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Bariatric surgery is the most effective treatment for weight loss and also promotes remission of preoperative metabolic comorbidities.
The aim of this study was to analyze preoperative comorbidities, evaluate postoperative outcomes, and assess complications 6 months after bariatric surgery in a hospital in the state of Santa Catarina, Brazil.
A retrospective cohort study was conducted with patients who underwent bariatric surgery between 2021 and 2022 and were followed up for a period of 6 months after the procedure.
There was a predominance of female patients (81.6%), with a mean age of 38.7 years. The preoperative prevalence of hypertension, Type 2 diabetes, dyslipidemia, and hepatic steatosis was 36.7, 22.4, 22.4, and 32.7%, respectively. The postoperative remission rates for these conditions were 55, 64, 70, and 69%, respectively. Except for diabetes, no significant differences were found between the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) groups. There was a significant reduction in weight (p<0.01) and body mass index (BMI) (p<0.01), with no statistical differences between the RYGB and SG groups. Postoperative complications occurred in 73.5% of patients, including anemia, vitamin deficiencies, cholelithiasis, dumping syndrome, anastomotic ulcer, chronic diarrhea, and anastomotic stricture.
The study described the preoperative comorbidity profile, postoperative outcomes, and complications with findings consistent with existing literature, except for underreporting dyslipidemia and hepatic steatosis. No statistical difference was observed between the surgical techniques performed.
Dysbiosis of the gut microbiota is frequently found in cases of obesity and related metabolic diseases, such as type 2 diabetes mellitus. The composition of the microbiota in diabetics is similar to that of obese people, thereby causing increased energy uptake efficiency in the large intestine of obese people, maintenance of a systemic inflammatory state, and increased insulin resistance. Bariatric surgery seems to entail an improvement in gut dysbiosis, leading to an increased diversity of the gut microbiota.
This study aimed to present a literature review on obesity-associated gut dysbiosis and its status post-bariatric surgery.
A systematic review of primary studies was conducted in PubMed, SciELO, BIREME, LILACS, Embase, ScienceDirect, and Scopus databases using DeCS (Health Science Descriptors) with the terms “obesity,” “intestinal dysbiosis,” “bariatric surgery,” and “microbiota.”
We analyzed 28 articles that had clinical studies or literature reviews as their main characteristics, of which 82% (n=23) corresponded to retrospective studies. The sample size of the studies ranged from 9 to 257 participants and/or fecal samples. The epidemiological profile showed a higher prevalence of obesity in females, ranging from 24.4 to 35.1%, with a mean age of around 25–40 years. There was a variation regarding the type of bariatric surgery, migrating between the Roux-en-Y bypass, adjustable gastric banding, and vertical gastrectomy. Of the 28 studies, 6 of them evaluated the gut microbiota of obese patients undergoing bariatric surgery and their relationship with type 2 diabetes mellitus/glucose metabolism/insulin resistance.
The intestinal microbiota is an important influencer in the regulation of the digestive tract, and obese individuals with comorbidities (diabetes mellitus, hypercholesterolemia, and metabolic syndrome) present important alterations, with an unbalance normal state, generating dysbiosis and the proliferation of bacterial species that favor the appearance of new diseases. Patients who undergo bariatric surgery present an improvement in the intestinal microbiota imbalance as well as reversibility of their comorbidities, increasing their life expectancy.
Obesity represents a chronic pro-inflammatory status that contributes to accelerated atherosclerosis and cell aging. Besides the widely used C-reactive protein and ferritin, other inflammatory markers have gained attention, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), which are related with the degree of inflammation in various pathological conditions, including obesity and its comorbidities.
To compare and monitor the levels of NLR and PLR before and after sleeve gastrectomy (SG).
Retrospective study that included a total of 622 patients with obesity who underwent SG as primer bariatric surgery in our center. Data regarding the presence of comorbidities, including type 2 diabetes (T2D), high blood pressure (HBP) and non-alcoholic fatty liver disease (NAFLD), variations in body weight and body mass index (BMI), and biochemical markers of inflammation, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP) were gathered. Values of NLR and PLR were correlated with weight loss and prognosis of comorbidities within the postoperative period.
