Remission and relapse of diabetes after sleeve gastrectomy and one-anastomosis gastric bypass: The Tehran Obesity Treatment Study.

AIMS: To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one-anastomosis gastric bypass (OAGB). METHODS: An observational prospective study with 5 years of follow-up was conducted in a total of 891 patients (82.5% female) with concomitant T2DM and obesity (body mass index ≥ 30.0 kg/m2) undergoing SG or OAGB between March 2013 and March 2021. T2DM remission was defined as achieving a glycated haemoglobin (HbA1c) level < 48 mmol/mol and a fasting plasma glucose (FPG) level <7 mmol/L, and being off glucose-lowering agents/insulin. T2DM relapse was defined as when FPG or HbA1c reverted to the diabetic range (≥7 mmol/L and ≥48 mmol/mol, respectively), or there was a need for pharmacotherapy. RESULTS: After bariatric surgery, the overall T2DM remission and relapse rates were 61.4 per 1000 person-months (95% confidence interval [CI] 56.8-66.4) and 5.7 per 1000 person-months (95% CI 4.1-7.9), respectively. These rates were similar in the SG and OAGB groups. Multivariate hazard ratio analysis identified history of insulin therapy and T2DM duration prior to surgery as predictors of remission, while treatment with ≥2 glucose-lowering agents was the only relapse predictor. Additionally, patients undergoing SG experienced either remission or relapse within a significantly shorter time frame compared to those undergoing OAGB. CONCLUSION: After 5 years of follow-up, there were no significant differences between the SG and OAGB groups with regard to T2DM remission and relapse. Bariatric surgery was less likely to result in remission in patients with a history of insulin therapy and longer durations of T2DM prior to surgery. Furthermore, patients who received ≥2 glucose-lowering agents, despite possible remission, were at a higher risk of experiencing late relapse.

Safety and efficacy of sleeve gastrectomy in non-diabetic individuals with class I vs. class II obesity: a matched controlled experiment from Tehran Obesity Treatment Study (TOTS).

BACKGROUND: This study aimed to evaluate the 3-year outcomes of sleeve gastrectomy in non-diabetic individuals with class I obesity. METHODS: A total of 78 participants with class I obesity and 78 participants with class II obesity, matched in terms of age, sex (93.6% female), and the rates of dyslipidemia and hypertension, were included in this prospective cohort study. Follow-up data, including metabolic features, body composition, nutritional characteristics, and surgery complications, were gathered at the baseline and 6, 12, 24, and 36 months post-bariatric surgery. Micronutrient deficiencies and comorbidities (hypertension and dyslipidemia) were evaluated in both groups using conditional logistic regression analysis, and Clavien-Dindo classification was used to compare surgical complications. RESULTS: Baseline characteristics of the participants in both groups were similar (n = 78, mean age: 36.4 ± 8.5). The two groups were also comparable in terms of weight loss, cardiovascular risk factors, and remission of obesity-related comorbidities 3 years following sleeve gastrectomy. Overall values of Δ total weight loss (TWL)%, Δ excess weight loss (EWL)%, and ß (95% CI) were - 1.86 (1.19), and - 2.56 (4.5) with a P value of 0.118 and 0.568, respectively. The occurrence of surgical complications and undesirable outcomes were also similar between the two study groups. CONCLUSION: Bariatric surgery is an effective and safe method to achieve weight loss and alleviate cardiovascular risk factors and obesity-related comorbidities in non-diabetic individuals with class I and class II obesity.

Comparing Effects of Bariatric Surgery on Body Composition Changes in Metabolically Healthy and Metabolically Unhealthy Severely Obese Patients: Tehran Obesity Treatment Study (TOTS).

