Research

11 pages, 550 KiB

Open AccessFeature PaperArticle

Mixed Meal Tolerance Test Versus Continuous Glucose Monitoring for an Effective Diagnosis of Persistent Post-Bariatric Hypoglycemia

by Ana M. Ramos-Levi, Miguel A. Rubio-Herrera, Pilar Matía-Martín, Natalia Pérez-Ferre, Clara Marcuello, Andrés Sánchez-Pernaute, Antonio J. Torres-García and Alfonso L. Calle-Pascual

J. Clin. Med. 2023, 12(13), 4295; https://doi.org/10.3390/jcm12134295 - 27 Jun 2023

Cited by 1 | Viewed by 1502

Abstract

Gastric bypass determines an increase in incretin secretion and glucose excursions throughout the day and may sometimes entail the development of severe post-bariatric hypoglycemia (PBH). However, there is no consensus on the gold standard method for its diagnosis. In this study, we evaluated [...] Read more.

Gastric bypass determines an increase in incretin secretion and glucose excursions throughout the day and may sometimes entail the development of severe post-bariatric hypoglycemia (PBH). However, there is no consensus on the gold standard method for its diagnosis. In this study, we evaluated the usefulness of a mixed meal tolerance test (MMTT) and continuous glucose monitoring (CGM) for the diagnosis of PBH, defined as glucose levels <54 mg/dL (3.0 mmol/L). We found that hypoglycemia occurred in 60% of patients after the MMTT and in 75% during CGM, and it was predominantly asymptomatic. The MMTT confirmed the diagnosis of PBH in 88.9%of patients in whom surgery had been performed more than three years ago, in comparison to 36.4% in cases with a shorter postsurgical duration. CGM diagnosed nocturnal asymptomatic hypoglycemia in 70% of patients, and daytime postprandial hypoglycemia in 25% of cases. The mean duration of asymptomatic hypoglycemia was more than 30 min a day. Patients with ≥2% of their CGM readings with hypoglycemia exhibited a higher degree of glucose variability than those with <1% of the time in hypoglycemia. Our results show that the MMTT may be a useful dynamic test to confirm the occurrence of hypoglycemia in a large number of patients with persistent and recurrent PBH during long-term follow-up after gastric bypass. CGM, on its part, helps identify hypoglycemia in the real-world setting, especially nocturnal asymptomatic hypoglycemia, bringing to light that PBH is not always postprandial. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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11 pages, 867 KiB

Open AccessArticle

Combined Effect of Genetic Variants on Long-Term Weight Response after Bariatric Surgery

by Macarena Torrego-Ellacuría, Ana Barabash, Pilar Matía-Martín, Andrés Sánchez-Pernaute, Antonio J. Torres, Alfonso L. Calle-Pascual and Miguel A. Rubio-Herrera

J. Clin. Med. 2023, 12(13), 4288; https://doi.org/10.3390/jcm12134288 - 26 Jun 2023

Cited by 1 | Viewed by 1073

Abstract

The pathophysiology of body weight control involves complex interactions between hormonal, environmental, behavioral and genetic factors. The purpose of this study was to analyze the association between single nucleotide polymorphisms (SNPs) of 13 genes encoding gastrointestinal peptides, their receptors or the proteins involved [...] Read more.

The pathophysiology of body weight control involves complex interactions between hormonal, environmental, behavioral and genetic factors. The purpose of this study was to analyze the association between single nucleotide polymorphisms (SNPs) of 13 genes encoding gastrointestinal peptides, their receptors or the proteins involved in their expression, with long-term weight response in a cohort of 375 patients undergoing bariatric surgery (BS). To evaluate weight response, we combined several variables to define specific response phenotypes six years after surgery. The study protocol was registered in ISRCTN (ID80961259). The analysis of the selected SNPs was performed via allelic discrimination using Taqman^® probes (Applied Biosystems, Foster City, CA, USA). The genotype association study was performed using the SNPstat program, with comparisons adjusted for sex, age, initial body mass index, type 2 diabetes, hypertension diagnosis and the type of surgery. We identified eight genetic variants associated with the weight response to BS, independently of the presurgery patient profile and the type of surgical technique, from which we calculated the unweighted risk score (RS) for each phenotype. The highest scoring category in each RS was significantly associated with lower weight loss (p = 0.0001) and greater weight regain (p = 0.0012) at the end of the follow-up. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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11 pages, 1297 KiB

Open AccessArticle

The Effect of Laparoscopic Sleeve Gastrectomy on the Course of Non-Alcoholic Fatty Liver Disease in Morbidly Obese Patients during One Year of Follow Up

by Paulina Głuszyńska, Aleksander Łukaszewicz, Inna Diemieszczyk, Jan Chilmończyk, Joanna Reszeć, Anna Citko, Łukasz Szczerbiński, Adam Krętowski and Hady Razak Hady

J. Clin. Med. 2023, 12(12), 4122; https://doi.org/10.3390/jcm12124122 - 18 Jun 2023

Viewed by 1599

Abstract

Background: Morbid obesity co-exists with non-alcoholic fatty liver disease in up to 90% of cases. Laparoscopic sleeve gastrectomy leads to a reduction in body mass and thus may improve the course of non-alcoholic fatty liver disease. The aim of this study was to [...] Read more.

Background: Morbid obesity co-exists with non-alcoholic fatty liver disease in up to 90% of cases. Laparoscopic sleeve gastrectomy leads to a reduction in body mass and thus may improve the course of non-alcoholic fatty liver disease. The aim of this study was to evaluate the effect of laparoscopic sleeve gastrectomy on the resolution of non-alcoholic fatty liver disease. Methods: The study included 55 patients with non-alcoholic fatty liver disease who underwent laparoscopic sleeve gastrectomy at a tertiary institution. The analysis consisted of preoperative liver biopsy, abdominal ultrasound, weight loss parameters, Non-Alcoholic Fatty Liver Fibrosis Score and selected laboratory parameters. Results: Before the surgery, 6 patients were diagnosed with grade 1 liver steatosis, 33 patients with grade 2 and 16 patients with grade 3. One year after the surgery, only 21 patients had features of liver steatosis at ultrasound. All weight loss parameters showed statistically significant changes during the observation; the median percentage of total weight loss was 31.0% (IQR: 27.5; 34.5) with p = 0.0003, the median percentage of excess weight loss was 61.8% (IQR: 52.4; 72.3) with p = 0.0013 and the median percentage of excess body mass index loss was 71.0% (IQR: 61.3; 86.9) with p = 0.0036 12 months after laparoscopic sleeve gastrectomy. The median Non-Alcoholic Fatty Liver Fibrosis Score at baseline was 0.2 (IQR: −0.8; 1.0) and decreased to −1.6 (IQR: −2.4; −0.4) (p < 0.0001). Moderate negative correlations between Non-Alcoholic Fatty Liver Fibrosis Score and percentage of total weight loss (r = −0.434, p < 0.0001), percentage of excess weight loss (r = −0.456, p < 0.0001) and percentage of excess body mass index loss (r = −0.512, p < 0.0001) were found. Conclusions: The study supports the thesis that laparoscopic sleeve gastrectomy is an effective method for treatment of non-alcoholic fatty liver disease in patients with morbid obesity. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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9 pages, 884 KiB

Open AccessArticle

Body Weight Reduction by Bariatric Surgery Reduces the Plasma Levels of the Novel Orexigenic Gut Hormone Insulin-like Peptide 5 in Patients with Severe Obesity

by Angelo Di Vincenzo, Marika Crescenzi, Marnie Granzotto, Sara Zancaner, Roberto Fabris, Mirto Foletto, Luca Prevedello, Federico Capone, Roberto Vettor and Marco Rossato

J. Clin. Med. 2023, 12(11), 3752; https://doi.org/10.3390/jcm12113752 - 29 May 2023

Cited by 1 | Viewed by 1088

Abstract

Insulin-like factor 5 (INSL5), a novel hormone secreted by the enteroendocrine cells of the distal colon, has been implicated in appetite and body weight regulation in animals given its orexigenic properties. We investigated basal INSL5 plasma levels in a group of morbidly obese [...] Read more.

