Background
Many patients complain of nutritional symptoms after bariatric surgery (BS), including hair loss, cramps, and paresthesia, but their link with biological alterations has been poorly ...studied.
Objectives
To assess in a large cohort of subjects the relationship between nutritional symptoms and biological deficits both in the short term (ST ≤ 1 year) and long term (LT ≥ 3 years) after the 2 most common procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).
Methods
Nutritional symptoms and biological parameters (including vitamins, minerals, and protein parameters) were prospectively recorded. All subjects with complete clinical and biological assessments from 2011 to 2018 were included.
Results
After BS, 555 subjects were studied in the ST (50% RYGB) and 494 in the LT (79% RYGB); multivitamin intake was 97% and 78%, respectively. The proportion of patients with hair loss decreased from 65 (ST) to 35% (LT) (
p
< 0.001). In contrast, cramps increase from 7 to 32% and paresthesia from 11 to 18% (
p
< 0.001). No significant difference was found between SG and RYGB. In subjects with hair loss, blood parameters of protein and iron metabolism were significantly lower than in subjects without hair loss, both in the ST and LT. In contrast, neither zinc nor group B vitamin levels were significantly different. None of the nutritional parameters tested was clearly associated with cramps and paresthesia.
Conclusion
After BS, the most frequent nutritional symptom is hair loss, essentially linked to iron and protein deficiencies. The causes of other nutritional symptoms are less clear and probably more heterogeneous.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
One anastomosis gastric bypass (OAGB) may expose the patient to certain specific complications. Here, we report the results of conversion of OAGB to Roux-en-Y gastric bypass (RYGB) in ...terms of outcomes and weight loss.
Methods
Between January 2009 and January 2019, all patients undergoing conversion of OAGB to RYGB because of complications due to OAGB (
n
= 23) were included. The primary efficacy endpoint was the effectiveness of converting OAGB to RYGB. The secondary endpoints were overall mortality and morbidity during the first 3 postoperative months, specific morbidity, reoperation, length of hospitalization, weight loss, and progression of comorbidities related to obesity at 2-year follow-up.
Results
Indications for conversion were bile reflux (
n
= 14; 60.9%), severe malnutrition (
n
= 3; 13%), gastro-gastric fistula (
n
= 4; 17.4%), and anastomotic leak (
n
= 2; 8.7%). The median time interval between OAGB and conversion to RYGB was 34 months (0–158). At the time of RYGB, median body mass index (BMI) was 28.0 kg/m
2
(18.2–50.7), representing a median BMI change of 14.0 (− 1.7–43.5). Fifteen surgeries (65.1%) were completed laparoscopically. Five complications (21.7%) were recorded, including 2 major ones (8.7%). Reoperation rate was 4.3% (
n
= 1). At 24 months of follow-up (
n
= 18; 78.3%), median BMI was 28.7 kg/m
2
(19.4–35.4), representing a median BMI change of 19.5 (12.2–43.1). No patient complained of bile reflux or persistent malnutrition.
Conclusion
RYGB performed as revisional surgery for complications after OAGB is an effective procedure with no major weight regain at 2 years of follow-up.
Graphical abstract
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Several studies reported a risk of nutritional deficiencies after sleeve gastrectomy (SG). Systematic long-term multivitamin (MV) supplementation after SG is recommended by guidelines but ...not followed in practice in France.
Objectives
To assess the determinants of nutritional status at 2 years or more after SG in patients treated or not with MV.
Methods
Nutritional parameters were prospectively recorded in our database from 2004. All patients who came back in our institution for follow-up at 2 years or more after SG were included. The last visit available was selected. Systematic MV was stopped at 1 year after SG except if there is risk of malnutrition. A deficiency was defined by a biological deficit or the need for a specific supplement, prescribed in accordance with biological deficit.
Results
One hundred forty-seven patients were included with a mean follow-up of 44 ± 17 months: 39 were still taking MV and 108 had stopped MV. Caloric and protein intake was lower, and albumin deficiencies were more frequent in patients still taking MV, as expected. The total number of deficiencies was not significantly different before and after SG even in patients without MV (3.7 ± 1.8 vs. 3.5 ± 1.8), but patients without MV tended to have more group B vitamin deficiencies after surgery. The main determinants of postoperative deficiencies were preoperative concentrations.