BACKGROUND: Among two popular obesity phenotypes, metabolically healthy severely obese (MHSO) and metabolically unhealthy severely obese (MUSO), it is important to clarify whether or not those with MHSO phenotype would benefit from bariatric surgery in terms of an improvement in body composition parameters. METHODS: A prospective cohort was conducted on a total of 4028 participants (1404 MHSO and 2624 MUSO) who underwent bariatric surgery; MHSO was defined as having abnormalities in none or one of these four parameters: systolic blood pressure and/or diastolic blood pressure, triglycerides, fasting plasma glucose, and high-density lipoprotein. Otherwise, the definition of MUSO was met. Body composition analysis was performed at the baseline and 6-, 12-, 24-, and 36-month post-surgery using bioelectrical impedance analyzer. RESULTS: Both phenotypes showed a significant decrease in fat mass (FM) and fat-free mass (FFM) and a significant increase in EWL% and TWL% (Ptrend < 0.05). FFM, FM%, and excess weight loss (EWL%) were significantly different between the two phenotypes (Pbetween < 0.05) during the follow-up. Multivariate linear regression demonstrated that compared to MUSO patients, MHSO individuals experienced a greater increase in total weight loss (TWL%) and EWL% at 12- and 24-month and in EWL% at 36-month post-surgery and also a lower decrease in the FFML/WL% after 12 months. CONCLUSION: Despite a lower decrease of FFML/WL% and a greater increase in TWL and EWL in MHSO phenotype at some time points, there were no clinically significant differences between the study groups in terms of body composition changes throughout the follow-up period.

A Comparative Analysis of Safety and Efficacy of Bariatric Surgery During the COVID-19 Pandemic and Pre-Pandemic Period: Insights from the Tehran Obesity Treatment Study.

BACKGROUND: The COVID-19 pandemic has raised global health concerns and posed challenges for postoperative follow-up care for patients undergoing bariatric surgery due to social distancing rules. METHODS: This was a cohort study on patients with morbid obesity who underwent bariatric surgery and had been enrolled in Tehran Obesity Treatment Study. Patients who had surgery between March 2020 and March 2021 were classified as those undergoing the procedure amid the COVID-19 pandemic, while those who had surgery between March 2017 and March 2018 were categorized as the pre-pandemic group. RESULTS: The study included 982 patients in the pre-COVID-19 pandemic group and 602 patients in the COVID-19 pandemic group, with mean ages of 39.61 and 39.51 years, respectively. After adjusting for preoperative body mass index (BMI) and surgery type, the patients who underwent surgery during the COVID-19 pandemic demonstrated comparable results to the pre-COVID-19 group in terms of total weight loss %, excess weight loss %, BMI reduction, and fat mass reduction during the 12-month postoperative period. Additionally, the rate of complications with a grade≥III based on the Clavien-Dindo classification was significantly lower in patients who underwent surgery during the COVID-19 pandemic. Notably, there were no deaths reported in either group. CONCLUSION: Despite social isolation and unfavorable lifestyle modifications, bariatric surgery-induced weight loss after one year was the same in patients undergoing the procedure either before or after the implementation of social distancing measures. More research is needed to analyze the influence of the COVID-19 pandemic on the long-term outcomes of bariatric surgery.

Diet quality and anthropometric indices of patients undergone bariatric surgery: the prospective Tehran obesity treatment study.

BACKGROUND: Patients undergone bariatric surgery (BS) has long-term risks including decrease in diet quality, nutritional deficiencies and weight regain. This study focus on assessing dietary quality and food group components in patients one year after BS, the relationship between dietary quality score and anthropometric indices, and also evaluating the trend of body mass index (BMI) of these patients three years after BS. METHODS: A total of 160 obese patients (BMI ≥ 35 kg/m2) were undergone sleeve gastrectomy (SG) (n = 108) or gastric bypass (GB) (n = 52), participated in this study. They were assessed for dietary intakes using three 24-hour dietary recalls one year after surgery. Dietary quality was assessed using food pyramid for post BS patients and healthy eating index (HEI). Anthropometric measurements were taken pre-surgery and 1, 2 and 3 years after operation. RESULTS: The mean age of patients was 39.9 ± 11 years (79% female). The mean ± SD percentage of excess weight loss was 76.6 ± 21.0 one year after surgery. Intake patterns are generally (up to 60%) not consistent with the food pyramid. The mean total HEI score was 64 ± 12 out of 100. More than %60 of participants is exceeding the recommendations for saturated fat and sodium. The HEI score did not show significant relationship with anthropometric indices. The mean of BMI in SG group increased over three years of follow up, while in GB group, there were no significant differences in BMI during three years of follow up. CONCLUSIONS: These findings showed that patients had not healthy pattern intake one year after BS. Diet quality did not show significant relationship with anthropometric indices. The trend of BMI three years after surgery was different based on surgery types.