Insulin-like factor 5 (INSL5), a novel hormone secreted by the enteroendocrine cells of the distal colon, has been implicated in appetite and body weight regulation in animals given its orexigenic properties. We investigated basal INSL5 plasma levels in a group of morbidly obese subjects before and after laparoscopic sleeve gastrectomy. Furthermore, we analyzed the expression of INSL5 in human adipose tissue. Before bariatric surgery, obese subjects showed basal INSL5 plasma levels that were positively correlated with BMI, fat mass, and leptin plasma levels. After weight loss by laparoscopic sleeve gastrectomy, INSL5 plasma levels in obese subjects were significantly lower than those observed before surgery. Finally, we did not detect any expression of the INSL5 gene in human adipose tissue, both at the mRNA and protein levels. The present data show that subjects with obesity have INSL5 plasma levels positively correlating with adiposity markers. After bariatric surgery, INSL5 plasma levels decreased significantly, and this decrease was not directly due to the loss of adipose tissue since this tissue does not express INSL5. Considering the orexigenic properties of INSL5, the reduction of its plasma levels after bariatric surgery in obese subjects could participate in the still unclear mechanisms leading to appetite reduction that characterize bariatric surgery procedures. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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9 pages, 1254 KiB

Open AccessArticle

Sarcopenia after Roux-en-Y Gastric Bypass: Detection by Skeletal Muscle Mass Index vs. Bioelectrical Impedance Analysis

by Georgi Vassilev, Christian Galata, Alida Finze, Christel Weiss, Mirko Otto, Christoph Reissfelder and Susanne Blank

J. Clin. Med. 2022, 11(6), 1468; https://doi.org/10.3390/jcm11061468 - 08 Mar 2022

Cited by 8 | Viewed by 1997

Abstract

Background: In sarcopenic patients the skeletal muscle reduction is the primary symptom of age- or disease-related malnutrition, which is linked to postoperative morbidity and mortality. The skeletal muscle mass index (SMI) from magnet resonance imaging (MRI) is increasingly used as a prognostic factor [...] Read more.

Background: In sarcopenic patients the skeletal muscle reduction is the primary symptom of age- or disease-related malnutrition, which is linked to postoperative morbidity and mortality. The skeletal muscle mass index (SMI) from magnet resonance imaging (MRI) is increasingly used as a prognostic factor in oncologic and surgical patients, but under-represented in the field of obesity surgery. The bioelectrical impedance analysis (BIA), on the other hand is a commonly used method for the estimation of the body composition of bariatric patients, but still believed to be inaccurate, because of patient-related and environmental factors. The aim of this study was to compare the postoperative SMI values as a direct, imaging measured indicator for muscle mass with the BIA results in patients undergoing Roux-en-Y gastric bypass (RYGB). Methods: We performed a prospective single-center trial. Patients undergoing RYGB between January 2010 and December 2011 at our institution were eligible for this study. MRI and BIA measurements were obtained 1 day before surgery and at 6, 12 and 24 weeks after surgery. Results: A total of 17 patients (four male, 13 female, average age of 41.9 years) were included. SMI values decreased significantly during the postoperative course (p < 0.001). Comparing preoperative and postoperative measurements at 24 weeks after surgery, increasing correlations of SMI values with body weight (r = 0.240 vs. r = 0.628), phase angle (r = 0.225 vs. r = 0.720) and body cell mass (BCM, r = 0.388 vs. r = 0.764) were observed. Conclusions: SMI decreases significantly after RYGB and is correlated to distinct parameters of body composition. These findings show the applicability of the SMI as direct imaging parameter for the measurement of the muscle mass in patients after RYGB, but also underline the important role of the BIA, as a precise tool for the estimation of patients’ body composition at low costs. BIA allows a good overview of patients’ status post bariatric surgery, including an estimation of sarcopenia. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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12 pages, 825 KiB

Open AccessArticle

Exploring Renal Changes after Bariatric Surgery in Patients with Severe Obesity

by Anna Oliveras, Susana Vázquez, María José Soler, Isabel Galceran, Xavier Duran, Albert Goday, David Benaiges, Marta Crespo, Julio Pascual and Marta Riera

J. Clin. Med. 2022, 11(3), 728; https://doi.org/10.3390/jcm11030728 - 29 Jan 2022

Cited by 1 | Viewed by 1879

Abstract

Obesity-related hyperfiltration leads to an increased glomerular filtration rate (GFR) and hyperalbuminuria. These changes are reversible after bariatric surgery (BS). We aimed to explore obesity-related renal changes post-BS and to seek potential mechanisms. Sixty-two individuals with severe obesity were prospectively examined before and [...] Read more.

Obesity-related hyperfiltration leads to an increased glomerular filtration rate (GFR) and hyperalbuminuria. These changes are reversible after bariatric surgery (BS). We aimed to explore obesity-related renal changes post-BS and to seek potential mechanisms. Sixty-two individuals with severe obesity were prospectively examined before and 3, 6 and 12 months post-BS. Anthropometric and laboratory data, 24 h-blood pressure, renin-angiotensin-aldosterone system (RAS) components, adipokines and inflammatory markers were determined. Both estimated GFR (eGFR) and albuminuria decreased from the baseline at all follow-up times (p-for-trend <0.001 for both). There was a median (IQR) of 30.5% (26.2–34.4) reduction in body weight. Plasma glucose, glycosylated hemoglobin, fasting insulin and HOMA-index decreased at 3, 6 and 12 months of follow-up (p-for-trend <0.001 for all). The plasma aldosterone concentration (median (IQR)) also decreased at 12 months (from 87.8 ng/dL (56.8; 154) to 65.4 (56.8; 84.6), p = 0.003). Both leptin and hs-CRP decreased (p < 0.001) and adiponectine levels increased at 12 months post-BS (p = 0.017). Linear mixed-models showed that body weight (coef. 0.62, 95% CI: 0.32 to 0.93, p < 0.001) and plasma aldosterone (coef. −0.07, 95% CI: −0.13 to −0.02, p = 0.005) were the independent variables for changes in eGFR. Conversely, glycosylated hemoglobin was the only independent variable for changes in albuminuria (coef. 0.24, 95% CI: 0.06 to 0.42, p = 0.009). In conclusion, body weight and aldosterone are the main factors that mediate eGFR changes in obesity and BS, while albuminuria is associated with glucose homeostasis. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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7 pages, 506 KiB

Open AccessArticle

Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy

by Dörte Wichmann, Veit Scheble, Stefano Fusco, Ulrich Schweizer, Felix Hönes, Wilfried Klingert, Alfred Königsrainer and Rami Archid

J. Clin. Med. 2021, 10(23), 5670; https://doi.org/10.3390/jcm10235670 - 30 Nov 2021

Cited by 2 | Viewed by 1430

Abstract

Introduction: Laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide with good results, high patient acceptance, and low complication rates. The most relevant perioperative complication is the staple line leak. For the treatment of this complication, endoscopic negative pressure [...] Read more.

Introduction: Laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide with good results, high patient acceptance, and low complication rates. The most relevant perioperative complication is the staple line leak. For the treatment of this complication, endoscopic negative pressure therapy has proven particularly effective. The correct time to start endoscopic negative pressure therapy has not been the subject of studies to date. Methods: Twelve patients were included in this retrospective data analysis over three years. Endoscopic negative pressure therapy was carried out using innovative open pore suction devices. Patients were treated with simultaneous surgery and endoscopy, so called rendezvous-procedure (Group A) or solely endoscopically, or in sequence surgically and endoscopically (Group B). Therapy data of the procedures and outcome measures, including duration of therapy, therapy success, and change of treatment strategy, were collected and analysed. Results: In each group, six patients were treated (mean age 52.96 years, 4 males, 8 females). Poor initial clinical situation, time span of endoscopic negative pressure therapy (Group A 31 days vs. Group B 18 days), and mean length of hospital stay (Group A 39.5 days vs. Group B 20.17 days) were higher in patients with rendezvous procedures. One patient in Group B died during the observation time. Discussion: Rendezvous procedures for patients with staple line leaks after sleeve gastrectomy is indicated for serious ill patients with perigastric abscesses and in need of laparoscopic lavage. The one-stage complication management with the rendezvous procedure seems not to result in an obvious advantage in the further outcome in patients with staple line leaks after laparoscopic sleeve gastrectomy. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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7 pages, 223 KiB

Open AccessCommunication

Managing the Unpredictable: Mechanistic Analysis and Clinical Recommendations for Lamotrigine Treatment after Bariatric Surgery

by Daniel Porat, Carmil Azran, Hasan Kais and Arik Dahan

J. Clin. Med. 2021, 10(23), 5627; https://doi.org/10.3390/jcm10235627 - 29 Nov 2021

Cited by 6 | Viewed by 2179

Abstract

Bariatric surgery may alter the absorption and overall bioavailability of oral drugs. Lamotrigine is a major antiepileptic and mood stabilizer, that its use after bariatric surgery has not yet been studied. In this article, we provide a thorough mechanistic analysis of the effects [...] Read more.

