Are patients with severe obesity aging faster? The impact of severe obesity on different aspects of biological age.

INTRODUCTION: Obesity and aging are characterized by chronic low-grade inflammation, which contributes to the onset of degenerative processes. OBJECTIVES: The objective was to comprehensively analyze the prevalence of premature aging in obesity and identify metabolic factors influencing aging. PATIENTS AND METHODS: In this prospective cohort study, the telomere length, 8-Oxo-2'-deoxyguanosine DNA damage, interleukin-6 (IL-6), metabolic age and cognitive functions were evaluated in the patients with severe obesity (study group (SG), defined as BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with comorbidities, n=100) and the healthy volunteers (control group (CG), defined as BMI 18.5 - 24.9 kg/m2, n=33). SG was further divided into two subgroups: study group 1 (SG1) - subjects with BMI≥ 50 kg/m2 and study group 2 (SG2) with BMI < 50 kg/m2. RESULTS: Our findings revealed that individuals in the SG exhibited shorter telomeres, higher levels of inflammation, and more advanced metabolic age compared to those in the CG. However, no significant differences in DNA damage or cognitive function abilities were observed between the SG and CG. Notably, SG1 displayed elevated IL-6 levels compared to SG2. Furthermore, IL-6 levels decreased significantly with increasing body fat, and individuals with higher visceral fat levels had longer telomeres. CONCLUSIONS: Premature aging manifests in obesity concerning telomere length, inflammation levels and metabolic age. Aging in obesity should be considered as a non-linear process.

The Role of the Western Diet and Oral Microbiota in Parkinson's Disease.

The type of diet not only affects the composition of the oral microflora but is also one of the more critical factors associated with an increased risk of Parkinson's disease, PD. This study compared diet preferences and oral microbiota profiles in patients with PD vs. healthy controls. This study compared the oral microbiota composition of 59 patients with PD and 108 healthy controls (without neurodegeneration) using 16S rRNA gene amplicon sequencing. According to results, oral microbiota in patients with PD is different compared from healthy controls. In particular, decreased abundance of Proteobacteria, Pastescibacteria, and Tenercutes was observed. The oral cavity of patients with PD was characterized by the high relative abundance of bacteria from the genera Prevotella, Streptococcus, and Lactobaccillus. There were also differences in food preferences between patients with PD and healthy controls, which revealed significantly higher intake of margarine, fish, red meat, cereals products, avocado, and olives in the patients with PD relative to healthy controls. Strong positive and negative correlations between specific food products and microbial taxa were identified.

External validation of predictive scores for diabetes remission after metabolic surgery.

PURPOSE: Bariatric surgery has proven to be the most efficient treatment for obesity and type 2 diabetes mellitus (T2DM). Despite detailed qualification, desirable outcome after an intervention is not achieved by every patient. Various risk prediction models of diabetes remission after metabolic surgery have been established to facilitate the decision-making process. The purpose of the study is to validate the performance of available risk prediction scores for diabetes remission a year after surgical treatment and to determine the optimal model. METHODS: A retrospective analysis comprised 252 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2009 and 2017 and completed 1-year follow-up. The literature review revealed 5 models, which were subsequently explored in our study. Each score relationship with diabetes remission was assessed using logistic regression. Discrimination was evaluated by area under the receiver operating characteristic (AUROC) curve, whereas calibration by the Hosmer-Lemeshow test and predicted versus observed remission ratio. RESULTS: One year after surgery, 68.7% partial and 21.8% complete diabetes remission and 53.4% excessive weight loss were observed. DiaBetter demonstrated the best predictive performance (AUROC 0.81; 95% confidence interval (CI) 0.71-0.90; p-value > 0.05 in the Hosmer-Lemeshow test; predicted-to-observed ratio 1.09). The majority of models showed acceptable discrimination power. In calibration, only the DiaBetter score did not lose goodness-of-fit in all analyzed groups. CONCLUSION: The DiaBetter score seems to be the most appropriate tool to predict diabetes remission after metabolic surgery since it presents adequate accuracy and is convenient to use in clinical practice. There are no accurate models to predict T2DM remission in a patient with advanced diabetes.

