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Severe obesity is often associated with inflammation and insulin resistance (IR), which expected to increase the risks of mortality and cancers. However, this relationship remains controversial, and it's unclear whether healthy lifestyles can mitigate these risks. The independent and joint associations of severe obesity (body mass index ≥ 35 m/kg2), inflammation (C-reactive protein > 10 mg/L and systemic inflammation markers > 9th decile), and IR surrogates with the risks of all-cause mortality and all-site cancers, were evaluated in 163,008 participants from the UK Biobank cohort. Further analyses were conducted to investigate how these associations were modified by lifestyle. During a median follow-up of 11.0 years, we identified 8844 deaths and 20,944 cancer cases. Severe obesity, inflammation and IR were each independently associated with increased risks of all-cause mortality [HRs(95%CIs) 1.24(1.17–1.30), 1.63(1.55–1.72) and 1.11(1.05–1.17)] and all-site cancers [1.06(1.02–1.10), 1.14(1.10–1.19) and 1.02(0.99–1.06)]. Joint analyses revealed significantly elevated risks of all-cause mortality and all-site cancers due to interaction between severe obesity, inflammation and IR, with the highest HRs(95%CIs) of 1.88(1.67–2.11) and 1.20(1.08–1.34), respectively. Further analyses showed stronger interaction between severe obesity, inflammation, IR and lifestyles, with similar associations observed in both males and females. Additionally, compared with unfavorable lifestyles, favorable lifestyles attenuated the risks of both all-cause mortality [the highest HRs(95%CIs) 2.35(1.75–3.15) vs. 3.72(2.86–4.84) for favorable vs. unfavorable lifestyles] and all-site cancers [1.16(0.89–1.53) vs. 1.63(1.26–2.10)]. Severe obesity interacts with inflammation and IR to exacerbate the risks of all-cause mortality and all-site cancers. Nonetheless, adherence to healthy lifestyles is recommended to mitigate these increased risks. [ABSTRACT FROM AUTHOR]

Septal reduction therapy is an effective treatment for hypertrophic obstructive cardiomyopathy (HOCM). Alcohol septal ablation (ASA) is indicated for HOCM patients who are ineligible for surgical myectomy, but several tips exist for the management of high-risk patients with ASA. Here, we present a case of successful ASA in a HOCM patient with multiple comorbidities, including severe obesity, drug-refractory bronchial asthma, poorly controlled diabetes, and steroid-induced immunosuppression. Pre-procedural strict glycemic control, pre-treatment with corticosteroids for bronchospasm prevention, minimal puncture sites for device insertion, and myocardial contrast echocardiography-guided procedure contributed to the achievement of successful ASA. With careful periprocedural management, ASA is a safe and effective treatment option for drug-refractory HOCM, even in high-risk patients with multiple comorbidities. Alcohol septal ablation can be a beneficial and safe treatment option for hypertrophic obstructive cardiomyopathy patients with multiple comorbidities, including severe obesity, drug-refractory bronchial asthma, poorly controlled diabetes, and steroid-induced immunosuppression. Detailed periprocedural management, including myocardial contrast echocardiography-guided procedure, is the key for achievement. [ABSTRACT FROM AUTHOR]

To describe maternal and perinatal outcomes in patients with BMI ≥30 kg/m2 by BMI class and gestational weight gain.Retrospective review of singleton pregnancies with pre-pregnancy BMI ≥30 kg/m2 who received care at our institution between January 1, 2016 and December 31, 2021. Patients were divided into three categories based on BMI (kg/m2): Class I (BMI 30.0–34.9), Class II (BMI 35–39.9), and Class III (BMI≥40) obesity. For gestational weight gain analysis, pregnancies were stratified into three groups: <11 pounds, 11–20 pounds, and >20 pounds. Maternal demographics and outcomes were compared using chi-square analysis, analysis of variance, nonparametric tests, and multivariable regression analysis.Of 641 patients included, 299 (46.6 %) were in Class I, 209 (32.6 %) in Class II, and 133 (20.7 %) in Class III. Readmission within 6 weeks postpartum, the only outcome found to have a significant difference between BMI categories, was higher in the Class III group (p=0.01). One hundred sixty-two (25.3 %) patients gained <11 pounds, 164 (25.6 %) gained 11–20 pounds, and 313 (48.8 %) gained ≥20 pounds. Greater gestational weight gain was associated with increased rates of cesarean delivery (p<0.001), higher quantitative blood loss (p=0.006), longer length of hospitalization (p=0.03), and higher birthweights (p<0.001).This represents a unique and actionable opportunity for clinicians to counsel and support their patients in adhering to optimal weight gain targets throughout their pregnancy. Future studies are needed to determine the optimal gestational weight gain recommendations for obese patients. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to explore the association between long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) and its components and severe obesity in children and adolescents. Methods: Data for children and adolescents aged 9–18 in this cross-sectional study were obtained from the 2019 Chinese National Survey on Students' Constitution and Health (CNSSCH). Data for PM2.5 and its components were obtained from the Tracking Air Pollution in China (TAP) dataset and matched with information on these children. Logistic regression models were used to assess the risk of severe obesity associated with long-term exposure to PM2.5 and its components. Results: A total of 160,205 children were included in the analysis. Long-term exposure to PM2.5 may increase the odds of severe childhood obesity, with this effect being more pronounced in girls. Among boys, the component with the most significant impact on severe obesity was organic matter (OM). The impact of PM2.5 and its components on severe obesity was greater in children from low economic and low parental education level households. Children with unhealthy lifestyle habits have higher odds of severe obesity due to long-term exposure to PM2.5 and its components. Conclusions: The findings of this research support the development of strategies aimed at addressing severe obesity in children, suggesting that adopting healthy lifestyle practices could mitigate the odds of severe obesity due to PM2.5 and its components. There is a need for an increased focus on children in economically underdeveloped areas and those with unhealthy lifestyle habits, particularly those in rural areas and those who do not engage in adequate physical activity or get enough sleep. [ABSTRACT FROM AUTHOR]

Background: Severe obesity is associated with a low-grade chronic inflammation, and high-sensitivity C-reactive protein (hs-CRP) is a marker that can be used to evaluate chronic inflammation status. Metabolic bariatric surgery (MBS) is shown to decrease hs-CRP level, but long-term results are scarce, and association with weight loss outcomes is undetermined. This study aims to evaluate chronic inflammation in patients with obesity using hs-CRP, and its association with long-term weight loss outcomes after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods: The long-term follow-up data of SLEEVEPASS (ClinicalTrials.gov NCT00793143) randomized clinical trial (RCT) was used. Hs-CRP was measured at baseline, and at 6 months, 1, 3, 5, 7, and 10 years after surgery, and the association with weight and weight loss outcomes were analyzed. Results: Hs-CRP at baseline was available for 59 out of 240 (24.6%) patients. In the whole study population, the nadir hs-CRP (mean estimate 1.14 mg/ml, 95% CI 0.87–1.49) was achieved at 3 years after surgery with a statistically significant difference to baseline (p = 0.003). No statistically significant difference was seen between LSG and LRYGB in hs-CRP change over time (operation*time interaction p = 0.540). Higher hs-CRP correlated with higher BMI at baseline (Spearman correlation 0.282, p = 0.030) and at 10 years (Spearman correlation 0.490, p = 0.001). At 10 years, a greater percentage total weight loss (%TWL) correlated with lower hs-CRP level (Spearman correlation − 0.558, p < 0.001). Baseline hs-CRP (Spearman correlation − 0.152, p = 0.299) and hs-CRP change in first 6 months postoperatively (Spearman correlation 0.167, p = 0.254) did not correlate statistically significantly with %TWL at 10 years. Conclusions: MBS decreases hs-CRP also at long-term follow-up with weight loss as the driving force. Neither baseline hs-CRP nor hs-CRP change at 6 months were feasible as a predictive marker for long-term outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Although noninvasive tests can be used to predict liver fibrosis, their accuracy is limited for patients with severe obesity and nonalcoholic fatty liver disease (NAFLD). We developed machine learning (ML) models to predict significant liver fibrosis in patients with severe obesity through noninvasive tests. Materials and Methods: This prospective study included 194 patients with severe obesity who underwent wedge liver biopsy and metabolic bariatric surgery at Taipei Medical University Hospital between September 2016 and December 2020. Significant liver fibrosis was defined as a fibrosis score ≥ 2. Patients were randomly divided into a training group (70%) and a validation group (30%). ML models, including support vector machine, random forest, k-nearest neighbor, XGBoost, and logistic regression, were trained to predict significant liver fibrosis, using DM status, AST, ALT, ultrasonographic fibrosis scores, and liver stiffness measurements (LSM). An ensemble model including these ML models was also used for prediction. Results: Among the ML models, the XGBoost model exhibited the highest AUROC of 0.77, with a sensitivity, specificity, and accuracy of 61.5%, 75.8%, and 69.5%, in validation set, while LSM, AST, ALT showed strongest effects on the model. The ensemble model outperformed all ML models in terms of sensitivity, specificity, and accuracy of 73.1%, 90.9%, and 83.1%. Conclusion: For patients with severe obesity and NAFLD, the XGBoost model and the ensemble model exhibit high predictive performance for significant liver fibrosis. These models may be used to screen for significant liver fibrosis in this patient group and monitor treatment response after metabolic bariatric surgery. [ABSTRACT FROM AUTHOR]

