Symptoms of bipolar disorder are associated with lower bariatric surgery completion rates and higher food addiction

Deciphering the shared genetic architecture between bipolar disorder and body mass index

BACKGROUND

The comorbidity between bipolar disorder (BD) and high body mass index (BMI) is well-documented, but their shared genetic architecture remains unclear. Our study aimed to explore this genetic correlation and potential causality.

METHODS

Utilizing large-scale genome-wide association study (GWAS) summary statistics, we quantified global and local genetic correlations between BD and BMI using linkage disequilibrium score regression (LDSC) and Heritability Estimation from Summary Statistics. Stratified LDSC characterized genetic overlap across functional categories. Cross-trait meta-analyses identified shared risk single nucleotide polymorphisms (SNPs), followed by colocalization analysis using Coloc. Bi-directional Mendelian randomization (MR) assessed causality, while tissue-level SNP heritability enrichment for BD and BMI was evaluated using LDSC-specific expressed genes and Multi-marker Analysis of Genomic Annotation.

RESULTS

We found a genetic correlation between BD and BMI, especially in localized genomic regions. Cross-trait meta-analysis identified 46 significant SNPs shared between BD and BMI, including three novel shared risk SNPs. Colocalization analysis verified two novel SNPs with shared causal variants linked to ITIH1 and TM6SF2 genes. MR analysis demonstrated a causal effect of BD on BMI, but not the reverse. Gene expression data revealed genetic correlation enrichment in five specific brain regions.

CONCLUSION

This study comprehensively analyzes the genetic correlation between BD and BMI, uncovering shared genetic architecture and identifying novel risk loci. These findings provide new insights into the interplay between BD and BMI, informing the development of diagnostic tools and therapeutic strategies.

Outcomes of Bariatric Surgery in Patients With Bipolar and Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis

Psychiatric disorders, particularly bipolar disorder (BD) and schizophrenia spectrum disorders (SCZ), are associated with high rates of obesity and metabolic diseases. This systematic review and meta-analysis evaluates the efficacy of bariatric surgery in BD/SCZ patients, aiming to inform clinical decisions and optimize treatment strategies for this population. MEDLINE, Embase, and Cochrane databases were searched up to September 2024. A restricted maximum likelihood random-effects model with mean differences (MD) for continuous outcomes and odds ratios (ORs) for binary outcomes, along with 95% confidence intervals (CI), was used. 13 studies involving 19,662 patients, of whom 1,117 (5.7%) were diagnosed with BD or SCZ, were included. The analysis revealed no significant differences in %TWL or BMI change at 6 months, 1 year, and 2 years. BD/SCZ patients showed a significantly smaller %EWL at 6 months; however, the differences at 1 and 2 years were no longer statistically significant. Similarly, no differences were found between BD/SCZ patients and controls regarding adherence to 6-month, 1-year, and 2-year follow-up, as well as 1-year remission rates of type 2 diabetes mellitus, hypertension, obstructive sleep apnea syndrome, dyslipidemia, or 30-day readmission and reoperation rates. Data from included studies also indicated no exacerbation of psychiatric disorders after surgery. This study suggests that bariatric surgery may be similarly effective in patients with BD and SCZ, offering potential benefits for a population burdened with both psychiatric and physical health challenges.

Multidisciplinary Approach on Metabolic Bariatric Surgery Evasion: Analysis of Predictors and Potential Influencing Factors in the Preoperative Period

This study aims to identify evasion predictors and factors in the preoperative period of metabolic bariatric surgery (MBS) through a review and evaluations of professionals involved, as well as patient knowledge and information, aiming at positive long-term results. This article performed a systematic literature review (SLR) in the PubMed, Scopus, and Web of Science databases. It used the PRISMA Protocol with a record of 7 years to obtain documents published a year before the pandemic, during and after it. The search strategy resulted in 4649 records, of which 51 studies were included in the review. Subsequently, an analysis was carried out in which the professionals who met the patient participated in a qualitative survey, in which the results were analyzed and compared to those obtained in the SLR. The decision to undergo MBS is influenced by fears, uncertainties, and the need for support, particularly for elderly patients. Health professionals are crucial in providing continuous guidance and support throughout the process.