Differences in the Composition of Gut Microbiota between Patients with Parkinson's Disease and Healthy Controls: A Cohort Study.

Gut microbiome and colonic inflammation can be associated with the predisposition and progression of Parkinson's disease (PD). The presented study aimed to compare gastrointestinal microbiota composition between patients diagnosed with PD and treated only with Levodopa to healthy controls. In this prospective study, patients were recruited in 1 academic hospital from July 2019 to July 2020. The detailed demographic data and medical history were collected using a set of questionnaires. Fecal samples were obtained from all participants. Next-Generation Sequencing was used to assess the microbiota composition. The endpoint was the difference in composition of the gut microbiota. In this study, we enrolled 27 hospitalized PD patients with well-controlled symptoms. The control group included 44 healthy subjects matched for age. Among PD patients, our results presented a higher abundance of Bacteroides phylum, class Corynebacteria among phylum Actinobacteria, class Deltaproteobacteria among phylum Proteobacteria, and genera such as Butyricimonas, Robinsoniella, and Flavonifractor. The species Akkermansia muciniphila, Eubacterium biforme, and Parabacteroides merdae were identified as more common in the gut microbiota of PD patients. In conclusion, the patients diagnosed with PD have significantly different gut microbiota profiles in comparison with healthy controls.

Quality of Life After Bariatric Surgery-a Systematic Review with Bayesian Network Meta-analysis.

OBJECTIVE: Comprehensive analysis and comparison of HRQoL following different bariatric interventions through systematic review with network meta-analysis. BACKGROUND: Different types of bariatric surgeries have been developed throughout the years. Apart from weight loss and comorbidities remission, improvement of health-related quality of life (HRQoL) is an important outcome of metabolic surgery. METHODS: MEDLINE, EMBASE, and Scopus databases have been searched up to April 2020. Inclusion criteria to the analysis were (1) study with at least 2 arms comparing bariatric surgeries; (2) reporting of HRQoL with a validated tool; (3) follow-up period of 1, 2, 3, or 5 years. Network meta-analysis was conducted using Bayesian statistics. The primary outcome was HRQoL. RESULTS: Forty-seven studies were included in the analysis involving 26,629 patients and 11 different surgeries such as sleeve gastrectomy (LSG), gastric bypass (LRYGB), one anastomosis gastric bypass (OAGB), and other. At 1 year, there was significant difference in HRQoL in favor of LSG, LRYGB, and OAG compared with lifestyle intervention (SMD: 0.44; 95% CrI 0.2 to 0.68 for LSG, SMD: 0.56; 95% CrI 0.31 to 0.8 for LRYGB; and SMD: 0.43; 95% CrI 0.06 to 0.8 for OAGB). At 5 years, LSG, LRYGB, and OAGB showed better HRQoL compared to control (SMD: 0.92; 95% CrI 0.58 to 1.26, SMD: 1.27; 95% CrI 0.94 to 1.61, and SMD: 1.01; 95% CrI 0.63 to 1.4, respectively). CONCLUSIONS: LSG and LRYGB may lead to better HRQoL across most follow-up time points. Long-term analysis shows that bariatric intervention results in better HRQoL than non-surgical interventions.

Differences in Compositions of Oral and Fecal Microbiota between Patients with Obesity and Controls.

