Search Results (269)

Background/Objectives: Obesity affects over 40% of solid organ transplant candidates, increasing graft complications. Bariatric surgery remains underutilized in this population due to safety concerns. We sought to evaluate predictors of graft success among patients with and without a history of bariatric surgery. Methods: We utilized the Nationwide Inpatient Sample (2015–2020) to identify adult solid organ transplant recipients with or without a history of bariatric surgery. Propensity score matching (2:1) was performed. The primary outcome was a composite of graft-related complications, including acute or chronic rejection, graft failure, and organ-specific transplant complications. Results: Among 196,871 transplant recipients, 2670 (1.4%) had a bariatric surgery history. After matching, 2530 bariatric surgery patients (age 55.6 ± 11.3 years, 37.5% female, 29.0% obese) were compared with 4817 controls (age 56.3 ± 13.9 years, 36.0% female. 29.1% obese). Bariatric surgery patients had significantly lower composite graft complications (7.7% vs. 10.5%; p < 0.001), driven by reductions in chronic graft rejection (2.1% vs. 3.1%; p = 0.01), kidney complications (6.2% vs. 8.4%; p < 0.001), and pancreas complications (0.2% vs. 0.6%; p = 0.004). Multivariate analysis showed bariatric surgery was independently associated with 23% reduced odds of graft complications (OR 0.77; 95% CI 0.61–0.96; p = 0.02). Conclusions: Bariatric surgery was independently associated with reduced graft-related complications in solid organ transplant recipients, supporting its role in improving post-transplant outcomes. Future studies should define the optimal timing of bariatric surgery relative to transplantation. Full article

Both obesity and chronic kidney disease (CKD) are increasingly recognized as global epidemics. Their escalating incidence and far-reaching health implications highlight the urgent need for comprehensive prevention and management strategies. This review aims to clarify how obesity interacts with end-stage kidney disease (ESKD) and how to improve the management of obese patients receiving kidney replacement therapy. It also explores underlying mechanisms, current treatments, future directions, and ongoing controversies. By highlighting this intricate relationship, the review seeks to enhance clinical practice and promote further research toward more personalized care for this vulnerable population. Obesity is frequent in dialysis patients and creates challenges related to body composition, metabolism, and treatment. While higher body mass index (BMI) may appear to improve survival, this paradox does not offset the cardiovascular and functional risks of visceral and sarcopenic obesity. Obesity also increases post-transplant complications and can limit access to transplantation. Lifestyle changes rarely achieve lasting weight loss, whereas bariatric surgery—especially sleeve gastrectomy—can improve transplant eligibility with fewer complications. Weight-loss medications may be used before transplantation but remain insufficiently studied in ESKD. After transplantation, weight-reduction efforts should continue, with pharmacotherapy preferred over bariatric surgery. Comprehensive assessment strategies and individualized management approaches in ESKD patients are essential to optimize outcomes in this growing patient population. Full article

Background/Objectives: Obesity is associated with cognitive decline, and metabolic bariatric surgery (MBS) can improve both physical and cognitive outcomes. However, cognitive improvements post-surgery are variable. This study explores the role of skeletal muscle health, specifically muscle strength and mass, in cognitive performance after MBS, aiming to identify factors that influence cognitive recovery. Methods: In this prospective study, 55 patients scheduled for MBS were assessed 1 month before and 12 months after surgery. Body composition, including appendicular lean mass (ALM) and fat mass, was measured using dual-energy X-ray absorptiometry (DXA). Handgrip strength (HGS) was assessed via dynamometry, and neurocognitive performance was evaluated using a standardized test battery. Results: Significant improvements in cognitive performance were observed at 12 months post-surgery in attention, memory, language, executive functions and overall cognitive performance. Regarding body composition, significant reductions were observed in fat mass and body mass index (BMI). A decrease in ALM and no changes in HGS were observed; however, when adjusted for body size, both showed an increase. Regression analysis identified baseline HGS, but not muscle mass, as a significant predictor of cognitive performance at 12 months post-surgery. Conclusions: MBS leads to significant improvements in cognitive function. Our results suggest that baseline HGS may play a role in predicting cognitive outcomes post-surgery, highlighting the need for comprehensive assessments of both physical and cognitive health in patients undergoing MBS. Further longitudinal studies are needed to explore causal relationships and the potential reversibility of cognitive deficits post-surgery. Full article