Abstract Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in individuals with obesity. Sexual dimorphism is present in MASLD. A noninvasive test to diagnose the severity of the disease, in particular the presence of Metabolic dysfunction-associated steatohepatitis (MASH), is lacking. This European multicenter prospective study uses a blood test based on mid-infrared (MIR) metabolic fingerprinting of individuals with severe or morbid obesity to diagnose MASH. Three hundred eighty-two individuals with severe or morbid obesity undergoing bariatric surgery were enrolled prospectively. Liver biopsies were obtained during surgery and assessed centrally. An algorithm was defined to calculate a score from the recorded MIR spectrum and to establish a diagnostic threshold to classify patients with MASH. Among the women (n = 217), MASH was diagnosed in 14.3% of cases. For women, the performance in terms of AUC were 0.83 and 0.82 in the calibration and validation groups, respectively. For a threshold of 0.1817, sensitivities were 86% and 70%, specificities were 81% and 75%, PPV were 43% and 32%, NPV were 97% and 94% and ACC were 82% and 74% for the calibration and validation groups, respectively. For men (n = 78; MASH: 33.3%), the performance of the spectral model was poor. The metabolic fingerprint obtained by MIR spectroscopy can rule out MASH in women with severe or morbid obesity. Its value in men needs new studies. Trial registration: ClinicalTrials.gov identifier: ClinicalTrials.gov identifier: NCT03978247 (04/06/2019)

Abstract Background Individuals with class II/III obesity have a high percentage of body fat. Assessing body composition in cases of severe obesity can be difficult and controversial both in clinical practice and scientific research. Thus, it is essential to explore the different aspects of evaluating body composition and to discuss the available methods to assess it in this population. Aims To summarise and discuss the methods used to measure body composition in adults with class II/III obesity and their potential in clinical practice and scientific research. Methods This is a narrative review using data from PubMed, Scielo, and Lilacs databases. Original articles on body composition analysis in adults with class II/III obesity i.e., a BMI ≥ 35 kg/m2 were eligible. Body composition assessment methods were analysed and described. Results Some imaging methods produced significantly accurate results. Dual-energy X-ray absorptiometry (DXA) significantly produces accurate results and has been used in clinical studies. However, due to its high cost, it is not applicable in clinical practice. Multifrequency bioelectrical impedance analysis (BIA) has good accuracy and is more appropriate for clinical practice than other methods. We have highlighted several aspects of the importance and applicability of performing body composition analysis in individuals with class II/III obesity. Conclusion DXA has been considered the most adequate method for clinical research. Multifrequency BIA may be a viable alternative to DXA for use in clinical practice. Assessing body composition and its components is important for people with class II/III obesity. It can help improve the effectiveness of interventions and clinical treatments, especially in reducing the risk of losing muscle mass. Muscle loss can cause sarcopenic obesity and other clinical complications, so understanding body composition is crucial. Assessing body composition can also help understand the impact of interventions on bones and avoid clinical complications.

Introduction: Interventions to support behaviour change in people living with chronic health conditions increasingly use patient groups as the mode of delivery, but these are often designed without consideration of the group processes that can shape intervention outcomes. This article outlines a new approach to designing group‐based behaviour change interventions that prioritizes recipients' shared social identity as group members in facilitating the adoption of established behaviour change techniques (BCTs). The approach is illustrated through an example drawn from research focused on people living with severe obesity. Methods: A prioritization process was undertaken in collaboration with stakeholders, including behaviour change experts, clinicians, and a former patient to develop an evidence‐based, group intervention informed by the social identity approach to health. Three phases of development are reported: (1) identification of the health problem; (2) delineation of intervention mechanisms and operationalization of BCTs for group delivery and (3) intervention manualization. The fourth phase, intervention testing and optimization, is reported elsewhere. Results: A group‐based behaviour change intervention was developed, consisting of 12 group sessions and 3 one‐to‐one consultations. The intervention aimed to support the development of shared social identity among recipients, alongside the delivery of evidence‐based BCTs, to improve the likelihood of successful intervention and health outcomes among people living with severe obesity. Conclusions: A manualized intervention, informed by the social identity approach to health, was systematically designed with input from stakeholders. The development approach employed can inform the design of behavioural interventions in other health contexts where group‐based delivery is planned. [ABSTRACT FROM AUTHOR]

Background and Objectives: Overweight and obesity are well-known conditions that negatively impact the health and lifestyle of an individual. Bariatric surgery is one of the most efficient weight loss techniques. Besides the main effect on the bodyweight, improvement in the levels of inflammatory biomarkers, such as interleukin 6 (IL-6), tumor necrosis factor alpha (TNFalfa), and others, has been observed. The purpose of this study was to establish the correlations between obesity-linked chronic systemic inflammation (estimated with inflammatory cytokine levels) and the weight loss process after metabolic surgery. Materials and Methods: An observational cohort study included two categories: the patients with obesity–bariatric group and the patients without obesity–control group. The study was performed between 1 February 2021 and 1 March 2023. Baseline characteristics, anthropometrics, biochemical assessment and inflammatory biomarkers were measured both before surgery and one year after the procedure, in the case of the bariatric group. The control group was assessed in the same period as the pre-surgery bariatric group. The bariatric group underwent two types of bariatric procedures: the majority underwent laparoscopic sleeve gastrectomy whereas a select few underwent one anastomosis laparoscopic gastric bypass. Results: We performed a prospective study comprising 55 Caucasian patients—from which 33 patients had morbid obesity, a mean age of 41.76 ± 10.78 and a mean BMI of 43.34± 7.51 kg/m2. The preoperative levels of IL-6 were positively correlated with waist circumference (r = 0.354, p = 0.043), weight (r = 0.549, p = 0.001) and BMI (r = 0.520, p = 0.002). After applying the Kruskal–Wallis test and Dunn's test, significant differences for IL-6 (p = 0.010) and adiponectin (p = 0.024) were obtained for values recorded pre- and post-surgery. No correlation was found between adiponectin, IL-6, TNF- α levels and anthropometric indices after surgery. Our study showed that bariatric surgery significantly changes the values of inflammatory cytokines one year after surgery. Nevertheless, we did not find significant correlations between the baseline values of these inflammatory markers and the weight loss process after surgery at a short-term (one-year) follow-up. Conclusions: Our study demonstrated that bariatric surgery significantly changes the level of inflammatory cytokines one year after operation. We demonstrate that preoperative levels of IL-6 are positively correlated with age, WC, and BMI. [ABSTRACT FROM AUTHOR]

Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in individuals with obesity. Sexual dimorphism is present in MASLD. A noninvasive test to diagnose the severity of the disease, in particular the presence of Metabolic dysfunction-associated steatohepatitis (MASH), is lacking. This European multicenter prospective study uses a blood test based on mid-infrared (MIR) metabolic fingerprinting of individuals with severe or morbid obesity to diagnose MASH. Three hundred eighty-two individuals with severe or morbid obesity undergoing bariatric surgery were enrolled prospectively. Liver biopsies were obtained during surgery and assessed centrally. An algorithm was defined to calculate a score from the recorded MIR spectrum and to establish a diagnostic threshold to classify patients with MASH. Among the women (n = 217), MASH was diagnosed in 14.3% of cases. For women, the performance in terms of AUC were 0.83 and 0.82 in the calibration and validation groups, respectively. For a threshold of 0.1817, sensitivities were 86% and 70%, specificities were 81% and 75%, PPV were 43% and 32%, NPV were 97% and 94% and ACC were 82% and 74% for the calibration and validation groups, respectively. For men (n = 78; MASH: 33.3%), the performance of the spectral model was poor. The metabolic fingerprint obtained by MIR spectroscopy can rule out MASH in women with severe or morbid obesity. Its value in men needs new studies. Trial registration: ClinicalTrials.gov identifier: ClinicalTrials.gov identifier: NCT03978247 (04/06/2019) [ABSTRACT FROM AUTHOR]

Introduction: Severe obesity results in high cardiovascular risk (CVR), increasing morbidity, and mortality. New and improved methods are needed to detect cardiovascular diseases rapidly in severe obesity. microRNAs (miRNAs) has shown promise as diagnostic tools. This study aimed to identify plasma miRNAs useful as biomarkers of CVR in people with severe obesity. Methods: The study included 66 people with severe obesity classified in groups with atheroma (n = 32) and free of plaques (n = 34). Plasma samples were collected 1 month before bariatric surgery and at 6 and 12 months of follow-up. Participants were screened for the levels of 188 miRNAs, and 24 promising candidates were individually validated by quantitative polymerase chain reaction. Results: After validation, 5 of the 24 miRNAs showed significant differences over time in both groups: miR-375 increased after bariatric surgery, whereas miR-144-5p, miR-20a-3p, miR-145-5p, and miR-21-3p exhibited decreased expression after bariatric surgery. The expression of 3 of the 24 miRNAs also differed between patients with and without atheroma: subjects with plaque had lower miR-126 but higher miR-21-3p and miR-133a-3p. Only miR-133a-3p exhibited exceptional discriminatory ability between subjects with and without plaque (area under the curve, 0.90; 95% confidence interval, 0.81–0.99). Conclusion: A specific signature of c-miRNA comprising miR-375, miR-144-5p, miR-20a-3p, miR-145-5p, and miR-21-3p may facilitate CVR monitoring after bariatric surgery. Furthermore, miR-21-3p, miR-126-3p, and miR-133a-3p show potential as specific biomarkers for subclinical atherosclerosis, with miR-133a-3p potentially able to diagnose subclinical atherosclerosis early in severe obesity. [ABSTRACT FROM AUTHOR]

Background/Objectives: The pediatric definition of severe obesity (OB) depends on the body mass index (BMI) references. We evaluated different BMI-derived metrics of the World Health Organization (WHO) system to define which cut-off is associated with the highest cardiometabolic risk (CMR); Methods: In this multicentric study, data were retrieved for 3727 youths (1937 boys; 2225 children, 1502 adolescents). OB was defined as BMI > 97th percentile (BMI97th), severe OB was defined as BMI > 99th percentile (BMI99th), BMI ≥ 120% of the 97th percentile (120% BMI97th), or BMI Z-score > 3 (WHO tables), or BMI ≥ the International Obesity Task Force (IOTF) value crossing a BMI of 35 kg/m2 at the age of 18 (IOTF35). The continuous CMR Z-score (sum of residual standardized for age and sex of waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, and HDL-cholesterol x −1) and the cluster of at least two CMR factors (hypertension, high triglycerides, low HDL-cholesterol, and high waist-to-height ratio) were calculated. Results: Continuous CMR Z-score was significantly higher both in children or adolescents with severe OB defined by 120% BMI97th compared to BMI99th (p < 0.0001), while it was lower only in adolescents with severe OB defined by 120% BMI97th compared to BMI Z-score >3 (p < 0.0001). Compared to 120% BMI97th, BMI Z-score > 3 and IOTF35 had higher specificity, but lower sensitivity in identifying children and adolescents with clustered CMR factors. Conclusions: The definition of severe OB based on 120% BMI97th is superior to BMI99th but it is inferior to BMI Z score > 3 as far as the association between severe OB and CMR factors is concerned. Pediatricians should take into consideration the implication of the use of different BMI metrics in those countries that recommend the WHO system. WHO BMI Z-score > 3 and IOTF35 can be used interchangeably to predict cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Background: Individuals with class II/III obesity have a high percentage of body fat. Assessing body composition in cases of severe obesity can be difficult and controversial both in clinical practice and scientific research. Thus, it is essential to explore the different aspects of evaluating body composition and to discuss the available methods to assess it in this population. Aims: To summarise and discuss the methods used to measure body composition in adults with class II/III obesity and their potential in clinical practice and scientific research. Methods: This is a narrative review using data from PubMed, Scielo, and Lilacs databases. Original articles on body composition analysis in adults with class II/III obesity i.e., a BMI ≥ 35 kg/m2 were eligible. Body composition assessment methods were analysed and described. Results: Some imaging methods produced significantly accurate results. Dual-energy X-ray absorptiometry (DXA) significantly produces accurate results and has been used in clinical studies. However, due to its high cost, it is not applicable in clinical practice. Multifrequency bioelectrical impedance analysis (BIA) has good accuracy and is more appropriate for clinical practice than other methods. We have highlighted several aspects of the importance and applicability of performing body composition analysis in individuals with class II/III obesity. Conclusion: DXA has been considered the most adequate method for clinical research. Multifrequency BIA may be a viable alternative to DXA for use in clinical practice. Assessing body composition and its components is important for people with class II/III obesity. It can help improve the effectiveness of interventions and clinical treatments, especially in reducing the risk of losing muscle mass. Muscle loss can cause sarcopenic obesity and other clinical complications, so understanding body composition is crucial. Assessing body composition can also help understand the impact of interventions on bones and avoid clinical complications. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is a set of conditions associated with an increased cardiovascular risk. Several serum fatty acids (FAs) seem to play an essential role in the development of cardiometabolic diseases and mortality. Thus, it is imperative to explore the impact of FAs on MetS parameters, using an early MetS screening tool such as MetScore, which is readily available in clinical practice. Aim: The aim of this study was to assess the potential correlation between serum FAs and cardiovascular risk using a MetScore. Methods: This cross-sectional study involved 41 women with severe obesity. The MetScore was calculated, and participants were categorized into high- and low-cardiovascular-risk groups based on the median MetScore value. Gas chromatography was used to quantify serum FAs. Generalized Linear Models were used to compare group means. The association was assessed through simple logistic regression, and an adjusted logistic regression was conducted to validate the association between Metscore and serum FAs. Results: The high-cardiovascular-risk group exhibited elevated values of HOMA-IR, palmitic, oleic, cis-vaccenic, and monounsaturated fatty acids, as well as the SCD-18C, indicating a heightened cardiovascular risk. Conversely, HDL-c, QUICK, gamma-linolenic, and eicosatetraenoic fatty acids showed lower values compared to the low-risk group. Conclusions: Women with severe obesity and high cardiovascular risk have lower values of some omega-3 and omega-6 FAs, considered cardioprotective and anti-inflammatory, and have higher lipogenic activity and FAs, correlated with high cardiovascular risk. These findings emphasize the need to address lipid metabolism in this population as a therapeutic target to reduce cardiovascular risk. Future research should explore clinical interventions that modulate fatty acid metabolism to mitigate cardiometabolic complications. [ABSTRACT FROM AUTHOR]

