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1. Factors Related to Weight Loss Maintenance in the Medium-Long Term after Bariatric Surgery: A Review

Author

Cornejo-Pareja, Isabel, Molina-Vega, María, Gómez-Pérez, Ana María, Damas-Fuentes, Miguel, Tinahones, Francisco J., [Cornejo-Pareja,I, Molina-Vega,M, Gómez-Pérez,AM, Damas-Fuentes,M, Tinahones,FJ] Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain. [Cornejo-Pareja,I, Tinahones,FJ] Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain. [Cornejo-Pareja,I, Tinahones,FJ] Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain., and ICP was supported by Rio Hortega, and Juan Rodes from the Spanish Ministry of Economy and Competitiveness (ISCIII), and cofounded by Fondo Europeo de Desarrollo Regional-FEDER (CM 17/00169, JR 19/00054). MMV was supported by Rio Hortega from the Spanish Ministry of Economy and Competitiveness (ISCIII) and cofounded by Fondo Europeo de Desarrollo Regional-FEDER (CM18/00120). AMGP was supported by a research contract from Servicio Andaluz de Salud (B-0033-2014). MDF was supported by Rio Hortega from the Spanish Ministry of Economy and Competitiveness (ISCIII) and cofounded by Fondo Europeo de Desarrollo Regional-FEDER (CM20/00183). This study was supported by the 'Centros de Investigación Biomédica en Red' (CIBER) of the Institute of Health Carlos III (ISCIII) (CB06/03/0018), research grants from the ISCIII (PI18/01160), and co-financed by the European Regional Development Fund (ERDF). The funders had no role in the manuscript.

Subjects
Bariatric surgery, Physical activity, Gut–brain axis, Surgical technique, Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Gastrointestinal Hormones [Medical Subject Headings], Weight regain, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Bariatrics::Bariatric Surgery [Medical Subject Headings], Psychiatry and Psychology::Behavior and Behavior Mechanisms::Behavior::Feeding Behavior [Medical Subject Headings], Ejercicio físico, Gut hormones, Diet, Psychiatry and Psychology::Psychological Phenomena and Processes::Psychophysiology::Appetite [Medical Subject Headings], Phenomena and Processes::Musculoskeletal and Neural Physiological Phenomena::Musculoskeletal Physiological Phenomena::Musculoskeletal Physiological Processes::Movement::Motor Activity::Exercise [Medical Subject Headings], Dieta, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Bariatrics::Bariatric Surgery::Gastric Bypass [Medical Subject Headings], Diseases::Pathological Conditions, Signs and Symptoms::Signs and Symptoms::Body Weight::Body Weight Changes::Weight Loss [Medical Subject Headings], Psychological disorders, Cirugía bariátrica, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings]
Abstract

Despite bariatric surgery being the most effective treatment for obesity, some individuals do not respond adequately, especially in the long term. Identifying the predictors of correct weight maintenance in the medium (from 1 to 3 years after surgery) and long term (from 3 years and above) is of vital importance to reduce failure after bariatric surgery; therefore, we summarize the evidence about certain factors, among which we highlight surgical technique, psychological factors, physical activity, adherence to diet, gastrointestinal hormones or neurological factors related to appetite control. We conducted a search in PubMed focused on the last five years (2015-2021). Main findings are as follows: despite Roux-en-Y gastric bypass being more effective in the long term, sleeve gastrectomy shows a more beneficial effectiveness-complications balance; pre-surgical psychological and behavioral evaluation along with post-surgical treatment improve long-term surgical outcomes; physical activity programs after bariatric surgery, in addition to continuous and comprehensive care interventions regarding diet habits, improve weight loss maintenance, but it is necessary to improve adherence; the impact of bariatric surgery on the gut-brain axis seems to influence weight maintenance. In conclusion, although interesting findings exist, the evidence is contradictory in some places, and long-term clinical trials are necessary to draw more robust conclusions. Yes

