Third reported case of rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-En-Y gastric bypass: case report and literature review.

INTRODUCTION: Obesity is a risk factor for zinc deficiency. After bariatric surgery, non-compliance to diet/vitamin supplements, surgical complications leading to vomiting/diarrhea, poor follow-up and malabsorption can precipitate or exacerbate pre-existing zinc deficiency. CASE REPORT: We report a patient with rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-en-Y gastric bypass (following primary laparoscopic sleeve gastrectomy). CONCLUSION: Bariatric teams should screen patients before bariatric surgery for nutritional deficiencies and continue surveillance of their nutritional status after surgery. They should maintain a high index of suspicion for zinc deficiency in patients with skin rash after bariatric surgery. LEVEL OF EVIDENCE: Level V, case report.

Infrequent but serious? Beriberi And Thiamine deficiency among adolescents and young adults after bariatric surgery.

BACKGROUND: Thiamine deficiency (TD) among adolescents following metabolic and bariatric surgery (MBS) has not been assessed. OBJECTIVE: We assessed TD among adolescents following MBS. SETTING: University Hospital. METHODS: A retrospective chart review was conducted for all adolescents and young adults (aged 10-25 years) who had MBS and subsequently presented with TD at our institution (n = 30). Diagnosis used clinical, laboratory, brain imaging, and neurophysiology criteria. Of 1575 patients, 7 subsequently had TD. Another 23 adolescents had MBS at private hospitals or overseas and presented at our institution with TD. RESULTS: Based on MBS undertaken at our institution, TD prevalence was .45 cases per 100 MBS. The mean age of patients was 19.5 ± 3.23 years, 53.3% were male, 96.7% had sleeve gastrectomy, and time from MBS to admission averaged 4.97 ± 11.94 months. Mean weight loss from surgery to admission was 33.68 ± 10.90 kg. Associated factors included poor oral intake (90%), nausea and vomiting (80%), and noncompliance with multivitamins (71%). Signs and symptoms included generalized weakness, nystagmus, numbness, and paraparesis (83.3%-80%). Seven patients had Wernicke encephalopathy full triad; 16 displayed a mixed picture of Wernicke encephalopathy and dry beriberi; and there were no cases of wet beriberi. Half the patients achieved complete resolution of symptoms, whereas 47% and 40% had residual weakness or persistent sensory symptoms, respectively. There was no mortality. Most common concurrent nutritional deficiencies were of vitamins K, D, and A. CONCLUSIONS: This is the first in-depth study of TD among adolescents after MBS. Although TD is uncommon among adolescents after MBS, it is serious, requiring diligent suspicion and prompt treatment. Bariatric teams should emphasize compliance with multivitamin regimens and follow it up.

Late Diabetes Relapse After Sleeve Gastrectomy Compared with Long-Term Remission: Characteristics and Cardiometabolic Outcomes.

Background: Studies of the relapse of type 2 diabetes mellitus (T2D) after laparoscopic sleeve gastrectomy (LSG) are scarce. We assessed the rate of relapse 5 years after LSG, compared relapsed patients to their baseline and to those with remission, and explored the independent predictors of relapse. Methods: Retrospective analysis of 103 adults who underwent primary LSG at our institution between 2011 and 2015. Data retrieved comprised 23 pre-/postoperative demographic, anthropometric, biochemical, and clinical characteristics. Univariate and multivariate analyses assessed the predictors of relapse. Results: In total, 54% of our patients experienced relapse. Nevertheless, their anthropometric and metabolic profiles significantly improved compared to the values before surgery, reflecting better weight, glycemic, clinical, and biochemical control (P values ranged from 0.012 to <0.0001). These improvements were mirrored by significant increase in the proportion of relapsed patients meeting the American Diabetes Association treatment goals of hemoglobin A1c (HbA1c), blood pressure, high-density lipoprotein, and triglyceride at 5 years compared with the proportion before surgery (P = 0.027-0.008). In addition, the anthropometric and metabolic profiles of relapsed patients were not different compared to those of patients with long-term remission (P = 0.075-0.686), except for a significantly higher prevalence of dyslipidemia and number of diabetes medications among the relapsed group (P = 0.008 and <0.0001, respectively). Multivariate analysis showed that most of the predictors tested operated in the appropriate direction but fell short of statistical significance. Weight regain at 3 years did not predict relapse at 5 years. Conclusions: Relapse of T2D per se should not undervalue the overall long-term health benefits of LSG. Long-term monitoring of glycemic status after LSG is recommended.