Background: The increasing prevalence of severe obesity among children and adolescents poses a significant challenge for pediatricians and general practitioners. This study aimed to investigate the relationships between biochemical results, anthropometry, blood pressure measurements, and bioimpedance analysis (BIA)-derived parameters to identify potential cardiometabolic complications associated with severe obesity. Methods: This study included 347 children (162 boys, 185 girls) aged 0–19 years, meeting the criteria for severe obesity based on BMI thresholds for different age groups. The patients were recruited in four pediatric endocrinology centers in Poland (Zabrze, Cracow, Rzeszow, Szczecin). Each participant underwent anthropometric measurements, pubertal stage assessment, blood pressure measurement, biochemical and hormonal tests, and BIA. Results: BMI showed significant associations with fat mass percentage (FM%) and waist-to-height ratio (WHtR) but not waist-to-hip ratio (WHR). The relationship between BMI and FM% was stronger in girls and prepubertal children. The metabolic syndrome (MetS) Z-score showed a strong positive correlation with BMI in the pubertal children. A negative correlation between HDL and triglycerides was observed only in the boys. The prepubertal children exhibited more significant correlations, despite a smaller sample size and shorter duration of obesity. Conclusions: Considering multiple parameters beyond BMI alone provides a better understanding of cardiometabolic risks associated with severe obesity in children. MetS Z-score was not a reliable indicator of increased cardiometabolic risk in younger children. Early-onset severe obesity was associated with a higher risk of metabolic complications. Early intervention is crucial to mitigate metabolic complications in this population. [ABSTRACT FROM AUTHOR]

Summary: We evaluated preoperative weight loss and days from initial consult to surgery in patients with BMI ≥50 kg/m2 who were and were not enrolled in medical weight management (MWM) prior to laparoscopic sleeve gastrectomy. We retrospectively identified patients with BMI ≥50 kg/m2 who had primary sleeve gastrectomy between 2014 and 2019 at two bariatric surgery centres in our healthcare system. Patients presenting after 2017 that received preoperative MWM (n = 28) were compared to a historical cohort of non‐MWM patients (n = 118) presenting prior to programme initiation in 2017 on preoperative percent total body weight loss (%TBWL) and days from initial consult to surgery. A total of 151 patients (MWM, 33; non‐MWM, 118) met inclusion criteria. BMI was significantly greater in MWM versus non‐MWM (p =.018). After propensity score matching, median BMI at initial consult in non‐MWM versus MWM no longer differed (p =.922) neither were differences observed on the basis of weight, age, sex, race or ethnicity. After PSM, MWM had significantly lower BMI at surgery (p =.018), lost significantly more weight from consult to surgery (p <.001) and achieved significantly greater median %TBWL from consult to surgery (p <.001). We noted no difference between groups on 6‐month weight loss (p =.533). Days from initial consult to surgery did not differ between groups (p <.863). A preoperative MWM programme integrated into multimodal treatment for obesity in patients with a BMI ≥50 kg/m2 resulted in clinically significant weight loss without prolonging time to surgery. [ABSTRACT FROM AUTHOR]

The stage of life at the onset of obesity is an important factor in assessing inflammatory state and cardiometabolic risk. This study aimed to evaluate the relationship between the obesity onset and the inflammatory profile in women with severe obesity. Public hospital, Brazil. Forty-eight women with severe obesity (20–59 yr old) were evaluated according to weight, height, neck circumference (NC), waist circumference (WC), and hip circumference, as well blood metabolic and inflammatory parameters. The participants were grouped according to obesity onset stage of life (early group: ≤19 yr; late group: >19 yr). The demographic means of the participants were: age of 39.7 years, weight of 122.7 kg and body mass index (BMI) of 48.4 kg/m2. The late group presented significantly higher values of leptin (lep)/adiponectin (adipo) ratio and homeostatic model assessment for insulin resistance (HOMA-IR) than the early group. The late group also had a lower adipo/lep ratio. Moreover, the late group showed correlations between the lep/adipo ratio and BMI (r =.460, P =.021), NC (r =.478, P =.016), and WC (r =.535, P =.006). Adipo was also correlated with NC (r = −.418, P =.038), WC (r = −.437, P =.029), and glycated hemoglobin (HbA1C) (r = −.485, P =.019). By contrast, in the early group, the lep/adipo ratio showed correlations with insulin (r =.647, P =.004) and HOMA-B (r =.564, P =.015). The inflammatory profile is correlated with anthropometric values in women with late-onset obesity. Inflammatory markers seemed to correlate with the glycemic profile in women with early-onset obesity. Furthermore, inflammation was higher in women with late-onset obesity compared to those with early-onset obesity. • First study to report the correlation of time of obesity onset and inflammation. • The study was performed only on women with severe obesity. • New insights were found regarding inflammation and obesity onset. • New findings were obtained regarding glycemic profile and obesity onset. [ABSTRACT FROM AUTHOR]

Preoperative management of patients living with severe obesity can be challenging; in this context, the preoperative weight loss may help to obtain better outcomes and less morbidity for bariatric surgery. Therefore, we evaluated the effectiveness of GLP-1 analogue Liraglutide in preoperative weight loss. We performed a single-center, quasi-experimental prospective study. Eligible participants were adults in preoperative management for bariatric-metabolic surgery with body-mass index ≥ 48 kg/m2. All patients were assigned liraglutide treatment, with an initial dose of 0.6 mg subcutaneous per day, the dose was increased each week until reaching 3.0 mg for 12 weeks. Weight loss and body composition were evaluated monthly using bioelectric impedance (BIA) (InBody 770 Scale®). We analyzed data using descriptive statistics, central tendency measures and dispersion for quantitative variables and absolute and relative frequencies for qualitative variables. A total of 37 individuals were included in this study, 28 (76%) were female and 9 (24%) were males, with an average age of 44 years. About the BMI, 19 patients (51%) had a BMI > 50 kg/m2, 10 (27%) > 40 kg/m2 and 8 (22%) > 60 kg/m2; with a total average BMI of 56.04 kg/m2. The initial weight was 147.4 ± 14.9 kg which decreased to 139.3 ± 16.8 kg; after 3 months of liraglutide administration. A total of 35 patients had some degree of weight loss (94.6%), while 2 (5.40%) had no weight changes. The total weight loss was 5.50% at 3 months of liraglutide treatment. Liraglutide could be an effective adjuvant therapy for preoperative weight loss in patients living with severe obesity. [ABSTRACT FROM AUTHOR]

Introduction: In the Netherlands, bariatric surgery in adolescents is currently only allowed in the context of scientific research. Besides this, there was no clinical pathway for bariatric surgery in adolescents. In this paper, the development of a comprehensive clinical pathway for bariatric surgery in adolescents with severe obesity in the Netherlands is described. Methods: The clinical pathway for bariatric surgery in adolescents consists of an eligibility assessment as well as comprehensive peri- and postoperative care. Regarding the eligibility assessment, the adolescents need to be identified by their attending pediatricians and afterwards be evaluated by specialized pediatric obesity units. If the provided treatment is considered to be insufficiently effective, the adolescent will anonymously be evaluated by a national board. This is an additional diligence procedure specifically established for bariatric surgery in adolescents. The national board consists of independent experts regarding adolescent bariatric surgery and evaluates whether the adolescents meet the criteria defined by the national professional associations. The final step is an assessment by a multidisciplinary team for adolescent bariatric surgery. The various disciplines (pediatrician, bariatric surgeon, psychologist, dietician) evaluate whether an adolescent is eligible for bariatric surgery. In this decision-making process, it is crucial to assess whether the adolescent is expected to adhere to postoperative behavioral changes and follow-up. When an adolescent is deemed eligible for bariatric surgery, he or she will receive preoperative counseling by a bariatric surgeon to decide on the type of bariatric procedure (Roux-en-Y gastric bypass or sleeve gastrectomy). Postoperative care consists of intensive guidance by the multidisciplinary team for adolescent bariatric surgery. In this guidance, several regular appointments are included and additional care will be provided based on the needs of the adolescent and his or her family. Furthermore, the multidisciplinary lifestyle intervention, in which the adolescents participated before bariatric surgery, continues in coordination with the multidisciplinary team for adolescent bariatric surgery, and this ensures long-term counseling and follow-up. Conclusion: The implementation of bariatric surgery as an integral part of a comprehensive treatment for adolescents with severe obesity requires the development of a clinical pathway with a variety of disciplines. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery (BS) is effective for achieving significant weight loss. However, weight regain (WR) is an emerging problem. Objective: To assess the prognostic value of morning serum cortisol, a 1 mg dexamethasone suppression test (DST), 24 h urinary free cortisol (UFC) and late-night salivary cortisol (LNSC) in a cohort of patients with severe obesity (pwSO) undergoing BS in terms of weight loss and WR. Methods: Patients scheduled for BS underwent the following procedures at baseline, 12 months and 24 months after BS: medical history, anthropometric data, blood analysis and cortisol tests. We evaluated total weight loss (TWL) ≥ 30% at 1 year and WR after 2 years as an increase of ≥10% of the maximum weight lost. Results: In total, 142 subjects were included; 101 (71.1%) were females and the mean age was 45.9 ± 9.2 years. Up to 76.8% of subjects achieved ≥30% TWL, without statistically significant differences in DST results or morning serum cortisol, UFC or LNSC levels. However, a higher pre-surgery morning serum cortisol level was a significant predictor of a WR ≥ 10% (cortisol 17.8 [IQR 13.1–18.5] vs. 12.0 [IQR 8.8–15.8] μg/dL; p < 0.01); OR of 1.216 (95% CI 1.069–1.384); AUC [0.761, CI: (0.616–0.906); p < 0.01]. A cut-off value of cortisol > 13.0 μg/dL was predictive of a WR ≥ 10% (sensitivity 0.71; specificity 0.63). Conclusions: No cortisol test was useful in predicting weight loss; however, the pre-surgery morning serum cortisol level was able to predict a WR ≥ 10% in a cohort of pwSO 2 years after BS. A cut-off value of cortisol > 13 μg/dL might be an easy tool to identify patients at higher risk of WR, enabling healthcare providers to implement tailored, long-term strategies to minimize this outcome. [ABSTRACT FROM AUTHOR]