Bariatric surgery may alter the absorption and overall bioavailability of oral drugs. Lamotrigine is a major antiepileptic and mood stabilizer, that its use after bariatric surgery has not yet been studied. In this article, we provide a thorough mechanistic analysis of the effects of bariatric surgery on multiple mechanisms important for the absorption, bioavailability and overall pharmacokinetics of lamotrigine. Attributable to its pharmacokinetic properties and drug characteristics, the use of lamotrigine after bariatric surgery may be challenging. The complex situation in which some mechanisms may lead to increased drug exposure (e.g., decreased metabolism, weight loss) while others to its decrease (e.g., hampered dissolution/solubility, decreased gastric volume), may result in lowered, unchanged, or enhanced lamotrigine plasma levels after the surgery. We conclude with a set of clinical recommendations for lamotrigine treatment after bariatric surgery, aiming to allow better patient care, and emphasizing the extra caution that needs to be taken with these patients. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

10 pages, 453 KiB

Open AccessArticle

Changes in Trimethylamine-N-oxide Levels in Obese Patients following Laparoscopic Roux-en-Y Gastric Bypass or Sleeve Gastrectomy in a Korean Obesity Surgical Treatment Study (KOBESS)

by Soo Jin Lee, Young Suk Park, Yong-Jin Kim, Sang-Uk Han, Geum-Sook Hwang, Yeyoung Han, Yoonseok Heo, Eunyoung Ha and Tae Kyung Ha

J. Clin. Med. 2021, 10(21), 5091; https://doi.org/10.3390/jcm10215091 - 29 Oct 2021

Cited by 2 | Viewed by 1614

Abstract

Trimethylamine N-oxide (TMAO), a gut microbe-dependent metabolite, has been implicated as a novel risk factor for cardiovascular events related to obesity and type 2 diabetes mellitus (T2DM). The aim of the study was to test the hypothesis if TMAO is associated with the [...] Read more.

Trimethylamine N-oxide (TMAO), a gut microbe-dependent metabolite, has been implicated as a novel risk factor for cardiovascular events related to obesity and type 2 diabetes mellitus (T2DM). The aim of the study was to test the hypothesis if TMAO is associated with the reduction of cardiovascular disease in the Korean obese patients who underwent bariatric surgery. From a subgroup of a multicenter, nonrandomized, controlled trial, titled KOBESS, 38 obese patients, 18 with and 20 without T2DM, who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were investigated. Bariatric surgery is indicated for Korean patients with a body mass index (BMI) ≥ 35 kg/m² or for Korean patients with a BMI ≥ 30 kg/m² who have comorbidities. Serum levels of TMAO and its precursors, betaine, carnitine, and choline were measured before and six months after bariatric surgery. The levels of TMAO and its precursors did not differ between obese patients with T2DM and non-T2DM at baseline. However, TMAO increased more than twofold in patients with T2DM after RYGB surgery, but not in patients without T2DM. Choline levels were decreased by half in all patients after RYGB. In patients with T2DM who underwent SG, TMAO, betaine, and carnitine levels did not change after the surgery. Furthermore, in obese patients who underwent bariatric surgery, increased TMAO levels were associated with both T2DM and RYGB, while reduced choline levels were associated with RYGB. These associations need to be further elucidated in follow-up studies to gain further insights into the relationship between TMAO levels and bariatric surgery outcomes. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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15 pages, 1296 KiB

Open AccessArticle

Long-Term Weight Outcomes after Bariatric Surgery: A Single Center Saudi Arabian Cohort Experience

by Assim A. Alfadda, Mohammed Y. Al-Naami, Afshan Masood, Ruba Elawad, Arthur Isnani, Shaik Shaffi Ahamed and Nora A. Alfadda

J. Clin. Med. 2021, 10(21), 4922; https://doi.org/10.3390/jcm10214922 - 25 Oct 2021

Cited by 12 | Viewed by 3781

Abstract

Background: Obesity is considered a global chronic disease requiring weight management through lifestyle modification, pharmacotherapy, or weight loss surgery. The dramatic increase in patients with severe obesity in Saudi Arabia is paralleled with those undergoing bariatric surgery. Although known to be beneficial in [...] Read more.

Background: Obesity is considered a global chronic disease requiring weight management through lifestyle modification, pharmacotherapy, or weight loss surgery. The dramatic increase in patients with severe obesity in Saudi Arabia is paralleled with those undergoing bariatric surgery. Although known to be beneficial in the short term, the long-term impacts of surgery within this group and the sustainability of weight loss after surgery remains unclear. Objectives: We aimed to assess the long-term weight outcomes after bariatric surgery. Setting: The study was conducted at King Khalid University Hospital (KKUH), King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. Methods: An observational prospective cohort study on adult patients with severe obesity undergoing bariatric surgery (sleeve gastrectomy (SG) or Roux-en Y gastric bypass (RYGB)) during the period between 2009 and 2015 was conducted. Weight loss patterns were evaluated pre- and post-surgery through clinical and anthropometric assessments. Absolute weight loss was determined, and outcome variables: percent excess weight loss (%EWL), percent total weight loss (%TWL), and percent weight regain (%WR), were calculated. Statistical analysis using univariate and multivariate general linear modelling was carried out. Results: A total of 91 (46 males and 45 females) patients were included in the study, with the majority belonging to the SG group. Significant weight reductions were observed at 1 and 3 years of follow-up (p < 0.001) from baseline. The %EWL and %TWL were at their maximum at 3 years (72.4% and 75.8%) and were comparable between the SG and RYGB. Decrements in %EWL and %TWL and increases in %WR were seen from 3 years onwards from bariatric surgery until the study period ended. The yearly follow-up attrition rate was 20.8% at 1 year post-surgery, 26.4% at year 2, 31.8% at year 3, 47.3% at year 4, 62.6% at year 5, and 79.1% at end of study period (at year 6). Conclusion: The major challenge to the successful outcome of bariatric surgery is in maintaining weight loss in the long-term and minimizing weight regain. Factors such as the type of surgery and gender need to be considered before and after surgery, with an emphasis on the need for long-term follow-up to enssure the optimal benefits from this intervention. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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9 pages, 440 KiB

Open AccessArticle

Dental Erosion in Obese Patients before and after Bariatric Surgery: A Cross-Sectional Study

by Cui Yang, Frederik Johannes Hammer, Christoph Reissfelder, Mirko Otto and Georgi Vassilev

J. Clin. Med. 2021, 10(21), 4902; https://doi.org/10.3390/jcm10214902 - 24 Oct 2021

Cited by 5 | Viewed by 1653

Abstract

Obese patients are at risk of dental erosion due to micronutrient deficiency, consumption of soft drinks, gastric reflux disease and vomiting. The present study evaluates the presence of dental erosion in obese patients before and after bariatric surgery using the BEWE (basic erosive [...] Read more.

Obese patients are at risk of dental erosion due to micronutrient deficiency, consumption of soft drinks, gastric reflux disease and vomiting. The present study evaluates the presence of dental erosion in obese patients before and after bariatric surgery using the BEWE (basic erosive wear examination) scoring system. A total of 62 patients with severe obesity were included in the analysis, 31 in the control group (without bariatric surgery) and 31 in the surgery group (after bariatric surgery). BEWE scores did not vary between groups. Vitamin D deficiency was detected in 19 patients in the control group and three in the surgery group (p < 0.001). The serum calcium and vitamin D values were significantly higher in the surgery group (p = 0.003, p < 0.001 consecutively). All patients after bariatric surgery showed compliance with supplements, including vitamin D and calcium daily. Patients after bariatric surgery were less likely to drink soft drinks regularly (p = 0.026). Obese patients, before or after bariatric surgery, are at risk for erosive dental wear. However, with sufficient education prior to surgery and consistent intake of vitamin and mineral supplements, significant erosive dental wear after bariatric surgery could be avoided. Regular dental examination should be included in the check-up and follow-up program. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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12 pages, 1507 KiB

Open AccessArticle

Caspase-Cleaved Keratin 18 Measurements Identified Ongoing Liver Injury after Bariatric Surgery

by Felix Hempel, Martin Roderfeld, Lucas John Müntnich, Jens Albrecht, Ziya Oruc, Borros Arneth, Thomas Karrasch, Jörn Pons-Kühnemann, Winfried Padberg, Harald Renz, Andreas Schäffler and Elke Roeb

J. Clin. Med. 2021, 10(6), 1233; https://doi.org/10.3390/jcm10061233 - 16 Mar 2021

Cited by 8 | Viewed by 2071

Abstract

Bariatric surgery has emerged as an effective treatment option in morbidly obese patients with non-alcoholic fatty liver disease (NAFLD). However, worsening or new onset of non-alcoholic steatohepatitis (NASH) and fibrosis have been observed. Caspase-cleaved keratin 18 (ccK18) has been established as a marker [...] Read more.

