showed that surgery reduced absolute lower-limb isometric strength (p=0.002). Patients who experienced a more significant reduction in BMI after surgery also suffered a higher loss of absolute muscle strength. However, they noted there were insufficient studies investigating medium- and long-term changes in muscle strength and/or quality after BS.
They cautioned that more high-quality studies are needed to evaluate the impact of surgery on muscle strength and the different domains of muscle quality in the medium and long term.
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Tirzepatide for Metabolic Dysfunction–Associated Steatohepatitis with Liver Fibrosis
An international team of researchers have reported that receiving tirzepatide for 52 weeks was more effective than placebo with respect to resolution of MASH without worsening of fibrosis.
The SYNERGY-NASH phase 2, dose-finding, multicentre, double-blind, randomised, placebo-controlled trial including 190 participants were randomly assigned to receive once-weekly subcutaneous tirzepatide (5mg, 10mg or 15mg) or placebo for 52 weeks. The primary end point was resolution of MASH without worsening of fibrosis at 52 weeks.
The percentage of participants who met the criteria for resolution of MASH without worsening of fibrosis was 10% in the placebo group, 44% in the 5mg tirzepatide group, 56% in the 10mg tirzepatide group and 62% in the 15mg tirzepatide group (p<0.001 for all three comparisons). The percentage of participants who had an improvement of at least one fibrosis stage without worsening of MASH was 30% in the placebo group, 55% in the 5mg tirzepatide, 51% in the 10mg tirzepatide group and 51% in the 15mg tirzepatide group.
The most common adverse events in the tirzepatide groups were gastrointestinal events and most were mild or moderate in severity.
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