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Objective:To investigate the changes of cardiac morphology and function in obese patients after bariatric surgery.Methods:The clinical data of 100 patients who underwent bariatric surgery, including gastric sleeve resection and gastric bypass in Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2021 were selected for retrospective analysis, including 67 females and 33 males, aged from 18 to 65 years, with average of (36.7±9.5) years. The software of SPSS 26.0 was used to conduct data analysis. Univariate and Logistic regression analysis was performed on the indicators of patients before bariatric surgery and 1 year after surgery, and ROC curves were drawn to determine the changes of cardiac morphology and cardiac function after bariatric surgery.Results:Compared with preoperative, one year after bariatric surgery, patients′ body weight [(112.2±30.2) kg vs(80.7±23) kg, P<0.001] and body mass indes [(38.77±8.26) kg/m 2vs (27.98±6.54) kg/m 2, P<0.001] were significantly decreased, and systolic and diastolic blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, blood uric acid, and resting heart rate were also significantly decreased ( P<0.05), cardiac ejection fraction was significantly improved [(65.5±5.9)% vs (67.9±4.7)%, P<0.001], ventricular septum, left ventricular posterior wall, left atrial diameter, left ventricular systolic and end-diastolic diameter were significantly reduced ( P<0.05), while the inner diameter of the ascending aorta was not significantly changed [(3.14±0.39) cm vs (3.09±0.38) cm, P=0.125]. In addition, there were no significant differences in cardiac morphology between gastric bypass and gastric sleeve resection. Logistic regression analysis showed that pre-bariatric BMI value, postoperative BMI reduction value, whether suffering from hypertension, and whether the inner diameter of the ascending aorta was widened were the important influencing factors for the improvement of ejection fraction after bariatric surgery ( P<0.05). The area under the ROC curve for predicting the improvement of ejection fraction was 0.772 (95% CI: 0.669-0.875), the specificity was 85%, the sensitivity was 66%, and the best cut-off point was 0.545. Conclusions:One year after bariatric surgery in obese patients, cardiac ejection fraction was significantly improved, and ventricular septum, left ventricular posterior wall, left atrial diameter, left ventricular systolic and end-diastolic diameter were significantly reduced compared with those before surgery. There was no significant difference between gastric sleeve resection and gastric bypass in the improvement of cardiac function and the effect on cardiac morphology. The combined prediction model composed of preoperative body mass index value, decreased body mass index value at 1 year after operation, whether suffering from hypertension, whether the inner diameter of the ascending aorta is widened and other indicators has a good predictive value for the improvement of ejection fraction in bariatric patients at 1 year after operation.
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Objective:To systematically evaluate the effect of bariatric and metabolic surgery on bone metabolism in obese patients.Methods:Search terms for the present meta-analysis included "bariatric surgery, metabolic surgery, sleeve gastrectomy, gastric bypass, bone metabolic indicators, bone mineral density", both in English and corresponding Chinese. PubMed, WOS, Cochrane, CNKI, and VIP databases were searched for longitudinal studies from the establishment of the database to September 20, 2022. The data on bone mineral density and bone metabolic markers in obese patients before and after bariatric surgery were extracted. RevMan5.4 and Stata17.0 software were used for Meta-analysis.Results:A total of 8 clinical studies with 420 patients were included. The results of the meta-analysis showed that compared with the preoperative baseline, lumbar spine bone mineral density ( WMD=0.05, 95% CI: -0.00~0.1), femoral neck bone mineral density( WMD=0.10, 95% CI: 0.05-0.15), hip bone mineral density( WMD=0.14, 95% CI: 0.10-0.17), and serum vitamin D 3 ( WMD=-4.87, 95% CI: -6.34--3.40)were decreased, while parathyroid hormone ( WMD=10.04, 95% CI: 5.32-14.76) was elevated after surgery. Conclusions:Current evidence demonstrates that metabolic and bariatric surgery can lead to decreased bone mineral density and impairs in bone metabolic markers early after surgery. Roux-en-Y gastric bypass surgery cause more adverse effects on bone metabolism than sleeve gastrectomy. The results imply that all patients undergoing metabolic and bariatric surgery should be monitored for bone metabolism and routinely take vitamin D and calcium supplements.