Bariatric surgery has emerged as an effective treatment option in morbidly obese patients with non-alcoholic fatty liver disease (NAFLD). However, worsening or new onset of non-alcoholic steatohepatitis (NASH) and fibrosis have been observed. Caspase-cleaved keratin 18 (ccK18) has been established as a marker of hepatocyte apoptosis, a key event in NASH development. Thus, ccK18 measurements might be feasible to monitor bariatric surgery patients. Clinical data and laboratory parameters were collected from 39 patients undergoing laparoscopic Roux-en-Y gastric bypass at six timepoints, prior to surgery until one year after the procedure. ccK18 levels were measured and a high-throughput analysis of serum adipokines and cytokines was carried out. Half of the cohort’s patients (20/39) presented with ccK18 levels indicative of progressed liver disease. 21% had a NAFLD-fibrosis score greater than 0.676, suggesting significant fibrosis. One year after surgery, a mean weight loss of 36.87% was achieved. Six and twelve months after surgery, ccK18 fragments were significantly reduced compared to preoperative levels (p < 0.001). Yet nine patients did not show a decline in ccK18 levels ≥ 10% within one year postoperatively, which was considered a response to treatment. While no significant differences in laboratory parameters or ccK18 could be observed, they presented with a greater expression of leptin and fibrinogen before surgery. Consecutive ccK18 measurements monitored the resolution of NAFLD and identified non-responders to bariatric surgery with ongoing liver injury. Further studies are needed to elicit the pathological mechanisms in non-responders and study the potential of adipokines as prognostic markers. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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14 pages, 510 KiB

Open AccessArticle

Improvement of Arterial Stiffness One Month after Bariatric Surgery and Potential Mechanisms

by Anna Oliveras, Isabel Galceran, Albert Goday, Susana Vázquez, Laia Sans, Marta Riera, David Benaiges and Julio Pascual

J. Clin. Med. 2021, 10(4), 691; https://doi.org/10.3390/jcm10040691 - 10 Feb 2021

Cited by 5 | Viewed by 1536

Abstract

Arterial stiffness (AS) is an independent predictor of cardiovascular risk. We aimed to analyze changes (Δ) in AS 1-month post-bariatric surgery (BS) and search for possible pathophysiological mechanisms. Patients with severe obesity (43% hypertensives) were prospectively evaluated before and 1-month post-BS, with AS [...] Read more.

Arterial stiffness (AS) is an independent predictor of cardiovascular risk. We aimed to analyze changes (Δ) in AS 1-month post-bariatric surgery (BS) and search for possible pathophysiological mechanisms. Patients with severe obesity (43% hypertensives) were prospectively evaluated before and 1-month post-BS, with AS assessed by pulse-wave velocity (PWV), augmentation index (AIx@75) and pulse pressure (PP). Ambulatory 24 h blood pressure (BP), anthropometric data, renin-angiotensin-aldosterone system (RAAS) components and several adipokines and inflammatory markers were also analyzed. Overall reduction in body weight was mean (interquartile range (IQR)) = 11.0% (9.6–13.1). A decrease in PWV, AIx@75 and PP was observed 1-month post-BS (all, p < 0.01). There were also significant Δ in BP, RAAS components, adipokines and inflammatory biomarkers. Multiple linear regression adjusted models showed that Δaldosterone was an independent variable (B coeff.95%CI) for final PWV (B = −0.003, −0.005 to 0.000; p = 0.022). Angiotensin-converting enzyme (ACE)/ACE2 and ACE were independent variables for final AIx@75 (B = 0.036, 0.005 to 0.066; p = 0.024) and PP (B = 0.010, 0.003 to 0.017; p = 0.01), respectively. There was no correlation between ΔAS and anthropometric changes nor with Δ of adipokines or inflammatory markers except high-sensitivity C-reactive protein (hs-CRP). Patients with PWV below median decreased PWV (mean, 95%CI = −0.18, −0.25 to −0.10; p < 0.001) and both AIx@75 and PP at 1-month, but not those with PWV above median. In conclusion, there is an improvement in AS 1-month post-BS that correlates with ΔBP and Δrenin-angiotensin-aldosterone components. The benefit is reduced in those with higher PWV. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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10 pages, 261 KiB

Open AccessArticle

Anxiety and Depression Affect Early Postoperative Pain Dimensions after Bariatric Surgery

by Sofia Gravani, Maria Matiatou, Pantelis T. Nikolaidis, Evangelos Menenakos, Constantinos G. Zografos, George Zografos and Konstantinos Albanopoulos

J. Clin. Med. 2021, 10(1), 53; https://doi.org/10.3390/jcm10010053 - 25 Dec 2020

Cited by 17 | Viewed by 2734

Abstract

Uncontrolled postoperative pain and prolonged immobilization after bariatric surgery have been associated with increased postoperative complications and prolonged hospitalization. The aim of our study was to evaluate the postoperative pain that follows bariatric surgery and identify any psychological factors that may affect the [...] Read more.

Uncontrolled postoperative pain and prolonged immobilization after bariatric surgery have been associated with increased postoperative complications and prolonged hospitalization. The aim of our study was to evaluate the postoperative pain that follows bariatric surgery and identify any psychological factors that may affect the early postoperative perception of pain. The study included 100 patients with obesity (women, n = 61; age 37.4 ± 9.9 years, mean ± standard deviation; Body Mass Index (BMI) 47.6 ± 6.5 kg/m²) who underwent bariatric surgery. Preoperative anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale (HADS), and the quantitative and qualitative dimension of early postoperative pain were evaluated by the McGill Pain Questionnaire Short Form (MPQ-SF). Furthermore, the postoperative analgesia protocol was recorded for each patient. Pain declined gradually during the first 24 h postoperative. Although preoperative anxiety had no correlation with the overall pain of postoperative Day 0, patients with a higher level of preoperative anxiety had significantly more intense and more unpleasant pain at 1 h post operation. In addition, depression influences both the intensity and unpleasantness of pain at different time points (1 h, 4 h and 24 h postoperative). Preoperative pain correlated with educational level, but not with age, BMI, gender, marital status, smoking and surgery type. In conclusion, preoperative anxiety and depression influence the early postoperative pain after bariatric surgery, and their preoperative identification is of major importance to enhance the implementation of fast-track postoperative protocols to prevent complications and prolonged hospitalization. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

12 pages, 1490 KiB

Open AccessArticle

Metabolomic Profiles Predict Diabetes Remission after Bariatric Surgery

by Jane Ha, Mi Jang, Yeongkeun Kwon, Young Suk Park, Do Joong Park, Joo-Ho Lee, Hyuk-Joon Lee, Tae Kyung Ha, Yong-Jin Kim, Sang-Moon Han, Sang-Uk Han, Yoonseok Heo and Sungsoo Park

J. Clin. Med. 2020, 9(12), 3897; https://doi.org/10.3390/jcm9123897 - 01 Dec 2020

Cited by 10 | Viewed by 2310

Abstract

Background: Amino acid metabolites (AAMs) have been linked to glucose homeostasis and type 2 diabetes (T2D). We investigated whether (1) baseline AAMs predict T2D remission 12 months after bariatric surgery and (2) whether AAMs are superior for predicting T2D remission postoperatively compared with [...] Read more.

Background: Amino acid metabolites (AAMs) have been linked to glucose homeostasis and type 2 diabetes (T2D). We investigated whether (1) baseline AAMs predict T2D remission 12 months after bariatric surgery and (2) whether AAMs are superior for predicting T2D remission postoperatively compared with existing prediction models. Methods: Among 24 participants undergoing bariatric surgery, 16 diabetes-related AAMs were quantified at baseline and postoperative 3 and 12 months. Existing prediction models included the ABCD, DiaRem, and IMS models. Results: Baseline L-dihydroxyphenylalanine (L-DOPA) (areas under receiver operating characteristic curves (AUROC), 0.92; 95% confidence interval (CI), 0.75 to 1.00) and 3-hydroxyanthranilic acid (3-HAA) (AUROC, 0.85; 95% CI, 0.67 to 1.00) better predicted T2D remission 12 months postoperatively than the ABCD model (AUROC, 0.81; 95% CI, 0.54 to 1.00), which presented the highest AUROC value among the three models. The superior prognostic performance of L-DOPA (AUROC at 3 months, 0.97; 95% CI, 0.91 to 1.00) and 3-HAA (AUROC at 3 months, 0.86; 95% CI, 0.63 to 1.00) continued until 3 months postoperatively. Conclusions: The AAM profile predicts T2D remission after bariatric surgery more effectively than the existing prediction models. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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16 pages, 306 KiB

Open AccessArticle

Variables Associated with Short-Term Weight Loss in a Cohort of Patients with Morbid Obesity According to Age and Three Types of Bariatric Surgery

by Maria D. Alvarez-Bermudez, Flores Martin-Reyes, Luis Ocaña-Wilhelmi, Francisco J. Moreno-Ruiz, Juan Alcaide Torres, Diego Fernandez-Garcia, Sergio Valdes, Noelia Moreno-Morales, Eduardo Garcia-Fuentes, Francisco J. Tinahones and Lourdes Garrido-Sanchez

J. Clin. Med. 2020, 9(11), 3537; https://doi.org/10.3390/jcm9113537 - 02 Nov 2020

Viewed by 1364

Abstract

Background The percentage of excess weight lost (%EWL) after bariatric surgery (BS) shows great discrepancies from one individual to another. Objective To evaluate the %EWL one year after BS and to determine the existence of baseline biomarkers associated with weight loss. Methods We [...] Read more.

