Associations of change in body fat percentage with baseline body composition and diabetes remission after bariatric surgery.

OBJECTIVE: The objective of this study was to determine the role of body fat percentage (BFP) changes in diabetes remission (DR) and the association between baseline body composition and its changes after bariatric surgery. METHODS: We analyzed 203 patients with type 2 diabetes who underwent Roux-en-Y gastric bypass. Body composition was measured using a gold-standard-derived predictive equation and magnetic resonance imaging. Body composition changes were calculated as 100 × (baseline value - follow-up value)/baseline value. We verified the results in a laparoscopic sleeve gastrectomy cohort with 311 patients. RESULTS: Compared with non-remission patients in the Roux-en-Y gastric bypass cohort, those who achieved DR showed a higher baseline fat-free mass index (FFMI) and experienced the most significant changes in BFP (p < 0.001). In comparative analyses, BFP changes were significantly better than BMI changes in identifying short- and long-term DR. Linear regression analysis identified FFMI as the most significant baseline variable correlated with BFP changes (p < 0.001). Baseline BMI was positively correlated with changes in BFP but negatively correlated with changes in FFMI. These findings were replicated in the laparoscopic sleeve gastrectomy cohort. CONCLUSIONS: BFP changes determine DR after bariatric surgery, and baseline FFMI is crucial for BFP changes. A low initial BMI is associated with a smaller BFP reduction and greater FFMI loss after bariatric surgery.

Development of Chinese food picture library for inducing food cravings.

Cue-induced food cravings are strong desires directed toward specific foods, usually ones with high caloric content, and can lead to overeating. However, although food cravings vary according to individual preferences for specific high-calorie food subtypes, a structured library of food craving-inducing pictures including multiple categories of high-calorie foods does not yet exist. Here, we developed and validated a picture library of Chinese foods (PLCF) consisting of five subtypes of high-calorie foods (i.e., sweets, starches, salty foods, fatty foods, and sugary drinks) to allow for more nuanced future investigations in food craving research, particularly in Chinese cultural contexts. We collected 100 food images representing these five subtypes, with four food items per subtype depicted in five high-resolution photographs each. We recruited 241 individuals with overweight or obesity to rate the food pictures based on craving, familiarity, valence, and arousal dimensions. Of these participants, 213 reported the severity of problematic eating behaviors as a clinical characteristic. Under the condition of mixing multiple subtypes of high-calorie foods, we did not observe significant differences in craving ratings for high- and low-calorie food images (p tukey > 0.05). Then, we compared each subtype of high-calorie food images to low-calorie ones, and found craving ratings were greater for the images of salty foods and sugary drinks (ps < 0.05). Furthermore, we conducted a subgroup analysis of individuals according to whether they did or did not meet the criteria for food addiction (FA) and found that greater cravings induced by the images of high-calorie food subtypes (i.e., salty foods and sugary drinks) only appeared in the subgroup that met the FA criteria. The results show that the PLCF is practical for investigating food cravings.

Prognostic and clinicopathological value of CDK12 mutation in prostate cancer: a meta-analysis.

BACKGROUND: Cyclin-dependent kinase 12 (CDK12) mutation has been shown to be associated with the prognosis and clinicopathological characteristics of various tumors. The aim of this meta-analysis was to investigate the role of mutations in prostate cancer (PCa). RESEARCH DESIGN AND METHODS: PubMed/Medline, EMBASE, Cochrane Library, and Web of Science database were searched for relevant articles. Meta-analysis was performed by using RevMan5.3 software, and the quality of the included literature was evaluated according to the Newcastle-Ottawa scale (NOS). RESULTS: A total of 13 studies comprising 5182 participants were enrolled in this meta-analysis. The frequency of CDK12 mutation in PCa was 7.26%. CDK12 mutation was significantly correlated with poor OS/PFS and had a shorter time to progress to CRPC. CDK12 mutant was associated with high-grade Gleason scores, while no relationships were found among CDK12 mutant, age, and the PSA level at diagnosis. CONCLUSION: This meta-analysis indicates that patients with CDK12 mutation have poor prognosis in PCa. CDK12 may be used as a biomarker for molecular subtype and a potential therapeutic target of PCa.

