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 IFSO updates SADI-S/SADS Position Statement, Duodenal Switch’s greater weight loss offset by increased complications, latest Tehran Obesity Treatment Study outcomes, post-surgical pregnancy is safe, factors influencing GLP-1 weight loss, and more (please note, log-in maybe required to access the full paper).
Single Anastomosis Duodeno-Ileostomy with Sleeve Gastrectomy/Single Anastomosis Duodenal Switch (SADI-S/SADS) IFSO Position Statement—Update 2023
After IFSO endorsed sleeve gastrectomy/single anastomosis duodenal switch (SADI-S/SADS) as a safe and effective procedure in 2021, A task force was established to conduct a systematic review of current evidence on SADI-S/SADS to guide clinical practice and update its Position Statement.
Providing an update in Obesity Surgery, they conducted a systematic review across three databases, focusing on studies examining SADI-S/SADS and its outcomes. A total of 93 studies were analysed and SADI-S/SADS was found to be efficacy in weight loss and medium-to-long-term control of type 2 diabetes mellitus (T2DM), along with positive outcomes regarding hypertension and hyperlipidaemia. Nutritional deficiencies were regularly identified, particularly in fat-soluble vitamins, anaemia and hypoalbuminemia. Therefore, lifelong supplementation and monitoring for nutritional deficiencies are recommended.
Despite significant efforts, high-quality evidence on SADI-S/SADS remains scarce, the authors write. The current position statement will be reviewed in two years.
To access this paper, please click here
Roux-en-Y Gastric Bypass vs Duodenal Switch in Patients with BMI ≥ 50 kg/m2; A Systematic Review and Meta-analysis
Duodenal Switch (DS) leads to significantly higher BMI and total weight loss in patients with BMI≥50 kg/m2 vs RYGB, but may be associated with higher rate of major malnutrition requiring revisional surgery, according to researchers from the US and Iran.
The systematic review & meta-analysis, published in SOARD, aimed to compare outcomes of DS and RYGB in terms of weight loss, resolution of obesity-related comorbidities, and complications among patients with a BMI ≥50 kg/m2. A systematic search identified 12 articles were included in this study (2678 patients, follow-up:1-15 years). Patients with DS had 7.31 kg/m2 higher BMI loss (95%CI:5.59-9.03, p<0.001) and 9.9% more total weight loss (95%CI:4.47-15.28%, p<0.001) compared to RYGB.
However, the rate of complications, reoperation, mortality and remission of comorbidities including diabetes, hypertension, dyslipidaemia, and obstructive sleep apnoea was not significantly different between DS and RYGB. However, the rate of malnutrition was 8.3% in DS group vs 1.2% in RYGB (p=0.02) with 5.4% DS patients needed revisional surgery for malnutrition vs none in RYGB (p=0.05). In addition, 24.6% of DS patients developed gallbladder disease needed cholecystectomy vs 4.5% after RYGB (OR: 6.36, 95% CI: 1.70-23.82, p=0.01).
To access this paper, please click here
Safety and efficacy of sleeve gastrectomy in non-diabetic individuals with class I vs. class II obesity: a matched controlled experiment from Tehran Obesity Treatment Study (TOTS)
Bariatric surgery is an effective and safe method to achieve weight loss and alleviate cardiovascular risk factors and obesity-related comorbidities in non-diabetic individuals with class I and class II obesity, according to the three-year outcomes from the Tehran Obesity Treatment Study (TOTS).
Writing in Surgical Endoscopy, they evaluate the three-year outcomes of sleeve gastrectomy in 78 non-diabetic individuals with class I obesity and 78 participants with class II obesity, matched in terms of age, sex (93.6% female), and the rates of dyslipidaemia and hypertension, were included in this prospective cohort study.
Micronutrient deficiencies and comorbidities (hypertension and dyslipidaemia) were evaluated in both groups using conditional logistic regression analysis, and Clavien–Dindo classification was used to compare surgical complications. Overall, values of Δ total weight loss (TWL)%, Δ excess weight loss (EWL)%, and β (95% CI) were − 1.86 (1.19), and − 2.56 (4.5) with a p value of 0.118 and 0.568, respectively.
The occurrence of surgical complications and undesirable outcomes were also similar between the two study groups.
To access this paper, please click here
Maternal, Fetal and Infant outcomes Associated with Bariatric Surgery - A Matched Cohort Study
Pregnancy after bariatric surgery appears safe and was associated with a reduced risk of several obesity related adverse pregnancy outcomes, according to a study led by researchers from McMaster University, Hamilton, Ontario, Canada.
Publish in the Annals of Surgery, the researchers wanted to determine the association between bariatric surgery and maternal, foetal and infant outcomes. Patients with obesity who received bariatric surgery from 2010 to 2016 and became pregnant matched on multiple factors to non-surgical pregnant patients with obesity. The primary outcomes of interest were the incidence included of gestational diabetes, preeclampsia/HELLP syndrome, small for gestational age (SGA), large for gestational age (LGA), and a composite of severe foetal/infant morbidity/mortality.
680 patients who underwent bariatric surgery and later became pregnant were matched to 2002 pregnant patients with obesity. Gestational diabetes occurred in 8.7% of the surgery group vs 18.8% of the non-surgical group (p<0.001). A lower incidence of preeclampsia/HELLP was observed post-surgery (p<0.001), surgery also impacted SGA (p<0.001) and LGA (p<0.001).
The researches found no associations between bariatric surgery and any adverse foetal or infant outcomes.
To access this paper, please click here
One-Year Weight Reduction With Semaglutide or Liraglutide in Clinical Practice
Researchers examining the factors influencing weight reduction of 10% or greater at one-year after injecting semaglutide or liraglutide, have concluded the medication’s active agent, its dosage, treatment indication, persistent medication coverage and gender were influencing factors.
Published in JAMA Network Open, the study included 3,389 patients (1341 patients received semaglutide for T2D and 1444 received liraglutide for T2D; 227, liraglutide for obesity; and 377, semaglutide for obesity) the mean percentage weight change at 1 year was −5.1% (7.8%) with semaglutide vs −2.2% (6.4%) with liraglutide (p<0.001); −3.2% (6.8%) for T2D as a treatment indication vs −5.9% (9.0%) for obesity (p<0.001).
In the multivariable model, semaglutide vs liraglutide, obesity as a treatment indication vs T2D, persistent medication coverage vs 90 medication coverage days or 90 to 275 medication coverage days within the first year, high dosage of the medication vs low and female sex were associated with achieving a 10% or greater weight reduction at year 1.
The authors cautioned that future research should focus on identifying the reasons for discontinuation of medication use and interventions aimed at improving long-term persistent coverage.
To access this paper, please click here
Comments