Background and Objectives: The aim of this study was to compare the differences in compositions of oral and fecal bacterial microbiota between patients with morbid obesity and normal-weight controls. Material and Methods: This was a prospective cohort study. The study included group 1 (patients with BMI ≥ 40 kg/m2) and group 2 (patients with BMI from 18.5 to 24.9 kg/m2). Our endpoint was the analysis of the differences in compositions of oral and fecal microbiota between the groups. Oral swabs and fecal samples were collected from the patients. The analysis of microbiota was conducted using next-generation sequencing. Results: Overall, the study included 96 patients; 52 (54.2%) were included in group 1, 44 (39.8%)-in group 2. In group 1, oral microbiota included significantly more bacteria from genera Veillonella, Oribacterium and Soonwooa, whereas, in group 2, Streptobacillus, Parvimonas and Rothia were more common. Fecal microbiota in group 1 included more Bacteroides, Odoribacter and Blautia and group 2 was more abundant in Ruminococcus, Christensenella and Faecalibacterium. Conclusions: Both oral and fecal gastrointestinal microbiota differs significantly among patients with severe obesity and lean individuals.

When to resume bariatric surgery after COVID-19 pandemic?: results of patients' and surgeons' survey.

BACKGROUND: Coronavirus Disease 2019 is affecting most countries around the world, including Poland. In response, all elective surgeries have been postponed. We asked patients and surgeons when they want bariatric surgery to resume after pandemic. The main aim of the study was to determine patients' and surgeons' expectations about when to resume bariatric surgery regarding COVID-19 pandemic state. METHODS: The study was conducted in two groups: Group 1-bariatric patients; Group 2-bariatric surgeons. Two online surveys were distributed. RESULTS: A total of 895 patients, 299 before, 596 after surgery and 32 surgeons took part in survey. All patients and surgeons declared willingness to resume bariatric surgeries after pandemic and responded that they should be resumed immediately the World Health Organization announces end of pandemic (42%). The majority of patients before surgery answered that bariatric procedures should be resumed immediately the number of daily incidents begins to decrease (53%). In the patient group, current body mass index (p < 0.001) and contact with COVID+/quarantined persons (p < 0.001) had impact on the response to resumption of bariatric procedures. CONCLUSIONS: Patients opted to wait for bariatric surgery until the oncological queue has become shorter. Surgeons presented a readiness to resume both procedures in parallel.

Feasibility of modified Edmonton Obesity Staging System in bariatric center.

BACKGROUND: The number of bariatric procedures is growing worldwide annually. While there is no doubt that a high body mass index is fundamental in qualification for surgical intervention, the Edmonton Obesity Staging System (EOSS) developed in 2009 may be an additional tool for identifying patients for whom surgery should be performed and those for whom the surgery should be postponed. OBJECTIVE: Assessment of the feasibility of modified EOSS as a qualification tool for surgery for obesity and related diseases and its association with morbidity. SETTING: University Hospital, Jagiellonian University Medical College, Cracow, Poland. METHODS: A retrospective study of prospectively collected data. All patients were assigned an EOSS score based on their medical record. We only considered the medical aspect, so the achieved results may be underpowered. Analyzed outcomes involved specific and overall complication rate, length of hospital stay, and weight loss. Regression models were created to assess the influence of EOSS on length of stay and complications. RESULTS: We included 761 patients who were operated on between 2009 and 2018 in our department. Of these, 505 patients received sleeve gastrectomy and 256 patients received Roux-en-Y gastric bypass. The median EOSS score was 2, which was assigned to 80% of the patients. The analysis showed no influence of modified EOSS on peri- or postoperative outcomes. Additionally, there were no significant differences in the number of patients who achieved bariatric success. The follow-up rate at 1 year was 70%. CONCLUSIONS: Our study suggests that modified EOSS score has no influence on the risk of developing complications and prolonged hospital stay. Patients with an EOSS score of ≥3 have higher major complication rate.

Impact of Adherence to the ERAS® Protocol on Short-term Outcomes after Bariatric Surgery.

