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Zuberi S, Egiz A, Iqbal H, Jambulingam P, Whitelaw D, Adil T, Jain V, Al-Taan O, Munasinghe A, Askari A, Aly MK, Iqbal FM. Characterizing barriers and facilitators of metabolic bariatric surgery tourism: a systematic review. Br J Surg 2024; 111:znae060. [PMID: 38547416 DOI: 10.1093/bjs/znae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/25/2024] [Accepted: 02/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Metabolic bariatric surgery tourism continues to rise and has become a growing concern for bariatric surgeons globally. With varying degrees of regulation, counselling and success, those that develop complications may have to deal with a multitude of challenges often distant from their country of operation. The aim of this study was to characterize the barriers and facilitators influencing individuals to undergo metabolic bariatric surgery tourism, in order to better understand the implications to the National Health Service and other healthcare systems. METHODS A systematic literature search, restricted to the English language, was performed to identify relevant studies. All studies were included until December 2022, the last search date. Study quality was assessed with the validated mixed-methods appraisal tool. A Braun and Clarke thematic analysis was undertaken to identify themes and subthemes. RESULTS A total of five studies met the inclusion criteria. Identified themes included: availability, accessibility, cost, eligibility, reputation, and stigma; the available evidence was of varying quality. CONCLUSION This work identifies a series of subthemes influencing the decision to undertake metabolic bariatric surgery tourism. The results highlight the limited literature available in understanding the complex motivational insights; the scale of the problem in the current healthcare system; cost and long-term outcomes. A National Emergency Bariatric Surgery audit would allow generation of more robust data to explore further the issues of clinical relationships and networks and to guide policy making.
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Affiliation(s)
- Sharukh Zuberi
- Department of General Surgery, Luton & Dunstable Hospital, Luton, UK
| | - Abdullah Egiz
- Department of General Surgery, Luton & Dunstable Hospital, Luton, UK
| | - Hasan Iqbal
- Department of General Surgery, Luton & Dunstable Hospital, Luton, UK
| | | | - Douglas Whitelaw
- Department of General Surgery, Luton & Dunstable Hospital, Luton, UK
| | - Tanveer Adil
- Department of General Surgery, Luton & Dunstable Hospital, Luton, UK
| | - Vigyan Jain
- Department of General Surgery, Luton & Dunstable Hospital, Luton, UK
| | - Omar Al-Taan
- Department of General Surgery, Luton & Dunstable Hospital, Luton, UK
| | - Aruna Munasinghe
- Department of General Surgery, Luton & Dunstable Hospital, Luton, UK
| | - Alan Askari
- Department of General Surgery, Luton & Dunstable Hospital, Luton, UK
| | - Mohamed K Aly
- Department of General Surgery, The Hillingdon Hospital, London, UK
| | - Fahad M Iqbal
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
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Antia A, Evbayeka E, Okorare O, Ubokudom D, Gbegbaje O, Daniel E. Impact of Bariatric Surgery on the Prevalence and Outcomes of Atrial Fibrillation in Obese Patients. Curr Probl Cardiol 2024; 49:102083. [PMID: 37717860 DOI: 10.1016/j.cpcardiol.2023.102083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
Obesity has been identified as a significant factor contributing to the development of numerous cardiovascular conditions and as a result, the cardiovascular community has prioritized efforts to address obesity and reduce its associated risks. However, despite these efforts, the prevalence of obesity continues to rise steadily, and is projected to double in the upcoming years. Atrial fibrillation is among the most prevalent and extensively researched cardiovascular comorbidities associated with obesity. Several mechanisms have been postulated, including scar tissue formation and fat deposition, which ultimately leads to atrial remodeling and subsequent arrhythmogenesis. Numerous strategies have been implemented to prevent and manage obesity, encompassing lifestyle adjustments, dietary modifications, pharmacological treatments, and surgical interventions. Bariatric surgery has garnered significant recognition over the years due to its promising outcomes, including a decrease in the overall prevalence of atrial fibrillation and other cardiovascular comorbidities in general in obese patients. This study focuses on the current trends regarding the impact of bariatric surgery on obese patients with atrial fibrillation.
