Long-term systemic effects of metabolic bariatric surgery: A multidisciplinary perspective.

Background: Obesity is a global health crisis with profound implications on various body systems, contributing to a series of comorbidities. Metabolic Bariatric Surgery (MBS) has emerged as an effective treatment option for severe obesity, with significant weight reduction and potential systemic physiological alterations. Objectives: This narrative review aims to provide a comprehensive analysis of the long-term effects of MBS on a wide array of body systems, including the heart, liver, kidneys, reproductive system, skin, lungs, digestive tract, pancreas, and blood, as well as related cancers of these organs. Methods: A systematic search was conducted in academic databases (PubMed, ISI Web of Science, and Scopus) for observational studies and reviews published between July 2000 and December 2023, investigating the association between MBS and the subsequent function of different organ systems. High-quality studies were prioritized to ensure reliable evidence synthesis. Results: MBS has demonstrated favorable outcomes in reducing cardiovascular disease risk, improving cardiac function, and alleviating heart failure symptoms. It has also been associated with improved respiratory function, remission of obstructive sleep apnea, and reduced cancer incidence and mortality. Additionally, MBS has shown benefits in managing gastrointestinal disorders, enhancing glycemic control, and promoting pancreatic beta-cell regeneration in type 2 diabetes mellitus. However, some methods of MBS are associated with a higher risk of cholelithiasis, GERD, and pancreatic exocrine insufficiency. Conclusion: MBS has far-reaching systemic effects beyond weight loss, offering potential long-term benefits for various organ systems and comorbidities associated with obesity. For many patients with severe obesity, the potential benefits of Metabolic and Bariatric Surgery (MBS) can outweigh the associated risks. However, careful evaluation by a qualified healthcare professional is crucial to determine candidacy and ensure a successful outcome. Further research is needed to fully elucidate the long-term impacts and tailor personalized treatment approaches.

Changes in Fat Mass Index and Fat-Free Mass Index Vary Significantly by Age and Sex of the Patient, and by Type of Bariatric Surgery.

BACKGROUND: The loss of fat-free mass after rapid weight loss following bariatric surgery shows BMI is inadequate for reporting weight loss, emphasizing the need for a more accurate body composition metric. This study assessed changes in fat mass index (FMI), fat-free mass index (FFMI), and dietary intake over 6 months after one-anastomosis gastric bypass (OAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) across age and sex groups. MATERIALS AND METHODS: This prospective observational study included 151 bariatric surgery candidates. Data on demographics, anthropometric, body composition, and food intake data were collected before and 6 months after surgery. SPSS version 22 was used for analysis, employing ANOVA and t-tests to assess group differences. RESULTS: Younger patients (≤ 35 years) had higher percent total and excess weight loss (%TWL and %EWL) across all bariatric surgeries, and those undergoing SG experienced more favorable changes in fat-free mass (FFM) and visceral fat compared to other procedures (P = 0.002). Males had higher percent change in fat mass index (%∆ FMI) and visceral fat than females with OAGB and RYGB (P < 0.05). Women undergoing SG and RYGB had a more significant decrease in energy intake compared to OAGB (P < 0.001), and the ≤ 35 and 35-44 age groups demonstrated lower reductions in energy intake following OAGB. CONCLUSION: Age, sex, and surgery type significantly affect bariatric surgery outcomes. Younger patients achieved greater weight-related improvements, while men undergoing RYGB experienced more substantial fat mass changes than women.

The association between dietary folate intake and risk of colorectal cancer incidence: A systematic review and dose‒response meta-analysis of cohort studies.