Association between serum copper, zinc and their ratio and handgrip strength among adults: a study from National Health and Nutrition Examination Survey (NHANES) 2011-2014.

Evidence for the association between serum copper and zinc status and handgrip strength is very limited only in several observational studies with study participants of specific population or a narrower age range. The aim of this study was to evaluate the association between serum copper, zinc and their ratio and handgrip strength in the general population. This study included adult participants aged 20-80 years with complete data of serum copper and zinc status and handgrip strength from NHANES 2011-2014. Handgrip strength was calculated as the average of the maximum measure obtained in each hand with a grip strength dynamometer and corrected using BMI. Serum copper and zinc levels were measured using inductively coupled plasma dynamic reaction cell mass spectrometry, and their ratios were calculated. The multivariable linear regression and restricted cubic spline models were used. Serum copper level was inversely associated with BMI-corrected handgrip strength, and the beta coefficients (95% confidence intervals) comparing the second, third, and fourth to the lowest quartiles of serum copper level were - 0.17 kg (- 0.26; - 0.08), - 0.22 kg (- 0.32; - 0.13), and - 0.36 kg (- 0.44; - 0.28), respectively (P for trend < 0.001). Non-linear association was detected between serum copper level and BMI-corrected handgrip strength (P < 0.01). Consistent with serum copper, serum copper/zinc ratio was inversely associated with BMI-corrected handgrip strength. However, no significant associations were observed between serum zinc level and BMI-corrected handgrip strength (all P > 0.05). Higher serum copper level and copper/zinc ratios were significantly associated with lower handgrip strength. Further research is needed to address related issues.

Neuroimaging and neuroendocrine insights into food cravings and appetite interventions in obesity.

This article reviews the previous studies on the distinction between food cravings and appetite, and how they are regulated by hormones and reflected in brain activity. Based on existing research, food cravings are defined as individual preferences influenced by hormones and psychological factors, which differ from appetite, as they are not necessarily related to hunger or nutritional needs. The article also evaluates the neuroimaging findings about food cravings, and interventions to reduce food cravings, such as mindfulness training, alternative sweeteners, non-invasive brain stimulation techniques, cognitive-behavioral therapy, and imaginal retraining, and points out their advantages, disadvantages, and limitations. Furthermore, the article delves into the potential future directions in the field, emphasizing the need for a neuroendocrine perspective, considerations for associated psychiatric disorders, innovative clinical interventions, and emerging therapeutic frontiers in obesity management. The article outlines the neuro-endocrine basis of food cravings, including ghrelin, leptin, melanocortin, oxytocin, glucagon-like peptide-1, baclofen, and other hormones and their brain regions of action. The article argues that food cravings are an important target for obesity, and more research is needed to explore their complex characteristics and mechanisms, and how to effectively interact with their neuro-endocrine pathways. The article provides a new perspective and approach to the prevention and treatment of obesity.

GPSM1 impairs metabolic homeostasis by controlling a pro-inflammatory pathway in macrophages.

G-protein-signaling modulator 1 (GPSM1) exhibits strong genetic association with Type 2 diabetes (T2D) and Body Mass Index in population studies. However, how GPSM1 carries out such control and in which types of cells are poorly understood. Here, we demonstrate that myeloid GPSM1 promotes metabolic inflammation to accelerate T2D and obesity development. Mice with myeloid-specific GPSM1 ablation are protected against high fat diet-induced insulin resistance, glucose dysregulation, and liver steatosis via repression of adipose tissue pro-inflammatory states. Mechanistically, GPSM1 deficiency mainly promotes TNFAIP3 transcription via the Gαi3/cAMP/PKA/CREB axis, thus inhibiting TLR4-induced NF-κB signaling in macrophages. In addition, we identify a small-molecule compound, AN-465/42243987, which suppresses the pro-inflammatory phenotype by inhibiting GPSM1 function, which could make it a candidate for metabolic therapy. Furthermore, GPSM1 expression is upregulated in visceral fat of individuals with obesity and is correlated with clinical metabolic traits. Overall, our findings identify macrophage GPSM1 as a link between metabolic inflammation and systemic homeostasis.

