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 association between COVID-19 and metabolic disease, outcomes from the CORONADO study, severe postoperative complications outcomes post-bariatric surgery, the outcomes from a French Ventral Hernia Repair registry, and a study highlighting the association between COVID-19 mortality and the proportion of the overweight people in a country's adult population (please note, log-in maybe required to access the full paper).
COVID-19 and metabolic disease: mechanisms and clinical management
An international team of authors has provided a review on the mechanisms of how metabolic and endocrine disorders might predispose patients to develop severe COVID-19. Reporting in The Lancet Diabetes Endocrinology they noted that up to 50% of the people who have died from COVID-19 had metabolic and vascular disorders.
They state that there are many direct links between COVID-19 and the metabolic and endocrine systems. Therefore, not only are patients with metabolic dysfunction at an increased risk of developing severe COVID-19 but also infection with SARS-CoV-2 might lead to new-onset diabetes or aggravation of pre-existing metabolic disorders.
They also update the practical recommendations and management of patients with COVID-19 and post-pandemic and summarise new treatment options for patients with both COVID-19 and diabetes, and highlight current challenges in clinical management.
History of bariatric surgery and COVID 19 outcomes in patients with type 2 diabetes: results from the CORONADO study
Writing in Obesity on behalf of The CORONADO investigators, the authors of this study assessed the impact of a history of metabolic and bariatric surgery (MBS) on the clinical outcomes in patients with type 2 diabetes (T2D) and severe obesity hospitalised for COVID-19.
The study included 2,398 CORONADO participants, 20 of whom had history of MBS. When they matched BMI at the time of surgery and after adjustment on diabetes duration, the composite primary outcome occurred less frequently within seven days (3 vs 17 events, p=0.03) and 28 days (3 vs 19 events, p=0.02) in patients with MBS (n=16) vs controls (n=44).
They concluded that the outcomes “are reassuring regarding COVID-19 prognosis in patients with diabetes with history of MBS compared to those without MBS”.
The impact of severe postoperative complications on outcomes of bariatric surgery – multicenter case-matched study
Investigators from Poland have reported that severe postoperative complications after bariatric surgery had no significant influence either on weight-loss effects or obesity-related diseases remission.
The researchers sought to assess the outcomes of bariatric treatment in patients with obesity and severe postoperative complications in comparison to patients with a noneventful perioperative course. They performed a multi-centre propensity score matched analysis of 206 patients from six surgical units and assessed the outcomes of bariatric procedures. They compared 103 patients with severe postoperative complications (70 SG and 33 RYGB) were compared to 103 patients with no severe complications in terms of peri- and postoperative outcomes.
The reported that the outcomes of bariatric treatment did not differ between compared groups. The median percentage of total weight loss (%TWL) 12 months after the surgery was 28.8% in the group with complications and 27.9% in patients with no severe complications (p=0.993). In addition, remission rates of both T2DM and arterial hypertension, showed no significant difference, SG vs RYGB respectively: 36% vs 42%, p=0.927 and 41 vs 46%, p=0.575.
Ventral Hernia Repair and Obesity: Results from a Nationwide Register Study in France According to the Timeframes of Hernia Repair and Bariatric Surgery
French researchers, writing in Obesity Surgery, have reported the outcomes from a French ventral hernia repair (VHR) in patients who had VHR concomitant with bariatric surgery or within 2 years before or after.
In total, 11,680 patients were included in the study – 2,039 underwent VHR in the two years before surgery, 3,388 had concomitant surgery and VHR, and 6,260 patients had VHR within two years after surgery. They found that patients who underwent a concomitant surgery presented a higher suture repair rate (86.1% versus 37.1% and 44.0%, p<0.001). Overall, recurrence of VH at ten years was 23.3% and was higher for patients who underwent VHR first (36.2%) than patients who underwent surgery first (24.5%) and the concomitant group (18.6%), p<0.001. Major complication rate was 11.1%, 7.8% and 16.9% (p<0.001) for VHR-first, concomitant and surgery-first groups, respectively.
They concluded that VHR before surgery entailed a higher risk of reoperation for recurrence and should be avoided. A concomitant repair entailed the lowest rate of recurrence.
COVID-19 mortality and the overweight: Cross-Country Evidence
Researchers from the US have found a positive, robust association between COVID-19 mortality and the proportion of the overweight people in a country's adult population.
The found that on an average, every percentage point increment in the proportion of the overweight in adult populations contributes to an additional 3.5% points to COVID-19 mortality for high income countries.
They stated that their findings, reported in the journal Public health in Practice, demonstrate the need for an effective alignment of public policy regulations with public health priorities.