Adequacy of basal metabolic rate prediction equations in individuals with severe obesity: A systematic review and meta-analysis

The determination of energy requirements in clinical practice is based on basal metabolic rate (BMR), frequently predicted by equations that may not be suitable for individuals with severe obesity. This systematic review and meta-analysis examined the accuracy and precision of BMR prediction equations in adults with severe obesity. Four databases were searched in March 2021 and updated in May 2023. Eligible studies compared BMR prediction equations with BMR measured by indirect calorimetry. Forty studies (age: 28-55 years, BMI: 40.0-62.4 kg/m2) were included, most of them with a high risk of bias. Studies reporting bias (difference between estimated and measured BMR) were included in the meta-analysis (n = 20). Six equations were meta-analyzed: Harris & Benedict (1919); WHO (weight) (1985); Owen (1986); Mifflin (1990); Bernstein (1983); and Cunningham (1980). The most accurate and precise equations in the overall analysis were WHO (-12.44 kcal/d; 95%CI: -81.4; 56.5 kcal/d) and Harris & Benedict (-18.9 kcal/d; 95%CI -73.2; 35.2 kcal/d). All the other equations tended to underestimate BMR. Harris & Benedict and WHO were the equations with higher accuracy and precision in predicting BMR in individuals with severe obesity. Additional analyses suggested that equations may perform differently according to obesity BMI ranges, which warrants further investigation.

IMPROVE 2022 International Meeting on Pathway-Related Obesity: Vision of Excellence

Nearly 90 clinicians and researchers from around the world attended the first IMPROVE 2022 International Meeting on Pathway-Related Obesity. Delegates attended in person or online from across Europe, Argentina and Israel to hear the latest scientific and clinical developments in hyperphagia and severe, early-onset obesity, and set out a vision of excellence for the future for improving the diagnosis, treatment, and care of patients with melanocortin-4 receptor (MC4R) pathway-related obesity. The meeting co-chair Peter Kühnen, Charité Universitätsmedizin Berlin, Germany, indicated that change was needed with the rapidly increasing prevalence of obesity and the associated complications to improve the understanding of the underlying mechanisms and acknowledge that monogenic forms of obesity can play an important role, providing insights that can be applied to a wider group of patients with obesity. World-leading experts presented the latest research and led discussions on the underlying science of obesity, diagnosis (including clinical and genetic approaches such as the role of defective MC4R signalling), and emerging clinical data and research with targeted pharmacological approaches. The aim of the meeting was to agree on the questions that needed to be addressed in future research and to ensure that optimised diagnostic work-up was used with new genetic testing tools becoming available. This should aid the planning of new evidence-based treatment strategies for the future, as explained by co-chair Martin Wabitsch, Ulm University Medical Center, Germany.

Multimodal approach utilising a weight management programme prior to bariatric surgery in patients with BMI ≥50 kg/m2: A propensity score matching retrospective cohort study

We evaluated preoperative weight loss and days from initial consult to surgery in patients with BMI ≥50 kg/m2 who were and were not enrolled in medical weight management (MWM) prior to laparoscopic sleeve gastrectomy. We retrospectively identified patients with BMI ≥50 kg/m2 who had primary sleeve gastrectomy between 2014 and 2019 at two bariatric surgery centres in our healthcare system. Patients presenting after 2017 that received preoperative MWM (n = 28) were compared to a historical cohort of non-MWM patients (n = 118) presenting prior to programme initiation in 2017 on preoperative percent total body weight loss (%TBWL) and days from initial consult to surgery. A total of 151 patients (MWM, 33; non-MWM, 118) met inclusion criteria. BMI was significantly greater in MWM versus non-MWM (p = .018). After propensity score matching, median BMI at initial consult in non-MWM versus MWM no longer differed (p = .922) neither were differences observed on the basis of weight, age, sex, race or ethnicity. After PSM, MWM had significantly lower BMI at surgery (p = .018), lost significantly more weight from consult to surgery (p < .001) and achieved significantly greater median %TBWL from consult to surgery (p < .001). We noted no difference between groups on 6-month weight loss (p = .533). Days from initial consult to surgery did not differ between groups (p < .863). A preoperative MWM programme integrated into multimodal treatment for obesity in patients with a BMI ≥50 kg/m2 resulted in clinically significant weight loss without prolonging time to surgery.

Successful Management With Continuous Negative Abdominal Pressure Therapy in a Severely Obese Patient With Inhalation Burn-Induced Severe Respiratory Failure Requiring Veno-Venous Extracorporeal Membrane Oxygenation: A Case Report

Continuous negative abdominal pressure (CNAP) therapy effectively provides respiratory support in patients with respiratory failure and severe obesity; however, its use in clinical practice remains limited. In this case, we report a significant improvement in the respiratory condition of a patient with severe obesity and inhalation burns following the application of CNAP in addition to venovenous extracorporeal membrane oxygenation (V-V ECMO) and mechanical ventilation. The patient was able to wean off these devices successfully. This case highlights the potential of CNAP therapy as an adjunct treatment for severe respiratory failure, particularly in obese patients for whom conventional interventions are insufficient.

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.

High-Titer Anti-ZSCAN1 Antibodies in a Toddler Clinically Diagnosed with Apparent Rapid-Onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation Syndrome

Severe obesity in young children prompts for a differential diagnosis that includes syndromic conditions. Rapid-Onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD) syndrome is a potentially fatal disorder characterized by rapid-onset obesity associated with hypoventilation, neural crest tumors, and endocrine and behavioral abnormalities. The etiology of ROHHAD syndrome remains to be established, but recent research has been focusing on autoimmunity. We report on a 2-year-old girl with rapid-onset obesity during the first year of life who progressed to hypoventilation and encephalitis in less than four months since the start of accelerated weight gain. The patient had a high titer of anti-ZSCAN1 antibodies (348; reference range < 40), and the increased values did not decline after acute phase treatment. Other encephalitis-related antibodies, such as the anti-NDMA antibody, were not detected. The rapid progression from obesity onset to central hypoventilation with encephalitis warns about the severe consequences of early-onset ROHHAD syndrome. These data indicate that serial measurements of anti-ZSCAN1 antibodies might be useful for the diagnosis and estimation of disease severity. Further research is needed to determine whether it can predict the clinical course of ROHHAD syndrome and whether there is any difference in antibody production between patients with and without tumors.

Complete Blood Count (CBC)-Derived Inflammation Indexes Are Useful in Predicting Metabolic Syndrome in Adults with Severe Obesity

Background: Metabolic syndrome (MetS) is a globally increasing pathological condition. Recent research highlighted the utility of complete blood count-derived (CBC) inflammation indexes to predict MetS in adults with obesity. Methods: This study examined CBC-derived inflammation indexes (NHR, LHR, MHR, PHR, SIRI, AISI, and SII) in 231 adults with severe obesity (88 males, 143 females; age: 52.3 [36.4-63.3] years), divided based on the presence (MetS+) or absence (MetS-) of MetS. The relationships between the indexes and the cardiometabolic risk biomarkers HOMA-IR, TG/HDL-C, and non-HDL-C were also evaluated. Results: Individuals with metabolic syndrome (MetS+) had significantly higher values of MHR, LHR, NHR, PHR, and SIRI than those without (MetS-) (MHR and NHR: p < 0.0001; LHR: p = 0.001; PHR: p = 0.011; SIRI: p = 0.021). These values were positively correlated with the degree of MetS severity. Logistic regression (MHR and NHR: p = 0.000; LHR: p = 0.002; PHR: p = 0.022; SIRI: p = 0.040) and ROC analysis (MHR: AUC = 0.6604; LHR: AUC = 0.6343; NHR: AUC = 0.6741; PHR: AUC = 0.6054; SIRI: AUC = 0.5955) confirmed the predictive potential of CBC-derived inflammation indexes for MetS in individuals with severe obesity. CBC-derived inflammation indexes also correlated with HOMA-IR (MHR, LHR, and NHR: p < 0.0001; PHR: p < 0.001; SIRI: p = 0.000) and TG/HDL-C (MHR, LHR, NHR and PHR: p < 0.0001; SIRI: p = 0.006). Conclusions: In conclusion, this study validates CBC-derived inflammation indexes for predicting MetS in individuals with severe obesity. The relationships between these indexes and cardiometabolic risk factors can enable clinicians to better grade MetS associated with obesity.

Sleeve gastrectomy - still popular bariatric method

INTRODUCTION

Obesity is currently the most common multifactorial disease affecting almost all social strata of the population. Conservative therapy of obesity usually succeeds in reducing excess weight by an average of 10-15%. After surgical treatment of severe obesity (bariatric surgery), the average decrease in excess weight is several times greater and, in most cases, has a long-term positive effect on the overall clinical condition of the patients.

METHODS

Sleeve gastrectomy (SG) is the most used bariatric method of treating severe obesity today. The principle of SG is a vertical resection of a major portion of the gastric greater curvature. After the resection, the residual stomach has the shape of a sleeve with a remaining volume of about 120-150 ml. The effect of the method is both restrictive and hormonal, because after SG, the plasma level of active ghrelin decreases in the long term, among other things.

