Weight loss and effect on co-morbidities in the long-term after duodenal switch and gastric bypass: a population-based cohort study

BackgroundUnsatisfactory weight loss is common after bariatric surgery in patients with super obesity (body mass index [BMI] ≥50 kg/m²). Unfortunately, this group of patients is increasing worldwide.ObjectiveThe aim of this study was to compare long-term weight loss and effect on co-morbidities after duodenal switch (DS) and gastric bypass (RYGB) in super-obese patients.SettingUniversity hospital, Sweden, national cohort.MethodsThis observational population-based cohort-study of primary DS and RYGB (BMI ≥48 kg/m²) in Sweden from 2007 to 2017 used data from 4 national registers. Baseline characteristics were used for propensity score matching (1 DS:4 RYGB). Weight loss was analyzed up until 5 years after surgery. Medication for diabetes, hypertension, dyslipidemia, depression, and pain were analyzed up until 10 years after surgery.ResultsThe study population consisted of 333 DS and 1332 RYGB, with 60.7% females averaging 38.5 years old and BMI 55.0 kg/m² at baseline. DS resulted in a lower BMI at 5 years compared with RYGB, 32.2 ± 5.5 and 37.8 ± 7.3, respectively, (P < .01). DS reduced prevalence of diabetes and hypertension more than RYGB, while reduction in dyslipidemia was similar for both groups, during the 10-year follow-up. Both groups increased their use of antidepressants and a maintained a high use of opioids.ConclusionThis study indicates that super-obese patients have more favorable outcomes regarding weight loss and effect on diabetes and hypertension, after DS compared with RYGB.     

个性化持续性健康教育对血脂异常人群血脂水平的影响

目的探讨个性化持续性健康教育对血脂异常人群血脂水平的干预效果。方法选取2016年10月至2018年3月在我院体检发现血脂异常的患者共184例,采用随机数字法将所有患者分为研究组和对照组,每组92例。对照组患者接受常规的健康教育方式;而研究组患者接受改良后的个性化持续性健康教育。比较两组患者干预前、干预3个月后以及干预6个月后血脂指标情况。采用自制的血脂健康知识问卷对两组患者干预前和干预6个月后掌握的相关治疗情况进行评价并比较。结果接受干预6个月后,两组患者所有血脂指标(总胆固醇、三酰甘油、低密度脂蛋白和高密度脂蛋白)均与干预前比,差异存在统计学意义(P<0.05)。接受干预3个月及6个月后,研究组患者的四项指标,与对照组相比,差异均存在统计学意义(P<0.05)。接受相应干预6个月后,两组患者的问卷评分均有显著提高,差异存在统计学意义(P<0.05),且研究组的分数明显高于对照组,差异有统计学意义(P<0.05)。结论个性化持续性健康教育能够帮助血脂异常人群更快更好地建立正确的健康观念,有效改善该类人群的血脂异常情况。     

空腹血糖受损患者血脂改变情况分析

目的探讨空腹血糖受损(impaired fasting glucose,IFG)患者血脂成分的改变情况。方法收集23例正常糖耐量(NGT)者和新诊断的44例IFG患者的临床资料,分别测定血脂谱。结果IFG患者血清甘油三酯(TG)水平显著高于NGT组(P<0.05),高密度脂蛋白—胆固醇(HDL-C)值明显低于NGT组(P<0.01)。结论新诊断的IFG患者已经存在血脂代谢异常。     

Estimate of reduced glomerular filtration rate by triglyceride-glucose index: insights from a general Chinese population

Objectives: Recent studies have identified triglyceride-glucose index (TyG) as a surrogate of insulin resistance. Since insulin resistance correlates with renal damage, our study aims to investigate the impact of TyG on the risk of reduced eGFR and explore its value to improve the risk stratification and prevention of reduced eGFR.

Methods: This cross-sectional study included 6466 participants (mean age:59.57 years, 60.2% females) from rural areas of northeast China between September 2017 to May 2018. TyG was calculated as ln[fasting triglyceride (mg/dL)×fasting plasma glucose (mg/dL)/2]. Reduced eGFR was defined as eGFR<60ml/min per 1.73m².

Results: The prevalence of reduced eGFR was 2.94%. After full adjustment, each SD increase of TyG caused 42.6% additional risk for reduced eGFR. When dividing TyG into quartiles, the top quartile had a 1.934 times risk than the bottom quartile. Furthermore, the risk of reduced eGFR increased linearly with the increment of TyG. Subgroup analysis also revealed the association was robust to several risk factors of renal damage. Finally, category-free net reclassification index (0.204, 95% CI: 0.060–0.349, p = 0.005) and integrated discrimination index (0.010, 95% CI: 0.005–0.016, p < 0.001) demonstrated the value of TyG to refine the risk stratification of reduced eGFR.

Conclusion: Our work reveals the robust association between TyG and reduced eGFR. Moreover, the present study implicates the potential role of TyG as a risk indicator to optimize the prevention of reduced eGFR. Lastly, the findings also suggest the importance of simultaneous glycemic and lipid control to avoid the development and progression of reduced eGFR.     

A comprehensive review of healthy effects of vegetarian diets

AimsA comprehensive review comparing the effect of vegetarian (V) and non-vegetarian (NV) diets on the major cardiometabolic diseases’ outcomes was performed.Data synthesisWe performed literature research (up to December 31, 2022) of the evidence separately for vascular disease (VD), obesity (OB), dyslipidemia (Dysl), hypertension (HPT), type 2 diabetes (T2D), metabolic syndrome (MetS), analyzing only cohort studies and randomized controlled studies (RCTs) and comparing the effect of V and NV diets. Cohort studies showed advantages of V diets compared to NV diets on incidence and/or mortality risk for ischemic heart disease, overweight and OB risk. Most cohort studies showed V had lower risk of HPT and lower blood pressure (BP) than NV and V diets had positive effects on T2D risk or plasma parameters. The few cohort studies on the risk of MetS reported mixed results. In RCTs, V diets, mainly low-fat-vegan ones, led to greater weight loss and improved glycemic control than NV diets and in the only one RCT a partial regression of coronary atherosclerosis. In most RCTs, V diets significantly reduced LDL-C levels (but also decreased HDL-C levels) and BP.ConclusionsIn this comprehensive review of the association between V diets and cardiometabolic outcomes, we found that following this type of diet may help to prevent most of these diseases. However, the non-uniformity of the studies, due to ethnic, cultural, and methodological differences, does not allow for generalizing the present results and drawing definitive conclusions. Further, well-designed studies are warranted to confirm the consistency of our conclusions.