Background
Large neutral amino acids (LNAAs) and gut microbial metabolites have been linked to insulin secretion and resistance. We investigated whether baseline LNAAs and kynurenine pathway ...metabolites and changes in tryptophan-derived gut microbial metabolites (TDGMs), such as indole compounds, were associated with improvements in insulin secretion and resistance after sleeve gastrectomy.
Methods
In this prospective single-arm longitudinal study, 23 patients with type 2 diabetes underwent sleeve gastrectomy. Twelve diabetes-related amino acid metabolites were quantified before surgery, and the following three indices were assessed as outcome measures: insulinogenic index, homeostasis model assessment–insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI). We also measured changes in TDGMs, including four indole compounds, 3 months after bariatric surgery. A linear regression model and receiver operating characteristic curves were assessed.
Results
The mean age and body mass index of study participants were 41.8 years (standard deviation (SD), 13.1 years) and 38.9 kg/m
2
(SD, 5.2 kg/m
2
), respectively. Several baseline amino acid metabolites were significantly associated with a change in insulin secretion or resistance 3 months after bariatric surgery. Phenylalanine and LNAAs showed superior performance for predicting improvements in insulin secretion and resistance. Among the TDGMs, Δindole-3-propionic acid was significantly associated with the Δinsulinogenic index, and Δindole-3-acetic acid was significantly associated with the ΔHOMA-IR and ΔQUICKI.
Conclusions
Our findings underscore the importance of baseline amino acid profiles, especially those of LNAAs and phenylalanine, and alterations in TDGMs for improving insulin secretion and resistance in the early postoperative period after sleeve gastrectomy.
Majority of dietary intake in US adults comes from ultra-processed foods (UPFs), which have been linked to several adverse health outcomes. Gallstone disease is highly prevalent and constitutes a ...significant burden to the US health system but remains understudied.
This study aims to investigate the association between UPF consumption and incident gallstone disease risk.
In this analysis, 44,149 males in the Health Professionals’ Follow-up Study (HPFS: 1986–2022), 71,145 females in the Nurses’ Health Study (NHS: 1986–2021) & 90,932 females in the Nurses’ Health Study II (NHS II: 1991–2021) were prospectively followed. Dietary intake was quadrennially assessed with semi-quantitative food frequency questionnaires and used to identify UPFs. The primary outcome was defined as cholecystectomy. Cox proportional hazards model was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).
Baseline median age was 54y in HPFS, 53y in NHS and 36y in NHS II. We identified 32,374 incident gallstone disease cases over 5,077,059 person-years. Participants in the highest UPF quintile had a higher incidence of gallstone disease compared to those in the lowest quintile (aHR: 1.29, 95% CI: 1.24–1.36, p<0.001). The incremental risk of incident gallstone disease was 2.8% per daily serving (95% CI: 2.4%–3.2%, p<0.001). This risk was driven by sugar-sweetened beverages and artificially-sweetened beverages on UPF subgroup-analyses. The proportion of risk mediated by obesity was 12.8% (95% CI: 7.7%–20.5%, p <0.001) in HPFS, 14.3% (95% CI: 10.4%–19.4%, p<0.001) in NHS and 39.4% (95% CI: 31.2%–48.1%, p<0.001) in NHS II. The partial population attributable risk was estimated at 15.9% (95% CI: 13.4%–18.3%).
UPF consumption is associated with a higher risk of gallstone disease, particularly consumption of sugar-sweetened beverages and artificially-sweetened beverages. A substantial proportion of this risk is potentially mediated by obesity in younger females.
IntroductionThe effects of bone marrow cell (BMC) therapy in patients with chronic ischemic heart disease (CIHD) remain controversial.HypothesisWe hypothesized that injection of BMCs in patients with ...CIHD would improve left ventricular (LV) structure and function. We also hypothesized that BMC therapy would improve clinical outcomes in CIHD patients.MethodsWe performed a systemic review and meta-analysis of pooled data from published randomized controlled trials (RCTs) that evaluated the efficacy of BMC administration in patients with CIHD. The effects of BMC injection on LV ejection fraction (LVEF), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), infarct size, and patient outcomes were analyzed using random-effects meta-analysis.ResultsThe literature search yielded 30 RCTs enrolling 1,548 patients. Transplantation of BMCs resulted in an improvement in LVEF in cell-treated patients compared with controls (2.89%; 95% confidence interval (CI)1.80 to 3.97; P<0.001). There was a trend toward reduced LVESV (-4.96 ml; 95% CI-11.64 to 1.71 ml; P= 0.14) and LVEDV (-5.95 ml; 95% CI-12.09 to 0.18 ml; P=0.06). The improvement in LVEDV was more pronounced (-7.42 ml; 95% CI-13.68 to -1.17ml; P=0.02) in patients with baseline LVEF <40%, indicating improved LV remodeling. BMC injection was also associated with marked reduction in the risk of all-cause mortality, rehospitalization due to heart failure, and ventricular arrhythmias in CIHD patients.ConclusionsBMC injection improves cardiac function and remodeling in patients with CIHD. These benefits are more pronounced in patients with LVEF <40% at baseline. Perhaps more importantly, BMC therapy also improves clinical outcomes that are critically important for this patient population with LV dysfunction, including survival, rehospitalization due to heart failure, and ventricular arrhythmias.
Patients with gastric cancer (GC) experience 2 characteristic treatment modalities (gastrectomy or endoscopic resection), which may induce heterogeneity in the risk of post-cancer treatment type 2 ...diabetes (T2D). We investigated differences in the risk for T2D development in survivors of GC according to the 2 treatment methods.