CONCLUSION

Obesity is considered one of the most serious global health problems today. In 2018 a total of 696,191 bariatric procedures were performed worldwide. Sleeve gastrectomy was originally used in high-risk severely obese patients as the first stage of a duodenal switch (DS) or gastric bypass. Since 2003, this method has been used independently because for most of the patients, SG had a sufficient effect on weight reduction and improvement of comorbidities, and that is why since 2015, SG has become the most frequently used bariatric method.

Postprandial Triglyceride, Glucose and Insulin Levels 10 Years After Bariatric Surgery in Women With Severe Obesity - A Pilot Study: Part 2 - Biliopancreatic Diversion

Obesity significantly increases the risk of developing metabolic and cardiovascular diseases. The most effective management tool for both obesity and type 2 diabetes (T2D) is bariatric/metabolic surgery. Delayed postprandial plasma triglyceride clearance contributes to the development of atherosclerosis in patients with T2D. Biliopancreatic diversion (BPD) was shown to be the most effective procedure in long-term T2D remission. However, the effect of BPD on postprandial metabolic profile has not been studied so far. In this pilot study, we therefore examined the changes in postprandial glucose, insulin, and triglyceride in women with severe obesity and T2D before surgery and then two and ten years after BPD. The studied cohort included 7 women (mean age at baseline=49.3±8.2 years) with severe obesity (mean BMI= 45.7±2.9 kg/m?) and T2D. A standardized liquid mixed-meal test was carried out in all subjects and the mean postprandial levels of plasma glucose, insulin, and triglyceride were analyzed by standard laboratory procedures. For statistical evaluation, ANOVA with Bonferroni multiple comparisons was used. Ten years after BPD not only a significant reduction of an average BMI (F=32.9, p<0.001) but also significant declines in mean postprandial plasma levels of glucose (F=155.3, p<0.001), insulin (F=69.8, p<0.001), and triglyceride (F=139.9, p<0.001) were demonstrated. The observed changes in postprandial metabolic profile may contribute to improved cardiometabolic health after bariatric surgery.

The Real-Life Use of a Protein-Sparing Modified Fast Diet by Nasogastric Tube (ProMoFasT) in Adults with Obesity: An Open-Label Randomized Controlled Trial

BACKGROUND

Protein-sparing modified fast (PSMF) diet is a very-low-carbohydrate ketogenic diet administered to patients with obesity, which preserves lean mass and suppresses appetite as well as continuous enteral feeding. Thus, we aim to evaluate the effect of the PSMF diet administered continuously by nasogastric tube (NGT) or orally.

METHODS

Patients with a body mass index (BMI) > 34.9 kg/m2 were randomly assigned to receive a whey protein PSMF formula through NGT (ProMoFasT) or orally. Data were collected at baseline and after 150 days. The endpoints were assessed in the intention-to-treat population.

RESULTS

We enrolled 20 patients in the ProMoFasT group and 24 in the oral group. No differences in body weight, BMI or waist circumference between the two groups were found after 150 days. At follow-up, FFM (%) and MM (%) results were higher in the ProMoFasT group than the oral group (63.1% vs. 52.9%, p = 0.012 and 45.0% vs. 36.1%, p = 0.009, respectively) and FM (kg) and FM (%) were significantly lower in the ProMoFasT group (36.9 kg vs. 44.0 kg, p = 0.033 and 37.4% vs. 44.9%, p = 0.012, respectively). Insulin levels were lower in the ProMoFasT group than the oral group at follow-up (11.8 mU/L vs. 28.0 mU/L, p = 0.001, respectively).

CONCLUSION

The ProMoFasT is more effective in improving body composition and glucometabolic markers than the same diet administered orally.

Understanding the Genetics of Early-Onset Obesity in a Cohort of Children From Qatar

CONTEXT

Monogenic obesity is a rare form of obesity due to pathogenic variants in genes implicated in the leptin-melanocortin signaling pathway and accounts for around 5% of severe early-onset obesity. Mutations in the genes encoding the MC4R, leptin, and leptin receptor are commonly reported in various populations to cause monogenic obesity. Determining the genetic cause has important clinical benefits as novel therapeutic interventions are now available for some forms of monogenic obesity.

OBJECTIVE

To unravel the genetic causes of early-onset obesity in the population of Qatar.

METHODS

In total, 243 patients with early-onset obesity (above the 95% percentile) and age of onset below 10 years were screened for monogenic obesity variants using a targeted gene panel, consisting of 52 obesity-related genes.

RESULTS

Thirty rare variants potentially associated with obesity were identified in 36 of 243 (14.8%) probands in 15 candidate genes (LEP, LEPR, POMC, MC3R, MC4R, MRAP2, SH2B1, BDNF, NTRK2, DYRK1B, SIM1, GNAS, ADCY3, RAI1, and BBS2). Twenty-three of the variants identified were novel to this study and the rest, 7 variants, were previously reported in literature. Variants in MC4R were the most common cause of obesity in our cohort (19%) and the c.485C>T p.T162I variant was the most frequent MC4R variant seen in 5 patients.

CONCLUSION

We identified likely pathogenic/pathogenic variants that seem to explain the phenotype of around 14.8% of our cases. Variants in the MC4R gene are the commonest cause of early-onset obesity in our population. Our study represents the largest monogenic obesity cohort in the Middle East and revealed novel obesity variants in this understudied population. Functional studies will be required to elucidate the molecular mechanism of their pathogenicity.

Functional Characterization of Novel MC4R Variants Identified in Two Unrelated Patients with Morbid Obesity in Qatar

The leptin-melanocortin pathway is pivotal in appetite and energy homeostasis. Pathogenic variants in genes involved in this pathway lead to severe early-onset monogenic obesity (MO). The MC4R gene plays a central role in leptin-melanocortin signaling, and heterozygous variants in this gene are the most common cause of MO. A targeted gene panel consisting of 52 obesity-related genes was used to screen for variants associated with obesity. Variants were analyzed and filtered to identify potential disease-causing activity and validated using Sanger sequencing. We identified two novel heterozygous variants, c.253A>G p.Ser85Gly and c.802T>C p.Tyr268His, in the MC4R gene in two unrelated patients with morbid obesity and evaluated the functional impact of these variants. The impact of the variants on the MC4R gene was assessed using in silico prediction tools and molecular dynamics simulation. To further study the pathogenicity of the identified variants, GT1-7 cells were transfected with plasmid DNA encoding either wild-type or mutant MC4R variants. The effects of allelic variations in the MC4R gene on cAMP synthesis, MC4R protein level, and activation of PKA, ERB, and CREB signaling pathways in both stimulated and unstimulated ɑ-MSH paradigms were determined for their functional implications. In silico analysis suggested that the variants destabilized the MC4R structure and affected the overall dynamics of the MC4R protein, possibly leading to intracellular receptor retention. In vitro analysis of the functional impact of these variants showed a significant reduction in cell surface receptor expression and impaired extracellular ligand binding activity, leading to reduced cAMP production. Our analysis shows that the variants do not affect total protein expression; however, they are predicted to affect the post-translational localization of the MC4R protein to the cell surface and impair downstream signaling cascades such as PKA, ERK, and CREB signaling pathways. This finding might help our patients to benefit from the novel therapeutic advances for monogenic forms of obesity.

One Anastomosis Gastric Bypass in 6722 Patients: Early Outcomes from a Private Hospital Registry

BACKGROUND

One-anastomosis gastric bypass (OAGB) is an emerging metabolic bariatric surgery (MBS) type used in both primary OAGB (pOAGB) and revisional OAGB (rOAGB). We studied ≤30-day outcomes of pOAGB and rOAGB and identified predictors of early complications.

METHODS

Electronic medical records of all OAGBs performed between January 2017 and December 2021 at a high-volume bariatric clinic in Israel comprising four hospital centers were scanned retrospectively using specialized data software (MDClone software, version 6.1). Data gathered were patients' characteristics, surgical procedure, and ≤30-day complications with Clavien-Dindo Classification (CDC). Multivariate logistic regression analyses were used to identify factors related to early complications of pOAGB and rOAGB.

RESULTS

A total of 6722 patients underwent a pOAGB (n = 5088, 75.7%) or rOAGB (n = 1634, 24.3%) procedure at our institution. Preoperative mean age and body mass index (BMI) were 40.6 ± 11.5 years and 41.2 ± 4.6 kg/m2, respectively. Early complications occurred in 258 (3.8%) patients (176 pOAGB and 82 rOAGB) and included mainly bleeding (n = 133, 2.0%), leaks (n = 31, 0.5%), and obstruction/strictures (n = 19, 0.3%). CDC complications for grades 1-2 and grades 3a--5 were 1.5% and 1.6%, respectively. The overall mortality rate was 0.03% (n = 2). Age, operative time ≥3 h, and any additional concomitant procedure were independent predictors of early complications following pOAGB, while a diagnosis of diabetes mellitus and operative time ≥3 h were independent predictors of early complications following rOAGB.

CONCLUSIONS

OAGB was found to be a safe primary and revisional MBS procedure in the ≤30-postoperative day term. The most common complications were gastrointestinal bleeding, leaks, and obstruction/stricture.