Exploring the prevalence and symptom presentation of food addiction among Norwegian bariatric surgery patients: associations with depression, dysregulated eating, and postoperative weight loss

BACKGROUND

Pathological eating and addictive processes are linked to obesity. Food addiction (FA) involves hedonic eating of highly palatable foods, accompanied by addictive symptoms like craving, loss-of-control (LOC) eating, and withdrawal. The main objectives of this study were to assess FA prevalence and symptoms in bariatric surgery candidates, and its relationship with depression, dysregulated eating, and 1- year postoperative weight loss (WL).

METHODS

Data from 69 bariatric surgery patients (74% female, 26% male, ) were analysed. Self-report measures including Yale Food Addiction Scale (YFAS) 2.0, Eating Disorder Examination-Questionnaire (EDE-Q), Repetitive Eating Questionnaire [Rep(eat)-Q] and Hospital Anxiety and Depression Scale (HADS) were administered pre-surgery and at 1-year follow-up.

RESULTS

The mean preoperative YFAS symptom score was 2.2. (SD = 2.59). 16% of the sample met YFAS diagnostic criteria for FA. Top reported FA criteria were "substance taken in larger amount than intended" (33%), "persisted desire or repeated unsuccessful attempts to quit" (29%), and "use in physically hazardous situations" (23%). The YFAS symptom scores correlated significantly with the frequency of LOC binge eating, depression and repetitive eating scores, but showed no correlation with age or BMI. Preoperative YFAS symptom scores did not significantly predict % WL at 1-year follow-up.

CONCLUSIONS

Our findings align with previous research, indicating that preoperative FA symptoms is unrelated to preoperative BMI and total %WL, but linked to eating pathology, such as LOC binge eating and grazing, as well as depression in bariatric surgery candidates.

Factors associated with progression or non-progression to bariatric surgery in adults: A systematic review

Access to bariatric surgery is limited, and the factors related to undergoing or not undergoing the procedure are poorly understood. To this end, a systematic review of PubMed, Embase, PsycINFO, and CINAHL was conducted to deduce the factors associated with progression or non-progression to bariatric surgery. Quantitative and qualitative English-language articles ranging in date from database conception to September 2023 were included. Eligible studies employed adult participants (18 years of age or above) who had been referred for bariatric surgery. A total of 57 studies were identified. Fifteen key factors were found, alongside six less frequently studied factors: age, sex, BMI, race and ethnicity, distance to clinic, socio-economic status, insurance coverage, physical health, psychological health, eating history and habits, substance use and smoking, social influence and relationships, pre-surgery process and requirements, surgery-related concerns, choice of surgery, and others (emergency room visitation, COVID-19 virus, health literacy, appearance perceptions, time-off work, and stigma related to surgery). No factors were found to be reliably associated with progression or non-progression to bariatric surgery; however, the nature of these findings is tentative considering methodological flaws and limited research. Further studies are required to elucidate potential inequities in bariatric surgery access and educate policymakers and health professionals.

Management of Patients With Kidney Disease Undergoing Bariatric Surgery: A Multidisciplinary Approach

Bariatric surgery is increasingly recognized as a safe and effective treatment for obesity in patients with chronic kidney disease (CKD), including stages 4, 5, and 5D (on dialysis). Among the available surgical methods, sleeve gastrectomy (SG) is the most commonly performed weight loss procedure and is mainly done to facilitate kidney transplantation (KT). However, many KT candidates treated with SG remain on the transplant waiting list for months to years, with some never receiving a transplant. Therefore, appropriate candidates for SG must be selected, and post-SG management should address the unique needs of this population, with a focus on sustaining the metabolic benefits of surgery while minimizing potential side effects related to rapid weight loss which may inadvertently lead to muscle and bone catabolism. Multidisciplinary post-SG care in this population may lead to overall better health on the transplant waiting list, resulting in a higher percentage of post-SG patients ultimately receiving KT. To tailor the effective treatment for these patients, clinicians should acknowledge that patients with CKD stage 4-5D have different nutritional needs and are metabolically and psychosocially distinct from the general bariatric surgery population. Sarcopenia is highly prevalent and may be exacerbated by muscle catabolism following SG if not adequately addressed. Blood pressure, glucose, and bone metabolism are all affected by the CKD stage 4-5D, and therefore require distinct diagnostic and management approaches. Long-standing chronic disease, associated comorbidities, and low adherence to medical therapies require ongoing comprehensive psychosocial assessment and support. This paper aims to review and consolidate the existing literature concerning the intersection of CKD stage 4-5D and the consequences of SG. We also suggest future clinical outcome studies examining novel treatment approaches for this medically complex population.