Background: Obesity and hypothyroidism are common medical conditions that are associated with each other. Bariatric surgery (BS) is a common approach used to achieve substantial weight loss in obese patients. However, there is limited evidence regarding the need for postsurgery levothyroxine (LT4) dose adjustment in patients with hypothyroidism undergoing BS. Methods: This was a three-year prospective cohort study assessing postsurgery LT4 requirements with attention to body composition changes. The current study included 1030 patients with hypothyroidism, who underwent sleeve gastrectomy (SG) (n = 707, 88.3% women) or one anastomosis gastric bypass (OAGB) (n = 323, 92% women). Patients were followed for 36 months after surgery. A bioelectrical impedance analyzer was used for body composition assessment. LT4 requirements were assessed by generalized estimating equation (GEE) methods adjusted for weight as a time-varying covariate. Results: During the follow-up, TSH (mIU/L) and T4 (ng/dL) measurements did not significantly change in the OAGB group over time. However, in the SG group, TSH measurement decreased over time (ptrend = <0.001). In the third year of the follow-up, 56.1% and 33.3% of patients in the SG and OAGB groups experienced LT4 (μg/day) dose reduction, while 24.4% and 9.1% of the participants experienced LT4 dose increments, respectively. GEE analysis showed a significant increase in the LT4/fat mass (FM) (μg/kg) ratio after 36 months of follow-up compared with the baseline in both the SG [1.8 (1.5–2.2) to 2.7 (2.0–3.5), ptrend = 0.039)] and OAGB [1.7 (1.4–2.2) to 3.2 (2.7–4.8), ptrend = <0.001)] groups. Moreover, patients who underwent OAGB experienced greater LT4/FM (μg/kg) dose adjustments compared to those undergoing SG (pbetween = 0.060). In both groups, after the first year, the increase in LT4/FM (μg/kg) plateaued (pinteraction = 0.009). Conclusion: Most hypothyroid patients experienced either a reduction or no change in LT4 (μg/day) dosage after 36 months in both surgical groups. The LT4/FM (μg/kg) was significantly increased in patients undergoing either SG or OAGB with greater alterations in the latter. Further studies on larger populations and with longer duration of follow-up are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Severe obesity defined as BMI value corresponding to an adult > 40 kg/m2 affects 1–5% of children and adolescents in Europe. The purpose of this study was to assess the occurrence of cardiovascular risk factors in children and adolescents with severe obesity. The analysis included 140 patients (75 female) at the mean age of 14 ± 2.1 SD (range 10–18) years (all recruited in 4 regional reference centers in Poland). Severe obesity was defined as BMI > 35 kg/m2 (children 6–14 years), and BMI > 40 kg/m2 (> 14 years). Fasting plasma samples have been obtained in all patients, and OGTT was performed in all patients. The metabolic risk factors were defined as high blood pressure (BP > 90 percentile for height, age, and sex), HDL cholesterol < 1.03 mmol/L, TG ≥ 1.7 mmol/L, and hyperglycemic state (fasting blood glucose > 5.6 mmol/L, or blood glucose 120′ after oral glucose load > 7.8 mmol/L). Additionally, the MetS z-score was calculated using Metabolic Syndrome Severity Calculator. One hundred twenty-four (89%) participants presented with high BP, 117 (84%) with abnormal lipid profile, and 26 with the hyperglycemic. Only 12 (9%) were free of metabolic complications. More than 60% of patients had more than one cardiovascular risk factor. The high BP was significantly associated with the severity of obesity (F = 9.9, p = 0.002). Patients with at least one metabolic complication presented with significantly younger age of the onset of obesity (the mean age of the patients with no overt obesity complications was 10 years, while the mean age of those who presented at least one was 4.7 ± 3.5 SD years (p = 0.002)). A significant positive association between in the value of the Mets BMI z-score with age was observed (R = 0.2, p < 0.05). There were no differences between girls and boys regarding Mets BMI z-score (1.7 ± 0.8 vs 1.7 ± 0.7, p = 0.8). Conclusions: The most common metabolic risk factor in children and adolescents with severe obesity was high BP. The most important factor determining presence of obesity complications, and thus the total metabolic risk, seems to be younger (< 5 years) age of onset of obesity. What is Known? • It is estimated that 1-5% of children and adolescents in Europe suffer from severe obesity corresponding to an adult BMI > 40 kg/m2, and it is the fastest growing subcategory of childhood obesity. • Children with severe obesity face substantial health risk that may persist into adulthood, encompassing chronic conditions, psychological disorders and premature mortality. What is new: • The most common complication is high BP that is significantly associated with the severity of obesity (BMI z-score), contrary to dyslipidemia and hyperglycemic state, which do not depend on BMI z-score value. • The most important factor determining presence of obesity complications, and thus the total metabolic risk, seems to be younger (< 5 years) age of onset of obesity. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains the most effective procedure to treat severe obesity with proven short- and intermediate-term benefits. The main goal is to describe the effects on weight and biochemical laboratory tests after long-term follow-up (11 years). Materials and Methods: A prospective cohort of adults with obesity treated with LRYGB between 2004 and 2010 in one center were studied. Patients with prior bariatric or upper digestive tract surgery, hiatal hernia >4 cm, alcoholism, or decompensated conditions were excluded. The study enrolled 123 patients, with a mean follow-up of 133±29 months and a 14% loss of participants. Results: The percentage of Total Weight Loss (%TWL) at one, five, and eleven years was 30.3±8.4%, 29.1±6.9%, and 23.4±7%, respectively. Of the patients, 61.3% (65/106) maintained a %TWL≥20 after eleven years. Recurrent Weight Gain (RWG) at five and eleven years was 2.6±11.4% and 11 ±11.5%, respectively. At the end of the follow-up, 31.1% (33/106) of patients had RWG≥15%. Hypercholesterolemia and hypertriglyceridemia improved in 85.7% (54/63) and 90.2% (7/61) of the cohort, respectively. Remission of diabetes occurred in 80% of this subgroup. Gallstones developed in 28% of patients, and bowel obstruction due to internal hernia occurred in 9.4%. Anemia due to iron deficiency appeared in 25 patients. Conclusion: After surgery, there is a significant and durable loss of weight, with a tendency for late Recurrent Weight Gain. Furthermore, the improvement in biochemical parameters is sustained over time, but surgery's adverse effects may appear later. [ABSTRACT FROM AUTHOR]

BackgroundPrevious studies on the association of adolescent obesity with comorbid diseases in Israel were conducted predominantly in the Israeli Jewish population.GoalTo compare associations of adolescent obesity with Hypertension (HTN), Diabetes Mellitus type 2 (DM2), and Polycystic ovaries (PCO), singly or in combination, between Arabs and Jews in Israel.MethodsA cross-sectional study of 313,936 Arab adolescents aged 14–19 years between the years 2007–2022, and 289,616 adolescents in a matched Jewish comparison group.ResultsThe crude prevalence of comorbidities increased consistently from the ‘underweight’ to the ‘class 3 obesity’ category (from 0.24 to 6.41%, from 0.32 to 4.59%, and from 0.49 to 5.35% for HTN, DM2 and PCO, respectively). Compared to the reference ‘normal weight’ category, an incremental increase of aOR was observed by increasing weight category. The aORs for the ‘class 3 obesity’ category (95% CIs) were 26.00 (21.62–31.10), 10.82 (8.83–13.14), and 6.06 (95% CI 4.57–7.87) for HTN, DM2, and PCO, respectively. In the Jewish comparison group, lower aORs for HTN and DM2 were observed in the ‘class 3 obesity’ category. The increase in aORs with the increase in weight categories was more striking in cases of multiple comorbidities.ConclusionThe finding of a strong association of obesity severity with major cardiometabolic consequences in adolescence, as well as the unique ethnic features of these associations, can help focus national health initiatives on vulnerable adolescent groups.