Factors associated with weight loss and health gains in a structured lifestyle modification programme for adults with severe obesity: a prospective cohort study

Background

Individual responses to behavioural weight loss interventions can vary significantly, and a better understanding of the factors associated with successful treatment might help to target interventions for those who will benefit the most. We sought to identify demographic and clinical characteristics that predicted intervention "success" (defined as ≥5% weight loss) and other health gains in patients with severe obesity attending a ten-week structured lifestyle modification programme.

Methods

We conducted a prospective cohort study of all 1122 patients (751 (66.9%) female, mean age 47.3 ± 11.9 years, mean body mass index (BMI) 46.7 ± 7.8 kgm-2) referred from our hospital-based obesity clinic, who started the structured lifestyle programme between 2012-2019. We compared routine clinical measures such as weight, fitness, blood pressure, lipids and HbA1c at baseline and follow-up. We also used validated questionnaires to quantify anxiety, depression and health-related quality of life.

Results

Of 1122 patients who started, 877 (78.2%) completed the programme and attended for follow up. Of these, 12.8% lost ≥5% body weight. The amount of weight lost was a strong and consistent predictor of improvements in metabolic, cardiovascular, and mental health, even after adjusting for age, sex, programme attendance and baseline fitness. Older age, male sex, being physically active and having lower anxiety and depression scores at baseline predicted greater weight loss. Younger age, depression and longer wait time to start the intervention were associated with drop-out.

Conclusions

In adults with severe obesity completing a structured lifestyle modification programme, older age and good mental health were associated with programme completion and attaining ≥5% weight loss. The magnitude of weight lost was a strong predictor of improvements in cardiovascular, metabolic and mental health associated with programme completion.

A specific gut microbiota signature is associated with an enhanced GLP-1 and GLP-2 secretion and improved metabolic control in patients with type 2 diabetes after metabolic Roux-en-Y gastric bypass

Objective

To determine changes in incretins, systemic inflammation, intestinal permeability and microbiome modifications 12 months after metabolic RYGB (mRYGB) in patients with type 2 diabetes (T2D) and their relationship with metabolic improvement.

Materials and methods

Prospective single-center non-randomized controlled study, including patients with class II-III obesity and T2D undergoing mRYGB. At baseline and one year after surgery we performed body composition measurements, biochemical analysis, a meal tolerance test (MTT) and lipid test (LT) with determination of the area under the curve (AUC) for insulin, C-peptide, GLP-1, GLP-2, and fasting determinations of succinate, zonulin, IL-6 and study of gut microbiota.

Results

Thirteen patients aged 52.6 ± 6.5 years, BMI 39.3 ± 1.4 kg/m2, HbA1c 7.62 ± 1.5% were evaluated. After mRYGB, zonulin decreased and an increase in AUC after MTT was observed for GLP-1 (pre 9371 ± 5973 vs post 15788 ± 8021 pM, P<0.05), GLP-2 (pre 732 ± 182 vs post 1190 ± 447 ng/ml, P<0.001) and C- peptide, as well as after LT. Species belonging to Streptococaceae, Akkermansiacea, Rickenellaceae, Sutterellaceae, Enterobacteriaceae, Oscillospiraceae, Veillonellaceae, Enterobacterales_uc, and Fusobacteriaceae families increased after intervention and correlated positively with AUC of GLP-1 and GLP-2, and negatively with glucose, HbA1c, triglycerides and adiposity markers. Clostridium perfringens and Roseburia sp. 40_7 behaved similarly. In contrast, some species belonging to Lachnospiraceae, Erysipelotricaceae, and Rumnicocaceae families decreased and showed opposite correlations. Higher initial C-peptide was the only predictor for T2D remission, which was achieved in 69% of patients.

Conclusions

Patients with obesity and T2D submitted to mRYGB show an enhanced incretin response, a reduced gut permeability and a metabolic improvement, associated with a specific microbiota signature.

Impact of Treatment with GLP1 Receptor Agonists, Liraglutide 3.0 mg and Semaglutide 1.0 mg, While on a Waiting List for Bariatric Surgery

BACKGROUND

Weight loss before undergoing metabolic and bariatric surgery (MBS) has been suggested to reduce perioperative complications, although with controversial results. The objective of this study is to evaluate the impact of treatment with GLP1-R agonists (liraglutide 3.0 mg and semaglutide 1.0 mg) on preoperative weight loss and patients' decisions regarding MBS while on a surgical waiting list.

MATERIALS AND METHODS

One hundred and two patients on a waiting list for MBS started treatment with GLP1-RA for at least 6 months. Changes in weight at 26 and 52 weeks, the number of patients achieving >5% weight loss, and patients' decisions regarding MBS were evaluated.

RESULTS

After 52 weeks, patients lost 16.9 ± 7.2% of weight with semaglutide 1.0 mg and 16.1 ± 5.8% of weight with liraglutide 3.0 mg. All patients lost ≥5% of initial weight, 84.7% lost ≥10%, 54.6% lost ≥15%, and 27.5% reached ≥20%. A total of 68.6% of participants were satisfied with the achieved weight loss and withdrew from the waiting list for MBS. A threshold of >15.1% weight loss had the greatest sensitivity and specificity for the final decision regarding undergoing MBS.

CONCLUSIONS

Losing >15% of initial weight after 52 weeks of treatment with liraglutide 3.0 mg or semaglutide 1.0 mg during the waiting list for MBS impacts patients' decisions regarding the final acceptance or rejection of the procedure.

Clinical significance of iron deficiency among candidates for metabolic surgery

BACKGROUND

Iron deficiency (ID), a known complication after metabolic surgery, is common among preoperative patients in the presence of inflammation. Evidence is now accumulating that preoperative ID may adversely affect perioperative outcomes.

OBJECTIVES

To investigate the relationship between preoperative iron status and the risk of postoperative severe anemia. In addition, this study investigates the relationship between preoperative iron status and length of surgical stay SETTING: A large regional tertiary health system.

METHODS

Among patients who underwent metabolic surgery between 2004 and 2020, 5171 patients had a full iron nutritional assessment prior to surgery. Study patients were divided into multiple smaller groups (10 female groups and 7 male groups) on the basis of levels of serum ferritin and Transferrin Saturation (T Sat) < or ≥20%. Study patients were followed after surgery and the time to the development of severe anemia (hemoglobin < 8 gm/dL) was recorded. Hospital length of stay (LOS) was analyzed in relation to preoperative iron status.

RESULTS

Lower ferritin levels were associated with older age in males (P = .0001) and younger age in females (P < .0001). For males, after adjustment for age, body mass index (BMI), and year of surgery, surgical LOS was prolonged in those with T Sat <20% (P = .0041). For females the time until the development of severe anemia was associated with baseline iron status (P < .0001).

CONCLUSIONS

Male preoperative patients for metabolic surgery with T Sat <20% are at risk for increased surgical LOS. Females with low ferritin levels consistent with ID are at increased risk for the development of postoperative severe anemia.

Long-term cancer outcomes after bariatric surgery

OBJECTIVE

Obesity is associated with increased cancer risk. Because of the substantial and sustained weight loss following bariatric surgery, postsurgical patients are ideal to study the association of weight loss and cancer.

METHODS

Retrospectively (1982-2019), 21,837 bariatric surgery patients (surgery, 1982-2018) were matched 1:1 by age, sex, and BMI with a nonsurgical comparison group. Procedures included gastric bypass, gastric banding, sleeve gastrectomy, and duodenal switch. Primary outcomes included cancer incidence and mortality, stratified by obesity- and non-obesity-related cancers, sex, cancer stage, and procedure.

RESULTS

Bariatric surgery patients had a 25% lower risk of developing any cancers compared with a nonsurgical comparison group (hazard ratio [HR] 0.75; 95% CI 0.69-0.81; p < 0.001). Cancer incidence was lower among female (HR 0.67; 95% CI 0.62-0.74; p < 0.001) but not male surgery patients, with the HR lower for females than for males (p < 0.001). Female surgery patients had a 41% lower risk for obesity-related cancers (i.e., breast, ovarian, uterine, and colon) compared with nonsurgical females (HR 0.59; 95% CI 0.52-0.66; p < 0.001). Cancer mortality was significantly lower after surgery in females (HR 0.53; 95% CI 0.44-0.64; p < 0.001).

CONCLUSIONS

Bariatric surgery was associated with lower all-cancer and obesity-related cancer incidence among female patients. Cancer mortality was significantly lower among females in the surgical group versus the nonsurgical group.

Challenges in obtaining accurate anthropometric measures for adults with severe obesity: A community-based study

AIMS

The number of people with severe obesity (BMI ⩾40 kg/m²) is increasing rapidly, but is poorly documented, partly as a result of inappropriate standard anthropometric measurement methods for community-based people.

METHODS

As part of a broader study, people receiving care services and with severe obesity were visited at home. The people were assessed for measurements using different weighing scales and a standard portable stadiometer. If the stadiometer could not be used, their half arm span and knee height were measured to estimate their height using standard predictive equations.

