Vad säger vetenskapen om överviktskirurgi

Viktminskning: Vad fungerar bäst Gastric Bypass/Sleeve eller sprutbehandling med glukagonliknande peptid-1-receptor agonister så som Semaglutid, GLP-1-analoger?

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Weight loss between glucagon-like peptide-1 receptor agonists and bariatric surgery in adults with obesity: A systematic review and meta-analysis

Länk till hela artikeln i National Library of Medicin: Weight loss between glucagon-like peptide-1 receptor agonists and bariatric surgery in adults with obesity: A systematic review and meta-analysis

Slutsats

Hos vuxna med fetma ger bariatrisk kirurgi fortfarande de högsta minskningarna i vikt och BMI.

Sammanfattning av artiklen

‍Objective: Glucagon-like peptide-1 (GLP-1) receptor agonists recently demonstrated 15% to 20% weight loss in adults with obesity, a range which has previously been achieved only with bariatric surgery. This systematic review and meta-analysis compares weight loss between GLP-1 receptor agonists and bariatric surgery.

Methods: The databases MEDLINE, MEDLINE In-Process, MEDLINE Epubs Ahead of Print, Embase Classic + Embase (OvidSP), and Cochrane (Wiley) were searched from inception to April 21, 2021, for randomized controlled trials and observational studies. Two independent reviewers extracted data, reported risk of bias, and graded certainty of evidence. Random-effects models were used to pool change in weight, BMI, and glycated hemoglobin.

Results: Six studies, encompassing 332 patients, were included. Among randomized controlled trials, mean difference in weight between all bariatric surgery types and GLP-1 receptor agonists was -22.68 kg (95% CI: -31.41 to -13.96), mean difference in BMI was -8.18 kg/m² (95% CI: -11.59 to -4.77), and mean difference in glycated hemoglobin was -1.28% (95% CI: -1.94% to -0.61%). Among observational studies, mean difference in weight was -25.11 kg (95% CI: -40.61 to -9.60), and mean difference in BMI was -10.60 kg/m² (95% CI: -17.22 to -3.98). Only one observational study reported glycemic outcomes.

Conclusion: In adults with obesity, bariatric surgery still confers the highest reductions in weight and BMI but confers similar effects in glycemic control when compared with GLP-1 receptor agonists.

Bariatric surgery for obesity and metabolic disorders: state of the art

Länk till hela artikeln i tidningen Nature: Bariatric surgery for obesity and metabolic disorders: state of the art‍

Sammanfattning av artiklen

• Fetma fortsätter att vara ett stort folkhälsoproblem över hela världen

• Bariatrisk kirurgi är en effektiv behandling för svår fetma som resulterar i förbättring eller remission av många fetmarelaterade komorbida tillstånd, såväl som ihållande viktminskning och förbättring av livskvalitet

• De fyra vanligaste bariatriska operationerna som utförs över hela världen är laparoskopisk sleeve gastrectomy, laparoskopisk Roux-en-Y gastric bypass, laparoskopisk justerbar gastrisk banding och duodenal switch

• Bariatrisk kirurgi är nu säker, med dödlighet jämförbar med vanliga elektiva allmänna kirurgiska operationer

• Nivå 1 bevis visar att bariatrisk kirurgi ger överlägsen kortsiktig och långvarig viktminskning och förbättring av typ 2-diabetes mellitus jämfört med konventionell medicinsk terapi

• Nyligen godkända laparoskopiska och endoskopiska enheter finns nu tillgängliga för behandling av patienter med fetma; Den långsiktiga effekten av dessa anordningar är dock okänd

Fetma är ett av de allvarligast och mest kritiska folkhälsotillstånden i världen. Bariatrisk kirurgi för svår fetma är en effektiv behandling som resulterar i förbättring och remission av många fetmarelaterade komorbiditeter, samt ger varaktig viktminskning och förbättring av livskvalitet.

