The Impact of Bariatric Surgery on Cardiopulmonary Function: Analyzing VO2 Recovery Kinetics

Impact of aging on maximal oxygen uptake in female runners and sedentary controls

The present study aimed to compare V̇O2max (absolute, adjusted to total body mass, and adjusted to lean mass) in recreational runners and sedentary women < and > 50 yr and verify the effect of aging and physical activity level on the three types of V̇O2 max expression. The study included 147 women:85 runners (45.7 ± 14.1 yr) and 62 sedentary controls (48.8 ± 9.8 yr). They were subjected to cardiopulmonary exercise testing for V̇O2 max measurement and a body composition test by dual-emission X-ray absorptiometry system. V̇O2max were expressed as absolute values (L/min), relative to total body mass values (mL/kg/min), and relative to lean mass values (mL/kgLM/min). The two-way analysis of variance revealed a significant interaction [F(2,131) = 4.43, p < 0.001] and effects of age group [F(2,131) = 32.79, p < 0.001] and physical activity group [F(2,131) = 55.64, p < 0.001] on V̇O2max (mL/min). V̇O2max (mL/kg/min) and V̇O2 max (mL/kgLM/min) were significantly influenced by age and physical activity levels. The multiple regression model explains 76.2 % of the dependent variable V̇O2max (mL/kg/min), age (β = -0.335, t = -7.841, p < 0.001), and physical activity group (β = -0.784, t = -18.351, p < 0.001). In conclusion, female runners had higher V̇O2 max values than sedentary women at all ages, even though aging has a greater impact on V̇O2 max in the runners group. In addition to cardiorespiratory fitness, women's metabolic lean mass function, as measured by V̇O2max adjusted by lean mass, is significantly influenced by aging. Finally, physical activity has a greater impact on V̇O2 max levels than aging.

Short-Term Effect of Bariatric Surgery on Cardiorespiratory Response at Submaximal, Ventilatory Threshold, and Maximal Exercise in Women with Severe Obesity

PURPOSE

People with obesity have varying degrees of cardiovascular, pulmonary, and musculoskeletal dysfunction that affect aerobic exercise testing variables. Short time after bariatric surgery, these dysfunctions could affect both peak oxygen consumption ([Formula: see text] O₂ peak), the gold standard for assessing cardiorespiratory fitness (CRF) and aerobic capacity evaluated with ventilatory threshold (VT1). The purpose of this study was to evaluate the short-term effect of bariatric surgery, i.e. before the resumption of physical activity, on submaximal, at VT1 and maximal cardiorespiratory responses in middle-aged women with severe obesity.

MATERIALS AND METHODS

Thirteen middle-aged women with severe obesity (age: 36.7 ± 2.3 years; weight: 110.5 ± 3.6 kg, BMI: 41.8 ± 1.1 kg/m²) awaiting bariatric surgery participated in the study. Four weeks before and 6 to 8 weeks after surgery, body composition was determined by bioelectrical impedance. The participants performed an incremental cycling test to [Formula: see text] O₂ peak.

RESULTS

After bariatric surgery, all body composition parameters were reduced, absolute [Formula: see text] O₂ peak and peak workload decline with a lower VT1. Relative [Formula: see text] O₂ at peak and at VT1 (ml/min/kg or ml/min/kg of FFM) remained unchanged. Ventilation was lower after bariatric surgery during exercise with no change in cardiac response.

CONCLUSION

Our results showed that weight loss alone at short-term after bariatric surgery decreased CRF as seen by a decrease in absolute [Formula: see text] O₂ peak, and peak workload with lower VT1, whereas relative [Formula: see text] O₂ (ml/min/kg or ml/min/kg of FFM) during exercise remained unchanged in women with obesity. Rapid FFM loss affects cardiorespiratory responses at submaximal and maximal.

Effects of bariatric surgery on cardiorespiratory fitness: A systematic review and meta-analysis