RESULTS

Measurements were taken for 15 women and 10 men (n = 25) aged 40-87 years (mean 62 years). Weights ranged from 98.4 to 211.8 kg (mean 150 kg), with 16 participants requiring bariatric scales. For the six people who were unable to stand, we used wheelchair scales (n = 1), bed weighing scales (n = 2), routine weights from care home records (n = 2) or weight data from hospital records (n = 1). The standard portable stadiometer could only be used for one person; the others required alternative measures from which to estimate height. Large body habitus obscured bony landmarks, meaning alternative measures gave diverse heights. Fourteen participants had a ⩾8 cm difference in height between estimates from half arm span and knee height measurements.

CONCLUSIONS

Standard practice commonly does not provide reliable measurements for people with severe obesity, particularly those with mobility difficulties. An inability to measure weight and height accurately can exclude people from appropriate care, obscuring the true numbers affected and the effectiveness of future service planning. Safe community care requires the availability of specialist scales and standardised methods for height estimation appropriate for older and disabled people with severe obesity.

Long- and Short-Term High-Intensity Interval Training on Lipid Profile and Cardiovascular Disorders in Obese Male Adolescents

This study investigated the effects of short-term and long-term periods (8 and 16 weeks) of high-intensity interval training (HIIT) on cardiovascular components, blood lipids, and 6-min walking test performance in obese young boys (age = 16.2 ± 0.7) with >34% body fat. The participants were split into two groups: severe obesity (SOG; n = 17) and moderate obesity (MOG; n = 16). All participants performed on a cycle ergometer for 16 weeks (3 times per week) of HIIT at 100% peak power output at the ventilatory threshold and recovered at 50% of peak power. Except for BMI, both groups improved all body composition measures after 16 weeks, with a higher percentage of change (Δ) in SOG. The 6-min walking test increased in both groups (p < 0.001). Furthermore, cardiovascular variables, blood lactate concentration at rest and after 5-min post-exercise, blood lipids, and insulin concentrations improved significantly in both groups. After 16 weeks, MOG significantly improved in HR_peak, blood glucose concentration, and rating of perceived exertion (RPE), but the percentage of change (Δ) was higher in SOG for all the other variables. SOG showed a higher (Δ) waist-to-hip ratio, maximum heart rate, resting heart rate, systolic blood pressure, blood lactate at 5-min post-exercise, and triglyceride concentrations after 8 and 16 weeks of training. In conclusion, a long-term HIIT program appears to be an appropriate training approach for obese boys with extra body fat. However, considering the RPE values, short-duration training sessions should be planned.

Aggravation of Ossified Ligamentum Flavum Lesion Is Associated With the Degree of Obesity

STUDY DESIGN

Retrospective cross-sectional study.

OBJECTIVES

There is insufficient data on the clinical features of ossification of the ligamentum flavum (OLF) of the thoracic spine and the risk of progression of ossified lesions. The link between obesity and ossification of the posterior longitudinal ligament (OPLL), which frequently coexists with OLF, has been demonstrated. However, the link between obesity and OLF has not been recognized. We aimed to determine the prevalence of obesity in thoracic OLF and whether the severity of OLF is associated with the degree of obesity.

METHODS

A total of 204 symptomatic Japanese subjects with thoracic OLF and 136 subjects without spinal ligament ossification as controls were included. OLF subjects were divided into 3 groups: 1) localized OLF (OLF <2-intervertebral regions); 2) multilevel OLF (OLF ≥3-intervertebral regions); and 3) OLF + OPLL. The severity of OLF was quantified using the OLF index using computed tomography imaging of the entire spine.

RESULTS

The proportion of severely obese subjects (BMI ≥ 30 kg/m2) was significantly higher both in the multilevel OLF group (25.5%) and the OLF + OPLL group (44.3%) than in the localized OLF group (3.6%) and the control group (1.4%) (P < 0.01). BMI, age, and coexistence of cervical OPLL and lumbar OLF were associated with thoracic OLF index in the multiple regression analysis.

CONCLUSIONS

Our findings demonstrated that obesity is a distinct feature of multilevel OLF in the thoracic spine and that the severity of OLF is associated with the degree of obesity.

Muscle Quality Index in Morbidly Obesity Patients Related to Metabolic Syndrome Markers and Cardiorespiratory Fitness

BACKGROUND

Muscle quality index (MQI) is an emerging health indicator obtained by dividing handgrip strength by body mass index (BMI) that needs to be studied in morbidly obese patients (defined by BMI ≥ 35 kg/m²).

OBJECTIVE

To determine the association between MQI, metabolic syndrome (MetS) markers, and cardiorespiratory fitness (CRF), and as a second objective to determine the potential mediation role of MQI in the relationship between abdominal obesity and systolic blood pressure (SBP) in this sample.

METHODS

This cross-sectional study included 86 severely/morbidly obese patients (age = 41.1 ± 11.9 y, nine men). MQI, metabolic syndrome markers, CRF, and anthropometric parameters were measured. Two groups were developed according to MQI; High-MQI (n = 41) and Low-MQI (n = 45).

RESULTS

The Low-MQI group reported higher abdominal obesity (High-MQI: 0.7 ± 0.1 vs. Low-MQI: 0.8 ± 0.1 WC/height; p = 0.011), SBP (High-MQI: 133.0 ± 17.5 vs. Low-MQI: 140.1 ± 15.1 mmHg; p = 0.048), and lower CRF (High-MQI; 26.3 ± 5.9 vs. Low-MQI; 22.4 ± 6.1 mL/kg/min, p = 0.003) than the High-MQI group. Waist-to-height ratio (β: -0.07, p = 0.011), SBP (β: -18.47, p = 0.001), and CRF (β: 5.21, p = 0.011) were linked to MQI. In a mediation model, the indirect effect confirms that MQI is a partial mediator of the association between abdominal obesity with SBP.

CONCLUSIONS

MQI in morbidly obesity patients reported an inverse association with MetS markers and a positive association with CRF (VO2_max). It mediates the relationship between abdominal obesity and SBP.

Irisin as a Novel Biomarker of Subclinical Atherosclerosis in Severe Obesity

Severe obesity (SO) can accelerate atherosclerosis and the onset of acute cardiovascular events. The diagnosis of atherosclerosis in the context of a high body mass index (BMI) can be challenging, making the identification of biomarkers clinically relevant. We aimed to assess the usefulness of irisin as a biomarker for subclinical atherosclerosis in participants with SO. This prospective observational study included 61 participants undergoing bariatric surgery for SO, defined as a BMI >40 kg/m² or >35 kg/m² with at least one comorbidity. Atherosclerotic plaques were detected by ultrasound. Plasma samples were obtained 1 month before and at 6 and 12 months after bariatric surgery to measure irisin by ELISA. Additionally, subcutaneous samples of adipose tissue were taken and genotyped to identify irisin polymorphism rs3480. Irisin levels were positively correlated with BMI (r = 0.23, p = 0.0064), negatively correlated with atheroma-related parameters (e.g., carotid intima-media thickness), and lower in subjects with atheroma (p < 0.0002). Irisin also showed good overall accuracy for discriminating plaque presence (AUC, 0.81; 95% CI, 0.6956-0.9156). However, the rs3480 polymorphism correlated with neither the irisin levels nor the presence of atheromas. Iirisin could identify subclinical atherosclerosis in SO and might facilitate clinical diagnosis.

Early Recognition of Overweight Hyperglycaemia May Improve Clinical Outcomes in Type 2 Diabetes

Diabetes is the ninth leading cause of death, directly accounting for 1.5 million deaths annually worldwide. Despite several breakthrough discoveries, little progress has been made in type 2 diabetes outcomes over the past 100 years. Younger age (below 60 years), a diet high in calories and processed food, and severe obesity (body mass index >35 kg/m²) may identify reversible beta cell dysfunction. Much of the clinical presentation pertains to flooding the body's adaptive limits with overnutrition. Recognizing this as a global societal trend brought about by lifestyle changes, sedentary work, mental stress and unlimited access to calorie-dense foods is crucial. Insulin resistance and genetic abnormalities cannot account for the dramatic increase in diabetes, from only 1% five decades ago to nearly 10% today. Obesity - and not insulin resistance - is at the core of the problem. As well as hyperglycaemia, end-organ damage can also be reversed with diet and weight loss in many affected individuals. We present the evolution of our understanding and compelling reasons to reframe diabetes in the severely obese to what it really is - overweight hyperglycaemia. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles. The objective of this review is to better understand global trends and the potential to improve outcomes by reframing the diabetes narrative towards remission. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles.

Childhood obesity trends: Association with same-day hospital admission in a National Outpatient Surgical Population

BACKGROUND

Although the prevalence of obesity in the general population and its perioperative implications among children undergoing inpatient surgeries are well known, little is known about obesity prevalence among children scheduled for ambulatory surgery.

AIMS

Here, we report the trends of obesity and severe obesity among children who underwent ambulatory surgery across multiple centers in the United States and explore the association of obesity status with admission following elective ambulatory surgery.

