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Journal Watch 31/08/2022

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 the findings that bariatric surgery induced weight loss improves brain health, an analysis of OAGB procedures in the US, WLS Optimum multivitamin supplement is more effective than over-the-counter supplementation, impact of BPD/DS on glucose homeostasis and gut hormones, and a paper reporting on the current health burden of obesity in China (please note, log-in maybe required to access the full paper).

Impact of weight loss on brain age: Improved brain health following bariatric surgery

There are significant obesity-related differences in brain health - as measured by the difference between brain age and actual age (delta age) - between individuals with obesity and those with normal weight, as well as a marked improvement in brain age following bariatric surgery, according to researchers from McGill University, Montreal and Université Laval, Québec, Canada. The findings were published in NeuroImage.

Using three distinct datasets: 1) CamCAN dataset to train the brain age prediction model, 2) Human Connectome Project (HCP) dataset to investigate whether individuals with obesity have greater brain age than individuals with normal weight, and 3) pre-surgery, as well as 4, 12, and 24 month post-surgery data from participants, they reported that a significant improvement in brain health, indicated by a decrease of 2.9 and 5.6 years in adjusted delta age at 12 and 24 months following bariatric surgery compared to baseline (p-value < 0.0005 for both).

They noted that the results suggest that obesity-related brain health abnormalities might be reversed by bariatric surgery-induced weight loss and widespread improvements in cardiometabolic alterations.

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The United States Experience with One Anastomosis Gastric Bypass at MBSAQIP-Accredited Centers

US researchers, writing in Obesity Surgery, have reported on the preoperative, intraoperative, and postoperative characteristics of adult patients who underwent primary or revision one anastomosis gastric bypass (OAGB) in the country.

During the study period, 803,906 bariatric procedures were performed and 645 (0.08%) were OAGB. Among these, 436 (67.6%) were primary and 209 (32.4%) were revision OAGB. The mean operation time was 89 min (SD, 59) and 8% were performed using a robotic approach. The overall complication rate was 7.4% and there was one death (0.2%). Revision OAGB had a longer mean operation time of 141 min (p<0.001).

The authors concluded that primary OAGB was a rarely performed bariatric procedure at MBSAQIP-accredited centres comprising only 0.05% compared to 4% worldwide. Future studies should compare safety of OAGB to that of established bariatric procedures like Roux-en-Y gastric bypass and sleeve gastrectomy.

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Nutritional Deficiencies 3 Years After Sleeve Gastrectomy Can Be Limited by a Specialized Multivitamin Supplement

Researchers from The Netherlands have found that the WLS Optimum multivitamin supplement (MVS) was more effective in sustaining normal serum concentrations than standard, over-the-counter supplementation.

The study, published in Obesity Surgery, compared micronutrient status of sleeve gastrectomy patients using this specialised MVS to users of standard MVS (sMVS) and non-users of multivitamin supplementation during the first three years post-surgery.

They reported that users of specialised MVS (Optimum 1.0 and 2.0) had higher serum concentrations of haemoglobin, folic acid and vitamin D compared to sMVS users and non-users during follow-up. Serum concentrations of vitamin B12 and (corrected) calcium were also higher in specialised MVS users than in non-users. Overall, fewer deficiencies for folic acid and vitamin D were observed in the Optimum groups.

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Impact of biliopancreatic diversion with duodenal switch on glucose homeostasis and gut hormones and their correlations to appetite

Investigators from Uppsala University, Uppsala, Sweden, writing in SOARD, have noted that Biliopancreatic diversion with duodenal switch (BPD/DS) reduces leptin, HOMA-IR and GIP, while markedly increasing GLP-1 and PYY.

Twenty-eight patients were included in the study that explore mixed meal-induced changes in glucose homeostasis and gut hormones, and their correlations to appetite perception. The reported that BPD/DS resulted in 66.1 ± 23.3% excess BMI loss (%EBMIL). Leptin was halved. Glucose and insulin levels were reduced, blunting a pre-surgical peak at 30 minutes, giving lower HOMA-IR (13.9 versus 4.8). However, reduced ghrelin and motilin concentrations were accompanied by pronounced peaks 20-30 minutes prior to meal responses. Postoperatively, satiety correlated with GLP-1 (r=0.56), while gastric motility index correlated with desire to eat (r=0.60), %EBMIL (r=-0.55) and %total weight loss (%TWL) (r=-0.49).

The study marks the magnitude change in GLP-1 with additional effects of PYY as important factors for weight loss, the authors concluded.

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Health consequences of obesity and projected future obesity health burden in China

Researchers from China and the US, writing the journal Obesity, have reported that the current health burden of obesity in China is high and it will sharply increase in coming years and affect population groups differently.

The study examined the effects of overweight/obesity on mortality and morbidity outcomes and the disparities, time trends, and projected future obesity health burden in China. A total of 31 cohorts and 50 cohort studies reporting on mortality (n=20) and morbidities (n=30) associated with obesity met study inclusion criteria.

In 2018, among adults, the prevalence of overweight/obesity, hypertension, and T2DM was 51.2%, 27.5%, and 12.4%, respectively. Their future projected prevalence would be 70.5%, 35.4%, and 18.5% in 2030, respectively. The projected number of adults having these conditions would be 810.65 million, 416.47 million, and 217.64 million, respectively. The urban-rural disparity in overweight/obesity prevalence was projected to shrink and then reverse over time.

They concluded that China needs to implement vigorous interventions for obesity prevention and treatment.

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