Timing of Maximal Weight Reduction Following Bariatric Surgery: A Study in Chinese Patients.

Introduction: Bariatric surgery is a well-received treatment for obesity with maximal weight loss at 12-36 months postoperatively. We investigated the effect of early bariatric surgery on weight reduction of Chinese patients in accordance with their preoperation characteristics. Materials and Methods: Altogether, 409 patients with obesity from a prospective cohort in a single bariatric center were enrolled retrospectively and evaluated for up to 4 years. Measurements obtained included surgery type, duration of diabetic condition, besides the usual body mass index data tuple. Weight reduction was expressed as percent total weight loss (%TWL) and percent excess weight loss (%EWL). Results: RYGB or SG were performed laparoscopically without mortality or complications. BMI generally plateaued at 12 months, having decreased at a mean of 8.78 kg/m2. Successful weight loss of >25% TWL was achieved by 35.16, 49.03, 39.22, 27.74, 20.83% of patients at 6, 12, 24, 36, and 48 months after surgery. Overall, 52.91% of our patients had lost 100% of their excess weight at 12 months, although there was a rather wide range among individuals. Similar variability was revealed in women of child-bearing age. Conclusion: Chinese patients undergoing bariatric surgery tend to achieve maximal weight loss and stabilization between 12 and 24 months postoperatively, instead of at >2 years. The finding of the shorter stabilization interval has importance to earlier intervention of weight loss related conditions and women's conception planning.

The genus Sutterella is a potential contributor to glucose metabolism improvement after Roux-en-Y gastric bypass surgery in T2D.

BACKGROUND: Alterations in gut microbiota have been associated with improvements in blood glucose due to bariatric surgery. OBJECTIVES: Our aim is to identify specific gut microbiota that contribute to the remission of T2D after RYGB and SG. METHODS: Rats fed a high-fat diet (HFD) were administered a low dose of streptozotocin as T2D models; next, their caecum content was collected 8 weeks after RYGB and SG. We also used case-control of gut microbial profiles of T2D patients and healthy people by collecting the mucosal-luminal interface from the ascending colon. Samples were profiled by 16S rRNA gene sequencing. RESULTS: RYGB and SG reduced weight and improved glucose and insulin tolerance. Principal coordinate analysis showed that SG and, especially, RYGB cause changes in the composition of gut microbiota. We found that family Alcaligenaceae (genus Sutterella) was significantly decreased in the ascending colon of patients with T2D and increased after RYGB surgery in the caecum of T2D rats as shown by a linear discriminant analysis effect size (LEfSe) analysis, with no significant changes after SG. This result might benefit the improvement of glycometabolism. CONCLUSIONS: RYGB can significantly reduce weight, improve glycometabolism and change the composition of the gut microbiota. Sutterella may have beneficial effects on glycometabolism in T2D patients after RYGB.

Roux-en-Y Gastric Bypass for T2D Treatment in Chinese Patients with Low BMI: 5-Year Outcomes.