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Affiliation(s)
- Akanimo Antia
- Department of Medicine, Lincoln Medical Center, Bronx, New York, United States of America.
| | - Endurance Evbayeka
- Department of Medicine, St. Luke's Hospital, St. Louis, Missouri, United States of America
| | - Ovie Okorare
- Department of Medicine, Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, New York, United States of America
| | - Daniel Ubokudom
- Department of Medicine, Thomas Hospital, Fairhope, Alabama, United States of America
| | - Oghenetejiri Gbegbaje
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, United States of America
| | - Emmanuel Daniel
- Department of Medicine, Trinity Health Ann Arbor, Ypsilanti, Michigan, United States of America
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Gala K, Brunaldi V, McGowan C, Sharaiha RZ, Maselli D, Vanderwel B, Kedia P, Ujiki M, Wilson E, Vargas EJ, Storm AC, Abu Dayyeh BK. Performance of Endoscopic Sleeve Gastroplasty by Obesity Class in the United States Clinical Setting. Clin Transl Gastroenterol 2024; 15:e00647. [PMID: 37787450 PMCID: PMC10810569 DOI: 10.14309/ctg.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Endoscopic sleeve gastroplasty (ESG) has gained popularity over the past decade and has been adopted in both academic and private institutions globally. We present outcomes of the largest cohort of patients from the United States undergoing ESG and evaluate these according to obesity class. METHODS We performed a retrospective analysis of adult patients who underwent ESG. Medical information was abstracted from the electronic record with weight records up to 2 years after ESG. Percent total body weight loss (%TBWL) at 6, 12, 18, and 24 months was calculated based on baseline weight at the procedure. SPSS (version 29.0) was used for all statistical analyses. RESULTS A total of 1,506 patients from 7 sites were included (501 Class I obesity, 546 Class II, and 459 Class III). Baseline demographics differed according to obesity class due to differences in age, body mass index (BMI), height, sex distribution, and race. As early as 6 months post-ESG, mean BMI for each class dropped to the next lower class and remained there through 2 years. %TWBL achieved in the Class III group was significantly greater when compared with other classes at all time points. At 12 months, 83.2% and 60.9% of patients had ≥10% and ≥15% TBWL for all classes. There were no differences in adverse events between classes. DISCUSSION Real-world data from a large cohort of patients of all BMI classes across the United States shows significant and sustained weight loss with ESG. ESG is safe to perform in a higher obesity class with acceptable midterm efficacy.
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Affiliation(s)
- Khushboo Gala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vitor Brunaldi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | | | | | | | - Michael Ujiki
- NorthShore University Health System, Evanston, Illinois, USA
| | - Eric Wilson
- University of Texas Health Science Center-Houston, Houston, Texas, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Qiu W, Hutch CR, Wang Y, Wloszek J, Rucker RA, Myers MG, Sandoval D. Multiple NTS neuron populations cumulatively suppress food intake. eLife 2023; 12:e85640. [PMID: 38059498 PMCID: PMC10781422 DOI: 10.7554/elife.85640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/05/2023] [Indexed: 12/08/2023] Open
Abstract
Several discrete groups of feeding-regulated neurons in the nucleus of the solitary tract (nucleus tractus solitarius; NTS) suppress food intake, including avoidance-promoting neurons that express Cck (NTSCck cells) and distinct Lepr- and Calcr-expressing neurons (NTSLepr and NTSCalcr cells, respectively) that suppress food intake without promoting avoidance. To test potential synergies among these cell groups, we manipulated multiple NTS cell populations simultaneously. We found that activating multiple sets of NTS neurons (e.g. NTSLepr plus NTSCalcr [NTSLC], or NTSLC plus NTSCck [NTSLCK]) suppressed feeding more robustly than activating single populations. While activating groups of cells that include NTSCck neurons promoted conditioned taste avoidance (CTA), NTSLC activation produced no CTA despite abrogating feeding. Thus, the ability to promote CTA formation represents a dominant effect but activating multiple non-aversive populations augments the suppression of food intake without provoking avoidance. Furthermore, silencing multiple NTS neuron groups augmented food intake and body weight to a greater extent than silencing single populations, consistent with the notion that each of these NTS neuron populations plays crucial and cumulative roles in the control of energy balance. We found that silencing NTSLCK neurons failed to blunt the weight-loss response to vertical sleeve gastrectomy (VSG) and that feeding activated many non-NTSLCK neurons, however, suggesting that as-yet undefined NTS cell types must make additional contributions to the restraint of feeding.