The mediating role of bariatric surgery in the metabolic relationship between parathyroid hormone and 25-hydroxyvitamin D.

Vitamin D metabolism is altered in obese individuals. Our findings indicated that in patients with severe obesity, a relatively low 25(OH)D concentration was required to suppress PTH. The PTH inflection point increased following surgery-induced weight loss, highlighting 25(OH)D different regulation mechanisms in patients with obesity. INTRODUCTION: An optimal and sufficient concentration of 25-hydroxyvitamin D (25(OH)D) has been suggested as the level required to maximally suppress intact parathyroid hormone (iPTH). We evaluated the role of surgery-induced weight loss in determining the threshold(s) of 25(OH)D required to suppress iPTH. METHODS: This study was conducted in the framework of the Tehran Obesity Treatment Study (TOTS). We prospectively analyzed 687 patients with severe obesity who participated in the TOTS and underwent bariatric surgery from March 2013 to March 2019. The patients were followed for 1 year after surgery. Anthropometric parameters and serum levels of iPTH, 25OHD, phosphorous, and calcium were measured. Nonlinear and piecewise linear regression was used to evaluate the relationship between 25(OH)D and iPTH and to determine the 25(OH)D-suppression point at which iPTH was maximally suppressed. RESULTS: Body mass index was 44.6 kg/m2 at the baseline and decreased to 29.7 kg/m2 1 year after surgery (P < 0.05). Before the surgery, iPTH and 25(OH)D showed an exponential relationship; iPTH began to decrease rapidly at 25(OH)D concentration of 12 ng/mL, reaching maximal suppression at 30 ng/mL. However, the relationship between 25(OH)D and iPTH was non-exponential 1 year after surgery. The piecewise linear regression model revealed the 25(OH)D concentration of 21 ng/mL as the inflection point following surgery-induced weight loss. CONCLUSION: In patients with severe obesity, PTH was suppressed at a relatively lower concentration of 25(OH)D; this threshold increased following surgery-induced weight loss. These findings suggest a role for bariatric surgery in regulating 25(OH)D metabolism in patients with obesity.

The relation of omentin gene expression and glucose homeostasis of visceral and subcutaneous adipose tissues in non-diabetic adults.

BACKGROUND: Adipose tissue (AT) is a passive reservoir for energy storage and an active endocrine organ responsible for synthesizing bioactive molecules called adipokines. Omentin is known as an anti-inflammatory adipokine that can modulate insulin sensitivity. The present study aimed to investigate the relationship between omentin mRNA expression and glucose homeostasis of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in non-diabetic adults. METHODS: VAT and SAT adipose tissues were collected from 137 adults aged ≥ 18 years hospitalized for abdominal surgery. Before surgery, preoperative blood samples were taken from the participants to measure fasting plasma glucose, insulin, and triglyceride. BMI, HOMA-IR, HOMA-B, and QUICKI were calculated. Insulin levels were measured with Mercodia kits using enzyme-linked immunosorbent assay (ELISA). In order to obtain omentin mRNA expression, real-time PCR was performed. RESULTS: Overall, 91 (66.4%) subjects were healthy [without insulin resistance (IR)], and 46 (33.6%) participants were with IR. In healthy and IR subjects, omentin gene expression was 1.04 and 2.32, respectively in VAT, and 3.06 and 1.30, respectively, in SAT (P > 0.05). After controlling for age and BMI, linear regression analysis indicated a significant positive association of SAT omentin expression with insulin concentration (ß = 0.048; 95% CI 0.009, 0.088, P = 0.017) and HOMA-IR (ß = 0.173; 95% CI 0.023, 0.323, P = 0.014). Moreover, a negative association of SAT omentin expression with HOMA-B (ß = - 0.001; 95% CI 0.002, - 0.001, P < 0.001) was observed. CONCLUSION: This study's finding confirms a direct association between IR with omentin mRNA levels in SAT. Besides, the indicator of insulin sensitivity had an inverse association with omentin gene expression in SAT. This aspect of research suggests that omentin secretion from SAT has a strong link with insulin regulation.