When Definitions Differ, are Comparisons Meaningful? Definitions of Weight Regain After Bariatric Surgery and Their Associations with Patient Characteristics and Clinical Outcomes - A Need for a Revisit?

INTRODUCTION: Definitions and prevalence of weight regain (WR) after bariatric surgery remains inconsistent and their clinical significance unclear. OBJECTIVES: To assess WR five years after sleeve gastrectomy (LSG), employing six definitions; and appraise their association with patient characteristics/clinical outcomes. METHODS: Consecutive patients (N = 589) who underwent LSG were followed up for 5 years. WR prevalence was calculated yearly employing six definitions. Regression analysis assessed associations between WR at 5 years, and patient characteristics (age, sex, preop BMI, number of follow-up visits, number of comorbidities) and remission of comorbidities (type 2 diabetes, hypertension, and dyslipidemia). RESULTS: Sample's mean age and BMI were 34 ± 11.6 years and 43.13 ± 5.77 kg/m2, and 64% were females. Percentage of patients with WR at 2, 3, 4, and 5 years fluctuated between 2.53% and 94.18%, subject to definition, and time point. The definition "Any WR" generated the highest prevalence of WR (86-94%) across all time points. At 5 years, for patient characteristics, preoperative BMI was associated with three definitions (P 0.49 to < 0.001), sex was associated with two (P < 0.026-0.032), and number of comorbidities was associated with one definition (P = 0.01). In terms of comorbidities, only hypertension was associated with WR (one definition, P = 0.025). No other definitions of WR were associated with any of the variables under examination. CONCLUSION: Weight regain is reasonably expected after BMS. WR definitions were of minor clinical significance due to weak associations with limited comorbidities. Dichotomous definitions might offer some guidance while managing individual patients. However, its utility as a comparator metric across patients/procedures requires refinements.

Effectiveness and Safety of Liraglutide in Managing Inadequate Weight Loss and Weight Regain after Primary and Revisional Bariatric Surgery: Anthropometric and Cardiometabolic Outcomes.

BACKGROUND: No study appraised the effectiveness and safety of liraglutide in managing inadequate weight loss or weight regain (IWL/ WR) after primary versus revisional bariatric surgery (BS). METHODS: Retrospective study of all eligible adults who completed liraglutide 3 mg therapy for IWL/WR after primary or revisional BS at our institution between May 2016 and June 2019 (N = 145; 119 primary, 82%; 26 revisional, 18%). Changes in anthropometric and cardiometabolic parameters were assessed before the start of liraglutide and at 6 and 12 months after treatment. RESULTS: The mean age was 43.32 ± 10.49 years, and 83% were females. Patients received liraglutide at a mean of 54.10 ± 31.75 months after their BS, for WR (74.3%) or IWL (25.6%). Liraglutide significantly reduced weight and BMI among primary and revisional patients (P < 0.0001 for all) and was equally effective in these reductions for both groups. Primary patients achieved total weight loss percentage (TWL%) of 5.97% and 6.93% at 6 and 12 months. Additionally, 52.3% and 60% of the patients lost ≥ 5% of their total weight (TW) at 6 and 12 months after primary BS. Revisional patients achieved TWL% of 6.41% and 4.99% at 6 and 12 months, and 60% and 48% of patients lost ≥ 5% TW at the two time points. Liraglutide did not improve cardiometabolic outcome for primary patients; for revisional patients, only the systolic blood pressure decreased after treatment. Liraglutide was well tolerated, and the most common side effect was nausea. CONCLUSIONS: Liraglutide is useful as an adjunct weight loss medication for patients achieving unsatisfactory outcomes with BS.