MATERIALS AND METHODS

Using data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (2012-2019), we selected children 2-18 years old who underwent outpatient surgical procedures under general anesthesia and had documented height, weight, and body mass index (BMI) data. We estimated the prevalence of overweight, obesity (class 1), and severe obesity (class 2 and class 3) patients and explored their association with same-day hospital admission, defined as hospital length of stay ≥1 day.

RESULTS

Data from 152 918 children (mean age: 9.7 ± 4.7 years) were analyzed. Of these, 16.4% (n = 25 007) were overweight, 13.8% (n = 21 085) were class 1 obese, 5.2% (n = 7879) were class 2 obese, and 3.0% (n = 4623) were class 3 obese. From 2012 to 2019, class 2 or 3 obesity prevalence increased by 26.7% and 32.5%, respectively. Overweight and obese children had relatively higher odds of same-day hospital admission compared to healthy weight children (overweight odds ratio [95% confidence interval]: 1.05 [1.02, 1.08]; class 1 obesity: 1.04 [1.00, 1.07]; class 2 obesity: 1.09 [1.02, 1.16]; class 3 obesity: 1.20 [1.11, 1.30]).

DISCUSION AND CONCLUSION

The burden of obesity continues to increase in children scheduled for ambulatory surgery. Children with class 2 and class 3 obesity have higher rates of same-day hospital admission following elective ambulatory surgery compared to healthy weight children, a factor that should be considered in scheduling these patients.

Braun Anastomosis: A Technique for Bile Reflux Improvement After Single Anastomosis Sleeve Ileal (SASI) Bypass; a Pilot Study

Background. Single anastomotic surgeries can increase the risk of reflux, marginal ulceration, and gastrointestinal complications. Braun anastomosis prevents bile reflux after gastric resection and gastrojejunal anastomosis surgeries. The present pilot study evaluated Braun's efficacy in a single anastomosis sleeve ileal (SASI) bypass surgery.Methods. 28 patients with a history of SASI bypass surgery from October 2017 to September 2021 were included in the study. Patients were divided into 2 groups based on having Braun anastomosis to this surgical procedure; group A: underwent SASI bypass without Braun anastomosis; group B: underwent SASI bypass with Braun anastomosis. The surgical complications in terms of bile reflux, marginal ulcer, reflux esophagitis, and gastritis were evaluated and compared between the groups. Results. Bile reflux and reflux esophagitis were seen more in group A than in group B (37.5% vs 8.3% and 18.8% vs 8.3%, respectively). In contrast, 2 patients (16.7%) in group B had marginal ulcers compared to 1 (6.3%) in group A. Also, gastritis was seen in 1 patient in each group (6.3% in group A vs 8.3% in group B). However, the differences were not statistically different. Conclusions. Braun anastomosis is probably an effective procedure to reduce bile reflux, a concern of SASI bypass. Besides, further studies with a larger study population are needed.

Retrospective analysis of the impact of severe obesity on kidney transplant outcomes

BACKGROUND

The prevalence of obesity among kidney transplant recipients is rising. We sought to determine the association between recipient body mass index (BMI) and post-transplant complications.

METHODS

Single-center, retrospective cohort study of all adult kidney transplant recipients from 2004 to 2020. Recipients were stratified into four BMI categories: normal-weight (BMI 18.5-24.9 kg/m2, n = 1020), overweight (BMI 25-29.9 kg/m2, n = 1002), moderately obese (BMI 30-34.9 kg/m2, n = 510) and severely-to-morbidly obese (BMI ≥35 kg/m2, n = 274). Logistic regression was used to estimate the association between BMI category and surgical site infections (SSIs).

RESULTS

Recipients with BMI ≥35 kg/m2 had significantly higher rates of SSIs (P < .0001) compared with recipients in all other categories. On multivariable analysis, recipients with BMI ≥35 kg/m2 had increased odds of SSIs compared with normal-weight recipients [odds ratio (OR) 3.34, 95% confidence interval (CI) 1.55-7.22, P = .022). On multivariable and Kaplan-Meier analyses, no BMI groups demonstrated increased odds for death-censored graft failure.

CONCLUSION

Severe obesity in kidney transplant recipients is associated with increased SSIs, but not kidney allograft failure.

Self-worth and developmental outcomes in young adults after pediatric bariatric surgery

OBJECTIVES

Bariatric surgery has emerged as a safe/effective treatment for adolescents with severe obesity; therefore, understanding its impact over the life course is imperative. This study examined self-worth and developmental outcomes during the transition to adulthood (19-24 years old) for youth who underwent surgery as adolescents (13-18 years old) and a nonsurgical group with severe obesity.

METHOD

As part of a prospective and multisite observational study series, adolescents (139 surgical, 83 nonsurgical) were followed for 6 years postsurgery/baseline when they completed height/weight measurements and measures of global self-worth, maturity, and occupational, educational, and social functioning as young adults. Growth curve analysis examined global self-worth change, while regressions were used to compare groups and examine adolescent-reported familial predictors and weight-related correlates for outcomes.

RESULTS

Relative to the nonsurgical group, the surgical group experienced a significant quadratic improvement in self-worth and higher year 6 romantic self-perceptions. For the surgical group only, greater family dysfunction predicted lower young adult self-worth and perceptions of maturity, while higher family connectedness predicted higher self-worth and perceptions of maturity. Greater percent weight loss was associated with higher perceptions of maturity for the surgical group.

CONCLUSIONS

Group difference findings suggest that the impact of surgery was on self-worth and romantic self-perceptions, outcomes linked in the developmental literature to body image. For both groups, functioning appeared similar to population-based findings, suggesting they are meeting "expected" age-salient developmental outcomes. The impact of earlier positive family functioning on self-worth and self-perceptions of maturity may place adolescents on pathways to success. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Neighborhood deprivation and residential property values do not affect weight loss at 1 or 3 years after bariatric surgery

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.

Opinions from the experts: Experiences of adolescents with severe obesity participating in meal replacement therapy

BACKGROUND

Meal replacement therapy (MRT) is a structured treatment that is effective for short-term weight reduction in adolescents with severe obesity. However, like other interventions, MRT response is variable.

OBJECTIVE

The goal of the current study was to characterize the experience of adolescents with severe obesity participating in MRT.

METHODS

Seventeen adolescents with severe obesity participated in semi-structured, individual interviews about their experience participating in MRT. The authors used a biopsychosocial model as the theoretical framework and data was analysed using Interpretive Phenomenological Analysis. A biopsychosocial model views an individual's health as a blend of biological characteristics, behavioural factors, and social conditions.

RESULTS

Results showed that adolescents with severe obesity described three biopsychosocial factors that were central to their experience with MRT: (1) scheduling and planning, (2) social support and pressure, and (3) intrapersonal factors. Specifically, adolescents with severe obesity identified that planning ahead, social support, and intrapersonal changes (e.g. self-confidence) can promote engagement in MRT. On the other hand, unplanned schedule changes, social pressures, and different intrapersonal factors (e.g., taste preference) can make engagement challenging.

CONCLUSIONS

Adolescents provided information on factors that supported or hindered their engagement in MRT, and themes were consistent with prior literature on health behaviour change. Overall, adolescents would recommend MRT to other teenagers who carry extra weight. Future research can use the rich information provided by adolescents with severe obesity to enhance and individualize treatment options.

Change in the prevalence of overweight/obesity in Czech seven-year-old children between 2008 and 2019

World Health Organization (WHO) Europe organizes Childhood Obesity Surveillance Initiative (COSI), in which the Czech Republic participates since the beginning. The aim of this project is to monitor the prevalence of overweight and obesity of 7-year-old children in the Czech Republic. Data were obtained from 2349 children examined by 72 pediatricians across the Czech Republic. Anthropometric parameters were measured and subjects filled questionnaire. The prevalence of obesity and overweight did not change significantly between 2008 and 2019. Although in the fifth round in 2019, the prevalence of obesity increased and the prevalence of overweight slightly decreased in both sexes. In 2019 6.09 % of boys and 7.12 % of girl had overweight. The prevalence of obesity in the fifth round was 9.26 % in boys and 8.64 % in girls (assessed according to the Czech reference values). Already in the first round we noticed a relatively high prevalence of severe obesity (3.21 % for boys and 0.8 % for girls), which did not differ significantly between rounds. Even if the prevalence of overweight has not significantly increased until 2019, preventive and treatment programs are very important, because it is an important part of the prevention and early detection of obesity in children.