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Affiliation(s)
- Weiwei Qiu
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States
| | - Chelsea R Hutch
- Department of Surgery, University of Michigan, Ann Arbor, United States
| | - Yi Wang
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States
| | - Jennifer Wloszek
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, United States
| | - Rachel A Rucker
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, United States
| | - Martin G Myers
- Department of Internal Medicine, University of Michigan, Ann Arbor, United States
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, United States
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, United States
| | - Darleen Sandoval
- Department of Pediatrics, University of Colorado, Aurora, United States
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Butler LR, Chen KA, Hsu J, Kapadia MR, Gomez SM, Farrell TM. Predicting readmission after bariatric surgery using machine learning. Surg Obes Relat Dis 2023; 19:1236-1244. [PMID: 37455158 DOI: 10.1016/j.soard.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND While bariatric surgery is an effective method for achieving long-term weight loss, postoperative readmissions are associated with negative clinical outcomes and significant costs. OBJECTIVES We aimed to use machine learning (ML) algorithms to predict readmissions and compare results to logistic regression. SETTING Hospitals participating in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, United States. METHODS Patients who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch between 2016 and 2020 were selected from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Patient variables reported by the MBSAQIP database were analyzed by ML algorithms random forest (RF), gradient boosting (XGB), and deep neural networks (NN), and the results of the predictive models were compared to logistic regression using area under the receiver operating characteristic curve (AUROC). RESULTS Our study included 863,348 patients, of which 39,068 (4.52%) were readmitted. AUROC scores were XGB .785 (95% CI .784-.786), RF .785 (95% CI .784-.785), and NN .754 (95% CI .753-.754), compared with .62 (95% CI .62-.621) for logistic regression (LR) (P < .001). The sensitivity and specificity for XGB, the best performing model, were 73.81% and 70%, compared with 52.94% and 70% for logistic regression. The most important variables were intervention or reoperation prior to discharge, unplanned ICU admission, initial procedure, and the intraoperative transfusion. CONCLUSIONS ML demonstrates significant advantages over logistic regression when predicting 30-day readmission following bariatric surgery. With external validation, models could identify the best candidates for early discharge or targeted postdischarge resources.
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Affiliation(s)
- Logan R Butler
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Kevin A Chen
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Justin Hsu
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shawn M Gomez
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hoyt T, Walter FA, Michl TM. Psychological Profiles and 12-Month Weight Outcomes of Women Evaluated for Reoperative Bariatric Surgery. Obes Surg 2023:10.1007/s11695-023-06583-6. [PMID: 37061626 DOI: 10.1007/s11695-023-06583-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The use of psychological screening instruments prior to bariatric surgery has been well established. However, there is currently no specific literature on psychological screening of candidates for reoperative bariatric surgery. METHODS This study evaluated archival data for 40 women who were candidates for reoperative bariatric surgery and completed the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). Profile analysis examined differences between patient groups who did and did not undergo reoperative surgery. MMPI-2-RF profiles for reoperative patients then were compared to previous samples of preoperative and postoperative patients. Hierarchical linear modeling was used to predict BMI following reoperative surgery over a 12-month period based on MMPI-2-RF scales while controlling for age and initial BMI. RESULTS Profile analysis results showed no significant differences on MMPI-2-RF scale scores between reoperative candidates who did and did not undergo a second surgery. With some minor differences attributed to minimization of symptoms, there were no systematic differences in MMPI-2-RF scale scores for reoperative surgery patients compared to preoperative and postoperative patient groups. BMI outcomes over a 12-month period showed that age and initial BMI were significantly better predictors than MMPI-2-RF scores. CONCLUSIONS Administration of MMPI-2-RF for reoperative bariatric surgery patients likely is equivalent to its typical use in preoperative screening. Only the MMPI-2-RF Disconstraint scale showed any relationship to BMI outcomes over time following reoperative surgery.
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Affiliation(s)
- Tim Hoyt
- Madigan Army Medical Center, 9040 Fitzsimmons Dr, Tacoma, WA, 98431, USA.