Multiple nutritional deficiencies among adolescents undergoing bariatric surgery: who is at risk?

BACKGROUND: Nutritional deficiencies among adolescents undergoing bariatric surgery (BS) have not been evaluated a in relation to patient's sex. OBJECTIVES: We compared the preoperative nutritional profile of adolescents characterized by sex and single versus multiple deficiencies. SETTING: University hospital. METHODS: Cross-sectional retrospective chart review of 415 eligible adolescents who underwent primary BS between 2011 and 2020. Data included preoperative demographic, anthropometric information as well as three sets of nutritional variables: anemia-related, calcium-related, and other nutritional variables. RESULTS: The sample comprised 247 males (59.5%) with a mean age of 15.89 ± 1.03 years and a mean body mass index (BMI) of 47.80 ± 6.57 kg/m2. Most common deficiencies were vitamin D (92.3%), albumin (51.8%), anemia (15.9%), zinc (11.1%), and vitamin B12 (8%); 21.7% had hyperparathyroidism. Females exhibited a significantly higher prevalence of low hemoglobin, low hematocrit, and iron deficiency. Multiple deficiencies were present among 97.6%, 73.2%, 23.6%, 15%, and 12.6% of adolescents, who had vitamin D, albumin, hemoglobin, zinc, and vitamin B12 deficiencies, respectively. Univariate analysis revealed that adolescents with a BMI of ≥50 kg/m2 were 1.24 times more likely to have multiple deficiencies (P = .004). Using multivariate log-binomial regression, BMI of ≥50 kg/m2 was a significant predictor of multiple nutritional deficiencies (P = .005, adjusted risk ratio = 1.23, 95% CI 1.06-1.42). Age and sex were not independent predictors of multiple nutritional deficiencies. CONCLUSION: To our knowledge, this study is the first to appraise single and multiple nutritional deficiencies in adolescents undergoing BS by sex. Multiple deficiencies were common. Females are at higher risk of anemia-related deficiencies. A BMI of ≥50 kg/m2 independently and significantly predicted multiple nutritional deficiencies. Correction before and monitoring after surgery are important.

Nutritional Deficiencies Among Adolescents Before and After Sleeve Gastrectomy: First Study with 9-Year Follow-up.

BACKGROUND: Globally, only two studies appraised the long-term nutritional status of adolescents after laparoscopic sleeve gastrectomy (LSG). METHODS: Retrospective chart review of all adolescents aged ≤ 18 years who underwent LSG with ≥ 5 years follow-up and had no subsequent revisional surgery (N = 146). We assessed 15 nutritional parameters preoperatively and at 1, 3, 5, 7, and 9 years post surgery. RESULTS: Mean age was 16.51 ± 1.29 years, 51% were males. We identified three patterns: 1) Significant worsening of preoperative deficiencies: 4.7% and 0.8% of the sample exhibited zinc and vitamin B12 deficiencies, worsening to 20.8% and 12.8% at 1 year, respectively. Likewise, 0.7% of the sample had low total protein, worsening to 8.3% at year 3. A total of 32.4% of females had preoperative low hemoglobin worsening to 57.9% at year 5. 2) Significant improvement: the percentage of males with preoperative low hemoglobin (5.6%) was reduced to 4.1% and 5.1% at years 1 and 3, respectively. 3) Persistent deficiency: all (100%) of adolescents had preoperative vitamin D deficiency that persisted through years 3 and 9 at 90.5% and 100%, respectively. The most common complications were food intolerance (51%), vomiting (47.5%), gastritis/ esophagitis (35.7%), and gastroesophageal reflux disease (20.3%). We observed one case of Wernicke's encephalopathy. Across the 9 years, 15.4% of the adolescents underwent intra-abdominal surgeries where 12.6% had cholecystectomy and one patient had appendectomy. CONCLUSION: Adolescents had several preoperative nutritional deficiencies, most of which worsened or persisted on the long term. This is the first study among adolescents to assess such deficiencies beyond 5 years.

