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Journal Watch 26/06/2024

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 surgery betters non-surgical intervention for OSA patients, long-term results after TORe of the gastrojejunal anastomosis, higher prevalence of osteoporosis and low bone mass after bariatric surgery, surgical patients experienced more positive development of health-related quality of life (HRQoL) vs. those receiving usual care and once-weekly subcutaneous semaglutide can significantly decrease body weight without risk of serious adverse events when compared with a placebo, and more (please note, log-in maybe required to access the full paper).

Adverse Cardiovascular Outcomes in Patients with Obstructive Sleep Apnea and Obesity: Metabolic Surgery versus Usual Care

Among patients with moderate-to-severe obstructive sleep apnoea (OSA) and obesity, metabolic surgery vs. nonsurgical management, was associated with a significantly lower risk of incident major adverse cardiovascular events (MACE) and death, researchers from the Cleveland Clinic, Cleveland, OH, have reported.


Writing in the Journal of the American College of Cardiology, they investigated the long-term relationship between metabolic surgery and incident MACE in patients with OSA and obesity. Baseline characteristics of patients who underwent metabolic surgery were balanced with a nonsurgical control group using overlap weighting methods.


In total, 13,657 patients (970 patients in the metabolic surgery group and 12,687 patients in the nonsurgical group) were included in the study. The mean between-group difference in body weight at ten years was 26.6 kg or 19.3% and the ten-year cumulative incidence of MACE was 27% in the metabolic surgery group and 35.6% in the nonsurgical group (p<0.001).


Furthermore, the ten-year cumulative incidence of all-cause mortality was 9.1% in the metabolic surgery group and 12.5% in the nonsurgical group (p=0.009).


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Long-term results after transoral outlet reduction (TORe) of the gastrojejunal anastomosis for secondary weight regain and dumping syndrome after Roux-en-Y gastric bypass

The transoral outlet reduction (TORe) procedure is a safe and effective in the treatment of patients with dumping syndrome after laparoscopic RYGB, investigators from Switzerland have concluded.


Reporting in Surgical Endoscopy, they retrospectively analysed data of patients who underwent TORe using an endoscopic suturing system from January 2015 to December 2020 was performed. A total of 71 subjects were included – 45 patients received the intervention for weight regain, nine for dumping syndrome and 17 for both. The primary endpoint was weight stabilisation or weight loss for subjects with weight regain and resolution of symptoms for those with dumping syndrome.


The median size of the gastrojejunal anastomosis was estimated at 30mm before intervention, and after performing a median of three endoscopic sutures, the median estimated gastrojejunal anastomosis width was reduced to 9.5mm. All interventions achieved weight stabilisation or weight loss or resolution of dumping symptoms within the first three months, 98.2% at 12 months, 91.4% at 24 months and 75.0% at 48 months. In 22/26 subjects a persisting improvement of dumping syndrome was achieved.


The researchers called for a prospective randomised trial to be conducted to compare the effects of TORe with other surgical methods like banding the gastrojejunal anastomosis.


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DXA evaluation of bone fragility 2 years after bariatric surgery in patients with obesity

There is a significantly higher prevalence of osteoporosis and low bone mass two years after bariatric surgery, French researchers have found.


Writing in Bone Reports, they sought to evaluate bone fragility on dual X-ray absorptiometry (DXA) in patients with obesity before and two years after bariatric surgery. The secondary objective was to identify risk factors for the development of a bone mineral density (BMD) ≤−2 SD at two years.


Among the 675 included patients, 77.8 % were women with a mean age of 49.5 years (±11.1). After bariatric surgery, there were significantly more patients with osteoporosis: 3.6% vs. 0.9% (p=0.0001). Multivariate analysis revealed that the risk factors for developing a BMD≤−2 SD 2 years after bariatric surgery in patients with normal BMD before surgery were age and lower lean and fat mass before the surgery.


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Fifteen-year changes in health-related quality of life after bariatric surgery and non-surgical obesity treatment

Over 15 years, surgical patients experienced more positive development of health-related quality of life (HRQoL) vs. those receiving usual care, according to researchers from Finland and Sweden. This difference was large for obesity-related problems, but otherwise the differences were small.


Writing in the International Journal of Obesity, they analysed data from the non-randomised, prospective, controlled Swedish Obese Subjects study. The surgery group (n=2,007, per-protocol) underwent gastric bypass, banding or vertical banded gastroplasty and matched controls (n=2,040) received usual obesity care.


Surgical patients experienced greater 15-year improvements in perceived health and overall mood and greater reductions in depression, obesity-related problems and social interaction limitations than controls (all p<0.001, adjusted for baseline differences). Effect size (ES) was classified as large only for obesity-related problems (ES=0.82). At the 15-year follow-up, surgical patients reported better perceived health (p<0.001) and less obesity-related problems (p=0.020) than controls.


In the surgery group, patients with baseline diabetes had smaller 15-year reductions in social interaction limitations (p<0.001) and depression (p=0.049) compared to those without baseline diabetes. Although surgical patients with a history of psychiatric disorder reported lower HRQoL vs. those without such history over the 15-year follow-up, there were no significant differences in the long-term improvements between the two groups (p=0.211–0.902).


Patients with pre-operative diabetes might be at increased risk for smaller long-term HRQoL improvements, they concluded.


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Efficacy and safety of once-weekly subcutaneous semaglutide on weight loss in patients with overweight or obesity without diabetes mellitus—A systematic review and meta-analysis of randomized controlled trials

For patients with overweight or obesity without type 2 diabetes, once-weekly subcutaneous semaglutide can significantly decrease body weight without risk of serious adverse events when compared with a placebo, according to a systematic review and meta-analysis of randomised controlled trials, researchers from the Marshfield Clinic Research Institute, Marshfield, WI, have reported.


Writing in Obesity Reviews, they conducted a comprehensive meta-analysis of randomised studies on once-weekly semaglutide in this patient population. They identified nine studies with 11,641 patients in the semaglutide group and 10,479 in the placebo group. They found that semaglutide resulted in significant benefits, including change in body weight (%): mean difference (MD) of −11.49% (p<0.0001), change in absolute body weight: MD of −11.74 kg (p<0.0001) and change in waist circumference: MD of −9.06 cm (p < 0.0001).


However, gastrointestinal side effects are predominant including nausea: odds ratio (OR) of 4.06 (p<0.0001), vomiting: OR of 4.43 (p<0.0001), diarrhoea: OR of 2.10 (p<0.0001), constipation: OR of 2.43 (p<0.0001), gallbladder disorders: OR of 1.26 (p = 0.010), and cholelithiasis: OR of 2.06 (p=0.04). Serious adverse events were not statistically significant: OR of 1.06 (p=0.82).


However, the percentage of participants discontinuing due to adverse events and gastrointestinal side effects was statistically significant: ORs of 2.22 (p<0.0001) and 3.77 (p<0.0001), respectively. The researchers noted that such gastrointestinal side effects are predominant with semaglutide, which can result in medication discontinuation.


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