Background The percentage of excess weight lost (%EWL) after bariatric surgery (BS) shows great discrepancies from one individual to another. Objective To evaluate the %EWL one year after BS and to determine the existence of baseline biomarkers associated with weight loss. Methods We studied 329 patients with morbid obesity undergoing three types of BS (biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)), depending on the %EWL one year after surgery: good responders (GR) (%EWL ≥ 50%) and non-responders (NR) (%EWL < 50%). Results The GR presented a higher percentage of change in anthropometric and biochemical variables compared to the NR group, even within each type of BS. There was a greater percentage of GR among those who underwent RYGB. The patients who underwent SG showed the lowest decrease in biochemical variables, both in GR and NR. Within the GR group, those with a lower age showed greater improvement compared to the other age groups. A %EWL ≥50% was negatively associated with the age and atherogenic index of plasma (AIP), and positively with the type of BS (RYGB). Conclusions The GR group was associated with lower age and AIP and undergoing RYGB. Additionally, those patients who underwent SG showed a lower metabolic improvement. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

12 pages, 1792 KiB

Open AccessArticle

Additional Metabolic Effects of Bariatric Surgery in Patients with a Poor Mid-Term Weight Loss Response: A 5-Year Follow-Up Study

by David Benaiges, Maria Bisbe, Juan Pedro-Botet, Aleix de Vargas-Machuca, Jose M. Ramon, Manuel Pera, Montserrat Villatoro, Laia Fontané, Helena Julià, Elisenda Climent, Olga Castañer, Juana A. Flores-Le Roux and Alberto Goday

J. Clin. Med. 2020, 9(10), 3193; https://doi.org/10.3390/jcm9103193 - 01 Oct 2020

Viewed by 1733

Abstract

To ascertain the 5-year metabolic effects of bariatric surgery in poor weight loss (WL) responders and establish associated factors. Methods: Retrospective analysis of a non-randomised prospective cohort of bariatric surgery patients completing a 5-year follow-up. Mid-term poor WL was considered when 5-year excess [...] Read more.

To ascertain the 5-year metabolic effects of bariatric surgery in poor weight loss (WL) responders and establish associated factors. Methods: Retrospective analysis of a non-randomised prospective cohort of bariatric surgery patients completing a 5-year follow-up. Mid-term poor WL was considered when 5-year excess weight loss was <50%. Results: Forty-three (20.3%) of the 212 included patients were mid-term poor WL responders. They showed an improvement in all metabolic markers at 2 years, except for total cholesterol. This improvement with respect to baseline was maintained at 5 years for plasma glucose, HbA1c, HOMA, HDL and diastolic blood pressure; however, LDL cholesterol, triglycerides and systolic blood pressure were similar to presurgical values. Comorbidity remission rates were comparable to those obtained in the good WL group except for hypercholesterolaemia (45.8% vs. poor WL, p = 0.005). On multivariate analysis, lower baseline HDL cholesterol levels, advanced age and lower preoperative weight loss were independently associated with poor mid-term WL. Conclusions: Although that 1 in 5 patients presented suboptimal WL 5 years after bariatric surgery, other important metabolic benefits were maintained. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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10 pages, 558 KiB

Open AccessArticle

Amino Acid Metabolites and Slow Weight Loss in the Early Postoperative Period after Sleeve Gastrectomy

by Yeongkeun Kwon, Mi Jang, Youngsun Lee, Jane Ha and Sungsoo Park

J. Clin. Med. 2020, 9(8), 2348; https://doi.org/10.3390/jcm9082348 - 23 Jul 2020

Cited by 8 | Viewed by 1989

Abstract

Background: Profiles of amino acid metabolites (AAMs) have been linked to obesity and energy homeostasis. We investigated whether baseline obesity-related AAMs were associated with weight status in the early postoperative period after sleeve gastrectomy. Methods: In this prospective, single-arm, longitudinal study, 27 bariatric [...] Read more.

Background: Profiles of amino acid metabolites (AAMs) have been linked to obesity and energy homeostasis. We investigated whether baseline obesity-related AAMs were associated with weight status in the early postoperative period after sleeve gastrectomy. Methods: In this prospective, single-arm, longitudinal study, 27 bariatric patients underwent sleeve gastrectomy. Twenty obesity-related AAMs were comprehensively quantified prior to surgery, and slow weight loss was defined as the lowest 40% of the percentage excess weight loss (%EWL) at three and six months postoperatively. Linear regression models were used to assess the association between baseline obesity-related AAMs and %EWL, and receiver operating characteristic curves were assessed. Results: Isoleucine and metabolites from the serotonin pathway were significantly associated with the %EWL at three and six months after sleeve gastrectomy. Among the metabolites identified to be significant in the regression analyses, serotonin (area under receiver operating characteristic curves (AUROC): 0.79, 95% confidence interval (CI): 0.59–0.97) and serotonin/5-hydroxytryptophan ratio (AUROC: 0.80, 95% CI: 0.58–1.00) showed superior performance in predicting slow weight loss six months after sleeve gastrectomy. Conclusions: Our findings underscore the importance of baseline AAM profiles, especially serotonin and serotonin/5-hydroxytryptophan ratio, in predicting slow weight loss in the early postoperative period after sleeve gastrectomy. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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15 pages, 792 KiB

Open AccessArticle

Long-Term Effects in Bone Mineral Density after Different Bariatric Procedures in Patients with Type 2 Diabetes: Outcomes of a Randomized Clinical Trial

by Fernando Guerrero-Pérez, Anna Casajoana, Carmen Gómez-Vaquero, Nuria Virgili, Rafael López-Urdiales, Laura Hernández-Montoliu, Jordi Pujol-Gebelli, Javier Osorio, Anna Prats, Anna Vidal-Alabró, Manuel Pérez-Maraver, Sonia Fernández-Veledo, Joan Vendrell and Nuria Vilarrasa

J. Clin. Med. 2020, 9(6), 1830; https://doi.org/10.3390/jcm9061830 - 11 Jun 2020

Cited by 9 | Viewed by 2386

Abstract

There is scant evidence of the long-term effects of bariatric surgery on bone mineral density (BMD). We compared BMD changes in patients with severe obesity and type 2 diabetes (T2D) 5 years after randomization to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG) and [...] Read more.

There is scant evidence of the long-term effects of bariatric surgery on bone mineral density (BMD). We compared BMD changes in patients with severe obesity and type 2 diabetes (T2D) 5 years after randomization to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG) and greater curvature plication (GCP). We studied the influence of first year gastrointestinal hormone changes on final bone outcomes. Forty-five patients, averaging 49.4 (7.8) years old and body mass index (BMI) 39.4 (1.9) kg/m², were included. BMD at lumbar spine (LS) was lower after mRYGB compared to SG and GCP: 0.89 [0.82;0.94] vs. 1.04 [0.91;1.16] vs. 0.99 [0.89;1.12], p = 0.020. A higher percentage of LS osteopenia was present after mRYGB 78.6% vs. 33.3% vs. 50.0%, respectively. BMD reduction was greater in T2D remitters vs. non-remitters. Weight at fifth year predicted BMD changes at the femoral neck (FN) (adjusted R²: 0.3218; p = 0.002), and type of surgery (mRYGB) and menopause predicted BMD changes at LS (adjusted R²: 0.2507; p < 0.015). In conclusion, mRYGB produces higher deleterious effects on bone at LS compared to SG and GCP in the long-term. Women in menopause undergoing mRYGB are at highest risk of bone deterioration. Gastrointestinal hormone changes after surgery do not play a major role in BMD outcomes. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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13 pages, 264 KiB

Open AccessArticle

Bariatric Surgery during COVID-19 Pandemic from Patients’ Point of View—The Results of a National Survey

by Maciej Walędziak, Anna Różańska-Walędziak, Michał Pędziwiatr, Jacek Szeliga, Monika Proczko-Stepaniak, Michał Wysocki, Tomasz Stefura and Piotr Major

J. Clin. Med. 2020, 9(6), 1697; https://doi.org/10.3390/jcm9061697 - 02 Jun 2020

Cited by 29 | Viewed by 3452

Abstract

Introduction: The aim of the study was to investigate the impact of the COVID-19 pandemic on bariatric care from the patients’ point of view. The COVID-19 pandemic has perturbed the functioning of healthcare systems around the world and led to changes in elective [...] Read more.