Higher Waist Hip Ratio Genetic Risk Score Is Associated with Reduced Weight Loss in Patients with Severe Obesity Completing a Meal Replacement Programme

Background: A better understanding of the influence of genetic factors on the response to lifestyle interventions in people with obesity may allow the development of more personalised, effective and efficient therapeutic strategies. We sought to determine the influence of six obesity-related genetic risk scores on the magnitude of weight lost by patients with severe obesity who completed a dietary intervention. Methods: In this single-centre prospective cohort study, participants with severe and complicated obesity who completed a 24-week, milk-based meal replacement programme were genotyped to detect the frequency of common risk alleles for obesity and type 2 diabetes-related traits. Genetic risk scores (GRS) for six of these traits were derived. Participants with a potentially deleterious monogenic gene variant were excluded from the analysis. Results: In 93 patients completing the programme who were not carrying a known obesity-related gene mutation, 35.5% had diabetes, 53.8% were female, mean age was 51.4 ± 11 years, mean body mass index was 51.5 ± 8.7 and mean total weight loss percent at 24 weeks was 16 ± 6.3%. The waist-hip ratio (WHR) GRS was inversely associated with percentage total weight loss at 24 weeks (adjusted β for one standard deviation increase in WHR GRS -11.6 [-23.0, -0.3], p = 0.045), and patients in the lowest tertile of WHR GRS lost more weight. Conclusions: Patients with severe and complicated obesity with a genetic predisposition to central fat accumulation had less weight loss in a 24-week milk-based meal replacement programme, but there was no evidence for influence from the five other obesity-related genetic risk scores on the response to dietary restriction.

Association Between Vitamin A Intake and Disease Severity in Early-Onset Heterotopic Ossification of the Posterior Longitudinal Ligament of the Spine

STUDY DESIGN

A sex- and age-matched case-control study and a cross-sectional study.

OBJECTIVE

In our previous study, patients with early-onset (<50 years of age) ossification of the posterior longitudinal ligament (OPLL) had distinct features such as morbid obesity, a high prevalence of lifestyle-related diseases, and diffuse ossified lesions mainly affecting the thoracic spine. Our goals were to determine whether early-onset OPLL patients have unbalanced dietary habits and to identify nutritional factors associated with OPLL exacerbation.

METHODS

In Study 1, the simple brief-type self-administered diet history questionnaire (BDHQ) was used to compare nutrient intake levels of early-onset OPLL patients (n = 13) with those of sex- and age-matched non-OPLL controls (n = 39) or with those of common OPLL (onset age ≥ 50 years, n = 62). In Study 2, serological validation was conducted for thoracic OPLL patients (n = 77) and non-OPLL controls (n = 101) in a nationwide multicenter study in Japan.

RESULTS

The BDHQ showed that the early-onset OPLL patients had significantly lower intakes of vitamins A and B6 than non-OPLL controls. These results were validated by lower serum vitamins A and B6 levels in the early-onset thoracic OPLL patients. The severity of OPLL negatively correlated with serum vitamin A levels in male early-onset OPLL patients. The multiple regression analysis revealed that the severity of thoracic OPLL had an association with onset age and serum vitamin A level.

CONCLUSIONS

Vitamin A deficiency resulting from unbalanced dietary habits is associated with exacerbation of male early-onset OPLL.

Metabolic dysfunction-associated fatty liver disease directly related to liver fibrosis independent of insulin resistance, hyperlipidemia, and alcohol intake in morbidly obese patients

AIM

Hepatic fibrosis is associated with various factors, including metabolic dysfunction-associated fatty liver disease (MAFLD), insulin resistance, and alcohol intake in patients with morbid obesity. We investigated factors directly associated with hepatic fibrosis in patients with morbid obesity using a graphical model.

METHODS

We enrolled 134 consecutive patients with morbid obesity who underwent liver biopsy during sleeve gastrectomy (median age 43.5 years; MAFLD 78.4%; homeostasis model assessment of insulin resistance [HOMA-IR] 5.97; >20 g/day alcohol intake 14.2%). Patients were classified into none/mild (F0/1; n = 77) or significant/advanced fibrosis (F2/3; n = 57) groups, based on histology. Factors associated with F2/3 were analyzed using logistic regression analysis and a graphical model.

RESULTS

F2/3 was observed in 42.5% of the enrolled patients. The prevalence of MAFLD and HOMA-IR values were significantly higher in the F2/3 group than in the F0/1 group; however, no significant difference in alcohol intake was observed between the two groups. On logistic regression analysis, MAFLD, but not HOMA-IR or alcohol intake, was the only independent factor associated with F2/3 (odds ratio 7.555; 95% confidence interval 2.235-25.544; p = 0.0011). The graphical model revealed that F2/3 directly interacted with MAFLD, diabetes mellitus, HOMA-IR, and low-density lipoprotein cholesterol. Among these factors, MAFLD showed the strongest interaction with F2/3.

CONCLUSIONS

We determined that MAFLD was more directly associated with significant/advanced fibrosis than insulin resistance or hyperlipidemia, and alcohol intake was not directly associated with hepatic fibrosis. Metabolic dysfunction-associated fatty liver disease could be the most important factor for hepatic fibrosis in patients with morbid obesity.

Food Insecurity Influences Weight Trajectory in Children with Obesity

Background: Social disadvantage is associated with children's risk of being overweight or obese, but little is known about how it impacts weight trajectory. This longitudinal analysis examines food insecurity and weight change over time among low-income children in a multidisciplinary weight management clinic. Methods: Food insecurity was assessed between 2008 and 2016 among 794 low-income patients (household income <$60k/year) who attended 3234 visits. Mixed-effects growth curve modeling was used to examine the association between baseline food security status and weight trajectory, using percentage of the 95th percentile for BMI (%BMIp95). Random effects (each child's growth curve) and fixed effects (food insecurity, starting age and %BMIp95, demographics, and months since the initial visit) were modeled, and interactions between food insecurity and elapsed time estimated the influence of food insecurity on weight trajectory. Results: Mean %BMIp95 was 129% (SD 24%), corresponding to severe obesity. Thirty percent of patients were food-insecure at baseline. After adjusting for other factors, monthly change in %BMIp95 was significantly smaller for food-insecure children compared to food-secure peers (difference in the coefficients for slope: 0.13, SE 0.05, p = 0.009). The modeled 12-month change in %BMIp95 was significant for food-secure children (-2.28, SE 0.76, p = 0.0026), but not for food-insecure children (-1.54, SE 1.22, p = 0.21). Conclusion: Household food insecurity was associated with a less optimal weight trajectory among children with obesity.

Psychosocial predictors of problematic eating in young adults who underwent adolescent bariatric surgery

Introduction

This study examined problematic eating and eating-related psychopathology among young adults who underwent adolescent bariatric surgery including concurrent and prospective associations with psychosocial factors and weight change.

Methods

VIEW point is a 6-year follow-up study within a prospective observational study series observing adolescents with severe obesity who had bariatric surgery (n = 139) or who presented to nonsurgical lifestyle modification programs (n = 83). Participants completed height/weight measurements, questionnaires, and diagnostic interviews. Regression analyses compared problematic eating across groups and examined Year 6 correlates (i.e., psychosocial factors and weight change) and baseline predictors (i.e., psychosocial factors) of eating-related psychopathology.

Results

Compared to the nonsurgical group, the surgical group reported lower eating-related psychopathology, objective binge eating, and grazing at Year 6. While chewing/spitting out and vomiting for weight/shape-related reasons were very infrequent for the surgical group, self-induced vomiting for other reasons (e.g., avoid plugging) was more common. For the surgical group, lower self-worth, greater internalizing symptoms, and higher weight-related teasing in adolescence predicted increased eating-related psychopathology in young adulthood. Year 6 eating-related psychopathology was concurrently associated with lower percent weight loss for the surgical group and greater percent weight gain for the nonsurgical group.

Conclusion

Undergoing adolescent bariatric surgery appears to afford benefit for problematic eating and eating-related psychopathology. Current findings suggest that the clinical intervention related to problematic eating and associated psychosocial concerns may be needed for young adults with obesity, regardless of surgical status.

The Leading Factors of Obesity and Severe Obesity in Korean Adults during the COVID-19 Pandemic

(1) Background: During the coronavirus disease 2019 (COVID-19) pandemic, the prevalence of obesity or severe obesity has increased worldwide to the point that it has even been referred to as a new disease. However, the impacts of the pandemic on obesity or severe obesity remain unclear, thus requiring a thorough examination of the leading factors of obesity and severe obesity during this time. (2) Methods: The required dataset for this study was extracted from the eighth (2019-2020) Korea National Health and Nutrition Examination Survey (KNHNES). The survey's data for 2019 and 2020 were analyzed to confirm the leading factors of obesity and severe obesity before and after the outbreak of COVID-19. The samples were weighted, and the data were analyzed using multiple logistic regression. (3) Results: In 2020, the prevalence of obesity and severe obesity in the Korean adult population aged 19 and over, compared with the normal weight group, showed significant increases of 2.5% and 1.4%, respectively, compared with those rates in 2019 (p < 0.05). The main variables affecting the obesity prevalence in Korean adults aged 19 and over in 2020 were gender, age, sitting time per day, and walking time per day, and the factors affecting severe obesity were gender and age. Meanwhile, the daily energy intake variable had no impact on the prevalence of obesity and severe obesity. (4) Conclusions: These findings will serve as a basis to help the present management directions and treatment approaches for individuals with obesity or severe obesity in the post-COVID-19 era.