The sample was predominantly female (79.3%) with average age 36.91±10.04 years, with comorbidities including HBP (25.1%), T2D (8.0%), and NAFLD (80.1%). Patients with HBP showed reduced NLR and CRP post-intervention, while those with T2D experienced decreased CRP but increased PLR. Correlation analysis found no significant correlation between BMI/weight changes and NLR but significant correlation with PLR. Post-surgery, NLR decreased for previously NAFLD patients, and PLR increased.
According to the results, patients with obesity present a significant decrease in NLR and an increase in PLR after SG.
Affective temperaments are part of the spectrum of mood disorders and comprise the concepts of hyperthymia, dysthymia and cyclothymia. Numerous studies have demonstrated a strong relationship between obesity and mood disorders.
The objective of the present study was to evaluate the frequency of affective temperaments in morbidly obese individuals and controls and to establish a possible association between affective temperaments and morbid obesity.
The study evaluated 106 cases (morbidly obese) and one hundred controls (non-obese). To assess affective temperaments, the Temperament Evaluation in Memphis Pisa and San Diego - Rio de Janeiro TEMPS-Rio de Janeiro scale was applied. Depressive symptoms were assessed using the Hamilton Depression Rating Scale, anxiety symptoms using the Hamilton Anxiety Rating Scale and manic symptoms using the Young Mania Rating Scale. For univariate and multivariate analysis, logistic regression models were adjusted.
The presence of at least one affective temperament was 74.5% in the morbidly obese group and 63% in the non-obese group. When comparing the two groups, the statistical analysis of the age subgroup of individuals aged 50 years or over showed an odds ratio of 2.56 (1.07-6.09) for hyperthymic temperament.
In the age group of 50 years or more, cases of morbid obesity are significantly more likely (2.56 times) to occur in individuals with a hyperthymic temperament. Among the three types of affective temperaments evaluated, only hyperthymia could be a risk factor for morbid obesity.
The coronavirus disease 2019 (COVID-19) greatly impacted patients undergoing bariatric surgery due to prolonged quarantine and lockdown measures.
The aim of this study was to qualitatively investigate the impact of the COVID-19 quarantine and lockdown measures on the mental and emotional health of post-bariatric surgery women.
A qualitative study was carried out, with individual interviews conducted via video calls using a video-communication service (Google Meet®). The moderator guide inquired about three pre-established topics based on the literature: mental and emotional health, social relationship, and the use of health technology.
A total of 12 women participated in this study, with an average age of 43±9.83 years, a body mass of 82.33±13.83 kg, a height of 1.62±0.06 m, a body mass index of 26.32±2.97 kg/m2, and post-surgery time of 12.83±4.37 months. The interviews had an average duration of 50.71±7.26 min. Our results suggested a negative impact of the COVID-19 pandemic on aspects of mental and emotional health, such as increased anxiety, depressive symptoms, fear, stress, and anguish, which were somehow diminished in patients who were closer to family members. Bariatric surgery was mentioned as a positive aspect by the patients for coping with clinical risk conditions.
The study showed a negative impact of the COVID-19 pandemic on aspects of mental and emotional health mostly due to lockdown measures, which led to social isolation and an increased burden with household chores.
Research indicates that patients undergoing bariatric surgery face a six to seven times higher risk of developing alcohol use disorder (AUD) compared with the population of obese individuals not undergoing surgical intervention. Studies suggest that problematic alcohol consumption encompassing depression escalates gradually after surgery.
The purpose of this study was to evaluate the impact of bariatric surgery on the incidence of AUD and depression during the postoperative period.
Prospective study that evaluated 68 patients who underwent either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). The presence of AUD and depression was assessed both pre- and post-operatively. AUD assessment utilized the AUD identification test-C score, whereas depression assessment employed the Beck Depression Inventory (BDI).
The average age of the sample was 42.81±9.28 years, with 85.3% being female. The mean follow-up was 16.54±7.41 months. In the preoperative assessment, 92.6% of the sample fell into the low-risk category for AUD. No significant difference was observed between the RYGB and SG groups. Postoperatively, 89.7% of the sample was classified as low risk for AUD, with no significant differences compared with the preoperative assessment. Regarding depression, there was no significant difference between pre- and post-operative periods for all patients. However, a notable trend toward a reduction in “severe depression” was observed in the postoperative period for patients undergoing SG (pre: 14.0% vs. post: 7.0%, p=0.013).