- Office of Force Resiliency, 4000 Defense Pentagon, Washington, DC, 20301-4000, USA.
| | - Fawn A Walter
- Madigan Army Medical Center, 9040 Fitzsimmons Dr, Tacoma, WA, 98431, USA
| | - Tegan M Michl
- Madigan Army Medical Center, 9040 Fitzsimmons Dr, Tacoma, WA, 98431, USA
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7
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Lorenz FJ, Goldenberg D. Hypocalcemia after parathyroidectomy in patients with a history of bariatric surgery. Endocrine 2023; 79:571-576. [PMID: 36305997 DOI: 10.1007/s12020-022-03234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE A growing body of literature has suggested that a history of bariatric surgery increases the risk of hypocalcemia after subsequent thyroidectomy, however little is known about the risk after parathyroidectomy. The purpose of this study was to determine the incidence of hypocalcemia after parathyroidectomy in patients with prior bariatric surgery. METHODS The TriNetX Research Network was queried using diagnosis and procedure codes to identify patients with a history of bariatric surgery who were subsequently diagnosed with primary hyperparathyroidism (PHP) and underwent parathyroidectomy between 2012 and 2022. The rate of hypocalcemia after parathyroidectomy was compared between those with a history of bariatric surgery and controls who underwent parathyroidectomy alone, matched for demographics, body mass index (BMI) ≥ 30 kg/m2, and history of calcium or vitamin D supplementation. RESULTS There were 34,483 included patients diagnosed with PHP who underwent parathyroidectomy. Of this cohort, 1.4% (n = 472) had prior bariatric surgery. There were 90% females and 10% males in this subset of patients, and the average age was 58 years. Compared to matched controls who underwent parathyroidectomy alone, these patients had a significantly increased risk of hypocalcemia within 0-1 month (RR, 95% CI, P) (17.2% vs. 9.3%; 1.8, 1.3-2.6, P < 0.001), 1-6 months (8.5% vs. 2.5%; 3.3, 1.8-6.3, P < 0.001) and 6-12 months (6.8% vs. 2.3%; 2.9, 1.5-5.7, P < 0.001) following surgery. CONCLUSION The current study is the first to indicate that patients with a history of bariatric surgery are at increased risk for short-term and permanent hypocalcemia after parathyroidectomy. Further research is required to determine optimal prevention and treatment strategies to decrease associated morbidity in this subset of patients.
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Affiliation(s)
- F Jeffrey Lorenz
- College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - David Goldenberg
- Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, PA, USA.
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8
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Mitsakos AT, Irish W, DeMaria EJ, Pories WJ, Altieri MS. Body mass index and risk of mortality in patients undergoing bariatric surgery. Surg Endosc 2023; 37:1213-1221. [PMID: 36156736 DOI: 10.1007/s00464-022-09651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prior literature has demonstrated that bariatric surgery is a safe approach for patients with morbid obesity. However, the relationship between body mass index (BMI) and risk of mortality in these patients has not been fully elucidated. Primary objective of this study was to evaluate the relationship between BMI and risk of mortality using data obtained from a national database, with a special focus on patients with BMI ≥ 70.0 kg/m2. METHODS A retrospective cohort study of patients with morbid obesity (BMI ≥ 40 kg/m2) undergoing first-time bariatric surgery between 2015 and 2018 was performed using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Primary outcome was intra-operative death or death within 30 days post-operatively. Patients were categorized into quartiles according to BMI. Multivariable analysis was performed to evaluate the association of BMI with risk of mortality. Relative risk (RR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively. RESULTS A total of 463, 436 patients were included with a 30-day mortality rate of 0.11%. Mean BMI (SD) was 48.2 (7.3) kg/m2; 1.5% of patients had BMI ≥ 70.0 kg/m2. On multivariable analysis, highest quartile patients had a significantly higher risk of mortality than lowest quartile patients. For patients with BMI ≥ 70.0 kg/m2, the risk of mortality was more pronounced with an eightfold increase compared to the lowest quartile. In patients with BMI ≥ 70.0 kg/m2, although sleeve gastrectomy (SG) was the most common procedure, the risk of mortality was significantly higher in patients undergoing Roux-en-Y gastric bypass (RYGB). CONCLUSIONS BMI is associated with increased risk of 30-day mortality. The effect of BMI is more pronounced in patients with BMI ≥ 70.0 kg/m2. In these patients, RYGB is associated with increased risk of mortality compared to SG.