Published
2021

2. Different Weight Loss Intervention Approaches Reveal a Lack of a Common Pattern of Gut Microbiota Changes

Author

Francisco J. Tinahones, Jose Manuel García-Almeida, Isabel Moreno-Indias, Ignacio Sajoux, Lourdes Garrido-Sánchez, Carolina Gutiérrez-Repiso, M. Rosa Bernal-Lopez, María Molina-Vega, [Gutiérrez-Repiso,C, Molina-Vega,M, Garrido-Sánchez,L, García-Almeida,JM, Moreno-Indias,I, Tinahones,FJ] Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain. [Gutiérrez-Repiso,C, Bernal-López,MR, Tinahones,FJ] Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain. [Bernal-López,MR] Departamento de Medicina Interna del Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain. [Sajoux,I] Pronokal Group, Medical Department Pronokal, Barcelona, Spain. [Tinahones,FJ] Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain., The research group belongs to the 'Centro de Investigación en Red de la Fisiopatología de la Obesidad y la Nutrición' (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. CGR was supported by a 'Juan de la Cierva, Incorporación' contract (IJCI-2017-33065). MMV is the recipient of a postdoctoral grant (Rio Hortega CM18/00120), IMI and MRBL were supported by the Miguel Servet program (CP16/00163, CP15/00028) from ISCIII. LGS is supported by Miguel Servet program from ISCIII (CPII18/00030) and Nicolás Monardes program from Consejería de Salud de la Junta de Andalucía (C-0028-2018). This work was supported in part by grants from ISCIII cofounded by Fondo Europeo de Desarrollo Regional—FEDER, PI15/01114, PI18/01160, CP16/00163, and as well as UMA18-FEDERJA-116 founded by Junta de Andalucía (Fondo Europeo de Desarrollo Regional FEDER). We acknowledge the PronoKal Group® for providing the diet and supplements for all the patients free of charge in support of the study.

Subjects
Weight loss, Rikenellaceae, Phenomena and Processes::Chemical Phenomena::Biochemical Phenomena::Biochemical Processes::Carbohydrate Metabolism::Fermentation [Medical Subject Headings], Mediterranean diet, medicine.medical_treatment, Obesidad, Medicine (miscellaneous), Physiology, lcsh:Medicine, Fermentación, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Genetic Techniques::Sequence Analysis::High-Throughput Nucleotide Sequencing [Medical Subject Headings], Gut flora, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, Lactobacillus, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Digestive System Surgical Procedures::Gastrectomy [Medical Subject Headings], 0303 health sciences, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Nutrition Therapy::Diet Therapy::Diet, Mediterranean [Medical Subject Headings], Pérdida de peso, Organisms::Bacteria::Gram-Positive Bacteria::Lactobacillales::Lactobacillaceae::Lactobacillus [Medical Subject Headings], very-low-calorie ketogenic diet, Dieta cetogénica, medicine.symptom, Microbioma gastrointestinal, bariatric surgery, 030209 endocrinology & metabolism, Gut microbiota, Biology, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Bariatrics::Bariatric Surgery [Medical Subject Headings], Article, 03 medical and health sciences, Gastrectomy, medicine, Obesity, Diseases::Pathological Conditions, Signs and Symptoms::Signs and Symptoms::Body Weight::Body Weight Changes::Weight Loss [Medical Subject Headings], Alistipes, 030304 developmental biology, Cirugía bariátrica, Bariatric surgery, Chemicals and Drugs::Lipids::Fatty Acids::Fatty Acids, Volatile [Medical Subject Headings], gut microbiota, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Nutrition Therapy::Diet Therapy::Ketogenic Diet [Medical Subject Headings], lcsh:R, Very-low-calorie ketogenic diet, medicine.disease, biology.organism_classification, Dieta mediterránea, Diseases::Nutritional and Metabolic Diseases::Nutrition Disorders::Overnutrition::Obesity [Medical Subject Headings], Fermentation, Metagenome, weight loss, Metagenoma, Ketogenic diet, Phenomena and Processes::Genetic Phenomena::Genetic Structures::Genome::Metagenome [Medical Subject Headings]
Abstract

Options for treatment of obesity include dietary approaches and bariatric surgery. Previous studies have shown that weight loss interventions have an impact on gut microbiota. However, a pattern of gut microbiota changes associated with weight loss independently of the type of intervention has not been described yet. This study includes 61 individuals who followed different weight loss strategies in three different trials: 21 followed a hypocaloric Mediterranean diet (MedDiet), 18 followed a very-low-calorie ketogenic diet (VLCKD) and 22 patients underwent sleeve gastrectomy bariatric surgery (BS). Gut microbiota profile was assessed by next-generation sequencing. A common taxon that had significantly changed within the three weight loss interventions could not be find. At the family level, Clostiridiaceae significantly increased its abundance with MedDiet and VLCKD, whilst Porphyromonadacean and Rikenellaceae significantly increased with VLCKD and BS. At genus level, in VLCKD and BS, Parabacteroides and Alistipes significantly increased their abundance whilst Lactobacillus decreased. At the species level, BS and VLCKD produced an increase in Parabacteroidesdistasonis and a decrease in Eubactieriumventriosum and Lactobacillusrogosae, whilst Orodibactersplanchnicus increased its abundance after the BS and MedDiet. Predicted metagenome analysis suggested that most of the changes after VLCKD were focused on pathways related to biosynthesis and degradation/utilization/assimilation, while BS seems to decrease most of the biosynthesis pathways. MedDiet was enriched in several pathways related to fermentation to short-chain fatty acids. Our results show that weight loss is not associated with a specific pattern of gut microbiota changes independently of the strategy used. Indeed, gut microbiota changes according to type of weight loss intervention.

Published
2021

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