BACKGROUND: RYGB was considered as an effective treatment for obese patients with T2D. However, 5-year outcomes including T2D remission after surgery have not been adequately studied in Chinese patients. OBJECTIVES: Our aim is to evaluate metabolic outcomes of RYGB in 5-year follow-up. METHODS: We retrospectively divided 59 Chinese patients into two groups, namely BMI groups (group A: BMI < 28 kg/m2; group B: BMI ≥ 28 kg/m2) and A1C groups (group C: A1C < 7%; group D: A1C ≥ 7%). Their medical records were collected and cardiovascular risk and medications were evaluated in 5 years after RYGB. RESULTS: Thirty patients were female (30/59, 50.85%). RYGB was performed laparoscopically without mortality or major complications. The mean BMI in 59 patients decreased from 30.89 ± 3.12 to 25.04 ± 3.48 in the fifth year. No one was lost to follow-up in 5 years. There were significant reductions in BMI, A1C, and oral medication or insulin in all groups. Diabetes remission rates in the first, third, and fifth years postoperation were 77.97, 61.02, and 49.15%. T2D relapse and requirement for antihypertensive agents increased in the third and fifth years. Larger quantity of subcutaneous fat area (SFA) and shorter duration of T2D preoperation were more likely to achieve remission of T2D postoperation. CONCLUSIONS: This study has confirmed that RYGB is an effective treatment for obese Chinese patients with T2D, resulting in diabetes remission, metabolic disorder control, and cardiovascular risk reduction.

Bone metabolism in Chinese patients after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass is a leading metabolic surgery for obese patients with type 2 diabetes mellitus. However, postoperative nutritional deficiencies and abnormal bone metabolism are possible. In this study, we investigated the mid-term impact on bone metabolism of laparoscopic Roux-en-Y gastric bypass. METHODS: This retrospective study involved 238 patients with type-2 diabetes mellitus and obesity who underwent laparoscopic Roux-en-Y gastric bypass in our institution; patients were followed for 3 years. Patients received a calcium supplement (1,200 mg per day), alfacalcidol (0.5 µg per day), and a multivitamin (1 tablet per day), postoperatively. We recorded and analyzed patients' body mass index, and blood levels of 25-hydroxy-vitamin D, calcium, and parathyroid hormone. Data for 16 patients 6 months postoperatively were selected randomly to evaluate bone-specific alkaline phosphatase and the bone resorption marker, C-terminal crosslinking telopeptide of type I collagen (CTX-1). RESULTS: Of the 238 patients, 111 were women, and 127 were men (mean age: 46.91±12.03 years; mean body mass index: 31.37 kg/m2). 25-hydroxy vitamin D3 levels did not change (P>0.05) compared with preoperative levels during the 3-year follow-up. Parathyroid hormone (PTH) levels increased (P<0.05), while serum calcium decreased (P<0.05). Patients' body mass index decreased sharply 3 months postoperatively (preoperative vs. postoperative mean: 31.37±3.52 vs. 25.60±2.86, respectively; P<0.05). We saw no decrease in 25-hydroxy vitamin D3 levels with supplementation, postoperatively. CTX-1 and bone-specific alkaline phosphatase levels showed no significant changes comparing pre- and postoperative levels at 6-, 12-, and 24 months (P>0.05). However, CTX-1 levels increased in the first 12 months postoperatively, then decreased in the second year; bone alkaline phosphatase levels increased gradually. CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass is effective for weight loss, but also has an impact on bone metabolism, which increases the risk of fracture. Our results highlight the importance of regular follow-ups and full-dose calcium and vitamin supplementation, postoperatively.

Monogenic Obesity Mutations Lead to Less Weight Loss After Bariatric Surgery: a 6-Year Follow-Up Study.