INTRODUCTION: Enhanced recovery after surgery had been introduced with success in many surgical fields, including bariatrics. There are numerous studies presenting how ERAS® has positively affected the outcomes following weight loss surgery. The effect of compliance with the protocol on postoperative results has not been extensively researched in the literature. METHODOLOGY: The 15-element protocol used in our department was analyzed, and compliance was calculated based on pre- and peri-operative elements. We gathered data on recovery parameters, complications, and length of hospital stay. Patients were divided into two groups according to their compliance: group 1 < 80%, group 2 > 80%. Multivariate analysis was used to determine which element had the greatest effect. RESULTS: Our study group consisted of 764 patients operated in between 2009 and 2017. The median compliance was 87.94%; group 1 had 68.1% compliance and group 2 reached 92.7%. There were significant differences in morbidity (group 1 13.6% vs. group 2 2.8%, p < 0.001) and length of hospital stay (4 vs. 3 days, p < 0.001). Compliance, early mobilization, and day of food tolerance have been identified as affecting morbidity, whereas for prolonged hospital stays, it was multimodal analgesia, food tolerance, the volume of oral fluids, and intravenous fluids. CONCLUSIONS: Compliance with the ERAS® protocol affects morbidity and length of hospital stay. More studies are required to establish which elements have the greatest impact and which are essential.

Thyroid hormones as potential prognostic factors in sepsis.

BACKGROUND: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host reaction to infection. There is an upward trend in sepsis prevalence and mortality worldwide. Sepsis causes hypoxia, which reduces the ability of cells to produce ATP. This process is also influenced by thyroid hormones. Some of the previous studies revealed association between the mortality rate in sepsis and thyroid hormone levels. We aimed to evaluate thyroid hormones' predictive value in septic patients. METHODS: Forty-nine adult patients with sepsis admitted to the Intensive Care Unit of Allergy and Immunology Department at the University Hospital in Krakow, Poland, between 2015 and 2017 were enrolled in the study. Blood samples were obtained from septic patients immediately after establishing the diagnosis, in order to measure free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) levels. The primary endpoint was 30-day survival rate. The secondary endpoint was death anytime during intensive care unit (ICU) stay. RESULTS: Patients who died within 30 days had significantly lower level of fT4 than survivors (9.8 vs. 12.7 pmol L^-1; P = 0.033). There was no statistically significant difference between the groups in TSH and fT3 levels. As for the secondary endpoint, both fT3 (1.6 vs. 1.8 pmol L^-1; P = 0.021) and fT4 (9.8 vs. 12.7 µIU mL^-1; P = 0.019) levels were significantly lower among non-survivors compared to survivors, which was not the case for TSH. CONCLUSIONS: Thyroid hormone levels were significantly lower among patients who died during ICU stay. The results of the presented study suggest that fT3 and fT4 levels may be taken into consideration as potential new prognostic factors in sepsis.

Continuous Glucose Monitoring in Bariatric Patients Undergoing Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-En-Y Gastric Bypass.

BACKGROUND: Few investigations have been conducted that compared blood glucose in patients with diabetes mellitus (DM2) and morbid obesity who had undergone laparoscopic sleeve gastrectomy (LSG) or gastric bypass (LRYGB). We aimed to compare the effects of these procedures using continuous glucose monitoring (CGM). METHODS: We prospectively studied patients that had qualified for LSG or LRYGB. The inclusion criteria were DM2 of ≤ 5 years, for which patients were taking oral anti-diabetic drugs, or no glucose metabolism disorder; and morbid obesity. CGM was performed between admission and the 10th postoperative day. RESULTS: We studied 16 patients with DM2 and 16 without. Eighteen patients underwent LSG and 14 underwent LRYGB. The median hemoglobin A1c was 5.5% (5.4-5.9%) in DM2 patients, which did not differ from control (p = 0.460). Preoperative mean daily glucose concentration was similar between DM2 and control patients (p = 0.622). For patients with DM2, LRYGB was associated with more frequent low glucose status, and these episodes lasted longer than in DM2 patients that underwent LSG (p = 0.035 and 0.049, respectively). DM2 patients that underwent LRYGB demonstrated lower glucose concentrations from third postoperative day than those that underwent LSG. Patients without DM2 did not demonstrate differences in daily mean glucose concentrations, or in incidence nor duration of hypoglycemia throughout the observation period. CONCLUSION: A significantly larger reduction in interstitial glucose concentration is present from third day in patients with DM2 who undergo LRYGB vs. LSG, accompanied by a lower incidence and shorter duration of low glucose episodes.

