Journal Watch 16/11/2022

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 a paper reporting RYGB was superior in improving glycemia vs best medical treatment, TF/SG is at least equivalent to LRYGB in resolution or reduction of reflux symptoms, the risk-benefit balance associated with bariatric surgery is highly favourable for pregnancies and newborns, healthcare providers should include assessments of both adverse childhood experiences and food insecurity to identify patients who may be at risk for disordered eating prior to bariatric surgery, and a paper that reported patients who underwent LSG had a reduced risk of complications and reoperations after surgery compared to those who had RYGB (please note, log-in maybe required to access the full paper).


Gastric bypass versus best medical treatment for diabetic kidney disease: 5 years follow up of a single-centre open label randomised controlled trial

Researchers from the Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil, have reported that albuminuria remission was not statistically different between best medical treatment and Roux-en-Y gastric bypass (RYGB) after five years in participants with diabetic kidney disease and class 1 obesity, with 6–7 in ten patients achieving remission of microalbuminuria (uACR <30 mg/g) in both groups. However, RYGB was superior in improving glycemia, diastolic blood pressure, lipids, body weight, and quality of life.


Writing in EClinicalMedicine, they compared the albuminuria-lowering effects of RYGB to best medical treatment in patients with diabetic kidney disease and obesity to determine which treatment is better. This five year, open-label, single-centre, randomised trial studied patients with diabetic kidney disease and class I obesity after 1:1 randomisation to best medical treatment (n=49) or RYGB (n=51). The primary outcome was the proportion of patients achieving remission of microalbuminuria after five years. Secondary outcomes included improvements in diabetic kidney disease, glycemic control, quality of life, and safety.


They reported that remission of albuminuria occurred in 59.6% (95% CI = 45.5–73.8) after best medical treatment and 69.7% (95% CI = 59.6–79.8) after RYGB (risk difference: 10%, 95% CI, −7 to 27, p=0.25). Patients after RYGB were twice as likely to achieve an HbA1c ≤ 6.5% (60.2% versus 25.4%, risk difference, 34.9%; 95% CI = 15.8–53.9, p<0.001). Quality of life after five years measured by the 36-Item Short Form Survey questionnaire (standardized to a 0-to-100 scale) was higher in the RYGB group than in the best medical treatment group for several domains.


The mean differences were 13.5 (95% CI, 5.5–21.6, p=0.001) for general health, 19.7 (95% CI, 9.1–30.3, p<0.001) for pain, 6.1 (95% CI, −4.8 to 17.0, p=0.27) for social functioning, 8.3 (95% CI, 0.23 to 16.3, p=0.04) for emotional well-being, 12.2 (95% CI, 3.9–20.4, p=0.004) for vitality, 16.8 (95% CI, −0.75 to 34.4, p=0.06) for mental health, 21.8 (95% CI, 4.8–38.7, p=0.01) for physical health and 11.1 (95% CI, 2.24–19.9, p=0.01) for physical functioning. Serious adverse events were experienced in 7/46 (15.2%) after best medical treatment and 11/46 patients (24%) after RYGB (p=0.80).


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Preliminary Results of a Study Comparing Pre-sleeve Endoscopic Fundoplication to Gastric Bypass on Gastroesophageal Reflux Disease Outcomes

Investigators at Lexington Medical Center, West Columbia, SC, have found that transoral fundoplication (TF) prior to SG is at least equivalent to RYGB in resolution or reduction of reflux symptoms at 12–15 months.


Writing in Obesity Surgery, 15 patients underwent TF prior to SG (TF/SG) and 15 patients underwent LRYGB. Subjective and objective criteria, including the GERD Health-Related Quality of Life (HRQL) and Reflux Symptom Index (RSI) survey, were used to assess symptoms. Surveys were collected pre-operatively, post-TF/pre-SG, 4–6 and 12–15 months post bariatric procedure.