Conclusion
Nutritional deficiencies are not more common after than before SG, even among patients who stopped MV. The interest of targeted supplementation in patients with deficiencies rather than systematic supplementation after SG needs to be confirmed by randomized studies.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Although the risk of cholelithiasis (CL) increases in patients after Roux-en-Y gastric bypass (RYGB), no prospective study has yet assessed the incidence of CL after sleeve gastrectomy (SG).
To ...compare, prospectively, the incidence and predictive factors for CL after both procedures.
A postoperative abdominal ultrasound follow-up was proposed to all patients with an intact gallbladder and who underwent RYGB or SG in Hôpital Louis Mourier from 2008 onward.
At least one ultrasound was performed on one hundred and sixty patients between 6 and 12 months postsurgery, 43 after SG and 117 after RYGB. Age, gender, initial body-mass index, co-morbidities were similar in both groups. Weight loss (WL) at 6 months was significantly lower after SG than after RYGB (26.9 ± 9.2 and 31.3 ± 7.5 kg, respectively = .001). The incidences of CL after SG and RYGB were similar (28% versus 34% respectively, P = .57). Most cases of CL occurred in the first year post surgery. During the follow-up, 12% and 13% of patients who underwent SG and RYGB, respectively, became symptomatic. WL of>30 kg at 6 months was a risk factor for CL after bariatric surgery, but we did not find any preoperative predictive factor for gallstone formation.
Despite lower WL after SG, the incidence of CL after SG and RYGB was similar at 2 years. Our results suggest that rapid WL is the main element leading to gallstone formation after both procedures.
Prader-Willi syndrome (PWS) is characterized by early-onset hyperphagia and increased circulating levels of the orexigenic Acylated Ghrelin (AG) hormone with a relative deficit of Unacylated Ghrelin ...(UAG). AZP-531, a first-in-class UAG analog, was shown to inhibit the orexigenic effect of AG in animals, to improve glycemic control and decrease body weight in humans. We aimed to investigate the safety and efficacy of AZP-531 in patients with PWS for whom no approved treatment for hyperphagia is currently available.
Multi-center, randomized, double-blind, placebo-controlled trial. Forty-seven patients with genetically confirmed PWS and evidence of hyperphagia received daily subcutaneous injections of AZP-531 (3 and 4 mg for 50-70 kg and >70 kg body weight, respectively) or matching placebo for 14 days. Assessments included adverse events, vital signs, safety laboratory tests, the Hyperphagia Questionnaire (HQ), patient-reported appetite, body composition and glycemic measures.
AZP-531 was well tolerated. There was a significant improvement with AZP-531 versus placebo in the mean total score, the 9-item score and the severity domain score of the HQ (p < .05). The highest reduction in the total and 9-item scores was observed in AZP-531 subjects with the highest hyperphagia score at baseline. Findings were supported by a reduction in appetite scores observed with AZP-531 only. Body weight did not change in both groups while a significant reduction in waist circumference and fat mass was observed only with AZP-531. AZP-531 significantly decreased post-prandial glucose levels in a baseline glucose dependent fashion.
AZP-531 may constitute a new treatment strategy to improve hyperphagia and metabolic issues in patients with PWS. These findings support further investigation in longer-term clinical trials.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Bariatric surgery has an impact on subsequent pregnancies, in particular an association between gastric bypass and small for gestational age. Knowledge is lacking on whether sleeve gastrectomy is ...associated with more favorable pregnancy outcomes. This study aimed to compare the impact of sleeve gastrectomy and Roux-en-Y gastric bypass on the incidence of small for gestational age (SGA), and of adverse pregnancy outcomes.
We conducted a retrospective study in a single reference center, including all patients with a history of sleeve or bypass who delivered between 2004 and 2021 after their first pregnancy following bariatric surgery. We compared the incidence of SGA, intrauterine growth retardation, preterm delivery and adverse maternal outcomes between patients who had sleeve versus bypass.
