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 sleep assessments for bariatric patients, continuous glucose monitoring is not a valid diagnostic test for dumping syndrome, administering vitamin D as a standard post-LSG regimen, recurrent reflux following primary fundoplication, BMS offers superior CV protection vs GLP-1RAs, GLP-1 RAs may reduce opioid overdose risk and expanding access to GLP-1s could save thousands of lives a year, and more (please note, log-in maybe required to access the full paper).
Assessing the Reliability and Validity of Sleep Assessments in Patients Seeking Metabolic and Bariatric Surgery
Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) are reliable and valid for patients undergoing bariatric surgery, investigators from Johns Hopkins School of Medicine, Baltimore, MD, have reported.
Published in SOARD, they stated that although ~80% of patients seeking bariatric surgery report disturbance in sleep function, no studies have assessed the psychometric properties of sleep measures in surgical samples.
Participants (n=939) were primarily female (83.4%) with a mean age of 41.7 (SD=11.5) years and mean BMI of 47.5 kg/m2 (SD=8.5). Confirmatory factor analyses (CFAs) indicated excellent fit for two-factor solutions for the PSQI and ISI. Internal consistency for the PSQI and ISI were acceptable. Convergent validity was demonstrated by large correlations between the PSQI and ISI (p<0.001), and moderate correlation between the PSQI, ISI, and QIDS (ps<0.001). The PSQI and ISI were moderately correlated with QIDS items assessing sleep function (p<0.001), but correlations with items assessing appetite change were small, demonstrating good discriminant validity.
To access this paper, please click here
Validity of Continuous Glucose Monitoring for the Diagnosis of Dumping Syndrome After Metabolic Surgery, in Comparison to the Oral Glucose Tolerance Test
Continuous glucose monitoring (CGM) is not a valid diagnostic test for dumping syndrome, researchers from CHU de Toulouse, Toulouse, France, have reported.
Writing in Obesity Surgery, they tested the diagnostic capacity of CGM in patients with and without dumping syndrome, as validated by oral glucose tolerance testing (OGTT).
symptoms and who had OGTT. CGM characteristics were compared in DS-positive (n=37) and DS-negative patients (n=14). None of the CGM parameters differed between the two groups: mean, variability, time in range, and time above or below range. They found OGTT induced different hematocrit and pulse rate responses (by DS definition) but no difference in blood glucose values.
Despite being a better-tolerated test than OGTT, CGM should not be recommended for the diagnosis of dumping syndrome, they concluded, although it may still be useful for monitoring glucose values in everyday life to help patients modify their diet, when dumping syndrome is caused by carbohydrates with high glycaemic index.
To access this paper, please click here
Effect of Laparoscopic Sleeve Gastrectomy on Calcium Metabolism Parameters, Vitamin D, and Parathyroid Hormone in Morbidly Obese Patients: Short-Term Results
Administering vitamin D as a standard postoperative treatment regimen may be helpful in reducing this deficiency, according to researchers from the University Hospital, İstanbul, Turkey.
Published in Cureus, the study authors investigated the effect of LSG on Ca metabolism parameters, vitamin D, and PTH in patients with morbid obesity, with 78 patients were included in the study.
They reported a significant decrease in the BMI values following surgery (p<0.01). Vitamin D level was found to be 18.7±4.2ng/mL at baseline, which increased to 37.6±2.5 ng/mL at 12 months after surgery (p<0.01). Before surgery, the PTH level was 69.1±8.7pg/mL, which decreased to 39.3±5.5pg/mL at 12 months postoperatively (p<0.01). The mean serum Ca level at baseline was 9.2±1.4mg/dL, which increased to 10.1±0.4mg/dL at 12 months after operation (p<0.01).
The authors recommended continuous monitoring of vitamin D, PTH and serum Ca levels after surgery to manage these issues effectively.
To access this paper, please click here
Evaluation of factors associated with reflux recurrence after fundoplication
There is no relationship between patient factors such as age, sex, race, and BMI and recurrent reflux following primary fundoplication, a study led by researchers from Weill Cornell Medical College, New York-Presbyterian Hospital, NY, has reported.