This retrospective nationwide population-based cohort study included 14,646 patients with GC who underwent gastrectomy (n = 12,918) or endoscopic resection (n = 1,728). We enrolled patients who survived for at least 5 years after gastrectomy or endoscopic resection, had no history of diabetes, and had not received adjuvant chemotherapy. T2D risk was evaluated using Cox regression for the gastrectomy group and compared to that of the endoscopic resection group. Because of the competing risks of incident T2D and death, a competing risk regression was performed.
After a median follow-up duration of 8.1 years, the incidence rates of T2D in the endoscopic resection group and gastrectomy group were 7.58 and 6.98 per 1,000 person-years, respectively. Patients undergoing gastrectomy showed a significantly higher risk for developing T2D than patients undergoing endoscopic resection (hazard ratio HR, 1.37; 95% CI 1.18 to 1.58; p < 0.0001). In subgroup analyses, gastrectomy was associated with increased T2D risk in female patients (HR, 1.72; 95% CI 1.22 to 2.43; p = 0.030 for interaction).
Among GC survivors, patients undergoing gastrectomy showed a 37% increased risk of T2D development compared to patients undergoing endoscopic resection. Subgroup analyses showed that T2D risk increased by up to 72% in female patients. These results provide insights for establishing screening and preventive strategies for GC survivors to prevent T2D according to different treatment modalities.
Gastrectomy for gastric cancer is associated with postoperative changes in cardiovascular risk factors, however, the impact of gastrectomy on cardiovascular events remains unclear. We assessed the ...incidence of cardiovascular events between patients undergoing gastrectomy or endoscopic resection for gastric cancer, and the general population.
This retrospective nationwide cohort study included patients with gastric cancer undergoing gastrectomy(n=37,698), endoscopic resection(n=2,773), and matched control population(n=161,887) between 2004 and 2013. We included patients without a history of cancer other than gastric cancer, myocardial infarction, or ischemic stroke. The primary outcome was the incidence of major adverse cardiovascular events (MACE) such as acute myocardial infarction, revascularization, or acute ischemic stroke, in patients with gastric cancer.
Among patients who underwent gastrectomy for gastric cancer, 2.9% (4.69 per 1000 person-years) developed novel MACE within the seven-year follow-up period. The gastrectomy group demonstrated a significantly decreased risk for MACE than the control population (hazard ratioHR, 0.65; 95% confidence intervalCI, 0.61-0.69; P <0.001). Among the patients undergoing endoscopic resection for gastric cancer, 5.4% (8.21 per 1000 person-years) developed novel MACE within the seven-year follow-up period. The risk for MACE in the endoscopic resection group was not significantly different from the control population.
Patients with gastric cancer who have undergone gastrectomy exhibit a reduced risk of cardiovascular diseases in comparison to the general population. In contrast, the risk for cardiovascular diseases in patients with gastric cancer who underwent endoscopic resection did not demonstrate a significant difference in cardiovascular risk in comparison to the general population.
Summary
Although Roux‐en‐Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most prevalent bariatric surgical procedures, high‐level evidence is scarce regarding the assessment of ...postoperative nutritional risk in RYGB versus SG. Therefore, we performed a systematic review and meta‐analysis to compare the risk of anemia and related micronutrient deficiencies after RYGB and SG. We analyzed 10 randomized controlled trials that compared RYGB and SG with reported incidence of postoperative anemia and/or anemia‐related micronutrient deficiencies (iron, vitamin B12, or folate). There were no significant differences in the risk of postoperative anemia (moderate level of evidence), iron deficiency (high level of evidence), or folate deficiency (moderate level of evidence). Patients undergoing RYGB had a higher risk of postoperative vitamin B12 deficiency than those undergoing SG (relative risk, 1.86; 95% confidence interval, 1.15–3.02; p = 0.012; high level of evidence). Our findings imply that patients undergoing RYGB require more stringent vitamin B12 supplementation and surveillance than those undergoing SG. Additionally, our results may aid patients with high concern for anemia and related micronutrient deficiencies in making informed decisions regarding surgical methods based on nutritional risk.
Summary
The micronutrient status and optimal monitoring schedule after bariatric surgery have not been sufficiently assessed. This systematic review and meta‐analysis investigated the longitudinal ...changes in micronutrient status after bariatric surgery. PubMed, EMBASE, and Cochrane Library were searched for articles that measured preoperative and postoperative serum micronutrient levels in patients undergoing Roux‐en‐Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Among guideline‐adherent studies, the longitudinal changes in micronutrient status were investigated using weighted mean difference (WMD) using a random‐effects model. Among the 82 included studies, the guideline adherence rates for micronutrient supplementation after bariatric surgery did not exceed 20%. In patients supplemented per guidelines, vitamin A significantly decreased after RYGB by −7.54 (95% confidence interval CI, −10.16 to −4.92) μg/dl at 12–23 months, vitamin E decreased after RYGB by −2.35 (95% CI, −3.65 to −1.05) μg/dl at ≥24 months, and ferritin by −54.93 (95% CI, −77.19 to −32.67 μg/L at ≥24 months after SG, compared with baseline, with moderate level of evidence. Significant decreases in micronutrient levels at certain follow‐up intervals in studies with supplementation per guidelines need to be considered to establish a post‐bariatric micronutrient monitoring schedule for timely detection and management of micronutrient deficiencies.
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