Abstract Objective Bariatric surgery induces a significant loss of both fat mass (FM) and fat-free mass (FFM). The proteoglycan receptor syndecan-4 (SDC4) plays a crucial role in adipose tissue and skeletal muscle functions. Thus, this study was performed (i) to assess plasma SDC4 levels after both Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) surgeries, and (ii) to explore potential associations with changes in body composition variables. Results Twenty-six patients (17 females) with severe obesity underwent SG (n = 13) or RYGB (n = 13) and were followed up to 1 year (1Y). Body weight, FM, FFM, and SCD4 were measured at baseline (BL), and at week 11 (W11) and 1Y after surgery. Independently of procedure, there was a significant body weight loss at W11, with an average FM and FFM reduction of 13.7 ± 0.6 kg and 5.3 ± 0.5 kg, respectively. Participants continued to lose weight afterwards, with a total weigth loss of 38.2 ± 1.5 kg at 1Y. No associations were found at BL between SDC4 levels and any anthropometric variable; however, SDC4 levels were lower than BL at both W11 and 1Y, independently of type of surgery. Additionally, changes in SDC4 between BL and 1Y were positively correlated with weight and FFM loss during the same period. Trial registration ClinicalTrials.gov NCT04051190 on 09/08/2019.

Abstract Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women that is associated with an increased risk of anxiety and depression and with a lower health-related quality of life (HRQoL). PCOS is closely associated with obesity, which per se can lead to symptoms of anxiety and depression and lower HRQoL. The first-line treatment for PCOS is weight loss through lifestyle intervention, which has been shown to improve all symptoms of the syndrome. The aim of this study was to investigate symptoms of anxiety and depression and HRQoL in women with severe obesity (BMI ≥ 35) with and without PCOS, and to evaluate the effect of a one-year structured weight loss intervention. A total of 246 women with severe obesity (PCOS n = 63, non-PCOS n = 183) were included. The comprehensive psychopathological rating scale self-rating scale for affective symptoms (CPRS-S-A) and the short form-36 (SF-36) were used to assess symptoms of anxiety and depression and HRQoL. In total 72 women of the 246 women with severe obesity completed a one-year weight loss programme and were followed up and compared with baseline data. In women with severe obesity, there were no differences in symptoms of anxiety and depression and HRQoL between women with and without PCOS at baseline. Clinically relevant anxiety symptoms were present in 71.3% (PCOS) and 65.6% (non-PCOS), and depression symptoms were present in 56.4% (PCOS) and 52.2% (non-PCOS). Significant weight loss improved physical HRQoL in all women, but reduced symptoms of anxiety and depression only in women without PCOS. There were no differences when comparing the changes between the groups. Women with severe obesity are severely affected by symptoms of anxiety and depression, independent of PCOS. Weight loss improved symptoms of anxiety and depression in women without PCOS, but there were no differences between groups in change from baseline to follow-up. Trial registration number: Clinical trial.gov: NCT01319162, March 18, 2011. Date of registration and enrolment of the first subject September 2011.

The application of a robotic platform in the bariatric surgical field is intended to enhance the already established advantages of minimally invasive surgery in terms of both technical and clinical outcomes. These advantages are especially relevant for technically challenging multiquadrant operations such as Roux-en-Y Gastric Bypass (RYGB). Consequently, robotic-assisted surgery has emerged as a possible application for bariatric surgeries. The study attempts to assess feasibility and safety of the Hugo™-Robotic-Assisted Surgery System (Hugo™-RAS) platform compared to the DaVinci® Surgical System (DaVinci®-SS) with a focus on complication rates and operative times. We retrospectively reviewed bariatric procedures performed from January 2013 until December 2023. We included all robotic RYGBs performed using Hugo™-RAS and DaVinci®-SS platforms. The study utilized Propensity Score Matching (PSM) analysis to address bias in selection, matching patients based on age, gender, body mass index, comorbidities and past abdominal operations. One hundred thirty-five patients were identified: 90 DaVinci®-SS and 45 Hugo™-RAS procedures. After PSM, each group consisted of 45 patients. There was no discernible disparity observed in relation to early (≤ 30 days) postoperative complications rate (p = 1), mean operative time (for docking time, console time and total operative time: p = 0.176, p = 0.678, p = 0.229, respectively) and postoperative hospital stay (p = 0.052) between DaVinci®-RSS and Hugo™-RAS procedures. Our results suggest that application of both Hugo™-RAS and DaVinci®-SS robotic platforms to RYGB is related to comparable safety profiles. Although DaVinci®-SS remains the most widely adopted platform in clinical practice, this study underscores the potential role of the Hugo™-RAS to provide effective solutions in robotic bariatric procedures. [ABSTRACT FROM AUTHOR]

The kinase suppressor of Ras 2 (KSR2) gene is associated with monogenic obesity, and loss-of-function variants in KSR2 have been identified in individuals with severe early-onset obesity. This study investigated KSR2 variants in 9 pediatric patients with severe early-onset obesity in Qatar using whole genome sequencing among a cohort of 240 individuals. We focused on KSR2 variants with a minor allele frequency (MAF) below 1% and a Combined Annotation Dependent Depletion (CADD) score above 13 to identify potential causative variants. Our analysis identified four KSR2 variants: one intronic (c.1765-8G>A) and three missense variants (c.1057G>A, c.1673G>A, and c.923T>C) in nine patients. The intronic variant c.1765-8G>A was the most frequent (seen in six individuals) and had a CADD score of 21.10, suggesting possible pathogenicity. This variant showed a significantly higher allele frequency in the Qatari population compared to the Genome Aggregation Database (gnomAD), indicating a possible founder effect. Molecular modeling of the missense variants revealed structural changes in the protein structure. The study concludes that these four KSR2 variants are associated with monogenic obesity, with an autosomal dominant inheritance pattern. The c.1765-8G>A variant's prevalence in Qatar underscores its importance in genetic screening for severe obesity. This research advances the understanding of genetic factors in severe early-onset obesity and may inform better management strategies. [ABSTRACT FROM AUTHOR]

Glycine is deficient in individuals with obesity but improves following bariatric surgery. Glycine deficiency could impair glutathione (GSH) synthesis and worsen oxidative stress. We examined the impact of obesity-associated glycine deficiency and bariatric surgery on GSH synthesis. Twenty-one participants with severe obesity and twenty-one healthy weight controls were recruited. [1,2-13C2] glycine was infused to measure the erythrocyte (RBC) GSH synthesis rate. Participants with obesity underwent bariatric surgery, and 19 were restudied six months post-surgery. Compared to healthy weight controls, individuals with obesity had significantly lower concentrations of RBC GSH (2.43 ± 0.23 vs. 2.63 ± 0.26 mmol/L, p < 0.01). However, there were no differences in GSH fractional synthesis rate [78.0 (51.4–123.7) vs. 76.9 (49.3–110.1) % pool/day, p = 0.58] or absolute synthesis rate [1.85 (1.25–3.32) vs. 1.92 (1.43–3.03) mmol/L RBC/day, p = 0.97]. Despite a post-surgery increase in glycine concentration, no statistically significant changes in RBC GSH concentration or synthesis rates were detected. Further, the significant correlation between plasma glycine and RBC GSH concentration at baseline (r = 0.46, p < 0.01) was also lost following bariatric surgery. GSH concentration was significantly lower in participants with obesity, but bariatric surgery did not significantly increase GSH concentrations or synthesis rates. [ABSTRACT FROM AUTHOR]

