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Journal Watch 4/10/2023

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 clinical trial that found fundus resection is not associated with improved glycaemic regulation, compared to typical LRYGBP, longer duration and higher severity of T2D were negatively associated with remission, no differences in micronutrient deficiencies between RYGB and VSG, mild psychopathology outcomes improve after bariatric surgery and more (please note, log-in maybe required to access the full paper).

Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial

Researchers from Greece have reported that fundus resection (FR) is not associated with improved glycaemic regulation, compared to typical laparoscopic Roux-en-Y gastric bypass (LRYGBP) and the significant decrease in BMI after LRYGBP+FR has to be further confirmed with longer follow-up.

The study, published in Obesity Surgery, they investigated whether the modification of LRYGBP with FR offers superior glycaemic control, compared to typical LRYGBP. The randomised clinical trial included 24 patients with body mass index (BMI) ≥40kg/m2 and type II diabetes mellitus (T2DM), who were randomly assigned to undergo LRYGBP and LRYGBP with fundus resection (LRYGBP+FR).

Ninety-five percent of patients showed complete remission of T2DM after 12 months. LRYGBP+FR was not related with improved glycaemic control, compared to LRYGBP. Ghrelin levels were not significantly reduced at six and 12 months after LRYGBP+FR. GLP-1 and PYY levels were remarkably increased postprandially in both groups at 6 and 12 months postoperatively (p<0.01).

In addition, patients who underwent LRYGBP+FR achieved a significantly lower BMI at 12 months in comparison to LRYGBP (p<0.05).

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Type 2 Diabetes Mellitus Remission after Roux-en-Y Gastric Bypass: A Multi-centered Experience with Long Term Follow Up

US researchers have reported longer duration and higher severity of T2D were negatively associated with remission while higher %TBWL had a positive association.

Writing in SOARD, they sought to determine the overall long-term T2D remission rates following RYGB and identifying predictive variables associated with remission. This multi-centred study including 815 patients who underwent RYGB at three tertiary referral centers for bariatric surgery.

They evaluated long-term T2D remission rates and annual T2D clinical and metabolic parameters up to 14 years after surgery. Patients were divided into four groups based on quartiles of total body weight loss percentage (%TBWL) to compare remission rates between groups.

The results revealed remission in 51% of patients. The predictors of remission included pre-operative duration of diabetes, baseline HbA1c, insulin use prior to surgery, number of anti-diabetic medications and %TBWL (all p<0.01). Remission rates were proportionally associated with %TBWL quartile [Q1 40.9%, Q2 52.7%, Q3 53.1%, Q4 56.1%] (p=0.02).

They concluded a significant proportion of patients in all quartiles experienced long-term remission after RYGB with a greater likelihood of remission correlated with greater weight loss.

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Postoperative micronutrient changes in bariatric surgery patients compliant with nutritional supplementation

Researchers from Chicago who compared micronutrient deficiencies following roux-en-y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) have reported there were no differences in micronutrient deficiencies between surgical techniques.

Writing in Surgical Endoscopy, they conducted an 11-point outpatient survey to consecutive patients ≥ 18 years who had undergone either RYGB or VSG to determine adherence with nutritional supplementation (including vitamins A, B1, B12, and D, thyroid stimulating hormone (TSH), iron binding capacity, transferrin, ferritin, folate, iron, albumin, haemoglobin A1C, zinc, glomerular filtration rate (GFR, and liver function values). Values were classified as “abnormal” or “normal.”

Preoperative and postoperative values were compared for differences, postoperative values were also compared between RYGB and VSG.

They found no significant differences between preoperative and postoperative values for any nutritional marker aside from vitamin B12. A total of 51/60 patients (85.0%) had normal preoperative B12 measurements, compared with 40/65 (61.5%) patients postoperatively (p=0.03). However, of 25 “abnormal” postoperative measurements, 20 (80%) were elevated values.

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Psychopathological profile before and after bariatric surgery

Spanish researchers who sought to identify psychopathology and eating behaviour pattern in candidates prepared for bariatric surgery compared to a normative population before and after surgery, have reported that a mild psychopathological profile is still present and becomes closer to that of the normative group after surgery.

Writing in Scientific Reports, there study included 32 patients seeking bariatric surgery who were evaluated with Personality Assessment Inventory (PAI), 36‐item EDE‐Q and BES before and after surgery. Thirty-two patients before and 26 one year after surgery were included.

After surgery, patients improved in somatic complaints (p<0.001) and depression (p = 0.04). Related eating disorders were more common than those of the normative group and improved significantly after surgery in scores for compulsive intake (BES p<0.001), and overall key behaviours of eating disorders and related cognitive symptoms (EDE-Q/G p<0.001).

Further studies are needed to evaluate the effects of mild psychopathology on outcomes after bariatric surgery, they concluded.

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What Is Best for Weight Loss? A Comparative Review of the Safety and Efficacy of Bariatric Surgery Versus Glucagon-Like Peptide-1 Analogue

California Institute of Behavioral Neurosciences & Psychology, Fairfield, US, report that bariatric surgery remains a highly effective intervention for weight loss and management of obesity-induced complications however, semaglutide represents a valuable non-invasive alternative resulting significant weight reduction and lower risks of adverse effects.

Reporting in Cureus, they compared the outcomes from STEP (Semaglutide Treatment Effect in People) trials, sustain trials, pioneer trials, and the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial, to evaluate the outcomes of these interventions.

Semaglutide demonstrated significant weight reduction in participants, although adverse effects such as gastrointestinal disturbances, increased pulse rate, and rare cases of thyroid cancer were observed. Long-term effects showed partial weight regain and a return of certain cardiometabolic variables to baseline levels after semaglutide withdrawal.

Bariatric surgery, demonstrated a higher efficacy in weight reduction and the management of obesity-induced complications such as diabetes, and to a significantly higher percentage of patients achieving desired diabetes treatment targets compared to medical therapy alone. While bariatric surgery showed superior efficacy, it also carried a higher risk of complications.

The researchers concluded that the choice between these interventions should be based on individual patient characteristics and a comprehensive assessment of the risk-benefit profile.

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