Preoperative Prediction of Body Mass Index of Patients with Type 2 Diabetes at 1 Year After Laparoscopic Sleeve Gastrectomy: Cross-Sectional Study.

Background: Very few models predict weight loss among type 2 diabetes mellitus (T2D) patients after laparoscopic sleeve gastrectomy (LSG). This retrospective study undertook such a task. Materials and Methods: We identified all patients >18 years old with T2D who underwent primary LSG at our institution and had complete data. The training set comprised 107 patients operated upon during the period April 2011 to June 2014; the validation set comprised 134 patients operated upon during the successive chronological period, July 2014 to December 2015. Sex, age, presurgery BMI, T2D duration, number of T2D medications, insulin use, hypertension, and dyslipidemia were utilized as independent predictors of 1-year BMI. We employed regression analysis, and assessed the goodness of fit and "Residuals versus Fits" plot. Paired sample t-tests compared the observed and predicted BMI at 1 year. Results: The model comprised preoperative BMI (ß = 0.757, P = 0.026) + age (ß = 0.142, P < 0.0001) with adjusted R2 of 0.581 (P < 0.0001), and goodness of fit showed an unbiased model with accurate prediction. The equation was: BMI value 1 year after LSG = 1.777 + 0.614 × presurgery BMI (kg/m2) +0.106 × age (years). For validation, the equation exhibited an adjusted R2 0.550 (P < 0.0001), and the goodness of fit indicated an unbiased model. The BMI predicted by the model fell within -3.78 BMI points to +2.42 points of the observed 1-year BMI. Pairwise difference between the mean 1-year observed and predicted BMI was not significant (-0.41 kg/m2, P = 0.225). Conclusions: This predictive model estimates the BMI 1 year after LSG. The model comprises preoperative BMI and age. It allows the forecast of patients' BMI after surgery, hence setting realistic expectations which are critical for patient satisfaction after bariatric surgery. An attainable target motivates the patient to achieve it.

The effect of protein supplements on weight loss, body composition, protein status, and micronutrients post laparoscopic sleeve gastrectomy (LSG): A Randomised Controlled Trial (RCT).

BACKGROUND: Low protein intake post-bariatric surgery can result in protein malnutrition, and muscle mass loss. Authors aim to assess the effect of protein supplements on weight loss, body composition, and micronutrient status following LSG. METHODS: This is a double-blinded RCT conducted between February/2017 to January/2018. Eligible post LSG patients were randomized into the intervention group who received daily protein supplements containing 20 g of protein and placebo group received zero protein supplements. Both groups received a standardized diet. Weight loss, body composition, and micronutrient status were analyzed at 1, 3, and 6 months. RESULTS: 48 participants were included in the final analysis (intervention: 21 and placebo:27). Excess weight loss percentage (EWL%) at 6 months was comparable between both groups (69.44 ± 21.99% and 71.40 ± 19.27% respectively). No significant difference observed in the anthropometric parameters. There was an increase in muscle mass and a decrease in muscle mass loss in the intervention group throughout the study period. However, these changes were not statistically significant. There was a significant increase in total protein (P=0.027) and magnesium (P=0.008) in the intervention group at 3 months. Albumin and iron levels were significantly higher at 6 months in the intervention group (P=0.036 & P=0.028 respectively). Other micronutrients did not differ at any time point between both groups. CONCLUSION: Protein supplements resulted in significant improvement in total protein, albumin, magnesium, and iron levels post LSG. Although not significant, protein supplements helped in maintaining the muscle mass and preventing muscle mass loss. ORIGINAL ARTICLE: This RCT is an original article and provides a level 2 evidence.

Increased Relative Abundance of Ruminoccocus Is Associated With Reduced Cardiovascular Risk in an Obese Population.