Of 244 patients, 145 had a sleeve and 99 had a bypass. The proportion of SGA < 10th percentile did not differ between the two groups (38/145 (26.2 %) vs 22/99 (22.22 %), respectively, p = 0.48). Preterm birth < 37 WG was lower in the sleeve group (5/145 (3.45%) vs 12/99 (12.12 %) in the bypass group (p = 0.01), as well as NICU hospitalizations (3 (2.07%) vs 12/99 (12.12%), p < 0.01). There was no difference regarding adverse maternal outcomes such as gestational diabetes and hypertensive complications. The proportion of SGA was not lower in patients with bypass when adjusting for other risk factors (BMI, smoking, geographic origin, diabetes and hypertension) (aOR 0.70; 95%CI 0.01 – 2.85).
sleeve was associated with an incidence of SGA which was as high as after bypass, however the incidence of preterm birth was lower.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Patients with diabetes and obesity are populations at high-risk for severe COVID-19 outcomes and have shown blunted immune responses when administered different vaccines. Here we used the ‘ANRS0001S ...COV-POPART’ French nationwide multicenter prospective cohort to investigate early humoral response to COVID-19 vaccination in the sub-cohort (‘COVPOP OBEDIAB’) of patients with obesity and diabetes.
Patients with diabetes (n = 390, type 1 or 2) or obesity (n = 357) who had received two vaccine doses and had no history of previous COVID-19 infection and negative anti-nucleocapsid (NCP) antibodies were included and compared against healthy subjects (n = 573). Humoral response was assessed at baseline, at one month post-first dose (M0) and one-month post-second dose (M1), through percentage of responders (positive anti-spike SARS-CoV-2 IgG antibodies (Sabs), geometric means of Sabs; BAU/mL), proportion of individuals with anti-RBD antibodies, and proportion of individuals with anti-SARS-CoV-2-specific neutralizing antibodies (Nabs). Potential clinical and biological factors associated with weak response (defined as Sabs < 264 BAU/mL) and presence of non-reactive anti-RBD antibodies at M1 were evaluated. Univariate and multivariate regressions were performed to estimate crude and adjusted coefficients with 95 % confidence intervals. Poor glycemic control was defined as HbA1c ≥ 7.5 % at inclusion.
Patients with diabetes, particularly type 2 diabetes, and patients with obesity were less likely to have positive Sabs and anti-RBD antibodies after the first and second dose compared to controls (p < 0.001). At M1, we found Sabs seroconversion in 94.1 % of patients with diabetes versus 99.7 % in controls, anti-RBD seroconversion in 93.8 % of patients with diabetes versus 99.1 % in controls, and Nabs seroconversion in 95.7 % of patients with diabetes versus 99.6 % in controls (all p < 0.0001). Sabs and anti-RBD seroconversion at M0 and M1 were also significantly lower in obese patients than controls, at respectively 82.1 % versus 89.9 % (p = 0.001; M0 Sabs), 94.4 % versus 99.7 % (p 0.001; M1 Sabs), 79.0 % vs 86.2 % (p = 0.004 M0 anti-RBD), and 96.99 % vs 99.1 % (p = 0.012 M1 anti-RBD). The factors associated with low vaccine response (BAU < 264/mL) in patients with diabetes were chronic kidney disease (adjusted OR = 6.88 1.77;26.77, p = 0.005) and poor glycemic control (adjusted OR = 3.92 1.26;12.14, p = 0.018). In addition, BMI ≥ 40 kg/m2 was found to be associated with a higher vaccine response (adjusted OR = 0.10 0.01;0.91, p = 0.040) than patients with BMI < 40 kg/m2.
COVID-19 vaccine humoral response was lower in patients with obesity and diabetes one month after second dose compared to controls, especially in diabetic patients with CKD or inadequate glycemic control. These findings point to the need for post-vaccination serological checks in these high-risk populations.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In the last 20 years, substantial improvements have been made in the diagnosis, treatment and management of patients with Prader-Willi syndrome (PWS). Few data on causes of death are available since ...those improvements were made. Our study assessed the causes of death among French patients with PWS over the first 11 years of experience of the nationwide French Reference Center for PWS (FRC-PWS).