Background and Objectives: Obesity is a major contributor to female reproductive dysfunction, frequently resulting in menstrual irregularity, anovulation, and subfertility. Bariatric surgery improves metabolic health; however, its effect on reproductive outcomes—particularly the shift from assisted to spontaneous conception—remains incompletely defined. This study aimed to evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on menstrual cycle regularity and spontaneous pregnancy rates in women of reproductive age. Materials and Methods: This retrospective observational study included 52 women aged 18–40 years who underwent LSG between January 2013 and October 2017. Self-reported menstrual history, as documented during routine preoperative assessment in the electronic medical records, and reproductive outcomes (including spontaneous and assisted conception) were compared between the preoperative and postoperative periods. The median follow-up duration was 38 months. Results: A significant improvement in menstrual regularity was observed (46.2% to 94.2%, p < 0.001). Among women attempting conception, 10/15 (66.7%) achieved spontaneous pregnancy; one conceived via ART. Notably, 57.1% of all pregnancies occurred within the first 12 months post-surgery, including three unintended conceptions. Additionally, among women who conceived spontaneously, four had a history of requiring assisted reproductive technologies (ART), including two who had previously failed to conceive despite ART treatment. Conclusions: LSG is associated with significant normalization of menstrual cycles and a qualitative shift toward spontaneous conception in morbidly obese women. The rapid return of fertility, which may exceed patient awareness, underscores the importance of comprehensive perioperative counseling regarding effective contraception to prevent unintended pregnancies during the active weight-loss phase. Full article

Background/Objectives: Obesity is an increasingly concerning public health issue due to its high prevalence and its association with multiple comorbidities. A significant proportion of patients with obesity who undergo bariatric surgery could exhibit suboptimal mid-term outcomes. This study aims to comprehensively assess anthropometric, clinical, biochemical, nutritional, and quality of life parameters in patients with severe obesity undergoing bariatric surgery, with a particular focus on outcomes at 24 months post-surgery to capture mid-term effects that may not be apparent during the first year of follow-up. Methods: A prospective study was conducted in 95 patients with obesity undergoing bariatric surgery (Roux-en Y gastric bypass; RYGB) at the Virgen de la Arrixaca University Clinical Hospital (Murcia, Spain) between 2020 and 2023. Participants were followed up at 6, 12, and 24 months after RYGB. The study incorporated anthropometric assessments (BMI, body composition via bioelectrical impedance), full biochemical profiling, dietary analysis (using a validated food frequency questionnaire), and quality of life assessment (SF-36 questionnaire). Results: Our results showed significant weight loss after the intervention, accompanied by improvements in metabolic parameters, and dietary habits. Regarding quality of life, significant improvements were observed in both the physical (baseline: 39.62%; 6 months: 52.40%; 12 months: 53.12%) and mental components (baseline: 42.08; 6 months: 53.40; 12 months: 52.14%) at 6 and 12 months post-surgery. However, our prospective 24-month follow-up revealed that, despite these initial benefits, mental health significantly declined compared with the 12-month follow-up (24 months: 46.85%). In contrast, the physical component remained relatively stable at 24 months (24 months: 50.91%). However, our prospective 24-month follow-up revealed that, despite these initial benefits, there was a decline in mental health compared to the 12-month follow-up. Conclusions: While bariatric surgery is associated with improvements in anthropometric measures and some aspects of quality of life, our findings underscore the need for continued mid-term support to address emerging challenges in mental well-being. Full article