Background: Obesity is a complex disease with underlying genetic, environmental, psychological, physiological, medical, and epigenetic factors. Obesity can cause various disorders, including cardiovascular diseases (CVDs), that are among the most prevalent chronic conditions in Qatar. Recent studies have highlighted the significant roles of the gut microbiome in improving the pathology of various diseases, including obesity. Thus, in this study, we aimed to investigate the effects of dietary intake and gut microbial composition in modulating the risk of CVD development in obese Qatari adults. Methods: We enrolled 46 adult subjects (18-65 years of age) who were classified based on their CVD risk scores, calculated using the Framingham formula, into a CVD no-risk group (score of <10%, n = 36) and CVD risk group (score of ≥10%, n = 10). For each study subject, we measured the gut microbial composition with a 16s rDNA sequencing method that targeted the v3-v4 region using Illumina Miseq, and their nutritional status was recorded based on 24-h dietary recall. Dietary intake, bacterial taxa summary, diversity index, microbial markers, pathway analysis, and network correlation were determined for the study subjects. Results: The CVD risk group showed a lower intake of vitamin D, reduced relative abundance of genera Ruminococcus and Bifidobacterium, no change in bacterial diversity, and higher levels of taurine, hypotaurine, and lipoic acid metabolism than the CVD no-risk group. Besides, the relative abundance of genus Ruminococcus was positively correlated with the intake of protein, monounsaturated fat, vitamin A, and vitamin D. Conclusion: Taken together, our results suggest that the genus Ruminococcus could be used as a microbial marker, and its reduced relative abundance could mediate the risk of CVDs in the Obese Qatari population.

Durability of Cardiometabolic Outcomes Among Adolescents After Sleeve Gastrectomy: First Study with 9-Year Follow-up.

BACKGROUND: Long-term durability of weight loss and comorbidity resolution beyond 7 years after laparoscopic sleeve gastrectomy (LSG) among adolescents is completely lacking. METHODS: Retrospective review of adolescents aged ≤ 18 years who underwent primary LSG at our institution between 2011 and 2015 (N = 146). We assessed anthropometric and cardiometabolic outcomes at 1, 3, 5, 7, and 9 years. RESULTS: Follow-up rates were 57.53%, 82.87%, 85.24%, 83.92%, and 83.33% at the five time points. The preoperative mean body mass index (BMI) (45.60 ± 6.50 kg/m2) decreased at year 1 (30.04 ± 4.96 kg/m2, P=0.001) and was maintained up to 9 years (30.20 ± 3.92 kg/m2, P = 0.001). Remission rates were triglycerides, 100% (11/11) at 5 years, and 100% (1/1) at 9 years; high density lipoprotein, 89.4% (17/19) at 5 years, and 100% (3/3) at 7 years; low density lipoprotein, 71.4% (11/14) and 100% (3/3) at 5 and 7 years; total cholesterol, 70% (7/10) at 5 years, and 100% (2/2) at 9 years; uric acid, 100% (3/3) at 5 years. Remission of liver enzymes was 84.6-100% (22/26-2/2) at 5-9 years. Prediabetes remission was 87.5% (14/16 and 7/8) at 5 and 7 years and 100% (3/3) at year 9. Type 2 diabetes complete remission was 50% (3/6, 1/2) at years 5 and 7, with all cases resolved at 9 years. The only case of hypertension completely resolved. CONCLUSIONS: LSG achieved substantial weight loss and remission of cardiometabolic risk factors that were sustained on the long term. This is the first study among adolescents to assess such outcomes beyond 7 years.

Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps-a Scoping Review.

Some patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric surgery (BS). We undertook a scoping review of WR and IWL after BS. We searched electronic databases for studies addressing the definitions, prevalence, mechanisms, clinical significance, preoperative predictors, and preventive and treatment approaches including behavioral, pharmacological, and surgical management strategies of WR and IWL. Many definitions exist for WR, less so for IWL, resulting in inconsistencies in the reported prevalence of these two conditions. Mechanisms and preoperative predictors contributing to WR are complex and multifactorial. A range of the current knowledge gaps are identified and questions that need to be addressed are outlined. Therefore, there is an urgent need to address these knowledge gaps for a better evidence base that would guide patient counseling, selection, and lead to improved outcomes.