Background: Dietary components can influence the incidence of colorectal cancer (CRC). Folate is one of the compounds that plays an essential role in the formation of DNA structures, which can lead to or prevent tumorigenesis. The present study is the first systematic review and dose-response meta-analysis of cohort studies evaluating the association between dietary folate intake and the risk of CRC. Methods: The PubMed/Medline, Scopus, and ISI Web of Science databases were systematically searched for cohort studies that assessed the association between folate intake and CRC up to January 2024. Summary relative risks (RRs) and 95 % confidence intervals (CIs) were calculated using a random effects model. Also, linear and nonlinear dose-response analyses were conducted for the dose-response associations between folate intake and risk of CRC. Results: Eighteen prospective cohort studies with 931,469 participants, 14,860 CRC patients, 3536 colon cancer (CC) patients, and 1075 rectal cancer (RC) patients were included in the analysis. The summary RR of CRC for each 100-µg increase in dietary folate intake was 0.97 (95 % CI: 0.95-0.99, I2: 0.0 %, P-heterogeneity: 0.616), which can be related to BMI (0.97 (95 % CI: 0.95-0.99)); a more protective effect was also observed in subjects who drank alcohol (0.97 (95 % CI: 0.95-0.99)) and those who smoked (0.97 (95 % CI: 0.95-0.99)). Additionally, it was positively related to a 7 % lower risk of CC (0.93 (95 % CI: 0.87-0.99, I2: 33.7 %, P-heterogeneity: 0.159)), and the null relation for RC was 0.98 (95 % CI: 0.90-1.08), I2: 16.6 %, P-heterogeneity: 0.309). There was evidence of nonlinearity in which up to 500 µg/day dietary folate intake was inversely associated with CC (P nonlinearity = 0.04). Conclusion: The findings showed an inverse association between dietary folate intake and the risk of CRC, especially in high-risk persons, those who have a higher BMI, alcohol drinkers, and smokers.

Cross sectional determinants of VO2 max in free living Iranians: Potential role of metabolic syndrome components and vitamin D status.

BACKGROUND AND AIMS: The purpose of the study was to evaluate the determinants of cardiorespiratory fitness (CRF) in Iranian adults and the potential contribution of vitamin D status. METHODS: In this cross-sectional study 264 cases (116 men and 147 women aged 18-70 years old were participated. Maximal oxygen consumption (VO2 max) was measured by the Bruce protocol utilizing treadmill exercise testing. Anthropometric data, body composition and fasting blood glucose and lipid concentrations were measured. Serum levels of 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were assessed using enzyme-linked immunosorbent assay. Stepwise linear regression analysis was applied to determine significant predictors of VO2 peak. We tested non-linear (quadratic and cubic terms) versus linear association of adjusted (for determinants) VO2 max and vitamin D levels. RESULTS: Multiple regression results showed that fat free mass, HDL-C and physical activity, waist circumference, age and sex were determinants of VO2 peak. All of these explained the 65.3% of VO2 peak. There was a non-linear cubic association (R2 = 0.03, p = 0.046) between serum 25(OH)D and adjusted VO2 peak in which 25(OH)D in people with a high 25(OH)D levels (>60 nmol/L), had better fitness and those with serum 25(OH) less than 20 nmol/L. We found no linear and non-linear associations between serum 1,25(OH)2 D and adjusted VO2 max. CONCLUSIONS: Our results showed that waist circumference and HDL-C, as components of metabolic syndrome, contribute ∼2% to the variance in VO2 max. Moreover, high concentrations of 25(OH)D but not 1,25(OH)2 D may make additional contributions to CRF.

Effect of a Persian metabolic diet on the functional dyspepsia symptoms in patients with postprandial distress syndrome: a randomized, double-blind clinical trial.

OBJECTIVES: Postprandial distress syndrome (PDS) is associated with food indigestion. Efficacy of drugs used against PDS is limited whereas dietary modifications were shown to have important beneficial effects. Traditional Persian Medicine (TPM) sages suggested a dietary regimen known as Persian metabolic diet (PMD) for the management of PDS patients. In this study, the efficacy of PMD in alleviating the symptoms of PDS was explored. METHODS: This single-center, parallel-group, randomized clinical trial included 56 patients whom were randomly allocated to PMD group (29 participants) and Optional diet (OD) group (27 participants). They were instructed to follow the protocol for two weeks. Using a standard validated questionnaire, all outcomes were evaluated at baseline, end of the intervention period, and end of follow-up time. RESULTS: At the end of the intervention period, comparing the changes of severity scores between the groups showed a statistically significant difference in week 2 (p-value<0.001) and week 8 (p-value<0.001) follow-up comparing to the baseline. Similarly, at the end of the follow-up period, epigastric fullness, epigastric discomfort, and bloating were significantly improved in the PMD group (p<0.001). CONCLUSIONS: This diet prepared based on Persian medicine seems to be effective in relieving the symptoms of patients with PDS.

