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 an IFSO Position Statement on weight recurrence, post-BMS VTE risk calculator, BMS reduces pancreatic cancer risk, post-op prevalence of dumping and hypoglycaemia symptoms and LSG not only significantly reduces body weight while also alleviating metabolic syndrome and comorbidities by altering gut microbiota, and more (please note, log-in maybe required to access the full paper).
Therapeutic Options for Recurrence of Weight and Obesity Related Complications After Metabolic and Bariatric Surgery: An IFSO Position Statement
An international team of researchers have published an IFSO Position Statement from a recent IFSO consensus meeting on the therapeutic options for recurrence of weight and obesity related complications after metabolic and bariatric surgery.
Published in Obesity Surgery, they noted that until recently, no universal definition existed for recurrent weight gain and insufficient weight loss. Standardization of reporting is key so outcomes can be compared and data can be pooled.
This IFSO Position Statement provide standard terminology and definitions that will likely resolve this in the future, guidance for the management of recurrent weight gain after bariatric surgery and publishers will need to enforce for authors to use these definitions.
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Development of Venous Thromboembolic Event (VTE) Risk Calculator for Metabolic and Bariatric Surgery Patients To Reduce Mortality
US researchers have reported that that patients with a venous thromboembolic events (VTE) risk ≥0.4% in the first 30 days following BMS may benefit from extended chemoprophylaxis.
Writing in SOARD, they sought to identify patients who are at a high risk for developing VTE and who may benefit from extended chemoprophylaxis following BMS. Using the 2015-2019 MBSAQIP data, they identified 696,069 patients who completed 30-day follow-up data and met the inclusion criteria. Using logistic regression analysis, they detected pre-operative and post-operative risk factors associated with VTE and validated their model externally using the MBSAQIP 2020-2021 datasets (N=273,692).
The overall incidence of VTE after MBS in the 696,069 (MBSAQIP 2015-2019 database) patients included in this analysis was 0.40% (2,759 patients). A cut-off point of 0.4% resulted in a sensitivity of 48.28%, with 24% of patients having a VTE risk greater than 0.4% within the 2015-2019 MBSAQIP dataset. Among all the perioperative factors, high risk for VTE included African American race (p<0.0001), operation length in minutes (p<0.0001), pre-op functional status (p= 0.007), procedure type (RYGB; p<.0001 and p=0.019 with respect to sleeve), pre-op BMI (p<0.001), history of pre-op vein thrombosis requiring therapy (p<0.0001), post-op superficial or organ space surgical site infection (p<0.0001), pre-op venous stasis (p=0.019),at least one readmission within 30 days (p<0.0001), or at least one reoperation within 30 days (p<0.0001).
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Metabolic–Bariatric Surgery Reduces Pancreatic Cancer Risk: A Meta-Analysis of Over 3.7 Million Adults, Independent of Type 2 Diabetes Status
MBS is associated with reduced pancreatic cancer risk regardless of T2D, with a more pronounced effect in T2D patients, according to researchers from the Broad Institute of MIT and Harvard Medical School, Boston, MA, the University Sussex Hospitals NHS Foundation Trust, Chichester, UK, and the University of Piraeus, Piraeus, Greece.
Writing in Diabetes/Metabolism Research and Reviews, they investigated the impact of BMS on pancreatic cancer risk in individuals with obesity based on type 2 diabetes status. Their systematic review and meta-analysis included 12 studies (3,711,243 participants). They found pancreatic cancer risk was lower in the BMS group for both T2D and the overall population than in the non-MBS group.
When comparing the types of MBS versus control, a significant difference was observed for sleeve gastrectomy and Roux-En-Y bypass. The authors called for additional research to investigate the impact of BMS types on pancreatic cancer.
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Prevalence of dumping and hypoglycaemia symptoms after bariatric surgery: A questionnaire-based cross-sectional study
Symptoms of dumping and post-bariatric hypoglycaemia (PBH) were common after RYGB, while no clear increase was observed after SG, according to researchers form Örebro University, Örebro, Sweden.
Published in Clinical Obesity, the study authors wanted to ascertain the prevalence of dumping and PBH symptoms before RYGB and SG at 6 months, 1 year, 2 years and 5 years after surgery in a Swedish population. A total of 742 DSS-Swe questionnaires were included. The average age at surgery was 42.0 years and the average body mass index was 41.8 kg/m2 (SD = 5.9). The surgical methods consisted of RYGB (66.3%) and SG (33.7%).
The proportion of RYGB patients with highly suspected dumping increased from 4.9% before surgery to 26.3% at five-year follow-up. PBH symptoms increased from 1.4% before surgery to 19.3% at the five-year follow-up. For SG patients, no significant increase in dumping or PBH symptoms was observed.
They noted that persistent T2D seems to be a protective factor against PBH symptoms.
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Bacterial and clinical metabolic signatures and their interactions in obese patients post-bariatric surgery
LSG not only significantly reduces body weight while also alleviating metabolic syndrome and comorbidities by altering gut microbiota, researchers from the Zhongnan Hospital of Wuhan University, Wuhan, China, report in the BMC Gastroenterology journal.
The researchers collected stool samples and clinical data from 30 patients with obesity before and 6 months after surgery. The composition of the gut microbiota was analyzed through 16S rRNA sequencing, and Spearman correlation analysis was used to determine the association between gut microbiota and clinical indicators.
The analysis of 30 patients showed a significant decrease in BMI (36.75±4.09 kg/m2 vs 26.37±3.47 kg/m2, p<0.0001). Glucose metabolism, including haemoglobin A1C levels, improved significantly (6.05±0.96 vs 5.05±0.25, p<0.0001), and liver function as well as serum lipid levels were also notably improved.
Interestingly, LSG increased the richness and composition of gut microbiota in obese patients post-surgery. These changes in gut microbiota were closely associated with improved clinical metabolic parameters.
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