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Affiliation(s)
- Anastasios T Mitsakos
- Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA. .,Department of Surgery, Vidant Medical Center, East Carolina University Brody School of Medicine, 2100 Stantonsburg Road, Greenville, NC, 27834, USA.
| | - William Irish
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Eric J DeMaria
- Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Walter J Pories
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Maria S Altieri
- Department of Surgery, Section of GI Surgery, Pennsylvania Hospital/University of Pennsylvania, Philadelphia, PA, USA
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Yu Y, Groth SW. Risk factors of lower birth weight, small-for-gestational-age infants, and preterm birth in pregnancies following bariatric surgery: a scoping review. Arch Gynecol Obstet 2023; 307:343-378. [PMID: 35332360 DOI: 10.1007/s00404-022-06480-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/17/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Bariatric surgery increases the risk of lower birth weight, small-for-gestational-age (SGA) infants, and preterm birth in a subsequent pregnancy. However, the factors that contribute to these adverse birth outcomes are unclear. This review aimed to collate available information about risk factors of lower birth weight, SGA, and preterm birth following bariatric surgery. METHODS A literature search was conducted using five databases (PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library) to obtain relevant studies. RESULTS A total number of 85 studies were included. Studies generally excluded surgery-to-conception interval, pregnancy complications, cigarette use, and maternal age as influencing factors of birth weight, SGA, or preterm birth. In contrast, most studies found that malabsorptive procedures, lower gestational weight gain, lower glucose levels, abdominal pain, and insufficient prenatal care were associated with an elevated risk of adverse birth outcomes. Findings were mixed regarding the effects of surgery-to-conception weight loss, pre-pregnancy body mass index, micronutrient deficiency, and lipid levels on birth outcomes. The examination of maternal microbiome profiles, placental function, alcohol use, and exercise was limited to one study; therefore, no conclusions could be made. CONCLUSION This review identified factors that appear to be associated (e.g., surgery type) or not associated (e.g., surgery-to-conception interval) with birth outcomes following bariatric surgery. The mixed findings and the limited number of studies on several variables (e.g., micronutrients, exercise) highlight the need for further investigation. Additionally, future studies may benefit from exploring interactions among risk factors and expanding to assess additional exposures such as maternal mental health.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Susan W Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Drewnowski A, Hong BD, Shen E, Ji M, Paz SR, Bhakta BB, Macias M, Crawford CL, Lewis KH, Liu J, Moore DD, Murali SB, Young DR, Coleman KJ. Neighborhood deprivation and residential property values do not affect weight loss at 1 or 3 years after bariatric surgery. Obesity (Silver Spring) 2023; 31:545-552. [PMID: 36627742 PMCID: PMC9877110 DOI: 10.1002/oby.23623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study examined the association between individual- and neighborhood-level sociodemographic factors and surgical weight loss at 1 year (short term) and 3 years (long term). METHODS Data were obtained from the baseline survey of the BELONG (Bariatric Experience Long Term) prospective longitudinal cohort study. Individual-level self-reported data on sex, race and ethnicity, education, and household income were obtained by survey. Data from the 2010 US Census were used to calculate area Neighborhood Deprivation Index score and median value of owner-occupied housing units at the census tract level. RESULTS Patients (N = 1341) had a mean age of 43.4 (SD 11.3) years, were mostly female (86%), were mostly Black or Hispanic (52%), had some college education (83%), and had annual household incomes ≥$51,000 (55%). Percentage total weight loss was 25.8% (SD 9.0%) at year 1 and 22.2% (SD 10.5%) at year 3. Race and ethnicity and age were significant predictors of weight loss at 1 and 3 years with a small effect of self-reported household income at year 1. There were no significant associations between census tract-level Neighborhood Deprivation Index score or value of owner-occupied housing units and weight loss at either time point. CONCLUSIONS Health systems could improve the chances of weight-loss maintenance after surgery by addressing factors related to racial and ethnic disparities and to income disparities.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA
| | - Benjamin D. Hong
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Ernest Shen
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, FL
| | - Silvia R. Paz
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Bhumi B. Bhakta
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Mayra Macias
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Cecelia L. Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, CA
| | - Kristina H. Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, NC
| | - Jialuo Liu
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Darren D. Moore
- Marriage and Family Therapy Program, The Family Institute, Northwestern University, Evanston, IL
| | - Sameer B. Murali
- Center for Obesity Medicine & Metabolic Performance, Department of Surgery, University of Texas McGovern Medical School, Houston, Texas
| | - Deborah R. Young
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Karen J. Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
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11
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Osińska M, Towpik I, Sanchak Y, Franek E, Śliwczyński A, Walicka M. Cost of Surgical Treatment of Obesity and Its Impact on Healthcare Expense-Nationwide Data from a Polish Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1118. [PMID: 36673873 PMCID: PMC9859611 DOI: 10.3390/ijerph20021118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
Weight loss surgery is linked to health benefits and may reduce the cost to the public healthcare systems. The aim of this study was to assess the cost and cost-structure in the one-year periods before and after a bariatric surgery in the Polish nationwide registry. The study included 2390 obese adults which underwent surgical treatment for obesity in 2017. The cost structure and the total costs per patient for one year before bariatric surgery, preoperatively, and for one year after surgery were analyzed. The total cost of the postoperative period was about PLN 3 million lower than during the preoperative period. After bariatric surgery, a reduction of approximately 59% in costs associated with hospital treatment was observed. The costs of outpatient specialist services, hospital treatment, psychiatric care, and addiction treatment also significantly decreased. There was a negative correlation between the changes in the cost of treatment of patients undergoing obesity surgery and their age. The health care cost during the period of one year after bariatric surgery is lower than in the year preceding the surgery (a greater cost difference is observed in younger people). This is mainly influenced by the reduction in costs associated with hospital treatment.
