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Cao Y, Luo P, Tang H, Li P, Wang G, Li W, Song Z, Su Z, Sun X, Yi X, Fu Z, Cui B, Zhu S, Zhu L. Insulin resistance levels predicted metabolic improvement and weight loss after metabolic surgery in Chinese patients with type 2 diabetes. Surg Obes Relat Dis 2024; 20:80-90. [PMID: 37739868 DOI: 10.1016/j.soard.2023.08.004] [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] [Received: 06/04/2023] [Revised: 07/12/2023] [Accepted: 08/05/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND The causes for failure of metabolic improvement and inadequate weight loss after metabolic surgery (MS) in Chinese patients with type 2 diabetes (T2D) have not been fully elucidated. The effect of insulin resistance (IR) on the outcome of T2D, hypertension, hyperlipidemia, and obesity after MS in Chinese patients with T2D and a body mass index (BMI) of 25-32.5 kg/m2 warrants further study. OBJECTIVES Patients with T2D and a BMI of 25-32.5 kg/m2 who underwent MS between July 2019 and June 2021 were included. SETTING University hospital, China. METHODS IR levels were evaluated with the glucose disposal rate (GDR). Improvement of T2D, hypertension, and hyperlipidemia was assessed with the composite triple endpoint (CTEP), and weight loss was assessed with the percent of total weight loss (%TWL). Partial correlation analysis, binary logistic regression analysis, multiple linear regression analysis, receiver operating characteristic curve (ROC) analysis, and subgroup analysis were used to analyze the relationship between the CTEP, %TWL at 1 year postoperative, and GDR preoperative. RESULTS This study analyzed the data of 51 patients with T2D and a BMI of 25-32.5 kg/m2 (30 men and 21 women) with a mean preoperative GDR of 3.72 ± 1.48 mg/kg/min. Partial correlation coefficients between CTEP, %TWL, and GDR were .303 (P = .041) and .449 (P = .001), respectively. The preoperative GDR was significantly positively correlated with CTEP (OR = 1.610, P = .024) and %TWL (β = 1.38, P = .003). The preoperative GDR predicted cutoff values of 4.36 and 5.35 mg/kg/min for CTEP attainment and %TWL ≥ 20%, respectively. CONCLUSION IR levels predicted metabolic improvement and weight loss 1 year after MS in Chinese patients with T2D and a BMI of 25-32.5 kg/m2.
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Affiliation(s)
- Yaoquan Cao
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ping Luo
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Guohui Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Song
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhihong Su
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xianhao Yi
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhibing Fu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Beibei Cui
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China.
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Johns AJ, Luce MS, Kaneski MJ, Lowery RA, Jachniewicz B, Salas A, McCreary R, Russell RM, Lyo V, Ali MR, Ahmed SM. The long weight: association between distressed communities index and long-term weight outcomes following bariatric surgery. Surg Endosc 2023; 37:7218-7225. [PMID: 37369948 PMCID: PMC10462541 DOI: 10.1007/s00464-023-10158-y] [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] [Received: 04/03/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is multifactorial, and its effect on post-bariatric weight recurrence is unclear. Distressed Community Index (DCI) is a composite SES score measuring community economic well-being. This study aims to evaluate the effect of DCI on long-term post-bariatric weight outcomes. METHODS Retrospective analysis of patients undergoing primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2015 and 2020 was performed. All weights in the electronic medical record (EMR), including non-bariatric visits, were captured. Patients were stratified into low tier (LT) and high tier (HT) DCI groups. RESULTS Of 583 patients, 431 (73.9%) were HT and 152 (26.1%) were LT. Average bariatric follow up was 1.78 ± 1.6 years and average postoperative weight in the EMR was 3.96 ± 2.26 years. Rates of bariatric follow up within the last year were similar (13.8% LT vs 16.2% HT, p = 0.47). LT had higher percent total body weight loss (%TWL; 26% LT vs 23% HT, p < 0.01) and percent excess weight loss (%EWL; 62% vs 57%, p = 0.04) at 1 year on univariate analysis. On multivariate linear regression adjusting for baseline characteristics and surgery type, there were no differences in %EWL between groups at 1 year (p = 0.22), ≥ 3 years (p = 0.53) or ≥ 5 years (p = 0.34) postop. While on univariate analysis LT only trended towards greater percentage of patients with > 15% increase from their 1-year weight (33.3% LT vs 21.0% HT, p = 0.06), on multivariate analysis this difference was significant (OR 2.0, LT 95%CI 1.41-2.84). There were no differences in the percentage of patients with > 15% decrease in %EWL from 1 to 3 + years postop between groups (OR 0.98, LT 95% CI 0.72-1.35). CONCLUSIONS While low tier patients had similar weight loss at 1 year, they were twice as likely to have weight recurrence at ≥ 3 years. Further studies are needed to identify factors contributing to greater weight recurrence among this population.