Preoperative mean scores were as follows: HRQL 32.53, RSI 21.7, 93% proton pump inhibitor (PPI) usage, 6.5% satisfaction rate. Mean BMI: 45.99 (TF/SG), 42.27 (LRYGB). At 12–15 months postoperatively: mean HRQL scores were 5.53 (TF/SG) and 6.67 (LRYGB). Both groups had a statistically significant improvement in HRQL-RSI postoperatively. PPI usage was 13% (TF/SG) and 34% (LRYGB). BMI decrease was 24% (TF/SG) and 31% (LRYGB).


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Risk-Benefit Balance Associated With Obstetric, Neonatal, and Child Outcomes After Metabolic and Bariatric Surgery

French researchers, writing in JAMA Network, have reported that the risk-benefit balance associated with metabolic and bariatric surgery (MBS) is highly favourable for pregnancies and newborns but may cause an increased risk of respiratory failure associated with bronchiolitis.


The researchers sought to assess the risk-benefit balance associated with MBS around obstetric, neonatal and child outcomes. The study included 53, 813 women on the French nationwide database who underwent an MBS procedure and delivered a child between January 2012 and December 2018.


The study team first compared prematurity and birth weights in neonates born before and after maternal MBS with each other. Then they compared the frequencies of all pregnancy and child diagnoses in the first 2 years of life before and after maternal MBS with each other.


They found a significant increase in the small-for-gestational-age neonate rate after MBS (+4.4%) and a significant decrease in the large-for-gestational-age neonate rate (−12.6%). They also stuy highlighted that compared with pre-MBS births, after MBS births had fewer occurrences of gestational hypertension (odds ratio [OR], 0.16; 95% CI, 0.10-0.23) and gestational diabetes for the mother (OR, 0.39; 95% CI, 0.34-0.45), as well as fewer birth injuries to the skeleton (OR, 0.27; 95% CI, 0.11-0.60), febrile convulsions (OR, 0.39; 95% CI, 0.21-0.67), viral intestinal infections (OR, 0.56; 95% CI, 0.43-0.71), or carbohydrate metabolism disorders in newborns (OR, 0.54; 95% CI 0.46-0.63), but an elevated respiratory failure rate (OR, 2.42; 95% CI, 1.76-3.36) associated with bronchiolitis.

They concluded that further studies are needed to better assess the middle- and long-term benefits and risks associated with bariatric surgery.


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Binge Eating in Patients Pursuing Bariatric Surgery: Understanding Relationships with Food Insecurity and Adverse Childhood Experiences

Study authors from the West Virginia University School of Medicine, Morgantown, WV, writing in SOARD, have reported that food insecurity strengthens the relationship between adverse childhood experiences and adult binge eating.


Their study sought to examine the association between binge eating and childhood abuse and/or neglect and household dysfunction and to explore whether the strength of the relationship between adverse childhood experiences and binge eating differs across levels of food insecurity in patients seeking bariatric surgery.


In total, 366 adults seeking bariatric surgery completed validated questionnaires as a component of a routine psychological evaluation prior to surgery. They noted that only childhood experiences of abuse and/or neglect were positively related to adult binge eating. Food insecurity moderated the relationship between adverse childhood experiences and binge eating, such that the relationship was stronger for individuals who endorsed the presence of both food insecurity and adverse childhood experiences, relative to individuals who endorsed the absence of both food insecurity and adverse childhood experiences.


They concluded that healthcare providers should include assessments of both adverse childhood experiences and food insecurity to identify patients who may be at risk for disordered eating prior to surgery, as these individuals may require additional interventions to address binge eating and related factors.


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A Comparison Between the Postoperative Complications of Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (RNYGB) in Patients With Morbid Obesity: A Meta-Analysis

Researchers from Northampton General Hospital, Northampton, UK, have report that RYGB and LSG had comparable mortality rates; however, patients who underwent LSG had a reduced risk of complications and reoperations after surgery compared to those who had RYGB.


Reporting in Cureus, the investigators conducted a meta-analysisfrom ten trials comparing RYGB and LSG. The pooled analysis found that patients who underwent RYGB needed some reoperation at a higher rate compared to those who had LSG. Patients who had LSG suffered from fewer post-operative sequelae.


While the risk of other complications was higher in RYGB, their analysis showed that the frequency of GERD after LSG was greater than after RYGB.


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