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Affiliation(s)
- Magdalena Osińska
- Department of Internal Diseases, Endocrinology and Diabetology, National Medical Institute of the Ministry of the Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
| | - Iwona Towpik
- Department of Internal Diseases, Diabetology, and Endocrinology, Collegium Medicum, University of Zielona Góra, 28 Zyty Str., 65-046 Zielona Góra, Poland
| | - Yaroslav Sanchak
- Department of Internal Diseases, Endocrinology and Diabetology, National Medical Institute of the Ministry of the Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
| | - Edward Franek
- Department of Internal Diseases, Endocrinology and Diabetology, National Medical Institute of the Ministry of the Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
- Department of Human Epigenetics, Mossakowski Medical Research Institute, 5 Pawińskiego Str., 02-106 Warsaw, Poland
| | - Andrzej Śliwczyński
- Faculty of Medicine, Lazarski University, 43 Świeradowska Str., 02-662 Warsaw, Poland
| | - Magdalena Walicka
- Department of Internal Diseases, Endocrinology and Diabetology, National Medical Institute of the Ministry of the Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
- Department of Human Epigenetics, Mossakowski Medical Research Institute, 5 Pawińskiego Str., 02-106 Warsaw, Poland
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12
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Rogers AM, Pauli EM. Is endoscopic sleeve gastroplasty ready for prime time? Gastrointest Endosc 2023; 97:22-24. [PMID: 36333126 DOI: 10.1016/j.gie.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ann M Rogers
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Eric M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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13
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Le Jemtel TH, Samson R, Oparil S. Integrated Care Model of Adiposity-Related Chronic Diseases. Curr Hypertens Rep 2022; 24:563-570. [PMID: 36083439 DOI: 10.1007/s11906-022-01223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Although obesity is a disease, most patients with obesity do not undergo effective treatment nor adhere to long-term care. We examine the barriers that patients with obesity confront when searching for effective treatment and propose an integrated care model of adiposity-related chronic diseases in a cardio-renal metabolic unit. RECENT FINDINGS The current care of obesity is fragmented between primary care providers, medical specialists and metabolic bariatric surgeons with little or no coordination of care between these providers. The current care of obesity heavily focuses on weight loss as the primary aim of treatment thereby reenforcing the weight stigma and turning patients away from effective therapy like metabolic bariatric surgery. An interdisciplinary cardio-renal metabolic unit that, besides weight loss, emphasizes prevention/remission of adiposity-related chronic diseases may deliver thorough and rewarding care to most patients with obesity.