Introduction: The efficacy of liraglutide for treating type 2 diabetes mellitus and obesity is well established, but their role in the treatment of weight regain after bariatric surgery remains unclear. Methods: We searched PubMed, Embase, and Cochrane Library databases in January 2024. A random-effects model was employed to compute mean differences (MD) and events per 100 observations with 95% confidence intervals (CI) for continuous and binary endpoints. Statistical analysis was performed using R software. Results: A total of 16 studies were included and 881 individuals. Patients were mostly female (50%), aged 36 to 55 years, with a mean body mass index (BMI) of 39.4 kg/m2, and had BS surgery 5 years prior. Over a mean follow-up time ranging from 3 months to 4 years, it was observed a statistically significant reduction in BMI (MD − 8.56 kg/m2; 95% CI 3.34 to 13.79; p < 0.01) and a mean reduction in total weight (MD − 16.03 kg; 95% CI 0.03 to 32.02; p = 0.05) after liraglutide use. Additionally, 65% of patients undertaking liraglutide showed total body weight loss (BWL) above 5% (65.8 events per 100 observations; 95% CI 54.96 to 75.20; p < 0.01), while 26% lost more than 10% of total BWL (26.77 events per 100 observations; 95% CI 19.17 to 36.02; p < 0.01). A limitation is a variability between the studies. Conclusions: Our findings support the use of liraglutide for weight management in patients who experience weight regain after BS. Liraglutide is well tolerated and promotes significant weight loss, providing clinicians with a therapeutic option for this clinical challenge. [ABSTRACT FROM AUTHOR]

Background: Bariatric and metabolic surgery (BMS) is an effective treatment for patients with severe obesity. Patients with higher body mass index (BMI) and patients undergoing revisional surgery have a higher rate of major complications. This study purpose is to evaluate perioperative outcomes of patients with BMI ≥ 50 kg/m2. Materials and Methods: A retrospective analysis of patients with a BMI ≥ 50 kg/m2 undergoing BMS between 2015 and 2023 was conducted. A comparative analysis was performed between patients undergoing primary versus revisional surgery. Results: A total of 263 patients were included in the study. Primary procedures were performed in 220 patients (83.7%) and revisional procedures in 43 patients (16.3%). BMS included one anastomosis gastric bypass (n = 183), sleeve gastrectomy (n = 63), and other procedures (n = 17). Mean BMI was 54.6 with no difference between groups. There was no difference in baseline characteristics except the revisional group was older (44.8 ± 9.6 versus 39 ± 13 years; p = 0.006), had higher rates of gastroesophageal reflux disease (21% vs 7.3%; p = 0.005), and fatty liver disease (74% vs 55%; p = 0.02). There was perioperative mortality in three cases (1.1%) with no significant difference between groups. Leak rates were higher, and length of stay (LOS) was longer in the revisional group (4.6% vs 0.45%; p = 0.018 and 2.9 vs 3.7; p = 0.006, respectively). Conclusion: Revisional BMS in patients with a BMI ≥ 50 kg/m2 is associated with increased leak rates and LOS. Mortality rate is 1.1% and is insignificantly different between groups. Further prospective and large-scale studies are needed to clarify the optimal surgical approach to patients with extreme BMI including revisional surgery. [ABSTRACT FROM AUTHOR]

Down syndrome (DS) is associated with several endocrine disorders, including diabetes, obesity, and primary hypogonadism. Here, we present a man with DS who manifested with atypical hypogonadotropic hypogonadism and in whom weight loss resulted in the improvement of hypothalamic GH deficiency. A 27-year-old man with DS and severe obesity was admitted for hypoxia resulting from obesity hypoventilation syndrome. Laboratory tests showed normal levels of LH and FSH despite low testosterone and free testosterone levels. Moreover, thyroid stimulating hormone and prolactin levels were slightly elevated, although a euthyroid function was observed, and GH and IGF-1 levels were low. Endocrinological stimulation tests revealed hypogonadotropic hypogonadism and hypothalamic GH deficiency. Reduction in body weight by 35.3% resulted in the improvement of the IGF-1, thyroid stimulating hormone, and prolactin levels to the reference range, whereas the LH and FSH levels remained low, despite slight elevation. Levels of leptin, which suppresses the hypothalamus-gonadotroph-gonadal axis and upregulates thyrotropin-releasing hormone expression, decreased with weight loss. Furthermore, ghrelin, whose levels increase with weight loss, stimulates GH secretion. Thus, leptin and ghrelin could have contributed to the observed changes in the pituitary hormone profile after weight loss. [ABSTRACT FROM AUTHOR]

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Purpose: The long-term outcomes of patients with staple line leaks (SLL) after SG are under-reported. The purpose of this study is to evaluate the long-term outcomes of patients with SLL after SG. Materials and Methods: A retrospective analysis of a maintained patient registry of patients undergoing SG between January 2012 and December 2020 in a single bariatric center was analyzed and included patients with SLL. Outcomes were compared to a group without SLL. Results: During this period, 1985 patients underwent SG of which 61 patients (3.1%) developed leak. 26 patients (1.3%) had overt SLL and the rest had organ space infection around the staple line. The mean age and body mass index (BMI) were 39.8 ± 11.3 and 41.5 ± 4.7, respectively. 7 patients (11.4%) underwent concomitant surgery and 12 patients (19.7%) had intraoperative complications. Leak was complicated by Clavien-Dindo ≥ 3 in 31 patients (50.8%). Reoperation rate was 27.8% (n = 17). ≥ 2 interventions were required in 26% of patients (n = 16). Two patients died during hospitalization due to septic complications. Long-term follow-up of median 121 months was available in 78% of the cohort (n = 48). The median total weight loss and BMI were 27% and 30.1 kg/m2, respectively. Weight loss outcomes were higher in comparison to patients without SLL. Seven patients (14.6%) underwent SG revision. All associated medical problems improved during follow-up except for gastroesophageal reflux which was found in 50% of cohort. Conclusion: Long-term outcomes of SG patients with SLL are satisfactory in terms of weight loss, resolution of comorbidities, and requirement for surgical revision. [ABSTRACT FROM AUTHOR]