Although bariatric surgery (BS) is recognized as an effective strategy for body weight loss, its impact on cardiorespiratory fitness (CRF) is still unclear. We aimed to examine postoperative changes in CRF (VO_2max/peak ) and its relationship with weight loss among adults undergoing BS. We systematically searched the WoS, PubMed, MEDLINE, and Scopus databases. Observational and intervention studies were selected reporting the presurgery and postsurgery CRF, measured by breath-by-breath VO₂ or its estimation. Eleven articles (312 patients) revealed that BS leads to a reduction in absolute VO_2max/peak in the short term (effect size, ES = -0.539; 95%CI = -0.708, -0.369; p < 0.001), and those patients who suffered a more significant decrease in BMI after BS also had a greater loss of absolute VO_2max/peak . However, VO_2max/peak relative to body weight increased after surgery (ES = 0.658; 95%CI = 0.473, 0.842; p < 0.001). An insufficient number of studies were found investigating medium and long-term changes in CRF after BS. This study provides moderate-quality evidence that the weight loss induced by BS can reduce CRF in the short term, which represents a therapeutic target to optimize BS outcomes. More high-quality studies are needed to evaluate the impact of BS on VO_2max/peak in the short, medium, and long term including normalized values for fat-free mass.

Assessment of the clinical and laboratorial profile of patients with obesity and asymptomatic COVID-19 undergoing bariatric surgery in Brazil

Purpose

to outline the clinical and laboratorial profile of patients with obesity undergoing bariatric surgery who presented positive reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (Sars-CoV-2) in the preoperative period without symptoms presentation.

Methods

Case series of 17 patients undergoing bariatric surgery who presented positive RT-PCR for Sars-CoV-2 in the preoperative period, with no reported symptoms. Data collected included demographic characteristics, length of hospital stay, waiting time for surgery, inflammatory markers, serum levels of micronutrients and dengue virus (DENV) serology.

Results

In total, 219 patients underwent bariatric surgery in our institution during the study period. The incidence of asymptomatic cases was 7.7%. The sample comprised 88.2% of women, with mean age of 39.3 years and mean preoperative body mass index (BMI) of 37.7 kg/m2. Thirty five percent of the sample had previous diagnosis of diabetes and 29.4% had hypertension. The mean time elapsed between positive RT-PCR and the operation was 17 ± 7.5 days and the mean length of postoperative hospital stay was 1.9 ± 0.43 day. Mean lymphocytes count was 2,409.7/mm3 and the mean platelet-to-lymphocyte ratio was 126.3. Mean C-reactive protein value was 5.8 mg/dL, while ferritin marked 107.4 µg/L. DENV IgG was identified in all patients who tested for it. Mean levels of vitamin D and zinc were 25.6 ng/mL and 79.9 µg/dL, respectively. There were no postoperative complications reported.

Conclusion

None of the included patients presented any of the laboratory markers related to disease severity. Moreover, it is important to notice that all patients who tested for DENV, had the specific IgG detected in their serum.

Graphical abstract

Bariatric Surgery in Adults with Obesity: the Impact on Performance, Metabolism, and Health Indices

This systematic review summarizes current evidence on the impact of bariatric surgery (BS) on physical performance, metabolic, and health indices in adults with obesity. This systematic review suggests that BS induced significant reductions in body weight, fat mass, and fat-free mass in individuals with obesity. Additionally, BS may improve many physical fitness and health indicators. Observed improvements manifest during a distinct period of time. To date, studies on BS and performance have been small in number, nonrandomized in design, and not controlled regarding gender distribution and/or post-surgery follow-up. Future studies should further investigate concerns associated with understanding of BS outcomes to improve these outcomes with potential benefits for quality of life, disability, mortality, morbidity, and overall BS success.

Metabonomic model for the assessment of type 2 diabetes remission after bariatric/metabolic surgery

OBJETIVO

To evaluate the differences in the metabonomic profile of patients who achieved remisison of Type 2 diabetes mellitus (T2DM) after bariatric surgery in relation to those who presented maintenance or recurrence of this condition after surgery.

METHODS

Thirthy-three patients with obesity and T2D were submitted to bariatric/metabolic surgery, among which, 22 experienced complete remission of T2D, and 11 did not experience remission in the postoperative period. Blood samples were taken in order to assess the serum profiles through a 1H NMR-based metabonomic study.

RESULTS

The metabonomic model for the assessment of T2D recurrence presented an accuracy of 93.9%, sensibility of 81.8%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 91.7%.

CONCLUSION

bariatric surgery provide specific effects on the distribution of metabolites in those patients who achieved remission of T2DM, and this new distribution can be assessed through a metabonomic model.

