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Journal Watch 31/05/2023

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 reduction in lipid-lowering and antidiabetic medications after surgery, outcomes from a RCT examining Rivaroxaban for post-bariatric thromboprophylaxis, a study examining the independent predictors of acute kidney injury, a systematic review and meta-analysis of the efficacy and safety of tirzepatide for treatment of overweight or obesity, and the factors associated with cognitive improvement after bariatric surgery, and more (please note, log-in maybe required to access the full paper).

Temporal Changes in Obesity-Related Medication After Bariatric Surgery vs No Surgery for Obesity

An international team of researchers have reported that bariatric surgery was associated with a substantial and long-lasting reduction in the use of lipid-lowering and antidiabetic medications compared with patients who did not have surgery.

Writing in JAMA Surgery, 26,396 patients who underwent bariatric surgery were matched with 131,980 controls to clarify the long-term use of lipid-lowering, cardiovascular, and antidiabetic medication after bariatric surgery vs no surgery for morbid obesity.

The proportion of lipid-lowering medication after bariatric surgery decreased from 20.3% at baseline to 12.9% after two years and 17.6% after 15 years, while it increased in the no surgery group from 21.0% at baseline to 44.6% after 15 years. Medications for cardiovascular conditions were used by 60.2% of bariatric surgery patients at baseline, decreased to 43.2% after two years, and increased to 74.6% after 15 years, while it increased in the no surgery group from 54.4% at baseline to 83.3% after 15 years.

Finally, antidiabetic medications were used by 27.7% in the bariatric surgery group at baseline, decreased to 10.0% after 2 years, and increased to 23.5% after 15 years, while it increased in the no surgery group from 27.7% at baseline to 54.2% after 15 years.

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Predictors and Outcomes of Acute Kidney Injury after Bariatric Surgery: Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Data Registry

New onset acute kidney injury (AKI) was associated with adverse 30-day outcomes in patients undergoing bariatric surgery, according to researchers from the Cleveland Clinic Florida.

The researchers, reporting in SOARD, performed a retrospective analysis of the MBSAQIP data registry for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass (LGBP). The primary outcome was incidence of AKI and secondary outcomes included 30-day complications, readmissions, reoperations and mortality.

A total of 747,926 patients were included in the study (LSG=73.1%, LGBP=26.8%), with AKI occurring in 446 patients (0.05%). The investigators report that patients with postoperative AKI had higher rates of complications, readmissions, reoperations and mortality.

Males, venous thromboembolism, hypertension, limited ambulation and LGBP were independent predictors of AKI. The researchers added prospective studies are needed to better describe these results.

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Efficacy and Safety of Rivaroxaban for Postoperative Thromboprophylaxis in Patients After Bariatric Surgery - A Randomized Clinical Trial

A randomised clinical trial led by the University of Bern, Bern, Switzerland, has found that once-daily VTE prophylaxis with 10mg of rivaroxaban was effective and safe in the early postoperative phase after bariatric surgery in both the short and long prophylaxis groups.

Reporting in JAMA Network Open, the trial recruited 272 bariatric surgery patients undergoing bariatric surgery, 134 received a 7-day (short prophylaxis) and 135 a 28-day (long prophylaxis) VTE prophylaxis course of 10mg rivaroxaban. The primary efficacy outcome was the composite of deep vein thrombosis (symptomatic or asymptomatic) and pulmonary embolism within 28 days after bariatric surgery. Main safety outcomes included major bleeding, clinically relevant nonmajor bleeding, and mortality.

A single thromboembolic event (0.4%) occurred (asymptomatic thrombosis in a patient undergoing sleeve gastrectomy with extended prophylaxis). Major or clinically relevant nonmajor bleeding events were observed in five patients (1.9%): two in the short prophylaxis group and three in the long prophylaxis group. Clinically nonsignificant bleeding events were observed in ten patients (3.7%): three in the short prophylaxis arm and seven in the long prophylaxis arm.

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Efficacy and safety of tirzepatide for treatment of overweight or obesity. A systematic review and meta-analysis

Investigators from the National University of Singapore, Singapore, have reported tirzepatide has significant potential as a weight loss drug in patients with overweight and obesity, with little increase in adverse events (AEs), compared to other weight loss drugs.

Writing in the International Journal of Obesity, the systematic review and meta-analysis sought to assess the efficacy and safety of tirzepatide for weight loss in patients with overweight or obesity.

RCTs included in this study revealed that among 5,800 patients, 78.22%, 55.60%, 32.28% achieved ≥5%, ≥10%, and ≥15% weight loss, respectively. Tirzepatide 5mg demonstrated weight loss superiority relative to placebo and semaglutide (n=1409) with dose-dependent increase for 10mg and 15mg doses. The comparison between tirzepatide and semaglutide was examined in the SURPASS-2 trial that was included in this systematic review. For AEs, there was increase odds of experiencing gastrointestinal AEs with tirzepatide compared to placebo, but no significant difference with semaglutide.

“With its ability to concurrently target multiple aspects of metabolic syndrome, it (tirzepatide) should be considered as the next helm of weight loss therapies,” the researchers concluded.

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Factors Associated With Cognitive Improvement After Bariatric Surgery Among Patients With Severe Obesity in the Netherlands

Lower C-reactive protein and leptin levels, as well as fewer depressive symptoms, might partly explain the mechanisms behind cognitive improvement after bariatric surgery, a study by researchers from the Netherlands has concluded.

Writing in JAMA Network Open, the study included 156 patients with severe obesity who were enrolled in the BARICO (Bariatric Surgery Rijnstate and Radboudumc Neuroimaging and Cognition in Obesity) study (146 participants completed the six-month follow-up and were included in the analysis).

The researchers assessed the overall cognitive performance (based on a 20% change index of the compound z score), inflammatory factors (eg, C-reactive protein and interleukin 6 levels), adipokines (eg, leptin and adiponectin levels), mood (assessed via the Beck Depression Inventory) and physical activity (assessed with the Baecke questionnaire).

They reported that after bariatric surgery, all plasma levels of inflammatory markers, including C-reactive protein (p<0.001) and leptin (p<0.001), were lower, whereas adiponectin levels were higher (p<0.001), depressive symptoms were (partly) resolved (p<0.001) and physical activity level was higher (p<0.001).

In addition, cognitive improvement was observed in 43.8% (57 of 130) of the patients overall. This group had lower C-reactive protein (p=0.04) and leptin levels (p=0.04) and fewer depressive symptoms at 6 months (p=0.045), compared with the group of participants who did not show cognitive improvement.

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