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Affiliation(s)
- Alexandra J Johns
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA
| | - M Siobhan Luce
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA
| | - Mason J Kaneski
- Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA
| | - Ryan A Lowery
- University of California, Davis Health, Sacramento, USA
| | | | - Angela Salas
- University of California, Davis Health, Sacramento, USA
| | | | | | - Victoria Lyo
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA
- Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA
- Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA
| | - Mohammed R Ali
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA
- Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA
- Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA
| | - Shushmita M Ahmed
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA.
- Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA.
- Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA.
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Riedel O, Braitmaier M, Dankhoff M, Hornschuch M, Klein M, Zachariassen W, Hoyer J. Quality of life in bariatric patients up to twelve years after surgery - Results from a nationwide retrospective cohort study. Obes Res Clin Pract 2023; 17:353-360. [PMID: 37591765 DOI: 10.1016/j.orcp.2023.08.001] [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: 06/13/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Bariatric interventions (BI, including surgical interventions) are effective in patients with massive obesity, i.e., a body mass index (BMI) > 40, and their number has steadily increased during the past decade. Yet, the stability of improvements in quality of life (QoL) in post-interventional patients is understudied and restricted to studies with small samples and short follow-ups. METHODS Patients with BI between 2004 and 2018 were identified in a health claims database and invited to fill in a survey, comprising sociodemographic and lifestyle information and psychometric scales. QoL was assessed with the Bariatric QoL (BQL) scale with lower scores denoting worse QoL. BMI and excess weight loss (EWL) were calculated for the time soon after intervention (EWL-T1) and when filling the survey (EWL-T2). RESULTS The majority of n = 2151 patients were female (80.7 %), had a mean age of 54.5 years and a mean BMI of 34.8. The mean EWL-T1 was 79 % (EWL-T2: 64.6 %). The mean BQL score was 47.6 and decreased with BMI (18.5-24.9: 52.6 vs. >40: 38.7), EWL-T2 (>66 %: 51.3 vs. <65 %: 42.1) and years since intervention (3-4: 48.2 vs >8: 45.1, each p < .001). For EWL-T1, the association between higher EWLs and higher BQL scores was stronger in females than in males (p < .005); for EWL at T2, both sexes did not differ in this regard (p = .848). Among normal-weight persons, males scored significantly lower on the BQL than females (44.9 vs. 54.9). CONCLUSIONS Post-interventional QoL improvements diminish over time and depend on the weight loss, with significant differences between men and women.
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Affiliation(s)
- Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | - M Braitmaier
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Michel Hornschuch
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Jana Hoyer
- Adipositas-Zentrum, Städtisches Klinikum Dresden, Dresden, Germany
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Auge M, Dejardin O, Menahem B, Lee Bion A, Savey V, Launoy G, Bouvier V, Alves A. Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center. J Clin Med 2022; 11:jcm11216310. [PMID: 36362536 PMCID: PMC9658876 DOI: 10.3390/jcm11216310] [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: 09/28/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies have evaluated the association between non-clinical and clinical determinants in terms of discontinuing follow-up after bariatric surgery. This cohort study aims to assess these associations. Data were collected from a prospectively maintained database of patients who underwent laparoscopic bariatric surgery from January 2012 to December 2019. The Cox model was used to assess the influence of preoperative determinants on follow-up interruptions for more than one year. Multilevel logistic regression was used to evaluate the association between clinical factors and post-operative weight loss with the regularity of follow-up. During the study period, 9607 consultations were performed on 1549 patients. The factors associated with a follow-up interruption from more than 365 days included male gender (HR = 1.323; CI = 1.146−1.527; p = 0.001) and more recent years of intervention (HR = 1.043; CI = 1.012−1.076; p = 0.0068). Revisional bariatric surgery was associated with a lower risk of follow-up interruption (HR = 0.753; CI = 0.619−0.916; p = 0.0045). Independent risk factors of an irregular follow up were higher age (HR = 1.01; CI = 1.002−1.017; p = 0.0086); male gender (OR = 1.272; CI = 1.047−1.545; p = 0.0153); and higher %TWL (Total Weight Loss) (OR = 1.040 CI = 1.033−1.048 p < 0.0001). A higher preoperative BMI (OR = 0.985; CI = 0.972−0.998; p = 0.0263) and revisional surgery (OR = 0.707; CI = 0.543−0.922; p = 0.0106) were protective factors of irregularity. This study suggests that the male gender and most recent dates of surgery are the two independent risk factors for follow-up interruption. Older age, male gender, and higher weight loss were all independent risk factors of an irregular follow-up. Revision bariatric surgery is a protective factor against interruption and irregular follow-up with a higher preoperative BMI. Further studies are needed to obtain long-term results in these patients with discontinued follow-ups.
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Affiliation(s)
- Marie Auge
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Olivier Dejardin
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Correspondence:
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Véronique Savey
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Guy Launoy
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Registre des Tumeurs Digestives du Calvados, CEDEX 5, 14076 Caen, France
| | - Véronique Bouvier
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Registre des Tumeurs Digestives du Calvados, CEDEX 5, 14076 Caen, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Registre des Tumeurs Digestives du Calvados, CEDEX 5, 14076 Caen, France
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New Insights on the Association Between Socioeconomic Status and Weight Loss After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:3752-3770. [DOI: 10.1007/s11695-022-06269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
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