Influence of COVID-19-Related Restrictions on the Prevalence of Overweight and Obese Czech Children

Apart from influencing the health of the worldwide population, the COVID-19 pandemic changed the day-to-day life of all, including children. A sedentary lifestyle along with the transformation of eating and sleep habits took place in the child population. These changes created a highly obesogenic environment. Our aim was to evaluate the current weight in the child population and identify the real effects of the pandemic. Height and weight data were collected by pediatricians from the pre-COVID-19 and post-COVID-19 periods from 3517 children (1759 boys and 1758 girls) aged 4.71 to 17.33 years. We found a significant rise in the z-score BMI between pediatric visits in the years 2019 and 2021 in both sexes aged 7, 9, 11, and 13 years. Especially alarming were the percentages of (severely) obese boys at the ages of 9 and 11 years, which exceed even the percentages of overweight boys. With the use of statistical modeling, we registered the most dramatic increment at around 12 years of age in both sexes. Based on our research in the Czech Republic, we can confirm the predictions that were given at the beginning of the pandemic that COVID-19-related restrictions worsened the already present problem of obesity and excess weight in children.

Acute Exacerbation of Anemia with Parvovirus B19 Infection One Year after Sleeve Gastrectomy for Severe Obesity

Pancytopenia due to malnutrition sometimes occurs after gastric bypass but is rare after sleeve gastrectomy. A 35-year-old patient underwent sleeve gastrectomy for severe obesity. Twelve months after the operation, rapid progression of macrocytic anemia with leukopenia and thrombocytopenia occurred, and a decrease in some vitamins and trace elements due to an insufficient food intake was also detected. Haptoglobin decreased, suggesting the presence of hemolysis. In addition, IgM antibody against parvovirus B19 was detected, followed by IgG antibody. Parvovirus B19 infection was suggested to be involved in the rapid progression of anemia in this malnourished patient after bariatric surgery.

Vitamin D Deficiency in Patients with Morbid Obesity before and after Metabolic Bariatric Surgery

Background: Metabolic bariatric surgery (MBS) is the most effective treatment for severe obesity. Vitamin D deficiency is a common complication encountered both during preoperative workup and follow-up. Aim: To estimate the prevalence of vitamin D deficiency in patients undergoing MBS. Methods: Prospectively maintained database of our university MBS center was searched to assess the rate of preoperative and postoperative vitamin D deficiency or insufficiency in patients undergoing MBS over a one-year period. Results: In total, 184 patients were included, 85 cases of Sleeve Gastrectomy (SG), 99 Gastric Bypass (GB; 91 One Anastomosis and 8 Roux-en-Y). Preoperative vitamin D deficiency and insufficiency were respectively found in 61% and 29% of patients, with no significant difference between SG and GB. After six months, 15% of patients had vitamin D deficiency, and 34% had vitamin D insufficiency. There was no significant difference in the rate of vitamin D deficiency or insufficiency and the percentage of total weight loss (%TWL) at 1, 3, and 6 postoperative months between SG and GB. Conclusions: Preoperative vitamin D deficiency or insufficiency is common in MBS candidates. Regular follow-up with correct supplementation is recommended when undergoing MBS. Early postoperative values of vitamin D were comparable between SG and OAGB.

Change in weight category among youth early in the COVID-19 pandemic

Remote learning and shelter-in-place orders during the COVID-19 pandemic are associated with obesity risk factors such as decreased physical activity, altered routines and sleep schedules, increased screen time, and non-nutritious food choices. The objective of this brief report is to describe change in weight category 3-6 months after the onset of the pandemic in a cohort of 4509 low-income youth. Inclusion criteria were youth aged 2-17 years with weight and height measure in a large primary care network between 1 January and 30 March 2020 (Q1), designated as pre-COVID period; and 1 June-30 September 2020, (Q3), as early-COVID period. Change in weight category was assessed between Q1 and Q3. Adjusting for visit type and time lapse, logistic regression was conducted to examine the association between weight category change and age, sex, and race/ethnicity. The proportion of youth with overweight or obesity increased from 37.8% to 44.6%; and declined by 5.6% in the healthy weight category. Over the 3-6 month period, 23.1% of youth gained ≥5 kg, 4.3% gained ≥10 kg, and 17.8% increased their BMI by ≥2 units. Among underweight youth, 45.3% switched to the healthy weight category, with a median weight gain of 2.1 kg (interquartile range [IQR] = 2.1 kg). Median weight gain was highest among those youth with severe obesity (5.8 kg, IQR = 5.2 kg). Younger age (2-9 years), female and ethnic-minority youth were more likely to change to a higher/worse weight category. Significant weight gain occurred in the first 3-6 months of the pandemic among low-income youth, reflecting the short-term effects of the pandemic.

Perceptions of Weight Management: Interviews with Adolescents with Severe Obesity and Their Mothers

Background: Adolescence is a challenging time for families, which is intensified when managing a chronic health condition. In adolescents with severe obesity, little is known about how adolescent/mother dyads approach management. Our study aims to (1) explore similarities/differences in adolescent/mother dyads' perceptions of weight management behaviors and (2) describe their experiences with successes and challenges related to weight management. Methods: This was a qualitative descriptive analysis of interviews from 21 adolescent/mother dyads. Conventional content analysis was used to identify themes characterizing dyads' weight management efforts. Results: Two patterns of perceptions were identified across the dyads specific to weight management behaviors: collaborative (dyads agreed) and conflicting (dyads disagreed). Weight management themes with collaborative perceptions were food preferences; food and emotion; the adolescent is active; exercise is not enjoyable; the family is active together; and stopping medications. Weight management themes with conflicting perceptions were responsibility for initiating and maintaining exercise, motivation and willingness to exercise, and responsibility for medications. Dyads had collaborative pattern responses on perceptions of success and challenges. Themes related to successes were weight loss and supportive relationships. Themes related to challenges were inconsistent daily routines and schedules, and unsupportive relationships. Conclusions: Dyads responded with collaborative or conflicting perceptions to weight management behaviors and with collaborative responses to success and challenges. Sustaining healthy habits was difficult from the perspectives of dyads. For youth with severe obesity, providing care that recognizes and addressees issues youth and their families experience may require improved and innovative interventions.

How safe bariatric surgery is-An update on perioperative mortality for clinicians and patients

Bariatric, metabolic or weight loss surgery produces sustained weight loss and imporovement in obesity related diseases. Bariatric surgery has existed for decades but there is limited reliable data on the risk of perioperative mortality following the procedures. This commentary focuses on a recent meta-analysis which has produced contemporaneous mortality data, and the findings are significant. Utilising data from 3.6 million patients the study has shown an overall pooled perioperative mortality of 0.08%, a significantly reduced risk compared to previous, smaller studies. This finding increases our knowledge of surgical risk for these procedures and should now equip health care groups to challenge barriers to uptake of bariatric surgery. Barriers currently include a worldwide lack of focus on treating obesity, lack of funding and resource from commissioners, and a general public and professional view that bariatric surgery may be high risk. In reality, this figure equates to mortality risk for procedures generally considered 'safe' such as laparoscopic cholecystectomy and knee arthroplasty. Bariatric surgery is a safe option for achieving sustained weight-loss and the treatment of obesity related diseases, and refusing access to surgery on the grounds of perioperative safety should now be an outdated premise.

Morbid obesity increases death and dropout from the liver transplantation waiting list: A prospective cohort study

Liver transplant (LT) candidates with a body mass index (BMI) over 40 kg/m² have lower access to a liver graft without clear explanation. Thus, we studied the impact of obesity on the waiting list (WL) and aimed to explore graft proposals and refusal.

METHOD

Data between January 2007 and December 2017 were extracted from the French prospective national database: CRISTAL. Competing risk analyses were performed to evaluate predictors of receiving LT. Competitive events were (1) death/WL removal for disease aggravation or (2) improvement. The link between grade obesity, grafts propositions, and reason for refusal was studied.

RESULTS

15,184 patients were analysed: 10,813 transplant, 2847 death/dropout for aggravation, 748 redirected for improvement, and 776 censored. Mortality/dropout were higher in BMI over 35 (18% vs. 14% 1 year after listing) than in other candidates. In multivariate analysis, BMI>35, age, hepatic encephalopathy, and ascites were independent predictors of death/dropout. Candidates with a BMI ≥ 35 kg/m² had reduced access to LT, without differences in graft proposals. However, grafts refusal was more frequent especially for 'morphological incompatibility' (14.9% vs. 12.7% p < 0.01).

CONCLUSION

BMI over 35 kg/m² reduces access to LT with increased risk of dropout and mortality. Increased mortality and dropout could be due to a lower access to liver graft secondary to increased graft refusal for morphological incompatibility.