Associations between chronotype, sleep disturbances and seasonality with fatigue and inflammatory bowel disease symptoms.

Growing number of studies suggests link between circadian rhythms and inflammatory bowel diseases (IBD) manifestation. We hypothesize that: 1) IBD are associated with increased eveningness and sleep disturbances; 2) eveningness and sleep disturbances are related to more severe IBD symptoms. In total, 129 participants were enrolled to this study, divided into three groups: 34 Crohn's disease (CD) patients, 38 ulcerative colitis (UC) patients and 57 healthy controls (HC) group. They all fulfilled a questionnaire, consisting of the Composite Scale of Morningness (CSM), Seasonal Pattern Assessment Questionnaire (SPAQ), Pittsburgh Sleep Quality Index, Inflammatory Bowel Disease Questionnaire (IBDQ) and Multidimensional Fatigue Inventory (MFI). Multiple regression models controlled for age and sex revealed that in CD group higher eveningness measured with CSM was associated with higher general fatigue, physical fatigue, mental fatigue and reduced motivation measured by MFI. Lower CSM morning affect is associated with greater general fatigue, physical fatigue and more reduced activity. Greater seasonality scores are associated with increased physical fatigue and more reduced activity and motivation. Lower sleep quality measured with PSQI is associated with higher physical fatigue and more reduced activity. Correlational analysis revealed that higher seasonality and lower sleep quality are associated with increased systemic and bowel symptoms and decreased emotional and social functions measured with IBDQ. In UC group, eveningness is associated with greater general fatigue, physical fatigue and more reduced activity. Higher CSM morning affect is associated with decreased general fatigue, physical fatigue and less reduced activity. Higher CSM circadian preference scores are associated with decreased general and physical fatigue, and less reduced activity. Increased seasonality is associated with more physical fatigue. Lower sleep quality is associated with greater general and physical fatigue. To our best knowledge this is the first study evaluating associations between chronotype and sleep disturbances with IBD symptoms. We have found that chronotype preferences, whose role in IBD has been until now overlooked, may be one of the important factors contributing to fatigue in this clinical group.

Risk Factors for Prolonged Length of Hospital Stay and Readmissions After Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB) are most commonly performed bariatric procedures. Laparoscopic approach and enhanced recovery after surgery (ERAS) protocols managed to decrease length of hospital and morbidity. However, there are patients in whom, despite adherence to the protocol, the length of stay (LOS) remains longer than targeted. This study aimed to assess potential risk factors for prolonged LOS and readmissions. METHODS: The study was a prospective observation with a post-hoc analysis of bariatric patients in a tertiary referral university teaching hospital. Inclusion criteria were undergoing laparoscopic bariatric surgery. Exclusion criteria were occurrence of perioperative complications, prior bariatric procedures, and lack of necessary data. The primary endpoints were the evaluations of risk factors for prolonged LOS and readmissions. RESULTS: Median LOS was 3 (2-4) days. LOS > 3 days occurred in 145 (29.47%) patients, 79 after LSG (25.82%) and 66 after LRYGB (35.48%; p = 0.008). Factors significantly prolonging LOS were low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence to bariatric center. The risk of hospital readmission rises with occurrence of intraoperative adverse events and low oral fluid intake on the day of surgery on. CONCLUSIONS: Risk factors for prolonged LOS are low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence. Risk factors for hospital readmission are intraoperative adverse events and low oral fluid intake on the day of surgery.