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Journal Watch 7/12/2022

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 longer BP limb length led to higher rates of T2DM remission, all of cardiac left-side structural indices improved significantly after bariatric surgery, higher magnesium levels associated with better glycaemic control and T2DM remission post-surgery, and oral butyrate supplementation may be effective in the treatment of paediatric obesity (please note, log-in maybe required to access the full paper).

Biliopancreatic Limb Length as a Potential Key Factor in Superior Glycemic Outcomes After Roux-en-Y Gastric Bypass in Patients With Type 2 Diabetes: A Meta-Analysis

Researchers from the Korea University College of Medicine, Seoul, South Korea, have reported that longer biliopancreatic (BP) limb length led to higher rates of type 2 diabetes remission and improvement by one year after Roux-en-Y gastric bypass (RYGB) in comparisons with the longer Roux limb length.

Writing in Diabetes Care, they investigated how the lengths of the BP and Roux limbs in RYGB differentially affect postoperative glycaemic outcomes in patients with type 2 diabetes. They conducted a systematic literature search using the PubMed, Embase, and the Cochrane Library databases.

They discovered that type 2 diabetes remission/improvement rates were as follows: long BP–long Roux group 0.80 (95% CI 0.70–0.90)/0.81 (0.73–0.89), long BP–short Roux group 0.76 (0.66–0.87)/0.82 (0.75–0.89), short BP–long Roux group 0.57 (0.36–0.78)/0.64 (0.53–0.75) and short BP–short Roux group 0.62 (0.43–0.80)/0.53 (0.45–0.61). Meta-regression analysis also showed that a longer BP limb resulted in higher postoperative type 2 diabetes remission and improvement rates, whereas a longer Roux limb did not.

There was no significant difference or heterogeneity in baseline characteristics, including diabetes-related variables, among the four groups.

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The Impact of Bariatric Surgery on Cardiac Structure, and Systolic and Diastolic Function in Patients with Obesity: A Systematic Review and Meta-analysis

Investigators from the Mashhad University of Medical Sciences, Mashhad, Iran, have reported that almost all of cardiac left-side structural indices improved significantly after bariatric surgery.

Writing in Obesity Surgery, the authors pooled data from all studies on the impact of bariatric surgery on cardiac structure, and systolic and diastolic function evaluated by either echocardiography or cardiac magnetic resonance.

Although cardiac left-side structural indices improved, right-side structural indices did not change significantly. Left ventricular ejection fraction and most of the diastolic function indices improved significantly after the bariatric surgery.

The subgroup analysis showed that the left ventricular mass index decreased more in long-term follow-up (≥ 12 months). In addition, subgroup analysis of studies based on surgery type did not reveal any difference in outcomes between gastric bypass and sleeve gastrectomy groups.

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Higher magnesium levels are associated with better glycaemic control and diabetes remission post-bariatric surgery

Investigators from the University of Porto, Porto, Portugal, have reported higher magnesium (Mg) serum levels at baseline and one-year after bariatric surgery were associated with better glycaemic control and higher rates of total T2DM remission at the first year.

Writing in BMC Endocrine Disorders, they evaluated the association between Mg supplementation post-BS and Mg serum levels with diabetes status in 403 patients after surgery. At baseline, 43.4% of the patients had Mg deficiency. Pre-BS, patients with Mg deficiency had poorer glycaemic control – HbA1c 7.2 ± 1.6% vs 6.4 ± 1.0% (p<0.001), fasting plasma glucose 146.2 ± 58.8 mg/dL vs 117.5 ± 36.6 mg/dL (p<0.001) and were under a greater number of anti-diabetic drugs 1.0 (IQR 0–2.0) vs 1.0 (IQR 0–1.0) (p =0.002).

At the first-year post-BS, 58.4% of the patients had total remission of T2DM and 4.1% had partial remission. Patients without Mg deficiency at one-year post-BS had higher rates of total and partial remission. Higher serum Mg levels at baseline is an independent predictor of total T2DM remission (p<0.0001). The optimal cut-off of baseline Mg to predict total T2DM remission was 1.50 mg/dL with a sensitivity of 73% and a specificity of 58% (area under ROC = 0.65). Patients that were under Mg supplementation post-BS had serum Mg values, glycaemic control and total remission of T2DM similar to patients non-supplemented.

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Feasibility and Efficacy of Magnetic Sphincter Augmentation for the Management of Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy for Obesity

Magnetic sphincter augmentation (MSA), utilising the LINX Reflux Management System, showed an overall improvement of GERD symptoms and significantly reduced proton pump inhibitor (PPI) use, according to researchers led by University Hospitals Cleveland Medical Center, Cleveland, OH.

Published in Obesity Surgery, the authors assessed the safety and efficacy outcomes of MSA after aparoscopic sleeve gastrectomy (LSG). The efficacy of the LINX device was measured comparing baseline to 12-month post-implant reductions in distal acid exposure, GERD-HRQL score, and average daily PPI usage.

GERD-HRQL scores showed significant improvement (80.8%, p<0.001), and reduction in daily PPI usage was seen (95.8%, p<0.001). Forty-four percent of subjects demonstrated normalisation or >=50% reduction of total distal acid exposure time (baseline 16.2%, 12 months 11%; p=0.038).

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Therapeutic Effects of Butyrate on Pediatric Obesity - A Randomized Clinical Trial

Oral butyrate supplementation may be effective in the treatment of paediatric obesity, according to a randomised clinical trial led by researchers at the University of Naples “Federico II,” Naples, Italy.

Writing in JAMA Network Open, the study included 54 children living with obesity, who received standard care for paediatric obesity supplemented with oral sodium butyrate (20 mg/kg body weight per day) or placebo for six months.

They reported that the children treated with butyrate had a higher rate of BMI decrease greater than or equal to 0.25 SD scores at six months (96% vs 56%, absolute benefit increase, 40%; 95% CI, 21% to 61%; p<0.01). At per-protocol analysis (n=48), the butyrate group showed the following changes as compared with the placebo group: waist circumference, −5.07 cm (95% CI, −7.68 to −2.46 cm; p<0.001); insulin level, −5.41 μU/mL (95% CI, −10.49 to −0.34 μU/mL; p=0.03); HOMA-IR, −1.14 (95% CI, −2.13 to −0.15; p=0.02); ghrelin level, −47.89 μg/mL (95% CI, −91.80 to −3.98 μg/mL; p<0.001); microRNA221 relative expression, −2.17 (95% CI, −3.35 to −0.99; p<0.001); and IL-6 level, −4.81 pg/mL (95% CI, −7.74 to −1.88 pg/mL; p<0.001).

Adverse effects included transient mild nausea and headache reported by 2 patients during the first month of butyrate intervention.

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