Anemia After Sleeve Gastrectomy and One-Anastomosis Gastric Bypass: An Investigation Based on the Tehran Obesity Treatment Study (TOTS).

BACKGROUND: Bariatric surgery has been associated with iron, folate, and vitamin B12 deficiencies, which can lead to anemia. This study compares the incidence of anemia between sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB). METHODS: Patients from a prospectively collected database of patients with morbid obesity undergoing a primary bariatric procedure from April 2013 to September 2018 were included. Statistical analysis was performed using the general estimation equation. Patients were followed for 6, 12, 24, and 36 months post-surgery. RESULTS: The present study included 2618 patients, of whom 72.3% underwent SG and 27.6% underwent OAGB. The majority of the study population were women (75.7%), and the mean age of the participants was 39.5 ± 11.7 years. At the end of the follow-up, the excess weight loss percentage was 66.15 in the SG group and 75.41 in the OAGB group (P < 0.05). The incidence of anemia at 12-, 24-, and 36-month was 16.2, 19.7, and 24.3% in the SG group and 28.4, 37.6, and 56.5% in the OAGB group, showing significantly higher incidence in the OAGB than the SG group ([Formula: see text] < 0.001). However, there was no significant difference between the SG and OAGB groups regarding the incidence of iron and vitamin B12 deficiency. CONCLUSIONS: The patients undergoing bariatric surgery, especially OAGB, should be closely monitored post-surgery regarding the incidence of anemia, and supplementation in developing countries could be continued even after the first year.

Comparison of mid-term effectiveness and safety of one-anastomosis gastric bypass and sleeve gastrectomy in patients with super obesity (BMI ≥ 50 kg/m2).

PURPOSES: There is no consensus regarding the optimal bariatric procedure in patients with super obesity [body mass index (BMI) ≥ 50 kg/m2]. This study compared the outcomes of one-anastomosis gastric bypass (OAGB) with those of sleeve gastrectomy (SG) in these patients. METHODS: This retrospective study was conducted based on the prospectively maintained data in a cohort of 557 patients with super obesity, who underwent either SG (n = 348) or OAGB with a 200-cm BPL (n = 154) or a 160-cm BPL (n = 55) by the same surgical team from March 2013 to 2017. RESULTS: Patients undergoing OAGB had greater weight loss in comparison to those managed by SG during the first, second, and third years of follow-up. Comparing the OAGB and SG groups within 3 years after surgery, the total weight loss was 36.5 vs. 33.2% (P < 0.001) and the ΔBMI was 20.1 vs. 18.1 kg/m2 (P < 0.001), respectively. The resolution of diabetes mellitus, hypertension and dyslipidemia were similar after the two procedures. The operative time and length of hospital stay were longer in the OAGB group, and incidence of complications, requiring either readmission or reoperation, was significantly higher after OAGB, in comparison to SG. There was no significant difference in the postoperative weight loss results, resolution of comorbidities, or the incidence of complications between the OAGB-160 and OAGB-200 groups, with the exception of protein-calorie malnutrition requiring revision surgery, which was exclusively observed in the OAGB-200 group. CONCLUSION: Although OAGB provides superior mid-term weight loss, SG remains the first option for patients with super obesity, due to the safer surgical profile and comparable metabolic improvement.

The effect of bariatric surgery in comparison with the control group on the prevention of comorbidities in people with severe obesity: a prospective cohort study.

BACKGROUND: Obesity is a global health priority, particularly in developing countries. The preventive effect of bariatric surgery against obesity-related diseases in the developing countries of the Middle East and North Africa region, where type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia prevail, has not been examined. METHOD: Severely obese participants who underwent bariatric surgery were compared with their counterparts who underwent no intervention. These patients had been followed up in two prospective cohort studies for three years. We here determined the incidence of new-onset T2DM, HTN, and dyslipidemia and reported absolute and relative risks for the incidence of these comorbidities in the two groups. RESULTS: In this study, 612 participants in the bariatric surgery group were compared with 593 participants in the control group. During the follow-up period, T2DM developed in eight (2.9%) people in the surgery group and 66 (15.0%) people in the control group (P < 0.001). New-onset HTN and dyslipidemia showed significantly lower frequencies in the surgery group compared to the control group (4 (1.8%) vs. 70 (20.4%) and 33 (14.3%) vs. 93 (31.5%), respectively). Regarding a less favorable metabolic profile in the surgery group at the baseline, the relative risk reductions associated with bariatric surgery were 94, 93, and 55% for the development of T2DM, HTN, and dyslipidemia, respectively. CONCLUSION: The risk reduction of obesity-related comorbidities after bariatric surgery should be considered in the decision-making process for public health in the region, which bariatric surgery could result in the prevention of comorbidities.

