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Journal Watch 28/2/2024

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 long-term outcomes of medical management and bariatric surgery for T2DM, post-SG complications in inflammatory bowel disease patients, post-op cognitive functioning in adolescents, magnetic anchoring device assisted-LSG vs standard LSG and post-op improvements in physical activity in patients with major depressive disorder, and more (please note, log-in maybe required to access the full paper).

Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes

Research led by the University of Pittsburgh, Pittsburgh, PA, have concluded that after seven to 12 years of follow-up, individuals originally randomized to undergo bariatric surgery had superior glycaemic control with less diabetes medication use and higher rates of diabetes remission compared with medical/lifestyle intervention.

Published in JAMA, they used data from four randomised clinical trials (Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes), in which patients were randomised to undergo either medical/lifestyle management or Roux-en-Y gastric bypass, sleeve gastrectomy or adjustable gastric banding. The primary outcome was change in haemoglobin A1c (HbA1c) from baseline to seven years for all participants.

At seven years, HbA1c decreased by 0.2% from a baseline of 8.2%, in the medical/lifestyle group and by 1.6% from a baseline of 8.7%, in the bariatric surgery group. The between-group difference was −1.4% (p<.001) at seven years and −1.1% (p=0.002) at 12 years. Fewer antidiabetes medications were used in the bariatric surgery group. Diabetes remission was greater after bariatric surgery (6.2% in the medical/lifestyle group vs 18.2% in the bariatric surgery group; p=0.02) at seven years and at 12 years (0.0% in the medical/lifestyle group vs 12.7% in the bariatric surgery group; p<0.001).

However, they also found that anaemia, fractures and gastrointestinal adverse events were more common after bariatric surgery.

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Bariatric Surgery Outcomes in Patients with Inflammatory Bowel Disease in the United States: An Analysis of the Nationwide Readmissions Database

Hospitalisations of patients with inflammatory bowel disease (IBD) who underwent sleeve gastrectomy (SG) experienced significantly higher post-operative complication rates, according to researchers from Creighton University, Omaha, NE.

Reporting in Obesity Surgery, they examined whether IBD was associated with adverse post-SG outcomes. A total of 2,030 hospitalisations were matched. The odds of complication were 48% higher for hospitalizations of patients with IBD (11.1% vs. 7.8%; p =0.009). The most common complication was nausea (4.9% vs. 3.7%, p = .187). No statistically significant difference was observed for all-cause 90-day readmissions, LOS, or hospital cost.

However, they also found similar lengths of stay and readmission rates compared to propensity-matched SG hospitalisations without IBD, this suggests many complications were minor. They concluded that SG remains a safe weight loss procedure for patients suffering from IBD and obesity.

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Cognitive functioning in adolescents with severe obesity undergoing bariatric surgery or intensive non-surgical treatment in Sweden (AMOS2): a multicentre, open-label, randomised controlled trial

There is no association of bariatric surgery and its accompanying significant weight loss with overall greater improvement in executive functions and memory in adolescents vs a non-surgical group without weight loss, according to Swedish researchers.

Reporting in eClinicalMedicine, they explored changes in cognitive function in adolescents over two years after bariatric surgery or intensive non-surgical treatment using data from the Adolescent Morbid Obesity Surgery 2 (AMOS2) randomised controlled trial. In total, 46 adolescents (23 bariatric surgery and 23 intensive non-surgical treatment) were included in the study.

At baseline, 23/46 (50%) of the adolescents had general intellectual functioning classified as borderline or below. For 15/18 (83%) aspects of cognitive functioning, no significant differences in change over two years were identified between groups. Three sub-tests assessing fundamental cognitive skills improved more over two years in operated adolescents than in intensive non-surgical treatment.

They concluded that the clinical relevance of greater improvements in basic cognitive skills needs to be explored.

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Magnetic anchoring device assisted-laparoscopic sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy: A retrospective cohort study

Both magnetic anchoring device assisted-laparoscopic sleeve gastrectomy (MLSG) and conventional laparoscopic sleeve gastrectomy (CLSG) prove safe and effective, however the patients who underwent MLSG have a shorter length of stay in hospital and a better quality of life (QOL) six months after surgery, researchers from the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China, have reported.

Reporting in Heliyon, they evaluate the safety and efficiency of MLSG and compared the short-term results between the two procedures in terms of weight loss, resolution of comorbidities and QOL.

In total, 135 patients were included in the analysis (CLSG n=120, MLSG n=115). The MLSG group had a markedly shorter time of operation (MLSG, 72.59 min vs. CLSG, 76.67 min; p=0.003), length of stay (MLSG, 5.59 days vs. CLSG, 5.96 days; p=0.016). There were no differences in terms of the postoperative complications between the two groups and the QOL of patients in MLSG was better at 6-month after surgery, but there was no significant difference between the two groups at one- or two-years after surgery.

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Effects of physical activity on depressive symptoms and weight loss in patients undergoing bariatric surgery

There was a gradual improvement in physical activity (PA) levels in patients with major depressive disorder (MDD) three-years following bariatric surgery, but no association with depressive symptom improvement nor weight loss, according to researchers led by King’s College London, London, UK.

Writing in Psychoneuroendocrinology, they obtained data from a sub-group of participants from the bariatric surgery and depression (BARIDEP) study who reported PA at baseline, six-months and three-years post-surgery follow-up. There were 23 patients with MDD (age=45.82±2.61; BMI=48.01±1.49 kg/m2) and 25 controls (age(±se)=44.28±2.08; BMI=49.75±2.33 kg/m2). Metabolic equivalent (MET) scores (weighted sum of walking, moderate, and vigorous PA) were lower in MDD than controls, before (W=354.5, p<0.01), six-months (W=405.5, p<0.05), but not three-years post-surgery.

The total sample, baseline HAM-D-17 was correlated with baseline MET score (p=0.016), PA days (p=0.032) and time walking (p=0.004). At three-years, HAM-D-17 was not correlated with any three-year IPAQ domain. No baseline IPAQ domains predicted three-year HAM-D-17 score. Weight loss post-surgery was not correlated with baseline or three-year follow-up IPAQ scores in (MDD, controls, total) groups.

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