The Impact of Traditional Medicine-Based Lifestyle and Diet on Infertility Treatment in Women Undergoing Assisted Reproduction: A Randomized Controlled Trial.

The problem of infertility is growing rapidly in the world. Traditional medicine with thousands of years of history has claimed that it can treat some kinds of infertility using nutritional and lifestyle modifications and interventions. The purpose of this study was to evaluate the effect of a traditional medicine-oriented diet and lifestyle on infertility treatment. Based on a clinical trial study, 180 infertile women who were 20-40 years old and candidates for in vitro fertilization (IVF) were randomly assigned to 2 groups: an intervention group and a control group. The intervention group used diet and lifestyle recommendations based on Iranian traditional medicine for at least 3 months. The number of ova, mature ovum number, embryo number, embryo quality, and fertilization rate were significantly higher in the intervention group than in the control group (for all items; p < 0.05). Overall pregnancy rate was significantly higher in the intervention group (35.2 vs. 12.4%; odds ratio [OR], 3.8; 95% CI, 1.8-8.3). The intervention group had a higher rate of getting spontaneous pregnancy than the control group (20.9 vs. 2.2%; OR, 11.5; 95% CI, 2.6-50.9). Chemical pregnancy was significantly higher in the intervention group (64 vs. 27.5%; OR, 4.7; 95% CI, 1.9-11.6). Diet and lifestyle modifications based on traditional medicine can contribute greatly to the infertility treatment. Thus, many infertility cases can be treated without the need to use advanced methods. In case of using assisted reproductive techniques, traditional medicine can enhance the efficiency of these methods.

Association between Dietary Inflammatory Index and Risk of Cardiovascular Diseases Among Firefighters.

BACKGROUND: Diet has an important role in systemic inflammation and development of cardiovascular diseases (CVD). Dietary Inflammatory Index (DII) is a new tool for evaluating the inflammatory potential of the diet. Firefighting is one of the most important occupations with stressful situations and high rates of CVD. In this study, we aimed to investigate the association between dietary inflammatory index (DII) and risk of cardiovascular diseases (CVD) among firefighters. METHODS: Two hundred and seventy-three male firefighters aged 18-50 years in various regions of Tehran participated in this cross-sectional study. Assessment of anthropometric, blood pressure, and biochemical parameters including glucose, total cholesterol, triglyceride, high-density lipoproteins (HDL-C), low-density lipoproteins (LDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and high-sensitivity C-reactive protein (hs-CRP) was done in all firefighters. A validated semi-quantitative questionnaire (168 items) was used for assessment of DII. RESULTS: HDL (P-value = 0.03) and hs-CRP (P-value = 0.05) were significantly higher in third tertile of DII scores than first. After adjustment for confounding factors, there was no significant difference in means (P-value >0.05). The association between DII and hs-CRP was not significant (P-value >0.05). CONCLUSIONS: Participants in higher DII scores intake less polyunsaturated fatty acids (PUFAs), monounsaturated fatty acids (MUFAs), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and some antioxidant. The association between hs-CRP and DII was not significant among firefighters.

Selenium Status after Roux-en-Y Gastric Bypass: Interventions and Recommendations.

BACKGROUND: Selenium is an essential element that plays a vital role in maintaining human health and its deficiency can lead to cardiovascular and hypothyroidism complications. In this context, the main concern is about morbidly obese patients who undergo a Roux-en-Y Gastric Bypass (RYGB). Although RYGB leads to 60-70% excess weight loss, micronutrient deficiencies are common after this procedure and can be problematic if not promptly detected. This review will therefore examine the evidence regarding selenium deficiency in RYGB patients, as well its nutritional treatment methods. METHODS: There were a total of 6 studies regarding RYGB and selenium deficiency, which were retrieved from PUBMED and SCOPUS electronic databases, ranging from 2006 to 2017. CONCLUSION: Selenium deficiency was observed before and after RYGB. Lifelong supplementation and regular patient monitoring after surgery are recommended.