Elevated miR-143 and miR-34a gene expression in human visceral adipose tissue are associated with insulin resistance in non-diabetic adults: a cross-sectional study.

OBJECTIVE: We aimed to evaluate the association of miR-143 and miR-34a expression in human visceral (VAT) and subcutaneous (SAT) adipose tissues with insulin resistance (IR). METHODS: VAT and SAT were obtained from 176 participants without diabetes. miR-143 and miR-34a expressions in VAT and SAT were measured using qRT-PCR. Fasting serum insulin and glucose concentration, homeostatic model assessment of IR index (HOMA-IR) and ß-cell function (HOMA-B), and quantitative insulin-sensitivity check index (QUICKI) were calculated. RESULTS: After adjustment for age, sex and body mass index (BMI), VAT miR-143 expression was positively associated with fasting plasma glucose (FPG), insulin, and HOMA-IR, and negatively associated with HOMA-B and QUICKI. miR-34a expression in VAT was directly associated with FPG, insulin, and HOMA-IR and negatively associated with QUICKI. In SAT, miR-34a expression was positively associated with insulin and negatively associated with QUICKI. The interaction terms of HOMA-IR and BMI categories were significant for both miR gene expressions in VAT. After stratifying participants based on BMI, the association of miR-143 and miR-34a expressions in VAT with IR indices remained significant only in obese patients. CONCLUSION: miR-143 and miR-34a expressions in VAT were independent predictors of IR in people without diabetes, and that this association was conditional on the degree of obesity. LEVEL OF EVIDENCE: Level of evidence III, cross-sectional analytic study.

The association of dietary and plasma fatty acid composition with FTO gene expression in human visceral and subcutaneous adipose tissues.

PURPOSE: The human obesity susceptibility gene, FTO, associates with body mass and obesity in humans through regulation of energy expenditure and intake. We aimed to determine how fatty acids in plasma and in diet associate with FTO gene expression in subcutaneous and visceral adipose tissues. METHODS: In this study, 97 participants aged ≥ 18 years were selected from patients admitted to the hospital for abdominal surgeries. Habitual dietary intake of participants was collected using a valid and reliable food frequency questionnaire (FFQ), from which the intake of fatty acids was quantified. Plasma fatty acids were assessed by gas-liquid chromatography. The mRNA expression of the FTO gene in visceral and subcutaneous adipose tissues obtained by biopsy was measured by Real-Time Quantitative Reverse Transcription PCR. Standardized ß-coefficients were calculated by multivariable linear regression. RESULTS: After adjusting for age, homeostasis model insulin resistance index (HOMA-IR), and body mass index, total fatty acid intake was significantly associated with FTO gene expression in visceral (STZß = 0.208, P = 0.037) and subcutaneous (STZß = 0.236, P = 0.020) adipose tissues. Dietary intake of monounsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) had positive significant associations with the expression of FTO in visceral (STZß = 0.227, P = 0.023; STZß = 0.346, P < 0.001, respectively) and subcutaneous (STZß = 0.227, P = 0.026; STZß = 0.274, P = 0.006, respectively) adipose tissues. There were no associations between plasma fatty acids and FTO mRNA expression in either subcutaneous or visceral adipose tissues. CONCLUSION: The weak association of dietary total fatty acids, MUFA, and PUFA with FTO gene expression in both adipose tissues may highlight the importance of dietary fatty acids composition along with total fat intake in relation to FTO gene expression.

Association of plasma fatty acids pattern with omentin gene expression in human adipose tissues: A cross-sectional study.