Background: Identifying differences between genders regarding long-term surgical outcomes in bariatric surgeries may be important for optimizing their results. Objective: The current study evaluated mid-term gender-specific differences in patients undergoing laparoscopic sleeve gastrectomy (LSG). Methods: A retrospective cohort study was done in our university-based hospital, including patients who underwent laparoscopic Sleeve Gastrectomy (LSG) between January 2014 and December 2017. We compared demographics and clinical history (including BMI) before and after surgery, as well as the Bariatric Analysis and Reporting Outcome System (BAROS) and complications. Results: We enrolled 217 patients, 86 of whom were males (39.6%), with an average age of 52 ± 0.8 years. We observed no significant differences between males and females in minimal BMI attained (26.35 ± 4.9 vs. 25.9 ± 4.5 respectively, p = 0.56), total complications rate (p = 0.165), early post-op complication rate (p = 0.158), need for re-operation (p = 0.357), and BAROS score (p = 0.42). Conclusions: LSG outcomes were similar for male and female patients, as measured by BAROS, BMI reduction, and complication rates. Further studies are warranted; however, in the meantime, LSG can be offered to the entire population, regardless of gender-specific considerations. Full article

Obesity is a growing health concern in Western countries and the link between obesity and mental disorders has been extensively studied, although less attention has been paid to post-traumatic stress spectrum symptoms (PTSS). This observational study aimed at exploring the correlations between lifetime trauma exposure and its related PTSS and maladaptive eating behaviours in obese patients who are candidates for bariatric surgery. A total of 189 obese candidates for bariatric surgery were recruited at the Azienda Ospedaliero-Universitaria Pisana (AOUP) and assessed by the Trauma and Loss Spectrum—Self-Report (TALS-SR Lifetime Version), Emotional Eating Scale (EES), Night Eating Questionnaire—Italian Version (I-NEQ), Grazing Questionnaire (GQ), and Eating Disorder Examination (EDE-Q), Eating Disorder Inventory (EDI). Based on the TALS-SR (Lifetime Version) scores, patients were dichotomised as either with low PTSS scores or high PTSS scores. Results showed high PTSS scores in more than a third of the sample (36.5%), with these individuals showing statistically significant higher total and EES domain scores, total and controllability GQ domain scores, I-NEQ mood/sleep domain scores, and EDE-Q shape concern domain score. A logistic regression showed an association between higher burden of emotional eating and greater probability of lifetime PTSS. PTSS appear to be frequent among bariatric surgery candidates and are related with maladaptive eating behaviours, suggesting accurate evaluation to optimise surgical outcomes. Full article

Background: There is no standardized definition for metabolic health. Overweight and obesity are often linked to metabolic dysfunction. Bariatric surgery promotes body weight loss and cardiometabolic health improvement. Objective: We aim to characterize metabolic health using distinct definitions and evaluate anthropometric and cardiometabolic features, both before and after different surgery procedures. Methods: We studied 3313 individuals from CRI-O [Porto, PT; BMI 39.56 (42.60; 46.20) kg/m²; 36 (43; 51) y; 82.7% women] who underwent Roux-en-Y gastric bypass (RYGB; 61.7%), sleeve gastrectomy (30.9%), or gastric band (7.5%) surgery. Anthropometric and cardiometabolic features were assessed at baseline and at yearly follow-ups, up to 4 years; the same for cardiometabolic dysfunction characterization using NCEP ATP III, Karelis, Meigs, Khan, Pluemacher, and Schulze definitions. Results: Baseline metabolic health classification and metabolically unhealthy phenotype (MUH) post-surgery prevalence decrease show substantial variability depending on the definition used. Unlike relative body weight loss, the altered metabolic feature number in MUH remains unchanged. Changes in MUH prevalence do not reflect body weight loss, nor does the variation in MUH percentage fully align with changes in altered metabolic features. Blood pressure, C-reactive protein, antihypertensive medication, and HOMA-IR are key contributors to baseline MUH. Post-surgical changes in body weight, lipid profile, and C-reactive protein vary by procedure. RYGB yields greater weight loss and more often improves cardiometabolic markers. However, post-operative metabolic phenotype is independent of surgery type. Conclusions: Metabolic health phenotypes pre- and post-surgery vary by definition, and the latter are not solely driven by weight loss or surgery type. In this cohort, RYGB shows the strongest beneficial impact. Full article