First Case Report of Fulminant Hepatitis After Laparoscopic Sleeve Gastrectomy Associated with Concomitant Maximal Therapeutic Dose of Acetaminophen Use, Protein Calorie Malnutrition, and Vitamins A and D, Selenium, and Glutathione Deficiencies.

Nonalcoholic fatty liver disease (NAFLD) is increasingly being linked to obesity. Although laparoscopic sleeve gastrectomy (LSG) is effective for weight loss that can ultimately resolve NAFLD, an initial transient deterioration of liver functions could be observed during the first few months post-operatively, after which a subsequent improvement of the liver functions might occur. Rapid weight loss, nutritional deficiencies, and protein malnutrition can all contribute to hepatic dysfunction and can affect the metabolism of medications such as acetaminophen leading to more insult to a compromised liver. We report acute liver failure after LSG associated with protein calorie malnutrition, multiple nutritional deficiencies in addition to concomitant use of therapeutic doses of acetaminophen. Treatment with N-acetylcysteine, and replacement of deficient multivitamins and trace elements resulted in significant improvement in liver functions.

Increased Fracture Risk After Bariatric Surgery: a Case-Controlled Study with a Long-Term Follow-Up.

PURPOSE: Bariatric surgeries are common procedures due to the high prevalence of obesity. This study aimed to investigate whether bariatric surgery increases fracture risk. MATERIAL AND METHODS: It was a case-controlled study. Patients who underwent bariatric surgery during 2011 and 2012 were matched for age (± 5 years) and gender to patients on medical weight management during the same period with a ratio of 1:2. The index date was defined as the date of bariatric surgery for both groups. The subject's electronic medical records were reviewed retrospectively to identify fractures documented by radiology during January 2020. RESULTS: Randomly selected 403 cases were matched to 806 controls with a median age of 36.0 years (IQR 14.0) and 37.0 years (IQR 14.0), respectively. Seventy per cent of the cohort were females. Eighty per cent received sleeve gastrectomy, and the remaining (17%) underwent gastric bypass. The mean duration of follow-up was 8.6 years. The fracture rate was higher in the surgical group as compared to the controls (9.4% vs 3.5%) with a crude odds ratio of 2.71 (95% CI 1.69-4.36). The median duration for time to fracture was 4.17 years for the surgical group and 6.09 years for controls (p-value = 0.097). The most common site of fractures was feet, followed by hands. Apart from a few wrist fractures, there was no typical osteoporotic sites fracture. CONCLUSION: Subjects who underwent bariatric procedures had more non-typical osteoporotic site fractures affecting mainly feet and hands, and fractures tend to occur earlier as compared to controls.

Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

BACKGROUND: Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared with R-RYGB (e.g., post sleeve gastrectomy/gastric banding) are controversial. METHODS: Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011-June 2015) at our center. One hundred twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension, dyslipidemia (remission, improvement, persistence, relapse, de novo), mortality and complications rates. RESULTS: A comparison of the effectiveness of P-RYGB with R-RYGB at 18 months revealed no significant differences in patients' age, gender, and preoperative BMI between groups. However, patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P < 0.001), reflected by a higher mean delta BMI (P = 0.02), total weight loss percentage (TWL%) (P < 0.0001) and excess weight loss percentage (EWL%) (P < 0.0001). No differences in glycemic parameters, lipid profiles, control of T2DM, hypertension, and dyslipidemia were observed. No death is reported and complication rates were comparable. CONCLUSIONS: Although R-RYGB effectively addressed inadequate weight loss, weight regain, and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared with P-RYGB. Neither procedure differed in their clinical control of T2DM, hypertension, and dyslipidemia. Both procedures exhibited comparable complication rates.