Validation of the two-minute step test in obese with comorbibities and morbidly obese patients

Cardiopulmonary fitness assessment is a valuable resource to obtain quantitative indicators of an individual's physical performance. The cardiopulmonary exercise test (CPX), considered the gold standard test for this evaluation, is costly and difficult to be accessed by the general population. In order to make this evaluation more accessible, and to better reflect the performance of daily life activities, alternative tests were proposed. Morbidly obese patients present limitations that impair physical performance assessment and could benefit from a test of shorter duration, provided it is validated. This observational study aimed to validate the two-minute step test (2MST) as a tool to evaluate functional capacity (FC) in obese with comorbidities and morbidly obese patients, compared the 2MST with CPX as a measure of physical performance, and developed a predictive equation to estimate peak oxygen uptake (VO₂) in the 2MST. The CPX and the 2MST were performed and metabolic and ventilatory parameters were recorded in 31 obese individuals (BMI>35 kg/m²). Pearson correlation and multiple linear regression analyses were performed to evaluate the peak VO₂ best predictors. Bland-Altman analysis was performed to assess the agreement between the two methods. Peak VO₂ measured by CPX and 2MST showed a strong correlation (r=0.70, P<0.001) and there was a moderate correlation between peak VO₂ of the 2MST and the number of up-and-down step cycles (UDS) (r=0.55; P=0.01). The reference equation obtained was: VO₂ (mL·kg^-1·min^-1) = 13.341 + 0.138 × total UDS – (0.183 × BMI), with an estimated standard error of 1.3 mL·kg^-1·min^-1. The 2MST is a viable, practical, and easily accessible test for FC. UDS and BMI can predict peak VO₂ satisfactorily.

INTERNAL HERNIA FOLLOWING LAPAROSCOPIC ROUX-EN-Y GASTRIC BY-PASS: INDICATIVE FACTORS FOR EARLY REPAIR

BACKGROUND

Internal hernia (IH) following laparoscopic Roux-en-Y gastric bypass (LRYGB) is a major complication that challenges the surgeon due to its non-specific presentation and necessity of early repair. Delayed diagnosis and surgical intervention of IH might lead to increased morbidity of patients and impairments in their quality of life.

OBJECTIVE

To evaluate the predictive factors for early diagnosis and surgical repair of IH after LRYGB.

METHODS

This study analyzed 38 patients during the postoperative period of LRYGB who presented clinical manifestations suggestive of IH after an average of 24 months following the bariatric procedure.

RESULTS

The sample consisted of 10 men and 28 women, with a mean age of 37.5 years and a mean body mass index (BMI) of 39.6 kg/m2 before LRYGB. All patients presented pain, 23 presented abdominal distension, 10 had nausea and 12 were vomiting; three of them had dysphagia, three had diarrhea and one had gastro-esophageal reflux. The patients presented symptoms for an average of 15 days, varying from 3 to 50 days. Seventeen (45.9%) patients were seen once, while the other 20 (54.1%) went to the emergency room twice or more times. Exploratory laparoscopy was performed on all patients, being converted to laparotomy in three cases. Petersen hernia was confirmed in 22 (57.9%). Petersen space was closed in all patients and the IH correction was performed in 20 (52.6%) cases. The herniated loop showed signs of vascular suffering in seven patients, and two (5.3%) had irreversible ischemia, requiring bowel resection.

CONCLUSION

The presence of recurrent abdominal pain is one of the main indicators for the diagnosis of IH after LRYGB. Patients operated at an early stage, even with negative imaging tests for this disease, benefited from rapid and simple procedures without major complications.

Bariatric surgery and the coronary artery calcium score

OBJECTIVE

to investigate the impact of bariatric surgery on the coronary artery calcium score (CACS), and to establish predictors of progression of this score in patients with obesity.

METHODS

prospective study that evaluated 18 obese patients before and after bariatric surgery. All patients were submitted to computed tomography scans and blood tests (total cholesterol, LDL, HDL, triglycerides, fasting plasma glucose, A1C, insulin, serum calcium, C-peptide and C-Reactive Protein) in order to determine CACS and Framingham risk score (FRS).

RESULTS

the FRS decreased 50% between the pre and postoperative evaluations. The mean CACS increased significantly at the late postoperative period, going from 8.5 to 33.1. HDL levels had also increased between the pre and postoperative periods. All of the other quantitative variables reduced significantly at the postoperative evaluation. When dividing CACS into four degrees, it was observed that 22.2% presented CACS=0 at the postoperative evaluation. The prevalence of mild CACS decreased from 77.8% to 50%, while moderate CACS remained the same (11.1%). Severe CACS increased from 11.1% to 16.7%. Older ages were linked to CACS progression, and this was the only variable that presented statistical association with progression.

CONCLUSION

bariatric surgery leads to positive cardiovascular outcomes, apparently regardless of CACS.