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 Modified Delphi Consensus on Controversies in OAGB, more complications after loop duodenal switch than RYGB, BMS in septuagenarians, bariatric surgery is associated with increased natriuretic peptide levels and 260 million people in the US predicted to be living with overweight or obesity by 2050, and more (please note, log-in maybe required to access the full paper).
MGB-OAGB International Club - Results of a Modified Delphi Consensus on Controversies in OAGB
Au updated modified Delphi consensus for MGB-OAGB has highlighted some unresolved controversies and has addressed issues around patient selection, technical standardization, revisional surgeries and post-operative care.
Written on behalf of the OAGB-MGB Consensus Contributors, published in Obesity Surgery, this latest consensus paper builds upon previous consensus efforts to address unresolved controversies for the procedure. A consensus panel of 86 bariatric experts from 25 countries participated in 3 rounds of voting on 29 questions.
Consensus (defined as at least 70% agreement) was achieved on 22 out of 29 questions. Key areas of agreement included suitability of OAGB for adolescents above the age of 15 years and patients with class 1 obesity with uncontrolled type 2 diabetes. Patients with severe esophagitis and Barrett’s oesophagus were not considered as good candidates for OAGB. Crural repair with OAGB was considered as an appropriate procedure in patients with large hiatus hernia, whilst a bilio-pancreatic limb (BPL) length of 150-200 cm was deemed suitable and it was recommended to tailor the BPL length to prevent protein energy malnutrition. There was also consensus to routinely administer ursodeoxycholic acid and proton-pump inhibitors for six months post-operatively.
To access this paper, please click here
Loop duodenal switch confers more complications with little gain of weight loss compared to Roux-en-Y gastric bypass
Patients who undergo loop duodenal switch (LDS) are more likely to experience postoperative complications vs. RYGB with no added benefit in weight loss or comorbidity resolution up to three years post operatively, according to researchers from Endeavor Health/NorthShore University Health System, Evanston, IL.
Reporting in Endoscopic Surgery, the study explored those outcomes after the two procedures from 238 patients who underwent RYGB and 54 who underwent LDS. Initial BMI was significantly higher in LDS compared to RYGB (56.9 ± 8.0; 46.5 ± 7.3; p<0.01).
At two years, percent total body weight loss (%TBWL) was significantly different with LDS having more %TBWL than RYGB (LDS: n=10, %TBWL = 44.7±14.1%; RYGB: n=47) There were no statistically significant differences at any other postoperative time point. There were no differences in intraoperative complications between the two groups, however postoperative complications were significantly higher in the LDS population (16.7%, 7.1%; p<0.01).
A subgroup analysis was completed in patients with initial BMI 50 and there were no significant differences at any postoperative time point.
To access this paper, please click here
Efficacy and safety of laparoscopic bariatric surgery in patients of 70 years and older: A systematic review and meta-analysis
A systematic review has reported that laparoscopic bariatric surgery is an effective and safe treatment for patients over 70 years of age, according to researchers from the University of Warmia and Mazury, Olsztyn, Poland.
Writing in Obesity Reviews, the study’s authors performed a systematic review and assessment of the literature studies of elderly (age ≥70 years old) who underwent laparoscopic bariatric surgery.
Fourteen retrospective studies were included (3,923 septuagenarians (female, 69.70%) and at one year post-surgery, the mean excess weight loss was 54.66%. At last follow-up, the improvement in obesity-related diseases was regarded as 50% diagnosed with diabetes, 36% with hypertension, 50% with reflux, 36% with sleep apnoea and 25% with hyperlipidaemia. The overall postoperative major morbidity and mortality were about 2% and 1%, respectively.
To access this paper, please click here
Short-Term and Long-Term Changes in Natriuretic Peptide Levels After Bariatric Surgery: A Systematic Review and Meta-Analysis
An international team of researchers has found bariatric surgery is associated with increased natriuretic peptide levels without deteriorating cardiac function and improving ejection fraction.
Writing in SOARD, they conducted a systematic search and identified 22 studies with 1,219 patients (33.2% Male, 45.5% gastric bypass surgery). Mean difference from baseline of short- and long-term NT-proBNP levels were 52.88pg/mL (95% CI, 21.30-84.46) and 39.63pg/mL (95% CI, -92.86- 13.60).
However, there was a significant increase was observed in BNP levels in both the short and long term. Surgery was associated with increased natriuretic peptide levels without deteriorating cardiac function and improving ejection fraction, although further studies should investigate its correlation with clinical symptoms and cardiac structural changes.
To access this paper, please click here
National-level and state-level prevalence of overweight and obesity among children, adolescents, and adults in the USA, 1990–2021, and forecasts up to 2050
If past obesity trends and patterns continue, an additional 3.33 million children and young adolescents (aged 5–14 years), 3.41 million older adolescents (aged 15–24 years), and 41.4 million adults (aged ≥25 years) will be living with overweight or obesity by 2050, the total number of children and adolescents with overweight and obesity will reach 43.1 million and the total number of adults with overweight and obesity will reach 213 million (202–221), according to GBD 2021 US Obesity Forecasting Collaborators.
Writing in The Lancet, historical trends of overweight and obesity prevalence from 1990 to 2021 were estimated using spatiotemporal Gaussian process regression models. All estimates were calculated by age and sex at the national level, with estimates for older adolescents (aged 15–24 years) and adults aged (≥25 years) also calculated for 50 states and Washington, DC.
In 2050, in most states, a projected one in three adolescents (aged 15–24 years) and two in three adults (≥25 years) will have obesity. Additionally, southern states, such as Oklahoma, Mississippi, Alabama, Arkansas, West Virginia and Kentucky, are forecast to continue to have a high prevalence of obesity, the highest percentage changes from 2021 are projected in states such as Utah for adolescents and Colorado for adults.
To access this paper, please click here
To access out summary of this paper, please click here
Comments