BACKGROUND AND AIMS: Omentin, as an adipokine, has been reported to improve insulin resistance and inflammation may be related to fatty acids (FAs). Plasma FAs can be used as biomarkers of dietary FAs and endogenous FA exposure. We aimed to evaluate the association between plasma FAs pattern and omentin gene expression in adipose tissue (AT). METHODS AND RESULTS: Visceral and subcutaneous AT and fasting blood were gathered from 97 adults aged >18 years. Participants were already admitted to hospitals for elective abdominal surgery. Dietary intakes were assessed using a food frequency questionnaire. The relative omentin gene expression in visceral and subcutaneous AT was measured by Real-Time PCR and plasma FAs was determined by gas chromatography. The principal component analysis was performed to derive the FAs pattern from plasma individual FAs. Three patterns were derived from plasma FAs, 1) high de-novo lipogenesis (DNL), 2) high trans saturated fatty acids (SFA), and docosahexaenoic acid (trans-SFA/DHA), and 3) high long-chain SFA (LC-SFA). After adjustment for age, sex, and insulin concentration, only the LC-SFA pattern was associated with omentin gene expression in visceral AT (ß = 2.25, P = 0.03). Other patterns were not associated with omentin gene expression in visceral and subcutaneous AT. CONCLUSION: A pattern characterized by high levels of myristic acid (14:0), heptadecanoic acid (17:0), pentadecanoic acid (15:0), and Cis_heptadecanoic acid (17:1), which named LC-SFA was related to omentin gene expression in visceral AT.

One-year outcomes of bariatric surgery in older adults: a case-matched analysis based on the Tehran Obesity Treatment Study.

PURPOSE: Knowledge is limited about the efficacy, safety, and long-term outcomes of bariatric surgery in older adult patients with obesity. METHODS: Fifty-six patients aged ≥ 60 years who underwent bariatric surgery, as either sleeve gastrectomy or gastric bypass, were matched for sex, baseline body mass index (BMI) and surgery type, with 112 younger controls, aged 18-60 years. We compared complications, weight loss, resolution of co-morbidities, and changes in body composition status (fat mass [FM], fat-free mass [FFM], lean mass [LM] and percentage of fat mass [FM%]) 12 months postoperatively between the groups. RESULTS: Complications were similar in the two groups. Diabetes mellitus (DM) and dyslipidemia showed similar remission and improvement rates postoperatively in the two groups. Remission from hypertension (HTN) was higher in the control group, but improvement rates were similar. Changes from baseline to 12 months postoperatively in weight, BMI, excess weight loss (EWL%), total weight loss (TWL%), FFM, and LM were greater in the control group than in the older-age group. Changes in FM and FM% were similar in the two groups. CONCLUSION: Bariatric surgery is a safe intervention for the management of obesity and obesity-related co-morbidities in older adults, with similar surgery-risk and complication rates to those of younger adults. Reduction in FM and FM% was equal in two groups and the concern about greater LM loss in older adults seems unfounded.

Comparison of the one-year outcomes of bariatric surgery in adolescents and young adults: a matched case-control study, Tehran Obesity Treatment Study (TOTS).

PURPOSES: The increasing use of bariatric surgery in adolescents has raised some concerns regarding the postoperative outcomes and the optimal time of surgery at young ages. However, no study has yet compared the weight loss and comorbidity resolution following bariatric surgery between adolescents and young adults. METHODS: This study was conducted on a case group of adolescents (aged 11-18) and a control group of young adults (aged 19-29) undergoing bariatric surgery (sleeve gastrectomy or gastric bypass). The two groups were matched in terms of gender, body mass index (BMI), and surgery type and were assessed regarding the surgical outcomes at 1 year after surgery. RESULTS: The baseline characteristics of the adolescents (n = 118, mean age: 17.0 ± 1.6 years) and young adults (n = 236, mean age: 25.2 ± 3.2 years) were similar, as well as surgery-associated complications. The mean loss of BMI (- 15.4 ± 3.6 vs. -15.8 ± 4.6 kg/m2) and 12-month percentage of excess weight loss (80.4 ± 20.1 vs. 80.2 ± 20.1%) were similar in the two groups. Both groups showed parallel reductions in the cardiovascular risk factors. The remission of hypertension, diabetes mellitus, and dyslipidemia was similar between the groups. The increase in the hemoglobin level and copper deficiency was greater in young adults, whereas the increase in ferritin deficiency was greater in adolescents. CONCLUSION: Similar to young adults, bariatric surgery is an effective and safe method to achieve weight loss, resolve obesity-related comorbidities, and improve cardiovascular risk factors in the adolescents.