Moderna bariatriska operationer inkluderar Roux-en-Y gastric bypass, sleeve gastrectomy, justerbart gastric band och duodenal switch. De allra flesta av dessa ingrepp utförs nu med laparoskopisk teknik (titthålskirurgi), vars främsta fördelar inkluderar snabb återhämtning, minskning av postoperativ smärta och minskning av sårrelaterade komplikationer, jämfört med öppen kirurgi.

Samtida bariatrisk kirurgi är nu säker, med en dödlighet på tre av 1 000 patienter; dock är alla bariatriska operationer förknippade med sina egna unika kortsiktiga och långsiktiga näringsmässiga och procedurrelaterade komplikationer.

Typ 2-diabetes mellitus (T2DM) är den mest studerade metabola störningen associerad med fetma, med data som visar att förbättring och remission av T2DM hos patienter med fetma är överlägsen efter bariatrisk kirurgi jämfört med konventionell medicinsk terapi. Bariatrisk kirurgi är nu en del av vissa behandlingsalgoritmer för medicinsk behandling av patienter med T2DM och svår fetma. Nya, minimalt invasiva och endoskopiska apparater för behandling av fetma har nu godkänts i USA, vilket kommer att utöka behandlingsmöjligheterna för individer med fetma.

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Life expectancy after bariatric surgery or usual care in patients with or without baseline type 2 diabetes in Swedish Obese Subjects

Länk till hela artikeln i tidningen Nature: https://www.nature.com/articles/s41366-023-01332-2

Results

In T2D and non-T2D subgroups, bariatric surgery was associated with increased life expectancy (2.1, 95% confidence interval (95% CI) 0.2–4.0; and 1.6, 0.5–2.7 years, respectively) and reduced overall mortality (adjusted hazard ratio (adjHR) = 0.77, 95% CI: 0.61–0.97; and 0.82, 0.72–0.94, respectively), and the treatment benefit was similar (interaction p = 0.615). Bariatric surgery was associated with reduced cardiovascular mortality in both subgroups (adjHR = 0.65, 95% CI: 0.46–0.91; and 0.70, 0.55–0.88, respectively (interaction p = 0.516)).

Conclusions

Bariatric surgery is associated with similar reduction of overall and cardiovascular mortality and increased life expectancy regardless of baseline diabetes status.

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The impact of maternal bariatric surgery on long-term health of offspring: a scoping review

Läs hela artikeln: https://www.nature.com/articles/s41390-023-02698-9

Abstract

While pregnancy post-bariatric surgery has become increasingly common, little is known about whether and how maternal bariatric surgery affects the next generation. This scoping review aimed to collate available evidence about the long-term health of offspring following maternal bariatric surgery. A literature search was conducted using three databases (PubMed, PsycINFO, EMBASE) to obtain relevant human and animal studies. A total of 26 studies were included: 17 were ancillary reports from five “primary” studies (three human, two animal studies) and the remaining nine were “independent” studies (eight human, one animal studies). The human studies adopted sibling-comparison, case-control, and single-group descriptive designs. Despite limited data and inconsistent results across studies, findings suggested that maternal bariatric surgery appeared to (1) modify epigenetics (especially genes involved in immune, glucose, and obesity regulation); (2) alter weight status (unclear direction of alteration); (3) impair cardiometabolic, immune, inflammatory, and appetite regulation markers (primarily based on animal studies); and (4) not affect the neurodevelopment in offspring. In conclusion, this review supports that maternal bariatric surgery has an effect on the health of offspring. However, the scarcity of studies and heterogenous findings highlight that more research is required to determine the scope and degree of such effects.

Impact

• There is evidence that bariatric surgery modifies epigenetics in offspring, especially genes involved in immune, glucose, and obesity regulation.
• Bariatric surgery appears to alter weight status in offspring, although the direction of alteration is unclear.
• There is preliminary evidence that bariatric surgery impairs offspring’s cardiometabolic, immune, inflammatory, and appetite regulation markers. Therefore, extra care may be needed to ensure optimal growth in children born to mothers with previous bariatric surgery.

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