Prevalence of food addiction among patients undergoing metabolic/bariatric surgery: A systematic review and meta-analysis

Candidates for metabolic/bariatric surgery show a high prevalence of food addiction (FA). However, few studies have investigated FA prevalence after bariatric surgery, especially using longitudinal studies. This systematic review with a meta-analysis aimed to determine pre- and postoperative prevalence of FA among patients undergoing metabolic/bariatric surgery. It included both cross-sectional and longitudinal studies that used the Yale Food Addiction Scale (YFAS). The following databases were searched: MEDLINE, ScienceDirect, LILACS, PsycArticles, CENTRAL, greylit.org, and opengrey.eu. Studies that used the YFAS to evaluate FA in pre- or postoperative patients were included. A random-effects meta-analysis was performed with cross-sectional studies to calculate the weighted prevalence of FA at the pre- and postoperative moments. For longitudinal studies, which measured FA at both time points for the same individuals, absolute prevalence reduction (APR) was calculated. Of the 6626 records, 40 studies were included in the meta-analysis. The preoperative weighted prevalence of FA was 32% (95% CI: 27-37%; 33 groups), whereas the postoperative prevalence was 15% (95% CI: 12-18%; 14 groups). Seven longitudinal studies showed a weighted APR of 26 p.p. (95% CI: 10-41 p.p.). Observational data suggest a reduction in the prevalence of FA among patients that undergo bariatric surgery. Interventional studies are needed to confirm these findings.

Psychosocial considerations in the combined bariatric surgery and organ transplantation population: a review of the overlapping pathologies and outcomes

PURPOSE OF REVIEW

This review highlights the salient data of the psychosocial concerns that influence outcomes of bariatric surgery and organ transplantation.

RECENT FINDINGS

Bariatric surgery has emerged as an important intervention with data supporting substantial and sustained weight loss, enhanced quality of life, remission of obesity-related medical comorbidities, and improved long-term patient and graft survival in transplant patients. Depression, suicide, anxiety, posttraumatic stress disorder, alcohol use, adherence, and psychopharmacology considerations can influence outcomes of both these surgeries.

SUMMARY

Obesity is increasingly prevalent among patients pursuing transplantation surgery, and it is often a factor in why a patient needs a transplant. However, obesity can be a barrier to receiving a transplant, with many centers implementing BMI criteria for surgery. Furthermore, obesity and obesity-related comorbidities after transplant can cause poor outcomes. In this context, many transplant centers have created programs that incorporate interventions (such as bariatric surgery) that target obesity in transplant candidates. A presurgery psychosocial assessment is an integral (and required) part of the process towards receiving a bariatric surgery and/or a transplantation surgery. When conducting a dual (bariatric and transplantation surgery) psychosocial assessment, it is prudent to understand the overlap and differentiation of specific psychosocial components that influence outcomes in these procedures.

The genetics of bipolar disorder with obesity and type 2 diabetes

BACKGROUND

Bipolar disorder (BD) presents with high obesity and type 2 diabetes (T2D) and pathophysiological and phenomenological abnormalities shared with cardiometabolic disorders. Genomic studies may help define if they share genetic liability. This selective review of BD with obesity and T2D will focus on genomic studies, stress their current limitations and guide future steps in developing the field.

METHODS

We searched electronic databases (PubMed, Scopus) until December 2021 to identify genome-wide association studies, polygenic risk score analyses, and functional genomics of BD accounting for body mass index (BMI), obesity, or T2D.