There is no significant difference in the presence of AUD and depression between pre- and post-operative assessments in patients who have undergone bariatric surgery.
Differences in skin color have socioeconomic and health implications; however, gaps persist in understanding health-related quality of life (HRQoL) perception.
To examine whether skin color differences influence HRQoL in obese patients undergoing Roux-en-Y gastric bypass surgery.
Cross-sectional study with participants of both genders, aged 18 to 60, and three to six months postoperatively. Data were collected from October 2018 to July 2019 at a bariatric clinic in Salvador, Bahia. Skin color, Moorehead-Ardelt II Quality of Life Questionnaire (MAQOL-II) scores, anthropometric measurements, socioeconomic status, physical activity, and body image perceptions were recorded.
Of 196 patients, 67.35% were Black. “Self-esteem” in MAQOL-II demonstrated the most significant post-surgical improvement, with 62.8% reporting “much better” outcomes. Adjusted residuals associated “much better” and “unchanged” responses with skin color. The overall MAQOL-II score indicated lower HRQoL scores (M=1.65; standard deviation - SD=0.98) for individuals with black skin compared to those with white skin. Analyzing questionnaire responses, both racial groups exhibited equal percentages (45.3%) reporting “much better” and “better” post-surgery progress. However, no statistically significant differences in HRQoL were observed when comparing skin color.
Skin color appears not to significantly impact the HRQoL of obese patients undergoing Roux-en-Y gastric bypass.
Obesity is a predisposing factor for serious comorbidities, particularly those related to elevated cardiovascular mortality. The atherogenic index of plasma (AIP) has been shown to be a useful indicator of patients with insulin resistance.
The aim of this study was to assess cardiovascular risk before and after surgical treatment of obesity.
A total of 615 patients undergoing bariatric surgery between 2007 and 2012 were evaluated using the analysis of electronic records (triglyceride/high-density lipoprotein cholesterol) before and after surgery. The AIP levels >3.5 mg/dL for men and >2.5 mg/dL for women were insulin-resistant and predisposed to cardiovascular events.
A total of 117 men had an AIP >3.5 mg/dL during the preoperative period, 13.5% during the early postoperative period, 14.3% during the intermediate period, and 18.2% during the late postoperative period. Among 498 women, 56.2% had an AIP >2.5 mg/dL before surgery, 17.9% in early postoperative period, 13.5% in the intermediate period, and 11.4% in the late period.
Bariatric surgery resulted in a significant effect on the AIP, insulin resistance, metabolic syndrome, and therefore, the risk of cardiovascular diseases.
Preoperative hospitalization with the purpose to obtain more effective weight loss provides intensive care for patients who have a higher body mass index (BMI) and associated diseases that involve a greater risk of peri- and postoperative complications. It is a therapeutic strategy that can make it possible to overcome obstacles related to the difficulty of adhering to obesity treatment.
To analyze the implementation of a preoperative hospitalization strategy for weight loss in patients eligible for bariatric surgery.
Retrospective study that included 194 patients with a BMI=50 kg/m2. They were grouped according to preoperative preparation strategies: inpatient (n=32) and outpatient (n=162), who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2010 and 2020. The groups were compared regarding preoperative weight loss before and after the strategies and postoperative up to two years after surgery.
Most patients were female and there were significant differences in age group (an average of 42.94 years in the preoperative hospitalization strategy group and 37.73 in the outpatient strategy group). The mean BMI in the hospitalized group was 63.01±8.72 kg/m2, and in the outpatient group it was 54.95±4.31 kg/m2. There was a significant difference only between initial and preoperative weight in the hospitalized group. Furthermore, the difference between initial weight and last recorded weight up to two years after surgery was significant in each group. The occurrence of associated diseases was higher in the outpatient group.
Patients following the preoperative hospitalization strategy experienced significant weight loss before surgery.
Obesity is recognized as a significant risk factor for various types of cancer. Although the incidence of some types of cancer across various primary sites is decreasing due to specific prevention measures (screening programs, smoking cessation), the incidence of neoplasms in the young population shows a significant increase associated with obesity. There is sufficient evidence to say that bariatric surgery has been shown to significantly lower the risk of developing obesity-associated cancers, which are linked to metabolic dysregulation, chronic low-grade systemic inflammation, and hormonal alterations such as elevated levels of insulin and sex hormones.
Desenvolvido por Surya MKT