Long-term durability of weight loss after bariatric surgery; a retrospective study

Impact of Short-Term Weight Loss on Hemostasis and Thrombosis after Bariatric Surgery

Introduction

Obesity causes thrombophilia and many coagulation problems related to slowing the capillary flow. We aimed to evaluate rapid weight loss outcomes in the early period after bariatric surgery on the coagulation system. Materials and Method. A prospective study enrolled 28 patients with a BMI > 40 kg/m2 who underwent bariatric surgery. Preoperative and postoperative (first and third months) demographic criteria-such as age, gender, weight, height, and alcohol and tobacco use, and biochemical parameters such as PLT, PT, aPTT, INR, bleeding time, coagulation time, fibrinogen, D-dimer, albumin, calcium, ionized calcium, vitamin D, and PTH-were analyzed.

Results

We found that both bleeding and thrombotic parameters increase in early-slowing surgery. The first-month platelet levels were significantly different from the preoperative values (p < 0.001). The prothrombin time in the first (p < 0.001) and third months (p < 0.009) was also comparable. The PTT in the first month was higher than in the preoperative period (p < 0.011). INR in the first month (p < 0.001) was higher than that in the preoperative period and the third month (p = 0.007) value was higher than in the first month. In terms of fibrinogen levels, all parameters indicated statistical significance within each other; preoperative to the first month (p < 0.001), the first month to the third month (p < 0.016). Third-month D-dimer levels were lower than the first month's values (p = 0.032).

Conclusion

Thromboembolic events have crucial importance in the converse scenario of haemorrhagic diathesis during the first months of bariatric surgery. Vitamin support and antithrombotic agents may be recommended in the early postoperative period.

Next-Generation Sequencing of a Large Gene Panel for Outcome Prediction of Bariatric Surgery in Patients with Severe Obesity

Obesity is a chronic disease in which abnormal deposition of fat threatens health, leading to diabetes, cardiovascular diseases, cancer, and other chronic illnesses. According to the WHO, 19.8% of the adult population in Italy is obese, and the prevalence is higher among men. It is important to know the predisposition of an individual to become obese and to respond to bariatric surgery, the most up-to-date treatment for severe obesity. To this purpose, we developed an NGS gene panel, comprising 72 diagnostic genes and 244 candidate genes, and we sequenced 247 adult obese Italian patients. Eleven deleterious variants in 9 diagnostic genes and 17 deleterious variants in 11 candidate genes were identified. Interestingly, mutations were found in several genes correlated to the Bardet-Biedl syndrome. Then, 25 patients were clinically followed to evaluate their response to bariatric surgery. After a 12-month follow-up, the patients that carried deleterious variants in diagnostic or candidate genes had a reduced weight loss, as compared to the other patients. The NGS-based panel, including diagnostic and candidate genes used in this study, could play a role in evaluating, diagnosing, and managing obese individuals, and may help in predicting the outcome of bariatric surgery.

Differential Gene Expression of Subcutaneous Adipose Tissue among Lean, Obese, and after RYGB (Different Timepoints): Systematic Review and Analysis

The main roles of adipose tissue include triglycerides storage and adipokine secretion, which regulate energy balance and inflammation status. In obesity, adipocyte dysfunction leads to proinflammatory cytokine production and insulin resistance. Bariatric surgery is the most effective treatment for obesity, the gold-standard technique being Roux-en-Y gastric bypass (RYGB). Since metabolic improvements after RYGB are clear, a better understanding of adipose tissue molecular modifications could be derived from this study. Thus, the aim of this systematic review was to find differentially expressed genes in subcutaneous adipose tissue of lean, obese and post-RYGB (distinct timepoints). To address this objective, publications from 2015-2022 reporting gene expression (candidate genes or transcriptomic approach) of subcutaneous adipose tissue from lean and obese individuals before and after RGYB were searched in PubMed, Elsevier, and Springer Link. Excluded publications were reviews, studies analyzing serum, other types of tissues, or bariatric procedures. A risk-of-bias summary was created for each paper using Robvis, to finally include 17 studies. Differentially expressed genes in post-RYGB vs. obese and lean vs. obese were obtained and the intersection among these groups was used for analysis and gene classification by metabolic pathway. Results showed that the lean state as well as the post-RYGB is similar in terms of increased expression of insulin-sensitizing molecules, inducing lipogenesis over lipolysis and downregulating leukocyte activation, cytokine production and other factors that promote inflammation. Thus, massive weight loss and metabolic improvements after RYGB are accompanied by gene expression modifications reverting the "adipocyte dysfunction" phenomenon observed in obesity conditions.

A Mediterranean-Style Diet Plan Is Associated with Greater Effectiveness and Sustainability in Weight Loss in Patients with Obesity after Endoscopic Bariatric Therapy

This study aimed to investigate the impact of a Mediterranean-style diet on weight loss effectiveness and sustainability in patients with obesity who underwent endoscopic bariatric therapies (EBT), relative to a protein diet plan. Thus, 132 patients with obesity (BMI 30–40 kg/m²) who underwent EBT, were asked to follow a Mediterranean-style diet plan (n = 52) or a protein diet plan (n = 26) for six months. General linear models were used to compare outcome variables between dietary intervention groups. Results showed that participants who followed a Mediterranean-style diet plan lost 14.2% more weight (95% CI: 3.0; 25.3), compared with those who followed a protein diet plan. Additionally, following a Mediterranean-style diet plan was associated with the sustainability of weight loss. Note that three months after the end of the dietary intervention, the patients who followed a Mediterranean-style diet plan were still losing weight (−1.2 ± 3.0 kg), while those with a protein diet plan gained, on average, 2.4 ± 3.3 kg (p < 0.001). Therefore, we conclude that combining EBT with a Mediterranean-style diet plan could represent an effective dietary intervention to improve the effectiveness and sustainability of weight loss after an EBT.

Roux-En-Y Gastric Bypass (RYGB) Surgery during High Liquid Sucrose Diet Leads to Gut Microbiota-Related Systematic Alterations

Roux-en-Y gastric bypass (RYGB) surgery has been proven successful in weight loss and improvement of co-morbidities associated with obesity. Chronic complications such as malabsorption of micronutrients in up to 50% of patients underline the need for additional therapeutic approaches. We investigated systemic RYGB surgery effects in a liquid sucrose diet-induced rat obesity model. After consuming a diet supplemented with high liquid sucrose for eight weeks, rats underwent RYGB or control sham surgery. RYGB, sham pair-fed, and sham ad libitum-fed groups further continued on the diet after recovery. Notable alterations were revealed in microbiota composition, inflammatory markers, feces, liver, and plasma metabolites, as well as in brain neuronal activity post-surgery. Higher fecal 4-aminobutyrate (GABA) correlated with higher Bacteroidota and Enterococcus abundances in RYGB animals, pointing towards the altered enteric nervous system (ENS) and gut signaling. Favorable C-reactive protein (CRP), serine, glycine, and 3-hydroxybutyrate plasma profiles in RYGB rats were suggestive of reverted obesity risk. The impact of liquid sucrose diet and caloric restriction mainly manifested in fatty acid changes in the liver. Our multi-modal approach reveals complex systemic changes after RYGB surgery and points towards potential therapeutic targets in the gut-brain system to mimic the surgery mode of action.