Introduction: The aim of the study was to investigate the impact of the COVID-19 pandemic on bariatric care from the patients’ point of view. The COVID-19 pandemic has perturbed the functioning of healthcare systems around the world and led to changes in elective surgical care, with bariatric procedures being postponed until the end of pandemic. There is no data in the literature about the effect of a new epidemiological situation on bariatric patients. Methods: The study was designed as an online survey containing multiple open questions about bariatric care during the COVID-19 pandemic. The survey was conducted among pre- and postoperative bariatric patients. Results: Out of 800 respondents, 74.53% felt anxiety about their health in regard to the present epidemiologic state. Some (72.25%) were aware of the fact that obesity was an important risk factor that could impair the course of the COVID-19 disease. Almost 30% of respondents admitted having put on weight, significantly more in the group of preoperative patients (43.8% vs. 22.69%; p < 0.001). Only 20.92% of patients had a possibility of continuing direct bariatric care; 67.3% of patients had an opportunity of remote contact with a bariatric specialist, including online consultations, teleconsultations and social media meetings. Conclusions: Limited access to medical care and quarantine lockdown may result in a deterioration of long-time operation outcomes and lower weight losses. Patients should be encouraged to profit from online consultations with specialists and telemedicine to reduce the negative effects of the pandemic on their health. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

9 pages, 235 KiB

Open AccessArticle

The Influence of Bariatric Surgery on Pregnancy and Perinatal Outcomes—A Case-Control Study

by Anna Różańska-Walędziak, Maciej Walędziak, Paweł Bartnik, Joanna Kacperczyk-Bartnik, Michał Janik, Piotr Kowalewski, Andrzej Kwiatkowski and Krzysztof Czajkowski

J. Clin. Med. 2020, 9(5), 1324; https://doi.org/10.3390/jcm9051324 - 02 May 2020

Cited by 9 | Viewed by 2664

Abstract

Introduction: Obesity in pregnant women increases the incidence of pregnancy-induced comorbidities and the rate of operative deliveries. Purpose of the Study: As bariatric surgery is the reference method of treatment of obesity, we wanted to evaluate its influence on the course of pregnancy [...] Read more.

Introduction: Obesity in pregnant women increases the incidence of pregnancy-induced comorbidities and the rate of operative deliveries. Purpose of the Study: As bariatric surgery is the reference method of treatment of obesity, we wanted to evaluate its influence on the course of pregnancy and perinatal outcomes. Material and Methods: Data was collected from 627 female patients after bariatric surgery, of whom 107 had a history of pregnancy after the surgery, and 345 non-bariatric patients who had a delivery at a tertiary perinatal center. Sixty-one cases were matched (1:1) with controls for age, pre-pregnancy BMI and presence of pre-pregnancy comorbidities. The main endpoints were gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), small (SGA) and large for gestational age infants (LGA) and cesarean sections (CS). Results: Patients after bariatric procedures were significantly less likely to have GDM (19.67%/37.7%; p = 0.0433), PIH (11.47%/16.39%; p = 0.6072) and preterm delivery (13.11%/37.7%; p = 0.0026). The CS rate was higher (57.38%/40.98%; p = 0.0987). There was an increased risk of SGA (18.03%/13.11%; p = 0.6072) and a decreased risk of LGA (6.56%/16.39%; p = 0.146). Conclusions: Patients after bariatric surgery have a decreased risk of pregnancy-induced comorbidities, preterm deliveries and LGA infants, with an increase in rate of CS and SGA infants compared to general population matched for pre-pregnancy BMI, age and presence of pre-pregnancy comorbidities. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

13 pages, 942 KiB

Open AccessArticle

New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range”

by Ana de Hollanda, Albert Lecube, Miguel Angel Rubio, Enric Sánchez, Núria Vilarrasa, José Gregorio Oliva, María Luisa Fernández-Soto, Jordi Salas-Salvadó, María D. Ballesteros-Pomar, Andreea Ciudin, Ferran Torres, Concepción Vidal, María José Morales, Sergio Valdés, Silvia Pellitero, Inka Miñambres, Lluís Masmiquel, Albert Goday, Lorena Suarez, Liliam Flores, Marta Bueno, Assumpta Caixàs, Irene Bretón, Rosa Cámara, Romina Olbeyra, Rona Penso, María José de la Cruz, Andreu Simó-Servat, Francisca María Pereyra-García, Elena Teresa López-Mezquita, Anna Gils, Enzamaria Fidilio, Orosia Bandrés, Ángel Martínez, Jose Abuín, Montserrat Marques-Pamies, Laura Tuneu, Magdalena Arteaga, Olga Castañer, Fernando Goñi, Cristina Arrizabalaga, Manuel Antonio Botana, Alfonso Calañas and Ángel Rebollo Show full author list Hide full author list

J. Clin. Med. 2020, 9(4), 1070; https://doi.org/10.3390/jcm9041070 - 09 Apr 2020

Cited by 6 | Viewed by 2888

Abstract

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the [...] Read more.

Almost one third of patients do not achieve type 2 diabetes remission after bariatric surgery or are unable to sustain this effect long term. Our objective was to delve further into the dynamic responses of diabetes after bariatric surgery and to evaluate the “time-within-remission range” as a variable of metabolic control. A descriptive cohort study was done using a computerised multicentre and multidisciplinary registry. All data were adjusted by propensity score. A total of 1186 subjects with a follow-up of 4.5 ± 2.5 years were included. Type of surgery, diabetes remission, recurrence of diabetes, “time-within-remission range” and key predictors of diabetes outcomes were assessed. All patients (70% women, 51.4 ± 9.2 years old, body mass index (BMI) 46.3 ± 6.9 kg/m²) underwent primary bariatric procedures. “Time-within-remission range” were 83.3% (33.3–91.6) after gastric bypass, 68.7% (7.1–87.5) after sleeve gastrectomy and 90% (83.3–92.8) after malabsorptive techniques (p < 0.001 for all). Duration of diabetes, baseline HbA1c and insulin treatment were significantly negatively correlated with the “time-within-remission range”. The association of bariatric techniques with “time-within-remission range”, using gastric bypass as a reference, were: odds ratio (OR) 3.70 (2.34–5.84), p < 0.001 for malabsorptive techniques and OR 0.55 (0.40–0.75), p < 0.001 for sleeve gastrectomy. Characteristics of type 2 diabetes powerfully influence the outcomes of bariatric surgery. The “time-within-remission range” unveils a superiority of gastric bypass compared to sleeve gastrectomy. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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20 pages, 3041 KiB

Open AccessArticle

A Longitudinal Study of the Antioxidant Barrier and Oxidative Stress in Morbidly Obese Patients after Bariatric Surgery. Does the Metabolic Syndrome Affect the Redox Homeostasis of Obese People?

by Barbara Choromańska, Piotr Myśliwiec, Magdalena Łuba, Piotr Wojskowicz, Jacek Dadan, Hanna Myśliwiec, Katarzyna Choromańska, Anna Zalewska and Mateusz Maciejczyk

J. Clin. Med. 2020, 9(4), 976; https://doi.org/10.3390/jcm9040976 - 01 Apr 2020

Cited by 26 | Viewed by 2892

Abstract

This is the first study to evaluate both the antioxidant barrier, glutathione metabolism, and oxidative damage to proteins and lipids in morbidly obese patients undergoing bariatric treatment. The study included 65 patients with class 3 obesity divided into two subgroups: morbidly obese patients [...] Read more.

This is the first study to evaluate both the antioxidant barrier, glutathione metabolism, and oxidative damage to proteins and lipids in morbidly obese patients undergoing bariatric treatment. The study included 65 patients with class 3 obesity divided into two subgroups: morbidly obese patients without metabolic syndrome (OB) and obese patients with metabolic syndrome (OB + MS). Blood samples were collected before surgery as well as one, three, six, and twelve months after the bariatric treatment. Superoxide dismutase and reduced glutathione (GSH) were significantly decreased, whereas glutathione reductase and uric acid were enhanced in morbidly obese patients before bariatric surgery as compared to lean control. Moreover, in the OB group, we observed the increase of superoxide dismutase (SOD) and the decrease of uric acid (UA) after the bariatric treatment; however, these changes were not observed in the OB + MS group. The oxidative damage to proteins (advanced glycation end products, AGE; advanced oxidation protein products, AOPP) and lipids (8-isoprostanes, 8-isop; 4-hydroxynoneal) was higher in OB as well as OB + MS patients. We noticed that AGE and AOPP levels diminished after the bariatric treatment, whereas redox status (ratio of GSH to oxidized glutathione) was still reduced in the OB + MS group. Summarizing, morbid obesity is associated with disturbances in the antioxidant barrier and enhanced oxidative damage to proteins and lipids. Although bariatric surgery improves redox homeostasis in obese patients, those with metabolic syndrome show a continuous decrease in the antioxidant status. In patients undergoing bariatric treatment, antioxidant supplementation may be considered. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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Review

Jump to: Research, Other

25 pages, 1242 KiB

Open AccessReview

Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review

by Irene Bretón, María D. Ballesteros-Pomar, Alfonso Calle-Pascual, Luis Antonio Alvarez-Sala and Miguel Angel Rubio-Herrera

J. Clin. Med. 2023, 12(16), 5429; https://doi.org/10.3390/jcm12165429 - 21 Aug 2023

Cited by 2 | Viewed by 1888

Abstract

Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks [...] Read more.

Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks that obesity poses to pregnancy. But on the other hand, decreased intake and malabsorption may increase the risk of malnutrition and micronutrient deficiency and negatively affect maternal and foetal health. The aim of this narrative review is to provide an updated analysis of the impact of different bariatric surgery techniques on mineral and micronutrient nutritional status during pregnancy and the possible effect on maternal–foetal health. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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13 pages, 327 KiB

Open AccessReview

Thyroid Function Alteration in Obesity and the Effect of Bariatric Surgery

by María Cordido, Paula Juiz-Valiña, Paula Urones, Susana Sangiao-Alvarellos and Fernando Cordido

J. Clin. Med. 2022, 11(5), 1340; https://doi.org/10.3390/jcm11051340 - 28 Feb 2022

Cited by 11 | Viewed by 3375

Abstract

The most common endocrine disease in obesity is hypothyroidism and secondary endocrine alterations, including abnormal thyroid function, are frequent in obesity. It is unclear whether impaired thyroid function is the cause or the consequence of increased adiposity; furthermore, there are no clear data [...] Read more.

The most common endocrine disease in obesity is hypothyroidism and secondary endocrine alterations, including abnormal thyroid function, are frequent in obesity. It is unclear whether impaired thyroid function is the cause or the consequence of increased adiposity; furthermore, there are no clear data regarding the best way to dose levothyroxine for patients with both hypothyroidism and obesity, and the effect of bariatric surgery (BS). The aim of the present article is to review some controversial aspects of the relation between obesity and the thyroid: (1) Thyroid function in obesity and the effect of BS (2) Thyroid hormone treatment (THT) in obese patients with hypothyroidism and the effect of BS. In summary: In morbidly obese patients, TSH is moderately increased. Morbid obesity has a mild central resistance to the thyroid hormone, reversible with weight loss. In morbidly obese hypothyroid patients, following weight loss, the levothyroxine dose/kg of ideal weight did not change, albeit there was an increment in the levothyroxine dose/kg of actual weight. From a clinical practice perspective, in morbid obesity, diagnosing mild hypothyroidism is difficult, BS improves the altered thyroid function and THT can be adapted better if it is based on ideal weight. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

14 pages, 499 KiB

Open AccessReview

Non-Alcoholic Fatty Liver Disease (NAFLD) and Bariatric/Metabolic Surgery as Its Treatment Option: A Review

by Paulina Głuszyńska, Dorota Lemancewicz, Janusz Bogdan Dzięcioł and Hady Razak Hady

J. Clin. Med. 2021, 10(24), 5721; https://doi.org/10.3390/jcm10245721 - 07 Dec 2021

Cited by 24 | Viewed by 3377

Abstract

The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) has considerably increased over the last years. NAFLD is currently the most common cause of chronic liver disease in the developing world. The diagnosis of NAFLD/NASH is often incidental, as the [...] Read more.

The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) has considerably increased over the last years. NAFLD is currently the most common cause of chronic liver disease in the developing world. The diagnosis of NAFLD/NASH is often incidental, as the early-stage of disease is frequently free of symptoms. Most patients recognized with NAFLD have severe obesity and other obesity-related disease such as type 2 diabetes mellitus (T2DM), insulin-resistance, dyslipidemia and hypertension. The only proven method for NAFLD improvement and resolution is weight loss. Bariatric surgery leads to significant and long-term weight loss as well as improvement of coexisting diseases. There is a lot of evidence suggesting that metabolic/bariatric surgery is an effective method of NAFLD treatment that leads to reduction in steatosis, hepatic inflammation and fibrosis. However, there is still a need to perform long-term studies in order to determine the role of bariatric surgery as a treatment option for NAFLD and NASH. This review discusses current evidence about epidemiology, pathogenesis and treatment options for NAFLD including bariatric/metabolic surgery and its effect on improvement and resolution of NAFLD. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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21 pages, 475 KiB

Open AccessReview

Impact of Bariatric Surgery on Adipose Tissue Biology

by Óscar Osorio-Conles, Josep Vidal and Ana de Hollanda

J. Clin. Med. 2021, 10(23), 5516; https://doi.org/10.3390/jcm10235516 - 25 Nov 2021

Cited by 13 | Viewed by 2386

Abstract

Bariatric surgery (BS) procedures are actually the most effective intervention to help subjects with severe obesity achieve significant and sustained weight loss. White adipose tissue (WAT) is increasingly recognized as the largest endocrine organ. Unhealthy WAT expansion through adipocyte hypertrophy has pleiotropic effects [...] Read more.

Bariatric surgery (BS) procedures are actually the most effective intervention to help subjects with severe obesity achieve significant and sustained weight loss. White adipose tissue (WAT) is increasingly recognized as the largest endocrine organ. Unhealthy WAT expansion through adipocyte hypertrophy has pleiotropic effects on adipocyte function and promotes obesity-associated metabolic complications. WAT dysfunction in obesity encompasses an altered adipokine secretome, unresolved inflammation, dysregulated autophagy, inappropriate extracellular matrix remodeling and insufficient angiogenic potential. In the last 10 years, accumulating evidence suggests that BS can improve the WAT function beyond reducing the fat depot sizes. The causal relationships between improved WAT function and the health benefits of BS merits further investigation. This review summarizes the current knowledge on the short-, medium- and long-term outcomes of BS on the WAT composition and function. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

8 pages, 999 KiB

Open AccessReview

Sleeve Gastrectomy and Roux-En-Y Gastric Bypass. Two Sculptors of the Pancreatic Islet

by Gonzalo-Martín Pérez-Arana, José Fernández-Vivero, Alonso Camacho-Ramírez, Alfredo Díaz Gómez, José Bancalero de los Reyes, Antonio Ribelles-García, David Almorza-Gomar, Carmen Carrasco-Molinillo and José-Arturo Prada-Oliveira

J. Clin. Med. 2021, 10(18), 4217; https://doi.org/10.3390/jcm10184217 - 17 Sep 2021

Cited by 1 | Viewed by 1998

Abstract

Several surgical procedures are performed for the treatment of obesity. A main outcome of these procedures is the improvement of type 2 diabetes mellitus. Trying to explain this, gastrointestinal hormone levels and their effect on organs involved in carbohydrate metabolism, such as liver, [...] Read more.

Several surgical procedures are performed for the treatment of obesity. A main outcome of these procedures is the improvement of type 2 diabetes mellitus. Trying to explain this, gastrointestinal hormone levels and their effect on organs involved in carbohydrate metabolism, such as liver, gut, muscle or fat, have been studied intensively after bariatric surgery. These effects on endocrine-cell populations in the pancreas have been less well studied. We gathered the existing data on these pancreatic-cell populations after the two most common types of bariatric surgery, the sleeve gastrectomy (SG) and the roux-en-Y gastric bypass (RYGB), with the aim to explain the pathophysiological mechanisms underlying these surgeries and to improve their outcome. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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14 pages, 545 KiB

Open AccessReview

Bariatric Surgery and Hypertension

by Elisenda Climent, Anna Oliveras, Juan Pedro-Botet, Albert Goday and David Benaiges

J. Clin. Med. 2021, 10(18), 4049; https://doi.org/10.3390/jcm10184049 - 07 Sep 2021

Cited by 10 | Viewed by 2630

Abstract

A clear pathogenetic association exists between obesity and arterial hypertension, becoming even more evident in subjects with severe obesity. Bariatric surgery has proved to be the most effective treatment for severe obesity, with its benefits going beyond weight loss. The present review aimed [...] Read more.

A clear pathogenetic association exists between obesity and arterial hypertension, becoming even more evident in subjects with severe obesity. Bariatric surgery has proved to be the most effective treatment for severe obesity, with its benefits going beyond weight loss. The present review aimed to determine the effects of bariatric surgery on arterial hypertension evident in short- and long-term follow-ups. Moreover, the differences between surgical techniques regarding hypertension remission are described as well as the possible pathophysiologic mechanisms involved. In addition, the effects of bariatric surgery beyond blood pressure normalization are also analyzed, including those on target organs and cardiovascular morbidity and mortality. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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18 pages, 371 KiB

Open AccessReview

by Isabel Cornejo-Pareja, María Molina-Vega, Ana María Gómez-Pérez, Miguel Damas-Fuentes and Francisco J. Tinahones

J. Clin. Med. 2021, 10(8), 1739; https://doi.org/10.3390/jcm10081739 - 16 Apr 2021

Cited by 25 | Viewed by 2883

Abstract

Despite bariatric surgery being the most effective treatment for obesity, some individuals do not respond adequately, especially in the long term. Identifying the predictors of correct weight maintenance in the medium (from 1 to 3 years after surgery) and long term (from 3 [...] Read more.