The Effect of a Multidisciplinary Lifestyle Intervention on Health Parameters in Children versus Adolescents with Severe Obesity

Lifestyle interventions are the common treatment for children and adolescents with severe obesity. The efficacy of these interventions across age groups remain unknown. Therefore, this study aimed to compare the effectiveness of a lifestyle intervention on health parameters between children and adolescents with severe obesity. A longitudinal design was carried out at the Centre for Overweight Adolescent and Children’s Healthcare (COACH) between December 2010 and June 2020. Children (2–11 years old, n = 83) and adolescents (12–18 years old, n = 77) with severe obesity received a long-term, tailored, multidisciplinary lifestyle intervention. After 1 year, 24 children (28.9%) and 33 adolescents (42.9%) dropped out of the intervention. The primary outcome was the change in body mass index (BMI) z-score after one and two years of intervention. The decrease in BMI z-score over time was significantly higher in children compared to adolescents, the mean decrease was 0.15 (0.08–0.23) versus 0.03 (−0.05–0.11) after one year and 0.25 (0.15–0.35) versus 0.06 (−0.06–0.17) after two years of intervention; p values for the difference between children and adolescents were 0.035 and 0.012. After two years, multiple improvements in cardio metabolic health parameters were observed, especially in children. In conclusion, during our tailored lifestyle intervention, a positive and maintained effect on health parameters was observed in children with severe obesity. Compared to children, the effect on health parameters was less pronounced in adolescents.

Antenatal fetal surveillance of women with severe obesity

OBJECTIVE

To estimate the impact of body mass index (BMI) categories on duration of the nonstress test (NST), and the need for additional tests of fetal wellbeing or interventions.

METHODS

We conducted a retrospective cohort study of women with singleton pregnancies who had an NST for the indications of severe obesity (BMI ≥40 kg/m²), diabetes (pre-gestational or gestational), hypertensive disorders (chronic, gestational, and preeclampsia), and others between 1 January 2015 until 31 December 2016. NST durations (<30 and ≥30 min) were compared between groups first based on BMI (kg/m²) categories (<30, 30-39, 40-49, and ≥50) and then based on BMI and comorbidities: (1) severe obesity alone, (2) severe obesity and comorbidities, and (3) comorbidities alone. We compared the results of the NSTs, any subsequent fetal testing or interventions, and pregnancy outcomes among groups. Demographic information was compared using t-tests for continuous data and χ² analyses or Fisher's exact test, if the cells sizes were small, for categorical data. NST durations based on BMI groups, as well as BMI and comorbidities groups, were compared using linear mixed models and ANOVA.

RESULTS

Three hundred and fifty-one women underwent 1665 NSTs during the study period. After excluding women <18 and >50 years, gestational age <30 weeks, fetal anomalies, and NSTs lasting longer than 60 min, the study population included 313 women and 1471 NSTs. The mean NST duration in minutes of the BMI ≥50 (32.2 ± 9.6) category was significantly longer than the NST duration of the other BMI categories (BMI <30: 29.4 ± 8.3; BMI 30-39: 29.7 ± 8.9; BMI 40-49: 29.9 ± 8.3) (p=.05). Additionally, there was an increased percentage of NSTs lasting ≥30 min as the BMI category increased (p=.005). Women in the severe obesity and comorbidities group (n = 79) were less likely to have a reactive NST than women with severe obesity alone (n = 56) or comorbidities alone (n = 178) (92% vs. 97% vs. 98%, p<.0001). They were also more likely to need a biophysical profile (BPP) (8% vs. 3% vs. 2%, p<.0001). Of the 25 women that were sent to the labor and delivery unit for evaluation, 20 (80%) were admitted and delivered. The reasons for delivery were hypertension (n = 9, 45%), an abnormal NST (n = 5, 25%), oligohydramnios (n = 4, 20%), and labor (n = 2, 10%).

CONCLUSIONS

We found an increase in NST duration as the BMI increased. Women with severe obesity and a comorbidity were more likely to have a nonreactive NST and require a subsequent BPP. Of the 20 patients delivered due to NST surveillance, the most common indication for delivery was hypertension.

Altered Spontaneous Brain Activity Patterns of Meibomian Gland Dysfunction in Severely Obese Population Measured Using the Fractional Amplitude of Low-Frequency Fluctuations

OBJECTIVE

Utilizing the fractional amplitude of low-frequency fluctuations (fALFF) technique, this study sought to correlate spontaneous cerebral abnormalities with the clinical manifestations of meibomian gland dysfunction (MGD) in severely obese (SO) population.

SUBJECTS AND METHODS

Twelve MGD patients in SO population (PATs) (4 males and 8 females) and twelve healthy controls (HCs) (6 males and 6 females) matched by gender and age were enrolled. Every participant underwent resting-state functional magnetic resonance imaging (rs-MRI) scanning. Spontaneous cerebral activity alterations were examined using the fALFF method. Receiver operating characteristic (ROC) curves were utilized to classify the medial fALFF values of the PATs and HCs. PATs were also asked to complete anxiety and depression score forms, permitting a correlation analysis.

RESULTS

In contrast with HCs, PATs had prominently increased fALFF values in the left lingual gyrus, the right globus pallidus, the right anterior cingulate and paracingulate gyri and the left middle occipital lobe (P < 0.05), and decreased fALFF values in the right cerebellum, the left fusiform gyrus, the right medial orbitofrontal gyrus, the left triangle inferior frontal gyrus and the left inferior parietal gyrus (P < 0.05). The results of the ROC curve indicated that changes in regional fALFF values might help diagnose MGD in SO population. Moreover, fALFF values in the right cerebellum of PATs were positively correlated with hospital anxiety and depression scores (HADS) (r = 0.723, P = 0.008). The fALFF values in the left triangle inferior frontal gyrus of PAT were negatively correlated with HADS (r = -0.651, P = 0.022).

CONCLUSIONS

Aberrant spontaneous activity was observed in multiple regions of the cerebrum, offering helpful information about the pathology of MGD in SO population. Aberrant fALFF values in these regions likely relates to the latent pathologic mechanisms of anomalous cerebral activities in PATs.

Nutritional status prior to bariatric surgery for severe obesity: a review

Obesity pandemic represents a threat to public health of paramount importance. Bariatric surgery represents the most effective and long-lasting treatment for severe obesity so far. The nutritional status of obese patients seeking bariatric surgery is impaired prior to surgery because of prevalent nutritional deficiencies. In addition, excess micronutrient levels may also occur, although this finding is not common. The onset of nutritional anomalies encountered in bariatric surgery candidates might stem from the following: obesity itself, poor quality food choices, preoperative weight loss or insufficient/excessive preoperative oral supplementation with vitamins and minerals. Nutritional management should begin preoperatively and should include a comprehensive assessment in order to identify those patients with clinical or subclinical deficiencies and hypervitaminoses. This paper provides background information on the nutritional status of bariatric surgery candidates, as well as on the prevalence and clinical significance of the most common micronutrient deficiencies and excess levels reported preoperatively among these patients.

Current bariatric-metabolic surgery

Obesity is a well-known phenomenon of recent times in adult and pediatric population, as well. It has been proved, that numerous comorbidities are in a different way connected with obesity. Conservative treatment of obesity is the domain of obesitologists, diabetologists, nutritionists and psychologists, as well. Great part of the conservative treatment of obesity lies on the experts on physical activities. Surgical treatment is dedicated to the patients with severe obesity. It is targeted not only at the weight reduction, but also, or at first, at the impact on comorbidities. There are standard procedures defined and they represent substantial part of performed procedures. Novel surgical and endoscopic procedures are introduced into the practice. There are many of them. So far neither of these procedures achieve comparable effectivity and durability with standard procedures in a long-time horizon. The aim of this paper is to present standard surgical procedures, to mention novel ones, surgical and endoscopic, as well. The procedures are presented with respect to the pediatric population too.

Lipidomic and Metabolomic Signature of Progression of Chronic Kidney Disease in Patients with Severe Obesity

Severe obesity is a major risk for chronic kidney disease (CKD). Early detection and careful monitoring of renal function are critical for the prevention of CKD during obesity, since biopsies are not performed in patients with CKD and diagnosis is dependent on the assessment of clinical parameters. To explore whether distinct lipid and metabolic signatures in obesity may signify early stages of pathogenesis toward CKD, liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-high resolution accurate mass-mass spectrometry (GC-HRAM-MS) analyses were performed in the serum and the urine of severely obese patients with and without CKD. Moreover, the impact of bariatric surgery (BS) in lipid and metabolic signature was also studied, through LC-MS and GC-HRAM-MS analyses in the serum and urine of patients with severe obesity and CKD before and after undergoing BS. Regarding patients with severe obesity and CKD compared to severely obese patients without CKD, serum lipidome analysis revealed significant differences in lipid signature. Furthermore, serum metabolomics profile revealed significant changes in specific amino acids, with isoleucine and tyrosine, increased in CKD patients compared with patients without CKD. LC-MS and GC-HRAM-MS analysis in serum of patients with severe obesity and CKD after BS showed downregulation of levels of triglycerides (TGs) and diglycerides (DGs) as well as a decrease in branched-chain amino acid (BCAA), lysine, threonine, proline, and serine. In addition, BS removed most of the correlations in CKD patients against biochemical parameters related to kidney dysfunction. Concerning urine analysis, hippuric acid, valine and glutamine were significantly decreased in urine from CKD patients after surgery. Interestingly, bariatric surgery did not restore all the lipid species, some of them decreased, hence drawing attention to them as potential targets for early diagnosis or therapeutic intervention. Results obtained in this study would justify the use of comprehensive mass spectrometry-based lipidomics to measure other lipids aside from conventional lipid profiles and to validate possible early markers of risk of CKD in patients with severe obesity.