Factors associated with complete and partial remission, improvement, or unchanged diabetes status of obese adults 1 year after sleeve gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy (SG) achieves type 2 diabetes (T2D) remission to various extents, and reasons for such variations are unknown. OBJECTIVES: We assessed patients' characteristics associated with T2D remission 1 year post SG. SETTING: University hospital. METHODS: Retrospective study of 230 T2D patients (18-64 yr) who underwent SG at our institution. We examined pre- and postoperative demographic, anthropometric, biochemical, and clinical characteristics associated with T2D complete remission, partial remission, improvement, or unchanged status. Independent predictors of T2D complete remission were assessed by binary logistic regression and then included in 7 predictive models. Logistic regression assessed the pre- and postoperative predictors of T2D complete remission and their predictive performance was measured with the area under the curve of the receiver operating characteristic curve. RESULTS: A total of 230 patients were included in the study, females comprised 69%, and mean age was 45.66 ± 8.84 years. Mean preoperative weight and body mass index were 115.69 ± 20.76 kg and 43.53 ± 6.98 kg/m2, respectively. Approximately two thirds (64.4%) of the sample had diabetes for >5 years. Insulin therapy users comprised 36.9% of the sample and 29.6% of patients were on ≥2 oral hypoglycemic agents (OHA). At 1 year, mean body mass index was 32.77 ± 6.09 kg/m2, percent excess weight loss (%EWL) was 62.29 ± 23.60% and glycosylated hemoglobin (HbA1C) improved from 8.1% to 6.18%. Approximately 42.2% of the sample achieved T2D complete remission. Compared with those with no remission, patients with complete remission were significantly younger, had shorter duration of diabetes, were not on insulin therapy, took fewer OHA, had higher C-peptide, lower preoperative HbA1C, were less likely to have had hypertension or dyslipidemia, and more likely to have achieved higher %EWL. Seven proposed models for prediction of complete remission showed the most useful model comprised diabetes duration + pre-HbA1C + %EWL + insulin therapy + age + OHA (area under the curve = .81). Independent predictors of complete remission were preoperative HbA1C, %EWL, insulin therapy, age, and OHA (but not diabetes duration). CONCLUSION: SG results in significant weight reduction and various extents of T2D remission. HbA1C, %EWL, insulin therapy, age, and OHA were independent predictors of complete remission. Assessing these factors before bariatric surgery is important to identify any modifiable characteristics that can be altered to increase the likelihood of remission.

Lorcaserin vs. Phentermine among non-surgical and surgical obese patients: Anthropometric, glycemic, lipid, safety and cost outcomes.

BACKGROUND: To evaluate effectiveness, safety, and costs of Lorcaserin vs. phentermine among obese non-surgical and surgical patients (post bariatric surgery). METHODS: This retrospective study retrieved charts of all patients (January 2013-June 2016) who received Lorcaserin or phentermine for 3 months. The study assessed anthropometric, glycemic, and lipid changes, as well as side effects and cost of medications among overweight and obese non-surgical (n = 83) and surgical patients (n = 46). These two patient groups were compared using Chi-square (χ2) and unpaired't' test for qualitative and quantitative variables respectively. RESULTS: At 3 months, among the non-surgical group, Phentermine patients had greater percentage of total weight loss (TWL%) (7.65 ±â€¯8.26 vs. 2.99 ±â€¯3.72%, P = 0.003), and greater BMI reduction (-3.16 ±â€¯3.63 vs. -1.15 ±â€¯1.53 kg/m2, P = 0.003) than Lorcaserin. Within the surgical group, Lorcaserin patients had significantly smaller TWL% (1.86 ±â€¯5.06 vs. 7.62 ±â€¯9.80%, P = 0.012), and smaller BMI reduction (-0.74 ±â€¯1.80 vs. -3.06 ±â€¯4.08 kg/m2, P = 0.012) than Phentermine. Lorcaserin exhibited significant total cholesterol and LDL improvements only among surgical patients with significant weight reduction (≥5% TW). Both medications were not associated with glycemic improvements among non-surgical and surgical groups. Phentermine had slightly more side effects but was less expensive. CONCLUSIONS: Among both patient groups, phentermine was more effective in achieving weight loss. Lorcaserin showed dyslipidemia improvements only among surgical patients who achieved significant weight reduction. Anti-obesity medications as part of weight management programs can result in weight loss among non-surgical and surgical patients, or halt weight regain among surgical patients. This is the first study to evaluate the effectiveness and safety of two anti-obesity medications (lorcaserin vs. phentermine) among two distinct obese patient groups, non-surgical and surgical patients.