Background: Obesity and its accompanying complications have an influence on diurnal rhythm, potentially causing cardiometabolic disease. This study explores how weight loss due to bariatric surgery affects circadian rhythm disruptions measurable through wearable heart rate monitors. Methods: A single-center observational study was performed, in which patients who had undergone primary bariatric surgery 3 years ago with telemonitoring of vital parameters using a wireless accelerometer were eligible to participate. A Wilcoxon signed-rank test was conducted to evaluate the delta of, or amount of change in, circadian patterns between the baseline (before) and post-weight-loss peak, nadir, and peak–nadir heart rates. Results: In this cohort of 69 patients, 70% were female, with a median total weight loss of 31.4% towards a median BMI of 28.4 kg/m². Analysis revealed significant changes in peak–nadir excursions post-weight loss. Peak, nadir, and peak–nadir differences showed a significant reduction in values in the post-weight-loss group. No significant correlations between other clinical endpoints and change in peak–nadir excursion were found in the multivariable regression models. Conclusions: In conclusion, this study reveals significant changes in circadian heart rate patterns before and after weight loss due to metabolic surgery. The results could add to the health benefits of bariatric surgery, as it could lower the incidence of diseases associated with changes in diurnal rhythm due to obesity. However, a clear clinical explanation is lacking, as no correlation with total weight loss nor other variables was substantiated. Full article

Obesity is a significant global health challenge, with prevalence rising steadily worldwide. Effective management often involves bariatric surgery, such as sleeve gastrectomy (SG), which has proven effective in reducing weight and improving comorbid conditions. This study aimed to evaluate nutritional status and protein source awareness and its impact on muscle mass among patients post SG surgery in Saudi Arabia. A cross-sectional study was conducted among 98 adults (aged 18–51 years) who underwent SG at the Department of Metabolic and Bariatric Surgery (Badana Clinic)/Mouwasat Hospital in Dammam from December 2023 to February 2024. Data were collected using an electronic questionnaire that covered demographics, dietary habits, physical activity, protein knowledge (from food and supplements), and a 24 h dietary recall. Body composition, including muscle mass, was assessed using the InBody270 Body Composition Analyzer. The results revealed that participants exhibited a high level of awareness regarding the importance of protein sources. However, muscle mass decreased by an average of 4.11 kg after surgery. This decline was attributed to insufficient protein intake, which ranged between 30 and 60 g per day, below recommended levels. Taste aversion and dietary limitations post-surgery contributed to this inadequate protein consumption. In conclusion, while participants understood the significance of protein for muscle maintenance, practical challenges in achieving adequate protein sources led to muscle mass loss. These findings underscore the importance of tailored nutritional strategies and education to optimize recovery and long-term health outcomes for SG surgery patients. Full article