Successful pregnancy and weight loss management in a woman unknowingly pregnant at the time of bariatric surgery: a case report.

BACKGROUND: Preventing unintended pregnancy is an important issue for women undergoing bariatric surgery, not only to avoid an adverse fetal outcome but to also ensure maximum weight loss for mother. Current guidelines strongly advise to use a reliable method of contraception following surgery and to delay pregnancy for 12-18 months after surgery. CASE PRESENTATION: We present the case of a woman who underwent laparoscopic sleeve gastrectomy while she was unknowingly pregnant. She was monitored closely throughout her pregnancy for maternal-fetal wellbeing and delivered a healthy full-term girl. At her last follow-up visit 6 months post-delivery, both mother and infant were in good general condition and the mother achieved 94.4% excess weight loss. CONCLUSIONS: In all-female patients of childbearing age planning to undergo bariatric surgery, pregnancy should be avoided by using a reliable method of contraception well before surgery. Pregnancy should also be excluded on the day of surgery.

Two-year outcomes of sleeve gastrectomy versus gastric bypass: first report based on Tehran obesity treatment study (TOTS).

BACKGROUND: Bariatric surgery is an effective treatment for obesity and its associated comorbidities. This is the first comprehensive report of a prospective cohort study, comparing sleeve gastrectomy (SG) with gastric bypass (GB) regarding their effectiveness and safety. METHODS: The prospectively collected data of patients, who presented to a specialized bariatric center and underwent a primary bariatric procedure, were compared in terms of weight loss, remission of obesity-associated comorbidities, complication rate, and quality of life improvement at 6-, 12-, and 24-month follow-ups. RESULTS: Of 3287 patients (78.6% female) analyzed, 67% (n = 2202) and 33% (n = 1085) underwent SG and GB, respectively. Effective outcomes were reported in both groups regarding the body composition indices. Type 2 diabetes mellitus (T2DM) remission rate at the end of follow-up was 53.3% and 63.8% in the SG and GB groups, respectively. Following the propensity score-adjusted analysis, the T2DM remission rate was not significantly different between the groups. Conversely, the remission rate of hypertension in the 24-month follow-up (39.1% vs. 54.7%) and the remission rate of dyslipidemia in all follow-ups were lower in the SG group, compared to the GB group. Moreover, both procedures caused substantial improvements in various domains of quality of life. The surgery duration, early complication rate, and nutritional deficiencies were lower in the SG group, compared to the GB group. CONCLUSION: Both surgical procedures were effective in the control of obesity and remission of its comorbidities. However, since SG was associated with a lower rate of complications, it seems that SG should be considered as a suitable procedure for obese patients, especially those with a healthier metabolic profile.

Dietary macro- and micro-nutrients intake adequacy at 6th and 12th month post-bariatric surgery.

BACKGROUND: Bariatric surgery (BS) is considered as an effective solution to control morbid obesity. Food restrictions resulting from the operation may decrease dietary nutrient intakes, particularly during the first year after BS. This study mainly aimed to assess the adequacy of dietary nutrient intakes at 6th and 12th month after BS. METHOD: Of the severely obese participants in the Tehran obesity treatment study in 2015-2016, 58 patients undergoing Roux-En-Y gastric bypass (N = 16) or sleeve gastrectomy (N = 42) were selected from Tehran Obesity Treatment Center. To assess the patients' dietary intake, a three-day, 24-h dietary recall was obtained on three unscheduled days (two non-consecutive weekdays and one weekend day) at 6th and 12th month after BS. To evaluate the adequacy of nutrient intake, the patients' intakes were compared to the current dietary reference intakes (DRIs), including estimated average requirements (EAR) or Adequate Intakes (AI). RESULTS: The mean age of the participants (71% women) undergoing BS was 37 ± 8 years. Anthropometric parameters significantly decreased at the 12th month after BS. The percentage of energy from carbohydrate intake increased significantly between the 6th and 12th month after BS (P = 0.04). The mean ± SD of protein intake was lower than the recommended dosage with a dramatic decrease from 45 ± 30 to 31 ± 15 (g/day) between the two intervals (P = 0.001). The mean intake of saturated fatty acid (SFA) decreased dramatically (P < 0.001) from 6 to 12 month; however, the median intake of n3-polyunsaturated fatty acid (n3-PUFA) intake increased (P = 0.02). None of the participants showed nutrient intake adequacy in terms of biotin, fat soluble vitamins, pantothenic acid, potassium, and zinc. Moreover, less than 10% of the participants showed nutrient intake adequacy in terms of folate, magnesium, manganese, and calcium according to DRIs during the both intervals after BS. CONCLUSION: Bariatric surgery can reduce dietary intakes, which is more obvious 12 months after the surgery. Out of 21 micronutrients, nearly all could not met the EAR and were received < 50%, also had significant reduction from the 6th to12th month after surgery.

