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 cancer incidence following bariatric surgery in renal transplant patients, impact of surgery on asthma severity and medication use, prescribing liraglutide for patients who experience post-op weight regain is beneficial, magnetic sphincter augmentation vs. fundoplication for reflux disease and sex-differential testosterone response to long-term weight loss, and more (please note, log-in maybe required to access the full paper).
Cancer Incidence Following Bariatric Surgery in Renal Transplant Recipients: A Retrospective Multi-Center
Post-renal transplantation bariatric surgery had a diminishing effect on overall and transplant-related cancer incidence in renal transplant recipients (RTR) with severe obesity, according to researchers from University of Texas Medical Branch, Galveston, TX.
Published in SOARD, the study evaluated the impact of bariatric surgery (BS) on cancer incidence in RTR with severe obesity in the post-transplantation setting, weight loss outcomes were also analysed. This retrospective study assessed cancer outcomes in RTR with post-transplantation BS versus RTR without BS from 2000 to 2023. After the exclusion process and propensity matching, both groups consisted of 153 patients.
They reported that RTR-BS had a significantly lower incidence of overall cancer and transplant-related cancers (p<0.05). No significant difference was identified in cutaneous, gastrointestinal and reproductive cancers. Percent excess weight loss (%EWL) was significantly lower in RTR-only cohort (11.4%) versus RTR-BS cohort (57.8%) at five years. Sleeve gastrectomy (SG) patients (73.19%) had significantly higher %EWL than Roux en-Y gastric bypass (RYGB) patients (49.33%) at three years but no difference in cancer incidence was noted between SG and RYGB patients.
In addition, weight loss was also demonstrated with post-renal transplantation bariatric surgery.
To access this paper, please click here
Impact of Bariatric Surgery on Asthma Severity and Medication Use
Bariatric surgery reduces the use of medications taken for management of asthma with the amount of asthma medication usage decreasing over time and sustained at 60 months post-surgery, according to researchers from Gundersen Health System, La Crosse, WI.
Reporting in Obesity Surgery, they sought to identify the long-term impact of bariatric surgery on asthma severity and medication use. Two hundred and sixty patients (84.6% female) were included in the study of which, had a 168 sleeve gastrectomy and 92 Roux-en-Y gastric bypass. The total number of patients on two or more asthma medications decreased from 46% preoperatively to 41% at 18 months to 36% at 36 months, and to 32% at 60 months after surgery.
The total number of patients free from asthma medication increased from 25% preoperatively to 33% at 60 months postoperatively. Asthma medication use decreased in both surgery groups, and neither operation demonstrated superiority.
To access this paper, please click here
Liraglutide for the Treatment of Weight Regain After Bariatric Surgery: A Systematic Review and Meta-analysis
Researchers from the Federal University of Acre, Acre, Brazil, have found that prescribing liraglutide for patients who experience weight regain after bariatric surgery results in a statistically significant reduction in BMI and total weight.
Writing in Obesity Surgery, this systematic review and meta-analysis included 16 studies (881 individuals). Patients were mostly female (50%), aged 36 to 55 years, with a mean body mass index (BMI) of 39.4 kg/m2, and had BS surgery five years previously.
Over a mean follow-up time ranging from three months to four years, it was observed a statistically significant reduction in BMI (MD − 8.56 kg/m2; 95% CI 3.34 to 13.79; p<0.01) and a mean reduction in total weight (MD − 16.03 kg; 95% CI 0.03 to 32.02; p=0.05) after liraglutide use. Additionally, 65% of patients undertaking liraglutide showed total body weight loss (BWL) above 5% (65.8 events per 100 observations; 95% CI 54.96 to 75.20; p < 0.01), while 26% lost more than 10% of total BWL (26.77 events per 100 observations; 95% CI 19.17 to 36.02; p<0.01).
Liraglutide is well tolerated and promotes significant weight loss, providing clinicians with a therapeutic option for this clinical challenge, the researchers concluded.
To access this paper, please click here
Medium-term outcomes after magnetic sphincter augmentation vs. fundoplication for reflux disease due to hiatal hernia: a propensity-score matched comparison in 282 patients
Magnetic sphincter augmentation (MSA) reduces the re-operation risk compared to fundoplication and may decrease adverse event rates after discharge, German researchers have reported.
Reporting in Surgical Endoscopy, they conducted a retrospective single-centre analysis of consecutive MSA and Nissen fundoplication cases. Patients underwent surgery, including hiatoplasty, for medical treatment-resistant reflux due to hiatal hernia. Surgical revision and proton pump inhibitor (PPI) reuptake rates were the primary outcomes. Patients with severe preoperative dysphagia/motility disorders were assigned different treatment pathways and excluded from the analysis.
Out of 411 eligible patients, 141 patients who underwent MSA and 141 with fundoplication had similar propensity scores and were analysed. At 3.9 years of mean follow-up, MSA was associated with lower surgical revision risk as compared to fundoplication (1.2% vs 3.0% per year, respectively; HR: 0.38; 95% CI 0.15–0.96; p=0.04), and similar PPI-reuptake risk (2.6% vs 4.2% per year; HR: 0.59; 95% CI 0.30–1.16; p=0.12). Adverse event rates during primary stay were similar (MSA vs. fundoplication: 1% vs. 3%, p=0.68), but fewer patients experienced adverse events in the MSA group after discharge (24% vs. 33%, p=0.11), driven by higher rates of self-limiting dysphagia (1% vs. 9%, p<0.01) and gas/bloating (10% vs. 18%, p=0.06) after fundoplication.
Differences between MSA and fundoplication in dysphagia requiring diagnostic endoscopy (11% vs. 8%, p=0.54) or surgical revision (2% vs. 1%, p=1.0) were non-significant. The device explantation rate was 4% (5/141).
To access this paper, please click here
Sex-differential testosterone response to long-term weight loss
Testosterone changes are proportional to the amount of weight loss, according to a study led by researchers from University of New South Wales Sydney, Sydney, Australia.
Writing in the International Journal of Obesity, they examined the incremental effect of weight loss on gonadal axes in men and women over three years, with hormones compared between dietary intervention (Diet) and bariatric procedures (Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and laparoscopic adjustable gastric banding (LAGB)). This prospective, observational study included 61 adults with BMI>30 kg/m2 with endocrine parameters measured at baseline and at six timepoints over three years.
The study found that for each 1kg of weight lost, between baseline and 36 months, total testosterone increased by 0.6% (95% CI: 0.2%, 1.0%, p=0.002) in males and decreased by 0.8% (95% CI: −1.4%, −0.3%, p=0.003) in females, and remained statistically significant when controlled for age and for menopausal status in females. At 36 months, in comparison with Diet, RYGB women had lower total testosterone by 54% (95% CI: −90%, −17%, p=0.004), reduced free androgen index (FAI) by 65% (95% CI; −114%, −17%, p=0.009), while SG had reduced FAI by 39% (95% CI; −77%, 0%, p=0.05). No such differences between groups were noted for male subjects. Adrenocorticotropic hormone declined by 0.3% (95% CI: 0.0, −0.5%, p=0.05), insulin-like growth factor-1 increased by 0.4% (95% CI; 0.2%, 0.7%, p=0.005), without such thyrotrophin change for each 1kg of weight loss, for entire cohort, over 36 months.
They concluded that in females the reduction in androgens was independent of age, menopausal status and were more pronounced after bariatric procedures. The observed changes in pituitary hormones may contribute to the metabolic benefits of bariatric surgery. Additional research should explore an impact of androgen reduction on functional and cognitive status in postmenopausal women.
To access this paper, please click here
Comentarios