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Affiliation(s)
- Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Lorenz FJ, Tucker J, Milarachi EN, Hearn M, King TS, Goldenberg D. Hypocalcemia After Thyroidectomy in Patients with Prior Bariatric Surgery: A Propensity Score Matched Analysis from a National Administrative Database. Thyroid 2022; 32:1382-1391. [PMID: 35994392 PMCID: PMC9836677 DOI: 10.1089/thy.2022.0312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Studies have suggested that patients with prior gastric bypass may be at increased risk for hypocalcemia following thyroidectomy. Unfortunately, most of these studies are limited to case reports and small series. This study represents the largest sample size to date to assess the incidence of post-thyroidectomy hypocalcemia in patients with a history of bariatric surgery. Methods: The TriNetX Research Network was queried to retrospectively identify patients with prior bariatric surgery who underwent total thyroidectomy between 2011 and 2021. The incidence of hypocalcemia following surgery was compared with patients who underwent total thyroidectomy, and hemithyroidectomy with no history of bariatric surgery. Results: We identified 446 patients with a history of bariatric surgery and subsequent thyroidectomy, 29,346 patients with total thyroidectomy, and 19,603 patients with hemithyroidectomy alone. The one-month incidence of hypocalcemia was 54.7% in those with a history of bariatric surgery who underwent thyroidectomy, 43.9% in those with thyroidectomy alone (relative risk, RR = 1.2 [confidence interval, CI 1.1-1.4], p < 0.001), and 8.1% in those with hemithyroidectomy only (RR = 6.8 [CI 6.1-7.4], p < 0.001). Permanent hypocalcemia was documented in 11.4% of patients with prior bariatric surgery who underwent thyroidectomy, 7.7% of those with thyroidectomy only (RR = 1.5 [CI 1.1-1.9], p = 0.003), and 2.9% of patients with hemithyroidectomy alone (RR = 3.9 [CI 3.0-5.2], p < 0.001). Significant differences persisted after matching demographics, prior need for supplementation, and risk factors for hypocalcemia after thyroidectomy. When stratified by bariatric procedure, patients with a history of Roux-en-Y gastric bypass (RYGB) (n = 35) had a greater, although not statistically significant, risk of short-term hypocalcemia (51.4%; RR = 1.2 [CI 0.8-1.6], p = 0.37), and a significantly increased risk of permanent hypocalcemia (20.0%; RR = 2.6 [CI 1.3-5.1], p = 0.005) compared with thyroidectomy alone. Sleeve gastrectomy (SG) (n = 40) was not associated with an increased risk of short-term (40.0%; RR = 0.9 [CI 0.6-1.3], p = 0.62) or permanent (7.5%; RR = 1.0 [CI 0.3-2.9], p = 0.96) hypocalcemia. Conclusions: Prior RYGB, but not SG, may increase the risk of permanent hypocalcemia after thyroidectomy. Additional research is necessary to determine optimal prevention and treatment strategies to reduce morbidity in this population.
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Affiliation(s)
- F. Jeffrey Lorenz
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jacqueline Tucker
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Emily Nicole Milarachi
- Department of Otolaryngology–Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Madison Hearn
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Tonya Sharp King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - David Goldenberg
- Department of Otolaryngology–Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
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15
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Coleman KJ, Paz SR, Bhakta BB, Taylor B, Liu J, Yoon TK, Macias M, Arterburn DE, Crawford CL, Drewnowksi A, Figueroa Gray MS, Hansell LD, Ji M, Lewis KH, Moore DD, Murali SB, Young DR. Cohort profile: The Bariatric Experience Long Term (BELONG): a long-term prospective study to understand the psychosocial, environmental, health and behavioural predictors of weight loss and regain in patients who have bariatric surgery. BMJ Open 2022; 12:e059611. [PMID: 35613770 PMCID: PMC9125764 DOI: 10.1136/bmjopen-2021-059611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The Bariatric Experience Long Term (BELONG) prospective study cohort was created to address limitations in the literature regarding the relationship between surgical weight loss and psychosocial, health, behaviour and environmental factors. The BELONG cohort is unique because it contains 70% gastric sleeve and 64% patients with non-white race/ethnicity and was developed with strong stakeholder engagement including patients and providers. PARTICIPANTS The BELONG cohort study included 1975 patients preparing to have bariatric surgery who completed a baseline survey in a large integrated health system in Southern California. Patients were primarily women (84%), either black or Hispanic (59%), with a body mass index (BMI) of 45.1±7.4 kg/m2, age 43.3±11.5 years old, and 32% had at least one comorbidity. FINDINGS TO DATE A total of 5552 patients were approached before surgery between February 2016 and May 2017, and 1975 (42%) completed a baseline survey. A total of 1203 (73%) patients completed the year 1 and 1033 (74%) patients completed the year 3 postoperative survey. Of these survey respondents, 1341 at baseline, 999 at year 1, and 951 at year 3 were included in the analyses of all survey and weight outcome data. A total of 803 (60% of eligible patients) had survey data for all time points. Data collected were self-reported constructs to support the proposed theoretical model. Height, weight and BMI were abstracted from the electronic medical record to obtain the main outcomes of the study: weight loss and regain. FUTURE PLANS We will collect self-reported constructs and obtain height, weight and BMI from the electronic medical record 5 years after bariatric surgery between April 2022 and January 2023. We will also collect patient experiences using focus groups of 8-12 patients each throughout 2022.