Our study relied on two sources of mortality information at national level between 2004 and 2014: The French Epidemiological Centre for the Medical Causes of Death (CépiDc) Registry and the FRC-PWS database. Causes of death were classified into seven categories: respiratory, cardiovascular, gastrointestinal, severe infection, sudden death, other causes, and unknown. Descriptive statistics were calculated separately for children (< 18 years-old) and adults (≥18 years-old).
One hundred and four deaths were identified in France from 2004 to 2014. The median age at death was 30 years, ranging from less than 1 month to 58 years. Seventeen deaths occurred in patients under 18 years, with 70% of them in children under 2 years. Respiratory causes accounted for more than 50% of the deaths in patients with PWS in both children and adults. Both cause and age of death did not significantly differ according to gender or genetic subtype.
Patients with PWS die prematurely due to a respiratory cause in most cases at all ages. In those adult patients with data on obesity, 98% were reported to be obese.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background Bariatric surgery is known to improve some pregnancy outcomes, but there is concern that it may increase the risk of small for gestational age. Objective To assess the impact of bariatric ...surgery on pregnancy outcomes and specifically of the type of bariatric surgery on the risk of fetal growth restriction. Study Design A single-center retrospective case-control study. The study group comprised all deliveries in women who had undergone bariatric surgery. To investigate the effects of weight loss on pregnancy outcomes, we compared the study group with a control group matched for presurgery body mass index. Secondly, to assess the specific impact of the type of surgery on the incidence of fetal growth restriction in utero, we distinguished subgroups with restrictive and malabsorptive bariatric surgery, and compared outcomes for each of these subgroups with a second control group, matched for prepregnancy body mass index. Results Among 139 patients operated, 58 had a malabsorptive procedure (gastric bypass) and 81 a purely restrictive procedure (72 a gastric banding and 9 a sleeve gastrectomy). Compared with controls matched for presurgery body mass index, the study group had a decreased rate of gestational diabetes (12% vs 23%, P = .02) and large for gestational age >90th percentile (11% vs 22%, P = .01) but an increased rate of small for gestational age <10th percentile. The incidence of small for gestational age was higher after gastric bypass (29%) than it was after restrictive surgery (9%) or in controls matched for prepregnancy body mass index (6%) ( P < .01 between bypass and controls). In multivariable analysis, after adjustment for other risk factors, gastric bypass remained strongly associated with small for gestational age (adjusted odds ratio, 7.16; 95% confidence interval, 2.74–18.72). Conclusion Malabsorptive bariatric surgery was associated with an increased risk of fetal growth restriction.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Prader-Willi syndrome (PWS) is a neurodevelopmental disorder with hypothalamic dysfunction leading to obesity and behavioral disabilities, including eating disorders (EDs). We evaluated the effects ...of the COVID-19 infection and lockdown on mental and physical health in PWS. At the end of April, 85 adults with PWS completed a self-administered questionnaire, including lockdown conditions, physical activity (PA), ED, and medical and behavioral outcomes. Body weight was measured at home and self-reported.
Patients (52.9% women, 44.8% disomic) were assessed, with a mean age of 28.05 ± 8.73 years and body mass index (BMI) of 36.76 ± 10.74 kg/m
. Seventy percent lived in the Paris region (France) and were confined with their parents. The mean weight change was 0.96 ± 3.28 kg. We compared patients showing weight loss (n = 39, - 3.30 ± 2.93 kg) to patients showing weight gain (n = 22, + 2.35 ± 1.54 kg): the BMI was lower (34.60 ± 9.18 versus 40.45 ± 9.45 kg/m
, p = 0.02), PA increased (25.6% versus 4.5%, p = 0.04), and EDs improved (51.3% versus 13.6%, p = 0.005). Behavioral disorders increased for 12.9% of the cohort. Three individuals (3.5%) were diagnosed with non-severe COVID-19.
Lockdown during the COVID-19 pandemic was associated with positive effects for most French adults with PWS, with weight loss probably associated with a more favourable environment during this period. We observed no severe forms of COVID-19.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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