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Journal Watch 8/5/2024

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 effects of bariatric surgery on sexual function and fertility, reduction of CV complications during delivery, patients' perspective on their post-bariatric drug therapy, post-sleeve paragastric neural blockade, hypothalamic inflammation improves through bariatric surgery and weight loss medications and cardiovascular complications, and more (please note, log-in maybe required to access the full paper).

Effects of bariatric surgery on sexual function and fertility: A narrative review

Bariatric surgery may positively impact female fertility, improving pregnancy and neonatal outcomes however, it is essential to consider the potential risks related to the adverse effects of malnutrition and rapid weight loss following surgery, according to authors writing on behalf of Global Obesity Collaborative.

Reporting in Obesity Reviews, they noted that bariatric surgery has generated promising results in alleviating sexual dysfunction and enhancing fertility, results which are often gender specific.

For example, improvements in sexual function can often be attributed to weight loss and subsequent optimisations in sex hormone levels in men. Bariatric procedures have shown limited benefits for male fertility; in fact, in some situations it can even be detrimental, leading to a decrease in sperm count and quality. Conversely, improving female sexual function may be related to a range of factors beyond weight loss and surgery may positively impact female fertility, improving pregnancy and neonatal outcomes.

“Nevertheless, it is essential to consider the potential risks related to the adverse effects of malnutrition and rapid weight loss following surgery, making it advisable to wait for 12–18 months before attempting pregnancy,” they concluded.

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Reduction of cardiovascular complications during delivery hospitalization in patients undergoing bariatric procedures

Bariatric surgery is associated with a decreased risk of cardiovascular complications during delivery researchers from Rochester General Hospital, Rochester, NY, have reported.

Writing in the International Journal of Obesity, they researchers performed a retrospective analysis utilising the National Inpatient Sample database to examine data from delivery admissions of pregnant women with obesity and a history of bariatric surgery. They compared the prevalence of cardiovascular complications from these pregnant individuals with those with obesity but had no such surgical history.

The study included 3,027,987 pregnancies in individuals with obesity and an additional 117,350 pregnancies following bariatric surgery. Cardiovascular outcomes showcased reduced odds of congestive heart failure [Adjusted odds ratios (AOR) 0.11, 95% confidence intervals (CI) 0.01–0.74], gestational hypertensive complications (AOR 0.55, 95% CI 0.53–0.59), and cardiac arrhythmia (AOR 0.76, 95% CI 0.64–0.89) in the post-surgery group, with no significant difference in peripartum cardiomyopathy rates (AOR 0.72, 95% CI 0.29–1.76) and no instances of stroke or acute MI. Perinatally, the surgery cohort had higher odds of preterm birth (AOR 1.30, 95% CI 1.24–1.38) and fetal growth restriction (AOR 2.47, 95% CI 2.32–2.63) but fewer incidents of being large for gestational-age (AOR 0.35, 95% CI 0.32–0.38). As bariatric surgery became increasingly recognised as a significant factor in certain complications, its prevalence among the study population increased from 2009 to 2019.

“This study highlights how insights from bariatric surgery outcomes could shape clinical guidelines for managing obesity in pregnant women,” they concluded.

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Patients' perspective on their drug therapy after bariatric surgery: A quantitative, cross-sectional interview study

There is a need for better and more individual support for patients with their drug therapy after bariatric surgery and, specifically, a multidisciplinary approach that includes pharmacists, according to researchers from Leipzig University Hospital and University of Leipzig, Leipzig, Germany.

Writing in Clinical Obesity, they conducted a quantitative telephone-based interview study with patients who have undergone bariatric surgery. The interview consisted of assessments in three parts: (i) current drug therapy: prescription, administration and adherence, (ii) changes after bariatric surgery and (iii) adverse events.

The 105 enrolled patients were taking a median of 10 (range: 3–30) drugs. In 1017 of 1080 drugs (94%), expectations in drug effectiveness were (rather) met. Of the 105 patients, 27% reported difficulties in drug administration, 44% forgot to take their drugs at least one time and 20% reported deviations from the prescription. Sixteen percent of the patients observed changes in drug effectiveness or tolerability, additionally to therapy adjustment by physicians. Seventy-four percent recognised at least one adverse event right before and/or after bariatric surgery, most frequently in gastrointestinal disorders.

They added that stronger involvement of the patients' perspective seems to be a valuable source in research and practice.

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Efficacy and Safety of Paragastric Neural Blockade in Controlling Pain, Nausea, and Vomiting After Sleeve Gastrectomy: A Randomized Controlled Trial

Paragastric neural blockade (PGNB) is an effective and safe method for managing pain, nausea, and vomiting that occur in the early period after LSG, according to the outcomes from a randomised controlled trial by researchers for Atlas University, Istanbul, Turkey.

Reporting in Obesity Surgery, 90 patients were divided into two equally formed groups: patients who underwent PGNB after LSG (n=45) and the control group (n=45). The VAS scores measured at postoperative hours one, six and 12 were statistically significantly lower in the PGNB group, however, there were no significant differences between the two groups in terms of the 24th hour VAS scores.

The mean PONV scores of the PGNB and control groups were 0.47±0.89 and 1.67±1.95, respectively, revealing a significantly higher value for the controls. The mean time to first mobilisation in the postoperative period was significantly shorter in the PGNB group and the satisfaction score of the PGNB group was significantly higher.

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Hypothalamic Inflammation Improves Through Bariatric Surgery, and Hypothalamic Volume Predicts Short-Term Weight Loss Response in Adults With or Without Type 2 Diabetes

Hypothalamic inflammation (HI) improvement after bariatric surgery and may support a role for HI in modulating the weight loss response to these interventions, researchers from the Hospital Clínic, Barcelona, Spain, have reported.

Published in Diabetes Care, their study sought to evaluate the effect of bariatric surgery on radiological biomarkers of HI and the association between the severity of such radiological alterations and post-BS weight loss trajectories.

The study included 72 individuals with obesity (20 with and 52 without type 2 diabetes) and 24 control individuals. Compared with control group, the obesity and type 2 diabetes groups showed a larger volume and higher mean diffusivity in the hypothalamic tubular inferior region, the area encompassing the arcuate nucleus.

They found these radiological alterations were positively associated with baseline anthropometric and metabolic measures and improved post-BS. A larger baseline tubular inferior hypothalamic volume was independently related to lesser weight loss one and two years after surgery.

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The association between weight loss medications and cardiovascular complications

The utilization of antiobesity medications (AOMs) effectively alleviates the high prevalence of cardiovascular disease (CVD), according to US researchers.

Reporting in Obesity, this retrospective cohort study examined the association between newly approved AOM use and cardiovascular events among Medicare patients with obesity using data from 2020 to 2022.

The analysis included 5,926 patients treated with semaglutide and tirzepatide, including Ozempic (5,404 patients), Wegovy (375 patients) or Mounjaro (147 patients). Hypertension, type 2 diabetes and hyperlipidemia were the most common comorbidities. For patients with AOMs, less incidence of heart failure (4.89% vs. 6.13%, p<0.0001), atrial fibrillation (3.83% vs. 5.17%, p<0.0001), arrhythmia (3.59% vs. 4.14%, p<0.0153), and peripheral vascular disease (3.44% vs. 2.94%, p<0.0395) was found versus patients without AOMs.

Patients receiving AOMs showed an 8% risk reduction in any CVD, so a protective effect on CVD was apparent over the first 375 days.

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