Objective: Bariatric surgery induces a significant loss of both fat mass (FM) and fat-free mass (FFM). The proteoglycan receptor syndecan-4 (SDC4) plays a crucial role in adipose tissue and skeletal muscle functions. Thus, this study was performed (i) to assess plasma SDC4 levels after both Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) surgeries, and (ii) to explore potential associations with changes in body composition variables. Results: Twenty-six patients (17 females) with severe obesity underwent SG (n = 13) or RYGB (n = 13) and were followed up to 1 year (1Y). Body weight, FM, FFM, and SCD4 were measured at baseline (BL), and at week 11 (W11) and 1Y after surgery. Independently of procedure, there was a significant body weight loss at W11, with an average FM and FFM reduction of 13.7 ± 0.6 kg and 5.3 ± 0.5 kg, respectively. Participants continued to lose weight afterwards, with a total weigth loss of 38.2 ± 1.5 kg at 1Y. No associations were found at BL between SDC4 levels and any anthropometric variable; however, SDC4 levels were lower than BL at both W11 and 1Y, independently of type of surgery. Additionally, changes in SDC4 between BL and 1Y were positively correlated with weight and FFM loss during the same period. Trial registration: ClinicalTrials.gov NCT04051190 on 09/08/2019. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a multifactorial disease associated with the development of many comorbidities. This disease is associated with several metabolic alterations; however, it has been shown that some individuals with obesity do not exhibit metabolic syndrome. Adipose tissue neutralizes the detrimental effects of circulating fatty acids, ectopic deposition, and inflammation, among others, through its esterification into neutral lipids that are stored in the adipocyte. However, when the adipocyte is overloaded, i.e., its expansion capacity is exceeded, this protection is lost, resulting in fatty acid toxicity with ectopic fat accumulation in peripheral tissues and inflammation. In this line, this study aimed to investigate whether polymorphisms in genes that control adipose tissue fat storage capacity are potential biomarkers for severe obesity susceptibility and also metabolic complications. Methods: This study enrolled 305 individuals with severe obesity (cases, BMI≥35 kg/m²) and 196 individuals with normal weight (controls, 18.5≤BMI≤24.9 kg/m²). Demographic, anthropometric, biochemical, and blood pressure variables were collected from the participants. Plasma levels of leptin, resistin, MCP1, and PAI1 were measured by Bio-Plex 200 Multiplexing Analyzer System. Genomic DNA was extracted and variants in DBC1 (rs17060940), SIRT1 (rs7895833 and rs1467568), UCP2 (rs660339), PPARG (rs1801282) and ADRB2 (rs1042713 and rs1042714) genes were genotyped by PCR allelic discrimination using TaqMan® assays. Results: Our findings indicated that SIRT1 rs7895833 polymorphism was a risk factor for severe obesity development in the overdominant model. SIRT1 rs1467568 and UCP2 rs660339 were associated with anthropometric traits. SIRT1 rs1467568 G allele was related to lower medians of body adipose index and hip circumference, while the UCP2 rs660339 AA genotype was associate with increased body mass index. Additionally, DBC1 rs17060940 influenced glycated hemoglobin. Regarding metabolic alterations, 27% of individuals with obesity presented balanced metabolic status in our cohort. Furthermore, SIRT1 rs1467568 AG genotype increased 2.5 times the risk of developing metabolic alterations. No statistically significant results were observed with Peroxisome Proliferator-Activated Receptor Gama and ADRB2 polymorphisms. Discussion/Conclusion: This study revealed that SIRT1 rs7895833 and rs1467568 are potential biomarkers for severe obesity susceptibility and the development of unbalanced metabolic status in obesity, respectively. UCP2 rs660339 and DBC1 rs17060940 also showed a significant role in obesity related-traits. [ABSTRACT FROM AUTHOR]

Summary: The determination of energy requirements in clinical practice is based on basal metabolic rate (BMR), frequently predicted by equations that may not be suitable for individuals with severe obesity. This systematic review and meta‐analysis examined the accuracy and precision of BMR prediction equations in adults with severe obesity. Four databases were searched in March 2021 and updated in May 2023. Eligible studies compared BMR prediction equations with BMR measured by indirect calorimetry. Forty studies (age: 28–55 years, BMI: 40.0–62.4 kg/m2) were included, most of them with a high risk of bias. Studies reporting bias (difference between estimated and measured BMR) were included in the meta‐analysis (n = 20). Six equations were meta‐analyzed: Harris & Benedict (1919); WHO (weight) (1985); Owen (1986); Mifflin (1990); Bernstein (1983); and Cunningham (1980). The most accurate and precise equations in the overall analysis were WHO (−12.44 kcal/d; 95%CI: −81.4; 56.5 kcal/d) and Harris & Benedict (−18.9 kcal/d; 95%CI ‐73.2; 35.2 kcal/d). All the other equations tended to underestimate BMR. Harris & Benedict and WHO were the equations with higher accuracy and precision in predicting BMR in individuals with severe obesity. Additional analyses suggested that equations may perform differently according to obesity BMI ranges, which warrants further investigation. [ABSTRACT FROM AUTHOR]

Summary: Nearly 90 clinicians and researchers from around the world attended the first IMPROVE 2022 International Meeting on Pathway‐Related Obesity. Delegates attended in person or online from across Europe, Argentina and Israel to hear the latest scientific and clinical developments in hyperphagia and severe, early‐onset obesity, and set out a vision of excellence for the future for improving the diagnosis, treatment, and care of patients with melanocortin‐4 receptor (MC4R) pathway‐related obesity. The meeting co‐chair Peter Kühnen, Charité Universitätsmedizin Berlin, Germany, indicated that change was needed with the rapidly increasing prevalence of obesity and the associated complications to improve the understanding of the underlying mechanisms and acknowledge that monogenic forms of obesity can play an important role, providing insights that can be applied to a wider group of patients with obesity. World‐leading experts presented the latest research and led discussions on the underlying science of obesity, diagnosis (including clinical and genetic approaches such as the role of defective MC4R signalling), and emerging clinical data and research with targeted pharmacological approaches. The aim of the meeting was to agree on the questions that needed to be addressed in future research and to ensure that optimised diagnostic work‐up was used with new genetic testing tools becoming available. This should aid the planning of new evidence‐based treatment strategies for the future, as explained by co‐chair Martin Wabitsch, Ulm University Medical Center, Germany. [ABSTRACT FROM AUTHOR]

Background: Obesity is a chronic inflammatory disorder that increases the risk of cardiovascular diseases (CVDs). Given the high CVD mortality rate among individuals with obesity, early screening should be considered. Plasminogen activator inhibitor (PAI-1), a cytokine that links obesity and CVDs, represents a promising biomarker. However, PAI-1 is not part of the clinical routine due to its high cost. Therefore, it is necessary to find good predictors that would allow an indirect assessment of PAI-1. Methods: This study enrolled 47 women with severe obesity (SO). The obtained anthropometric measurements included weight, height, neck (NC), waist (WC), and hip circumference (HC). Blood samples were collected to analyse glucose and lipid profiles, C-reactive protein, liver markers, adiponectin, and PAI-1 (determined by ELISA immunoassay). Homeostasis model assessment-adiponectin (HOMA-AD), homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), triglyceride–glucose index (TyG), and atherogenic index of plasma (AIP) were calculated. The women were grouped according to PAI-1 levels. The data were analysed using IBM SPSS Statistics, version 21. The significance level for the analysis was set at 5%. Results: Women with SO who have higher levels of PAI-1 have lower values of high-density lipoprotein cholesterol (HDL) (p = 0.037) and QUICKI (0.020) and higher values of HOMA-AD (0.046) and HOMA-IR (0.037). HOMA-IR was demonstrated to be a good predictor of PAI-1 in this sample (B = 0.2791; p = 0.017). Conclusions: HOMA-IR could be used as a predictor of PAI-1 levels, pointing out the relevance of assessing glycaemic parameters for the prevention of CVDs in women with SO. [ABSTRACT FROM AUTHOR]

Introduction: Metabolic syndrome (MS) is linked to oxidative stress and intracellular redox imbalance, both triggered by chronic inflammatory conditions. The aim of our research was to figure out if bariatric surgery changes the production of free radicals in obese people. In addition, the relationship between metabolic syndrome(MS) and associated conditions is represented by oxidative stress (OS) and intracellular redox imbalance, both of which are induced by the chronic inflammatory conditions that define MS.

Background: The aim of this study was to explore the association between long-term exposure to particulate matter with an aerodynamic diameter 2.5) and its components and severe obesity in children and adolescents. Methods: Data for children and adolescents aged 9–18 in this cross-sectional study were obtained from the 2019 Chinese National Survey on Students’ Constitution and Health (CNSSCH). Data for PM2.5 and its components were obtained from the Tracking Air Pollution in China (TAP) dataset and matched with information on these children. Logistic regression models were used to assess the risk of severe obesity associated with long-term exposure to PM2.5 and its components. Results: A total of 160,205 children were included in the analysis. Long-term exposure to PM2.5 may increase the odds of severe childhood obesity, with this effect being more pronounced in girls. Among boys, the component with the most significant impact on severe obesity was organic matter (OM). The impact of PM2.5 and its components on severe obesity was greater in children from low economic and low parental education level households. Children with unhealthy lifestyle habits have higher odds of severe obesity due to long-term exposure to PM2.5 and its components. Conclusions: The findings of this research support the development of strategies aimed at addressing severe obesity in children, suggesting that adopting healthy lifestyle practices could mitigate the odds of severe obesity due to PM2.5 and its components. There is a need for an increased focus on children in economically underdeveloped areas and those with unhealthy lifestyle habits, particularly those in rural areas and those who do not engage in adequate physical activity or get enough sleep.

Background: Social disadvantage is associated with childrens risk of being overweight or obese, but little is known about how it impacts weight trajectory. This longitudinal analysis examines food insecurity and weight change over time among low-income children in a multidisciplinary weight management clinic. Methods: Food insecurity was assessed between 2008 and 2016 among 794 low-income patients (household income