Evolution of 29 Anthropometric, Nutritional, and Cardiometabolic Parameters Among Morbidly Obese Adolescents 2 Years Post Sleeve Gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a popular treatment for adolescent morbid obesity. Research on LSG outcomes among adolescents assessed a narrow range of anthropometric, nutritional, or cardiometabolic parameters, leading to an incomplete picture of these changes. We examined a wide variety of anthropometric, nutritional, and cardiometabolic parameters among adolescents before and after LSG. METHODS: We retrospectively reviewed medical charts of all obese adolescents who underwent LSG at Hamad Medical Corporation, Qatar, between January 2011 and June 2015 (N = 102). We assessed preoperative levels and postoperative changes in 4 anthropometric, 15 nutritional, and 10 cardiometabolic parameters. RESULTS: The study sample comprised 79 patients with complete information (36 males, mean age 15.99 ± 1.1 years). At a mean of 24.2 months post-LSG, we observed (1) significantly reduced mean weight and body mass index by 51.82 ± 28.1 kg and 17 ± 6.24 kg/m2, respectively; (2) the highest prevalence of post-LSG deficiencies pertained to vitamin D, albumin, and ferritin (89.3, 38, and 33.3%, respectively); (3) low hemoglobin levels (29.3%) only in females; (4) trace elements were not deficient; (4) significant reductions in percentage of adolescents with elevated low-density lipoprotein (from 66.1 to 38.9%), alanine aminotransferase (from 45.3 to 10.9%), and aspartate aminotransferase (from 24.1 to 8.6%) levels; (5) 100% remission of prediabetes cases; and (6) 80% remission of type 2 diabetes cases. CONCLUSIONS: LSG achieved significant weight loss and improvement of cardiometabolic risk factors among adolescents. However, the slight worsening of preexisting nutritional deficiencies warrants careful preoperative surveillance and appropriate postoperative nutritional supplementation.

Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I): a randomised controlled trial to examine the impact of an intensive lifestyle intervention consisting of a low-energy diet and physical activity on body weight and metabolism in early type 2 diabetes mellitus: study protocol for a randomized controlled trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and obesity are syndemic and will have a significant impact on affected individuals and healthcare services worldwide. Evidence shows that T2DM remission can be achieved with significant weight loss in those who are younger with early diabetes and requiring fewer medications for glycaemic control. DIADEM-I aims to examine the impact of an intensive lifestyle intervention (ILI) using a low-energy diet (LED) meal replacement approach combined with physical activity in younger individuals with early T2DM. METHODS: The planned study is an ongoing, non-blinded, pragmatic, randomised controlled, parallel-group trial examining the impact of an LED-based ILI on body weight and diabetes remission in younger (18-50 years) T2DM individuals with early diabetes (≤ 3-year duration). The ILI will be compared to usual medical care (UMC). The primary outcome will be weight loss at 12 months. Other key outcomes of interest include diabetes remission, glycaemic control, diabetes complications, cardiovascular health, physical activity, mental health, and quality of life. It is planned for the study to include 138 subjects for assessment of the primary outcome. Safety will be assessed throughout. DISCUSSION: If DIADEM-I demonstrates a clinically significant effect for younger individuals with early T2DM, it will inform clinical guidelines and services of the future for management of T2DM. TRIAL REGISTRATION: ISRCTN: ISRCTN20754766 (date assigned: 7 June 2017); ClinicalTrials.gov, ID: NCT03225339 Registered on 26 June 2017.