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Affiliation(s)
- Karen J Coleman
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Silvia R Paz
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bhumi B Bhakta
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Brianna Taylor
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jialuo Liu
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Tae K Yoon
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Mayra Macias
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - David E Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Cecelia L Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Adam Drewnowksi
- Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| | | | - Laurel D Hansell
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Kristina H Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Darren D Moore
- Marriage and Family Therapy Program, The Family Institute, Northwestern University, Evanston, Illinois, USA
| | - Sameer B Murali
- Center for Obesity Medicine & Metabolic Performance, Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Deborah R Young
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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16
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Neurohormonal Changes in the Gut–Brain Axis and Underlying Neuroendocrine Mechanisms following Bariatric Surgery. Int J Mol Sci 2022; 23:ijms23063339. [PMID: 35328759 PMCID: PMC8954280 DOI: 10.3390/ijms23063339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 02/05/2023] Open
Abstract
Obesity is a complex, multifactorial disease that is a major public health issue worldwide. Currently approved anti-obesity medications and lifestyle interventions lack the efficacy and durability needed to combat obesity, especially in individuals with more severe forms or coexisting metabolic disorders, such as poorly controlled type 2 diabetes. Bariatric surgery is considered an effective therapeutic modality with sustained weight loss and metabolic benefits. Numerous genetic and environmental factors have been associated with the pathogenesis of obesity, while cumulative evidence has highlighted the gut–brain axis as a complex bidirectional communication axis that plays a crucial role in energy homeostasis. This has led to increased research on the roles of neuroendocrine signaling pathways and various gastrointestinal peptides as key mediators of the beneficial effects following weight-loss surgery. The accumulate evidence suggests that the development of gut-peptide-based agents can mimic the effects of bariatric surgery and thus is a highly promising treatment strategy that could be explored in future research. This article aims to elucidate the potential underlying neuroendocrine mechanisms of the gut–brain axis and comprehensively review the observed changes of gut hormones associated with bariatric surgery. Moreover, the emerging role of post-bariatric gut microbiota modulation is briefly discussed.
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17
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Bohm MS, Sipe LM, Pye ME, Davis MJ, Pierre JF, Makowski L. The role of obesity and bariatric surgery-induced weight loss in breast cancer. Cancer Metastasis Rev 2022; 41:673-695. [PMID: 35870055 PMCID: PMC9470652 DOI: 10.1007/s10555-022-10050-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/06/2022] [Indexed: 02/07/2023]
Abstract
Obesity is a complex metabolic condition considered a worldwide public health crisis, and a deeper mechanistic understanding of obesity-associated diseases is urgently needed. Obesity comorbidities include many associated cancers and are estimated to account for 20% of female cancer deaths in the USA. Breast cancer, in particular, is associated with obesity and is the focus of this review. The exact causal links between obesity and breast cancer remain unclear. Still, interactions have emerged between body mass index, tumor molecular subtype, genetic background, and environmental factors that strongly suggest obesity influences the risk and progression of certain breast cancers. Supportive preclinical research uses various diet-induced obesity models to demonstrate that weight loss, via dietary interventions or changes in energy expenditure, reduces the onset or progression of breast cancers. Ongoing and future studies are now aimed at elucidating the underpinning mechanisms behind weight-loss-driven observations to improve therapy and outcomes in patients with breast cancer and reduce risk. This review aims to summarize the rapidly emerging literature on obesity and weight loss strategies with a focused discussion of bariatric surgery in both clinical and preclinical studies detailing the complex interactions between metabolism, immune response, and immunotherapy in the setting of obesity and breast cancer.
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Affiliation(s)
- Margaret S. Bohm
- Department of Microbiology, Immunology, and Biochemistry, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - Laura M. Sipe
- Division of Hematology and Oncology, Department of Medicine, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - Madeline E. Pye
- Division of Hematology and Oncology, Department of Medicine, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - Matthew J. Davis
- Division of Bariatric Surgery, Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - Joseph F. Pierre
- Department of Microbiology, Immunology, and Biochemistry, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163 USA ,Department of Nutritional Sciences, College of Agriculture and Life Science, The University of Wisconsin-Madison, Madison, WI 53706 USA
| | - Liza Makowski
- Department of Microbiology, Immunology, and Biochemistry, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163 USA ,Division of Hematology and Oncology, Department of Medicine, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163 USA ,Department of Pharmaceutical Sciences, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN 38163 USA ,College of Medicine, UTHSC Center for Cancer Research, The University of Tennessee Health Science Center, Cancer Research Building Room 322, 19 S Manassas Street, Memphis, TN 38163 USA
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