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Journal Watch 5/2/2025

owenhaskins

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 BMS and the prevalence of psychiatric disorders, CT scans to identify internal herniations, assessing the Diabetes Remission Index and the Weight Loss-Adjusted Diabetes Remission Index, preoperative hypoalbuminemia with conversion and revisional bariatric surgery and ARMMS-T2D Study, and more (please note, log-in maybe required to access the full paper).

A longitudinal study of the association between the outcome of bariatric surgery and mental health indicators in Chinese patients: an examination of the interaction effect

Taiwanese researchers have reported patients who underwent BMS exhibited a high prevalence of psychiatric disorders, but the presence of pre-operative psychiatric disorders did not significantly affect weight change after surgery.


Writing in BMC Psychiatry, they evaluated the changes in physical and mental health before and after BMS, and investigated the association between surgical outcome and mental health status.

In total, 147 patients were included in the study and the average body mass index decreased by 13.46 (SD 8.28), the Chinese Health Questionnaire (CHQ) scores decreased by 1.52 (SD 2.76) and the Taiwanese Depressive Questionnaire (TDQ) scores decreased by 5.08 (SD 8.58).


The prevalence of any psychiatric disorder in these patients was found to be 34% with no significant difference in the Percentage of Total Weight Loss (%TWL) between individuals with or without psychiatric disorders, although patients with psychiatric disorders had higher CHQ and TDQ scores after surgery. In multiple linear regression models, the TDQ-by-follow-up duration interaction was predictive of the %TWL, and both married status and the level of tertiary education were identified as negatively associated factors.


“Despite the improvements in physical and mental health post-surgery, the findings indicate that the impact of depression on effectiveness of bariatric surgery is modulated by the time elapsed since the surgery, emphasising the importance of ongoing mental health care for these patients,” the researchers concluded.


To access this paper, please click here


New Insights into Ruling Out Internal Herniations After Laparoscopic Gastric Bypass on the Abdominal CT Scan: The OPERATE study

Incorporating additional computed tomography (CT) signs into an existing scoring system can help clinicians to safely rule out internal herniations (IH) in patients with abdominal pain after bariatric surgery, according to researchers from the Netherlands.


Reporting in Obesity Surgery, they sought to validate the Eindhoven2020 (EHV20) scoring system for ruling out IH and improve its diagnostic accuracy through additional radiologic parameters.

In total, 375 patients with abdominal pain after gastric bypass surgery were selected if a CT scan was performed. CT scans were scored following the EHV20 scoring system containing ten signs of IH to confirm the individual and collective accuracy of these signs.


IH was confirmed during laparoscopy in 27 patients. On CT, the highest sensitivity was achieved by the swirl sign (66.7%) and the highest specificity by a small bowel behind the superior mesenteric artery (99.7%). The area under the receiver operating characteristic curve (AUC) based on the EHV20 scoring system for ruling out IH was 0.845 (95% CI 0.730–0.959). The AUC could be improved to 0.905 (95% CI 0.825–0.985) (p=0.088) through the incorporation of several additional signs.


The authors noted that this new scoring system included swirl sign, small bowel obstruction, enlarged nodes, venous congestion, mesenteric oedema, dilated alimentary or biliary loop, free fluid, and backward flow in the biliary loop with possible backflow in the residual stomach.


To access this paper, please click here


The Diabetes Remission Index (DRI) - A Novel Prognostic Calculator Model Predicting Diabetes Remission Before and After Metabolic Procedures

The Diabetes Remission Index (DRI) and Weight Loss-Adjusted Diabetes Remission Index (W-DRI) models accurately predict T2D remission post-BMS, enabling personalised patient care and informed decision-making US researchers have found.


Writing in the Annals of Surgery, their multi-centre, retrospective cohort study included patients with T2D and overweight/obesity (BMI ≥27 kg/m²) who underwent RYGB or SG between 2008 and 2018. Institution 1 (I-1) data (n=503) was used to develop and internally validate the models, while Institution 2 (I-2) data (n=409) was used for external validation. The DRI model incorporated preoperative variables, and the W-DRI model additionally included post-surgical weight loss.


In I-1, 44.7% of patients achieved T2D remission, with a DRI model AUC of 0.80. In I-2, 52.6% achieved remission, with a model AUC of 0.78. Incorporating weight loss improved W-DRI predictive accuracy (AUC: 0.82 in I-1, 0.79 in I-2) and calibration plots demonstrated strong agreement between predicted and observed remission rates.


To access this paper, please click here


Utility of Preoperative Hypoalbuminemia as Independent Predictor of Post-Conversion and Revisional Bariatric Surgery Outcomes: MBSAQIP Registry Analysis

Hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion BMS, although there maybe increase in surgical site infection (SSI) and readmission rates, investigators from the US and Lebanon have found.


Reporting in the Journal of the American College of Surgeons, they identified 58,327 BMS revisions and anastomotic conversions from the 2020-2022 MBSAQIP registry. A preoperative albumin level of 3.5 g/dL was used as a threshold to identify patients with hypoalbuminemia.


Univariate analyses showed an association between hypoalbuminemia and postoperative morbidity however, multivariable regression and 1:1 matched analysis showed hypoalbuminemia is not an independently significant driver of 30-day overall postoperative complications (including leaks), reoperation or reintervention.


Interestingly, 1:1 matched analysis demonstrated significantly increased odds of 30-day postoperative superficial SSI (OR 8.138, p=0.049) and readmission (OR 1.75, p=0.045) associated with albumin levels lower than 3.5 g/dL.


To access this paper, please click here


Health-Related Quality of Life and Health Utility After Metabolic/Bariatric Surgery Versus Medical/Lifestyle Intervention in Individuals With Type 2 Diabetes and Obesity: The ARMMS-T2D Study

Metabolic surgery produces sustained weight loss and improves PCS, general health, physical functioning, vitality, and HU in individuals with type 2 diabetes and obesity compared with medical therapy up to 12 years after intervention, according to the latest findings from the ARMMS-T2D Study.


The study, published in Diabetes Care, included 228 individuals with type 2 diabetes and obesity randomly assigned to MBS (Roux-en-Y gastric bypass, sleeve gastrectomy, or gastric band; n=152) or MLI (n=76) in the ARMMS-T2D study. HRQoL (36-Item Short-Form Health Survey [SF-36], including Physical Component Score [PCS] and Mental Component Score [MCS]) and HU (Short Form 6 Dimensions [SF-6D]) were measured annually up to 12 years.


The outcomes revealed PCS improved significantly more in the MBS versus MLI group over 12 years (+2.37±0.53 vs. −0.95±0.73; difference 3.32±0.85; p<0.001). MBS was associated with better general health (p<0.001), physical functioning (p=0.001) and vitality (p=0.003). Reduction in BMI was greater after MBS versus MLI (p<0.001) and correlated with improved PCS (p<0.001).


However, the change in PCS was not associated with change in HbA1c. MCS changed minimally from baseline and was similar between MBS and MLI groups during follow-up (−0.21±0.61 vs. −0.89±0.84; difference 0.68±0.97; p=0.48). Improvements in HU were greater in the MBS versus MLI group over 12 years (+0.02±0.01 vs. −0.01±0.01; difference 0.03±0.01; p=0.003).


To access this paper, please click here

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