Objectives: To assess retinal microvascular changes in patients with Grade II and III obesity before and after bariatric surgery using Optical Coherence Tomography Angiography (OCTA), and to compare these metrics with age- and sex-matched healthy controls. Methods: Prospective, consecutive, longitudinal cohort study with a 12-month follow-up. Grade II and III obese patients scheduled for bariatric surgery underwent comprehensive ophthalmic examinations, including OCTA imaging, prior to the surgery and postoperatively at 1 month, 6 months, and 12 months post-surgery. Results: A total of 43 eyes from 43 patients with obesity (one eye per patient) were included at baseline. At 12 months post-surgery, there was a significant increase in vessel density (VD) (16.70 vs. 17.68; p < 0.01) and perfusion density (PD) (0.406 vs. 0.433; p < 0.01), reaching values comparable to those of the control group (17.73 and 0.434, respectively). Significant reductions were also observed in body mass index (BMI) (43.74 vs. 29.53; p < 0.01), body weight (122.44 kg vs. 81.90 kg; p < 0.01), and intraocular pressure (IOP) (15.72 mmHg vs. 14.16 mmHg; p < 0.01). Conclusions: This study demonstrates a compelling association between obesity and retinal microvascular impairment, highlighting the efficacy of bariatric surgery not only in achieving substantial weight loss but also in improving the retinal perfusion of these patients, achieving metrics at 12 months comparable to age- and sex-matched healthy controls at baseline. These findings raise the hypothesis of the potential utility of OCTA as a monitoring tool for tracking the microvascular status in patients with obesity undergoing bariatric surgery in a longitudinal manner. Full article

Background/Objectives: To assess whether laparoscopic adjustable gastric banding (LAGB) and combined lifestyle intervention (CLI) reduce hepatic steatosis more effectively than CLI alone in adolescents with severe obesity. Methods: Adolescents aged 14–16 with a BMI ≥ 40 kg/m² (or ≥35 kg/m² with comorbidity) were randomized to receive LAGB + combined lifestyle intervention (CLI, n = 30) or CLI alone (n = 30). Hepatic fat was assessed at baseline and one year via ultrasound-based Hepatorenal Index (HRI), liver span, and ALAT levels. Results: Of 59 participants (mean age 15.7, 80% female, BMI 44.3 kg/m²), 58.9% had steatosis at baseline (HRI ≥ 1.40). After one year, BMI decreased by 5.6 kg/m² in the LAGB group but remained stable in controls. Steatosis resolution (HRI < 1.05) occurred in 21.4% of LAGB versus 4.4% of CLI patients (p = 0.078). Liver span declined by 1.09 cm post-LAGB (95% CI −2.05 to −0.13) and correlated with HRI improvement. ALAT levels were unchanged. Conclusions: LAGB led to greater reductions in hepatic fat and size than lifestyle changes alone. Though steatosis resolution was not statistically significant, findings suggest bariatric surgery may be a promising strategy for mitigating early hepatic changes in severe adolescent obesity. What is already known: Severe obesity in adolescents is frequently accompanied by hepatic steatosis, which can progress to metabolic dysfunction–associated steatotic liver disease (MASLD). Bariatric procedures—such as laparoscopic adjustable gastric banding (LAGB)—are proven to induce substantial weight loss and improve obesity-related comorbidities in youth. What this study adds: This is the first randomized controlled trial to evaluate the effect of LAGB on hepatic steatosis specifically in adolescents. At one year, 21.4% of LAGB-treated patients no longer met the sensitive HRI cut-off for steatosis (<1.05) versus 4.4% of controls. Moderate weight loss after LAGB corresponded with significant improvements in the Hepatorenal Index and liver span, suggesting a reduction in hepatic fat content. Full article

To evaluate the consumption of ultra-processed foods (UPFs), culinary abilities, and food addiction (FA) in adults after different periods since bariatric and metabolic surgery, this cross-sectional study recruited and collected data via social media from adults who underwent metabolic and bariatric surgery. The Brazil Food and Nutritional Surveillance System markers of dietary consumption and the NOVA-UPF screener assessed dietary patterns and UPF consumption, the modified Yale Food Addiction Scale 2.0 assessed FA, and the Cooking Skills Index (CSI) assessed culinary abilities. 1525 participants were included, with a mean age of 38 ± 8 years and a mean time since surgery of 37 ± 54 months. Individuals with longer postoperative time showed a higher NOVA-UPF score and higher consumption of hamburgers/sausages, sweetened beverages, and instant noodles (p < 0.01 for all), without a corresponding decrease in fresh fruit and vegetable consumption. Each year since surgery increased NOVA-UPF score by 0.67 [CI95%: 0.57; 0.76] points. CSI showed no association with time (−0.41; [CI95%: −1.33; 0.50]), while FA prevalence was lowest at 48 months and increased thereafter (p < 0.01). FA prevalence initially decreased up to 4 years post-surgery, followed by a partial increase beyond 4 years, although remaining below levels observed within the first 6 months. Time since surgery is associated with higher UPF consumption and a non-linear trajectory of FA prevalence, but not with culinary abilities. Full article