Is apelin gene expression and concentration affected by dietary intakes? A systematic review.

Overproduction of apelin in obesity could be one of the last protective defenses before type 2 diabetes develops. To summarize the existing evidence on the association between dietary intake and apelin gene expression and concentration. We systematically searched MEDLINE, EMBASE, and google scholar and hand-searched bibliographies, including peer-reviewed articles with English abstracts, without restriction in publication date, updated until 21 February 2016 that reported the association between dietary intake and apelin gene expression or concentration. From a total of 1075 articles, we identified 12 relevant studies. There were 6 clinical trials in human and 6 studies in animals. Overall, two of three studies conducted in humans showed that calorie-restriction diet in obese subjects decreases apelin concentration. Five animal studies reported that higher intake of fatty acids and eicosapentaenoic acid (EPA) increased apelin expression and concentration. Given the paucity of data available, the heterogeneity of study designs used, and exposures tested, no quantitative meta-analysis was justified. Based on human studies, hypocaloric diet can reduce apelin concentration in obese individuals. In addition, higher intakes of total fatty acids and EPA may increase apelin gene expression and concentration.

Major dietary patterns and their associations with total weight loss and weight loss composition 2-4 years after sleeve gastrectomy.

BACKGROUND: Food intakes 1-2 years following bariatric surgery depend more on patients than the surgery's gastrointestinal tract changes. This study aimed to determine the major dietary patterns of patients after the first two years of sleeve gastrectomy and to investigate their associations with total weight loss (TWL) and the proportion of TWL as fat mass (FM) and fat-free mass (FFM) loss. METHODS: This cross-sectional study included 146 patients undergoing sleeve gastrectomy 2-4 years after surgery. Dietary patterns were determined using principal component analysis based on the 19 food groups. The percentage of FM loss relative to TWL (%FML) and FFM loss relative to TWL (%FFML) were calculated. A suboptimal clinical response was defined as a TWL of less than 25%. High FM loss and excessive FFM loss were defined based on the highest tertiles. Linear and logistic regression models were used to derive unstandardized (B) coefficients and odds ratios (OR), with dietary pattern scores serving as both a continuous and a binary variable (higher vs. lower adherence groups based on median). RESULTS: Two predominant dietary patterns were retained. Each 1-unit increase in the first dietary pattern score characterized by high intakes of fast foods, soft drinks, processed meats, sugar confectionary, salty snacks, grains, and organ meats was associated with higher %FFML (B = 1.99; 95% confidence interval (CI) 0.34, 3.66), lower %FML (B = - 1.84; 95% CI - 3.49, - 0.20), and higher odds of excessive FFM loss (OR = 1.84; 95% CI 1.09, 3.11). Participants with higher adherence to the first dietary pattern had lower %TWL, and greater odds of suboptimal clinical response and excessive FFM loss than those with lower adherence. Each 1-unit increase in score for the second dietary pattern characterized by a high intake of fruits, dairy, vegetables, legumes, eggs, nuts, red meats, poultry, and fish was associated with lower odds of suboptimal clinical response (OR = 0.51; 95% CI 0.31, 0.86). CONCLUSION: Patients should be encouraged to modify their diet by reducing the consumption of ultra-processed foods and increasing their intake of high-quality protein sources, fruits, and vegetables to achieve the best postoperative outcome.