Despite bariatric surgery being the most effective treatment for obesity, some individuals do not respond adequately, especially in the long term. Identifying the predictors of correct weight maintenance in the medium (from 1 to 3 years after surgery) and long term (from 3 years and above) is of vital importance to reduce failure after bariatric surgery; therefore, we summarize the evidence about certain factors, among which we highlight surgical technique, psychological factors, physical activity, adherence to diet, gastrointestinal hormones or neurological factors related to appetite control. We conducted a search in PubMed focused on the last five years (2015–2021). Main findings are as follows: despite Roux-en-Y gastric bypass being more effective in the long term, sleeve gastrectomy shows a more beneficial effectiveness–complications balance; pre-surgical psychological and behavioral evaluation along with post-surgical treatment improve long-term surgical outcomes; physical activity programs after bariatric surgery, in addition to continuous and comprehensive care interventions regarding diet habits, improve weight loss maintenance, but it is necessary to improve adherence; the impact of bariatric surgery on the gut–brain axis seems to influence weight maintenance. In conclusion, although interesting findings exist, the evidence is contradictory in some places, and long-term clinical trials are necessary to draw more robust conclusions. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

15 pages, 343 KiB

Open AccessReview

Factors Affecting Metabolic Outcomes Post Bariatric Surgery: Role of Adipose Tissue

by Sara H. Keshavjee, Katherine J. P. Schwenger, Jitender Yadav, Timothy D. Jackson, Allan Okrainec and Johane P. Allard

J. Clin. Med. 2021, 10(4), 714; https://doi.org/10.3390/jcm10040714 - 11 Feb 2021

Cited by 6 | Viewed by 2048

Abstract

Obesity is an ever-growing public health crisis, and bariatric surgery (BS) has become a valuable tool in ameliorating obesity, along with comorbid conditions such as diabetes, dyslipidemia and hypertension. BS techniques have come a long way, leading to impressive improvements in the health [...] Read more.

Obesity is an ever-growing public health crisis, and bariatric surgery (BS) has become a valuable tool in ameliorating obesity, along with comorbid conditions such as diabetes, dyslipidemia and hypertension. BS techniques have come a long way, leading to impressive improvements in the health of the majority of patients. Unfortunately, not every patient responds optimally to BS and there is no method that is sufficient to pre-operatively predict who will receive maximum benefit from this surgical intervention. This review focuses on the adipose tissue characteristics and related parameters that may affect outcomes, as well as the potential influences of insulin resistance, BMI, age, psychologic and genetic factors. Understanding the role of these factors may help predict who will benefit the most from BS. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

11 pages, 818 KiB

Open AccessReview

The Metabolic Rearrangements of Bariatric Surgery: Focus on Orexin-A and the Adiponectin System

by Anna Valenzano, Nicola Tartaglia, Antonio Ambrosi, Domenico Tafuri, Marcellino Monda, Antonietta Messina, Francesco Sessa, Angelo Campanozzi, Vincenzo Monda, Giuseppe Cibelli, Giovanni Messina and Rita Polito

J. Clin. Med. 2020, 9(10), 3327; https://doi.org/10.3390/jcm9103327 - 16 Oct 2020

Cited by 18 | Viewed by 2684

Abstract

The accumulation of adipose tissue represents one of the characteristics of obesity, increasing the risk of developing correlated obesity diseases such as cardiovascular disease, type 2 diabetes, cancer, and immune diseases. Visceral adipose tissue accumulation leads to chronic low inflammation inducing an imbalanced [...] Read more.

The accumulation of adipose tissue represents one of the characteristics of obesity, increasing the risk of developing correlated obesity diseases such as cardiovascular disease, type 2 diabetes, cancer, and immune diseases. Visceral adipose tissue accumulation leads to chronic low inflammation inducing an imbalanced adipokine secretion. Among these adipokines, Adiponectin is an important metabolic and inflammatory mediator. It is also known that adipose tissue is influenced by Orexin-A levels, a neuropeptide produced in the lateral hypothalamus. Adiponectin and Orexin-A are strongly decreased in obesity and are associated with metabolic and inflammatory pathways. The aim of this review was to investigate the involvement of the autonomic nervous system focusing on Adiponectin and Orexin-A after bariatric surgery. After bariatric surgery, Adiponectin and Orexin-A levels are strongly increased independently of weight loss showing that hormone increases are also attributable to a rearrangement of metabolic and inflammatory mediators. The restriction of food intake and malabsorption are not sufficient to clarify the clinical effects of bariatric surgery suggesting the involvement of neuro-hormonal feedback loops and also of mediators such as Adiponectin and Orexin-A. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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16 pages, 2056 KiB

Open AccessSystematic Review

Effect of Bariatric Surgery on Intima Media Thickness: A Systematic Review and Meta-Analysis

by Tannaz Jamialahmadi, Željko Reiner, Mona Alidadi, Wael Almahmeed, Prashant Kesharwani, Khalid Al-Rasadi, Ali H. Eid, Manfredi Rizzo and Amirhossein Sahebkar

J. Clin. Med. 2022, 11(20), 6056; https://doi.org/10.3390/jcm11206056 - 13 Oct 2022

Cited by 6 | Viewed by 1648

Abstract

Background: Obesity, and in particular extreme obesity, as a global health problem is an important risk factor for many diseases, including atherosclerotic cardiovascular disease (ACVD). Bariatric surgery might stop or slow atherogenesis by decreasing excessive weight in the early stages of atherogenesis, by [...] Read more.

Background: Obesity, and in particular extreme obesity, as a global health problem is an important risk factor for many diseases, including atherosclerotic cardiovascular disease (ACVD). Bariatric surgery might stop or slow atherogenesis by decreasing excessive weight in the early stages of atherogenesis, by suppressing low-grade systemic inflammation as well as by inhibiting oxidative stress and endothelial dysfunction. The aim of this meta-analysis was to provide an answer to whether bariatric surgery has a significant effect on intima-media thickness (IMT) which is a surrogate marker of early atherosclerosis and has a good correlation with atherosclerotic coronary heart disease. Methods: A systematic literature search in PubMed, Scopus, Embase, and Web of Science as well as grey literature was performed from inception to 1 July 2022. The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V3 software. Overall, the estimate of effect size was measured by a random effects meta-analysis. To account for the heterogeneity of studies regarding study design, characteristics of the populations, and treatment duration, a random-effects model (using the DerSimonian–Laird method) and the generic inverse variance weighting approach were used. To assess the existence of publication bias in the meta-analysis, the funnel plot, Begg’s rank correlation, and Egger’s weighted regression tests were used. Results: The meta-analysis of 30 trials, including 1488 subjects, demonstrated a significant decrease in IMT after bariatric surgery. The reduction in IMT was also robust in the leave-one-out sensitivity analysis. It must be stressed that the results of the random-effects meta-regression did not suggest any relationship between the changes in IMT and delta body mass index (BMI) or duration of follow-up after the bariatric surgery. However, the subgroup analyses showed a better IMT reduction after laparoscopic sleeve gastrectomy (LSG) when compared to Roux-en-Y gastric bypass (RYGB). Within a year, the IMT follow-up values showed a further improvement. Conclusions: Bariatric surgery significantly reduced IMT. Significant associations were found between the surgery type and IMT changes, as well as a significant effect of follow-up duration on the changes of IMT after bariatric surgery. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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15 pages, 9718 KiB

Open AccessSystematic Review

Effects of Supervised Physical Exercise as Prehabilitation on Body Composition, Functional Capacity and Quality of Life in Bariatric Surgery Candidates: A Systematic Review and Meta-Analysis

by Andrea Herrera-Santelices, Graciela Argüello-Florencio, Greice Westphal, Nelson Nardo Junior and Antonio Roberto Zamunér

J. Clin. Med. 2022, 11(17), 5091; https://doi.org/10.3390/jcm11175091 - 30 Aug 2022

Cited by 5 | Viewed by 1862

Abstract

Background: Prehabilitation is a strategy used aiming to reduce the risk factors and complications of surgery procedures, but there is no consensus on the effectiveness of supervised physical exercise and its optimal prescription during this phase. Objectives: To determine the effects of exercise [...] Read more.

Background: Prehabilitation is a strategy used aiming to reduce the risk factors and complications of surgery procedures, but there is no consensus on the effectiveness of supervised physical exercise and its optimal prescription during this phase. Objectives: To determine the effects of exercise prehabilitation on body composition, functional capacity and quality of life in candidates for bariatric surgery. Search methods: A search was conducted in PubMed, Web of Science, SciELO, Scopus, MEDLINE and CINAHL. Selection criteria: Only randomized clinical trials that examined the effectiveness of supervised physical exercise were included. The main outcomes were body composition, functional capacity, quality of life and surgical outcomes. Data collection and analysis: Two researchers independently selected the literature, extracted the data and evaluated the risk of bias. A third researcher was consulted when a consensus was not reached. The risk of bias was assessed by the tool recommended by the Cochrane Collaboration, the quality of the evidence by GRADE, and to analyze the effects of prehabilitation on the primary objectives, RevMan software, version 5.3 was used. Main results: The search resulted in 4550 articles, of which 22 met the eligibility criteria, leaving 5 articles selected for this review. One article was assessed as a high bias risk and four as an uncertain risk, which included 139 candidates for bariatric surgery. Most of the studies evaluated the body composition, functional capacity and quality of life; none reported surgical outcomes. Conclusions: Supervised physical exercise has positive effects on the body composition, functional capacity and quality of life; there was no evidence for surgical outcomes, which opens up a field of study for future research of this population. Full article

(This article belongs to the Special Issue Bariatric Surgery: Latest Advances and Prospects)

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