Objective: To compare the clinical and metabolic impact of the relationship between leptin, serum soluble leptin receptor (sOB-R), free leptin index (FLI), and ghrelin among different metabolic and bariatric surgeries (MBSs) in patients with severe obesity. Method: Cohort study including 194 patients >18 years old diagnosed with obesity (body mass index (BMI) ≥ 30 kg/m²) undergoing bariatric surgery at the General Hospital of Mexico. Participants were distributed into three surgical groups: Roux-en-Y gastric bypass (RYGB) (n = 36), one anastomosis gastric bypass (OAGB) (n = 86), and sleeve gastrectomy (SG) (n = 72); all operations were performed laparoscopically. Pre- and post-surgical measurements were taken, including anthropometric measurements, lipid profile, glycated hemoglobin (HbA1c), leptin, sOB-R, ghrelin, and FLI. Protocol registration: DI/16/304/04/090. Results: A total of 194 patients with obesity were analyzed, the average weight was 114.9 ± 24 kg, and the preoperative BMI was 43.1 ± 8.0 kg/m². Three types of MBSs were compared. Post-surgery, all groups showed a significant percentage of excess weight loss (%EWL), for example, in OAGB 65.6 ± 12.2%EWL at 12 months (p < 0.0001). In addition, ghrelin levels decreased significantly, especially in a short time compared with pre-surgery levels (from 4 ± 2.5 to 1.6 ± 1 ng/mL per first week (p < 0.0001)). Similarly, leptin diminished in a short time (p < 0.01). Soluble leptin receptor showed differences in the biochemical behavior of leptin, with FLI decreasing significantly (p < 0.003) after one year (p = 0.001). Conclusions: All techniques were effective in reducing body weight, %EWL, and hormonal modulation during the first three months. In addition, ghrelin and FLI levels partially increased as a physiological adaptation to weight loss and resumption of food intake, without reaching initial values. Full article

Metabolic dysfunction–associated fatty liver disease (MAFLD) is now the leading indication for liver transplantation (LT), reshaping the landscape of transplant hepatology. Its close association with obesity, type 2 diabetes, cardiovascular disease, and extrahepatic malignancies poses unique challenges throughout the transplant continuum. This narrative review synthesizes current evidence across the pre-, peri-, and post-transplant spectrum, with a focus on practical implications for clinical management. We explore pre-transplant evaluation, focusing on how metabolic comorbidities, frailty, and organ allocation disparities intersect with emerging interventions such as GLP-1 receptor agonists, bariatric surgery, and structured weight loss programs. The increase in pediatric MAFLD, especially its early-onset aggressive form, indicates an evolving and concerning future burden on transplant programs. In the peri-operative and post-transplant periods, we address MAFLD recurrence, cardiometabolic complications, and the rising incidence of new cancers, particularly in relation to calcineurin inhibitor (CNI) exposure. Customized immunosuppression strategies, using mTOR inhibitors and mycophenolate mofetil, are discussed for their role in balancing graft protection with reducing cancer risk. We also review the application of machine perfusion technologies to optimize and expand the pool of steatotic donor livers. Future directions include the development of non-invasive diagnostic biomarkers, precision immunosuppression, and genomics-based risk stratification. Collectively, these insights emphasize the urgent need for multidisciplinary, patient-specific approaches and prospective, multicenter studies to optimize outcomes and equity in the era of MAFLD-driven liver transplantation. Full article