RESULTS

The first genome-wide association studies (GWAS) of BD accounting for obesity found a promising genome-wide association in an intronic gene variant of TCF7L2 that was further replicated. Polygenic risk scores of obesity and T2D have also been associated with BD, yet, no genetic correlations have been demonstrated. Finally, human-induced stem cell studies of the intronic variant in TCF7L2 show a potential biological impact of the products of this genetic variant in BD risk.

LIMITATIONS

The narrative nature of this review.

CONCLUSIONS

Findings from BD GWAS accounting for obesity and their functional testing, have prompted potential biological insights. Yet, BD, obesity, and T2D display high phenotypic, genetic, and population-related heterogeneity, limiting our ability to detect genetic associations. Further studies should refine cardiometabolic phenotypes, test gene-environmental interactions and add population diversity.

TCF7L2 lncRNA: a link between bipolar disorder and body mass index through glucocorticoid signaling

Bipolar disorder (BD) and obesity are highly comorbid. We previously performed a genome-wide association study (GWAS) for BD risk accounting for the effect of body mass index (BMI), which identified a genome-wide significant single-nucleotide polymorphism (SNP) in the gene encoding the transcription factor 7 like 2 (TCF7L2). However, the molecular function of TCF7L2 in the central nervous system (CNS) and its possible role in the BD and BMI interaction remained unclear. In the present study, we demonstrated by studying human induced pluripotent stem cell (hiPSC)-derived astrocytes, cells that highly express TCF7L2 in the CNS, that the BD-BMI GWAS risk SNP is associated with glucocorticoid-dependent repression of the expression of a previously uncharacterized TCF7L2 transcript variant. That transcript is a long non-coding RNA (lncRNA-TCF7L2) that is highly expressed in the CNS but not in peripheral tissues such as the liver and pancreas that are involved in metabolism. In astrocytes, knockdown of the lncRNA-TCF7L2 resulted in decreased expression of the parent gene, TCF7L2, as well as alterations in the expression of a series of genes involved in insulin signaling and diabetes. We also studied the function of TCF7L2 in hiPSC-derived astrocytes by integrating RNA sequencing data after TCF7L2 knockdown with TCF7L2 chromatin-immunoprecipitation sequencing (ChIP-seq) data. Those studies showed that TCF7L2 directly regulated a series of BD risk genes. In summary, these results support the existence of a CNS-based mechanism underlying BD-BMI genetic risk, a mechanism based on a glucocorticoid-dependent expression quantitative trait locus that regulates the expression of a novel TCF7L2 non-coding transcript.

Liver Transplantation After Bariatric Surgery: a Clinical Cohort Study

PURPOSE

Individuals that undergo bariatric surgery are at higher risk for problematic alcohol use via pharmacokinetic changes in alcohol metabolism and cross addictions. Little data exists regarding post-bariatric surgery patients with alcohol-related liver disease (ALD) who ultimately require liver transplantation. The aim of this project was to better understand demographic, medical, and psychological characteristics of post-bariatric surgery patients who undergo liver transplantation due to ALD.

METHODS

This retrospective clinical cohort identified 1416 patients who underwent ALD liver transplantation over a 10-year timespan at three academic medical centers. Electronic medical records were reviewed for patient characteristics, including sex, age, body mass index, surgery dates, Model for End Stage Liver Disease (MELD) scores, medical history, psychiatric history, and mortality rates.

RESULTS

Within the sample of liver transplantation patients, 1.3% had undergone bariatric surgery prior to transplantation. Fifty percent of the post-bariatric surgery sample was female. The MELD score was higher and the median age at transplantation was younger in the post-bariatric surgery subgroup in comparison to that in the non-bariatric surgery patients. Mood and anxiety disorders were more common among those with a history of having bariatric surgery, with major depressive disorder having the largest difference between subgroups.

CONCLUSIONS

Among patients who require a liver transplantation due to ALD, those with a history of bariatric surgery are more likely to be female, younger, and diagnosed with mood disorders. Further studies with larger and more diverse samples are necessary to better understand how to prevent development of alcohol use disorder in the bariatric surgery population.