Published in Surgical Endoscopy, the study included 137 patients who met inclusion criteria. In total, 17 (12.4%) patients developed recurrent reflux, with 6.5% of them required secondary fundoplication. There were no significant differences in demographic, pre-operative or intra-operative characteristics between patients who developed recurrent reflux and those who did not (p>0.05). However, in the subset of patients who underwent EndoFLIP monitoring during surgery (60%); patients who developed recurrent reflux had lower HPZ values post-wrap compared to those who did not (p<0.01).
The researchers added that larger studies are needed to evaluate the impact of HPZ on outcomes following fundoplication in order to develop guidelines for clinicians.
To access this paper, please click here
Comparative Effectiveness of Bariatric Metabolic Surgery Versus Glucagon-Like Peptide-1 Receptor Agonists on Cardiovascular Outcomes and Mortality: A Meta-Analysis
Bariatric metabolic surgery (BMS) offers superior cardiovascular protection and improved survival outcomes compared to glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with obesity, a team of international researchers has found.
Published in Cureus, the study authors compared the effectiveness of BMS and GLP-1RAs on cardiovascular outcomes and mortality in patients with obesity. They identified four observational studies meeting the inclusion criteria, comprising a total of 247,000 patients.
The results showed that BMS was associated with a significantly lower risk of MACE compared to GLP-1RAs (RR: 0.71, 95% CI: 0.56-0.90, p=0.004), indicating a 29% reduction in MACE risk. Additionally, BMS demonstrated a 25% reduction in all-cause mortality risk (RR: 0.75, 95% CI: 0.65-0.87, p<0.0001).
To access this paper, please click here
The association between glucose-dependent insulinotropic polypeptide and/or glucagon-like peptide-1 receptor agonist prescriptions and substance-related outcomes in patients with opioid and alcohol use disorders: A real-world data analysis
Prescriptions of glucose-dependent insulinotropic polypeptide (GIP) and/or glucagon-like peptide-1 receptor agonists (GLP-1 RA) appear to be associated with lower rates of opioid overdose and alcohol intoxication in patients with opioid use disorder and alcohol use disorder, according to researchers from Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL.
The study, published in the journal Addiction (a journal from the Society for the Study of Addiction), aimed to estimate the strength of association between prescriptions of GIP) and/or GLP-1 RA and the incidence of opioid overdose and alcohol intoxication in patients with opioid use disorder (OUD) and alcohol use disorder (AUD), respectively.
The study included 503 747 patients with a history of OUD and 817 309 patients with a history of AUD, aged 18 years or older. Patients with GIP/GLP-1 RA prescriptions demonstrated statistically significantly lower rates of opioid overdose [adjusted incidence rate ratio (aIRR) in OUD patients: 0.60; 95% confidence interval (CI) = 0.43–0.83] and alcohol intoxication (aIRR in AUD patients: 0.50; 95% CI = 0.40–0.63) compared to those without such prescriptions.
When stratified by comorbid conditions, the rate of incident opioid overdose and alcohol intoxication remained similarly protective for those prescribed GIP/GLP-1 RA among patients with OUD and AUD.
To access this paper, please click here
To read our summary of this paper, please click here
Estimating the lives that could be saved by expanded access to weight-loss drugs
Expanding access to glucagon-like peptide-1 (GLP-1) receptor agonists and dual gastric inhibitory polypeptide and GLP-1 receptor agonists, could prevent 42,000 deaths annually, including more than 11,000 deaths among people with type 2 diabetes, according to researchers at Yale School of Public Health and the University of Florida
For the study, the researchers quantified the annual mortality burden directly attributable to limited access to these medications in the US. By integrating hazard ratios of mortality across BMI categories with current obesity prevalence data, combined with healthcare access, willingness to take the medication, and observed adherence to and efficacy of the medications, they estimated the impact of making these medications accessible to all those eligible.
The study authors said the findings underscore the urgent need to address barriers to access and highlight the transformative public health impact that could be achieved by expanding access to these novel treatments.
To access this paper, please click here
To read our summary of this paper, please click here
Comments