OBJECTIVES: Bariatric surgery is emerging as the most effective treatment option for patients with obesity. Hypothalamic arcuate nucleus plays an important role in metabolic homeostasis. However, the influence of mutations related to the feeding center on weight loss after bariatric surgery is still unclear. We aimed to diagnose monogenic obesity by whole exome sequencing (WES) and explore whether monogenic mutations influence the effectiveness of bariatric surgery. METHODS: We collected obese patients aged 15 to 55 with a BMI > 28 kg/m2 and who underwent laparoscopic sleeve gastrectomy from March 2011 to June 2017 in Shanghai. Data related to weight loss and metabolic characteristics preoperatively and postoperatively were collected, including fasting blood glucose (FBG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides. WES was performed in obese patients using genomic DNA from whole blood samples. RESULTS: We investigated the proportion of 131 obese adults with one mutation as high as to 8.4% and then evaluated the association between these mutations and weight loss. Mutation carriers had less weight loss over both short-term and long-term periods. Survival analyses indicated it was harder to attain the goal of 20% weight loss for mutation carriers (Plog-rank = 0.001; Pbreslow < 0.001), and the difference remained significant with a Cox regression model. Improvement in FBG, HDL cholesterol, and triglyceride levels postoperatively was observed in both groups, while there were significant differences between the two groups. CONCLUSIONS: Our data indicated that 8.4% of obesity cases were caused by change in genetics, and mutations had negative effects on the efficacy of bariatric surgery.

The middle-term result of laparoscopic sleeve gastrectomy in Chinese obesity patients in a single hospital, with the review of literatures and strategy for gastric stenosis.

BACKGROUND: The aim of this study was to evaluate the medium-term metabolic results of laparoscopic sleeve gastrectomy (LSG) in Chinese patients. METHODS: We performed a retrospective study of our LSG results between February 2011 and February 2015, and conducted a literature review of stenosis after LSG during a recent 10-year period. RESULTS: Of 142 patients in our study, the mean initial body mass index (BMI) was 38.34 kg/m2, the mean age of the patients (44 males and 98 females) was 29.36 years. All patients were followed up for at least 36 months. There was a significant reduction in BMI and blood lipid levels. For one case with gastric stenosis (0.7%), resolution was achieved by conversion to gastric bypass, with a satisfied result in weight loss and diabetes remission. The incidence of stenosis after LSG in previous studies was 0.1-3.5%. Among the cases of stenosis, 83.0% resolved with dilation, and the remainder resolved with a surgical procedure. CONCLUSIONS: LSG is a relatively safe surgical option for weight loss as a primary procedure in our study. Stenosis after LSG requires diagnosis and treatment promptly. Surgery can be a feasible treatment option, but care must be taken to avoid complications.

Effect of Roux-en-Y gastric bypass on thyroid function in euthyroid patients with obesity and type 2 diabetes.

BACKGROUND: The impact of bariatric surgery on thyroid hormone levels is poorly understood. OBJECTIVES: To investigate changes in serum-free thyroxine (FT4) and thyroid-stimulating hormone (TSH) after Roux-en-Y gastric bypass (RYGB) in euthyroid patients with obesity and type 2 diabetes. SETTING: University Hospital, China. METHODS: Eighty-one euthyroid Chinese patients with obesity and type 2 diabetes who underwent RYGB, and 20 healthy volunteers were enrolled in this retrospective study. Participants were evaluated for changes in anthropometric parameters, metabolic indexes, FT4, and TSH at baseline and 6 months after surgery. Multiple linear regression analysis was used to identify factors that could predict changes in FT4 and TSH. RESULTS: Mean FT4 levels decreased from 16.26-14.59 pmol/L (P<.01), while TSH levels decreased significantly (2.19±1.09 mIU/L versus 1.97±1.12 mIU/L, P = .027) 6 months postsurgery. Multiple linear regression analysis showed that the waist/hip ratio (ß =-7.406, P = .031) and duration of diabetes (ß =-.087, P = .009) were independent factors contributing to this decrease in FT4 levels. Moreover, changes in TSH levels were significantly and positively correlated with 2-hour postprandial blood glucose at patient baseline (ß = .064, P< .01). CONCLUSIONS: The present study is the first to show that both serum levels of FT4 and TSH decrease after RYGB in euthyroid patients with obesity and type 2 diabetes. Our results suggest that not only can RYGB improve metabolic abnormalities, but it may also alter the feedback regulation of the thyroid system.

Silencing of TCTN1 inhibits proliferation, induces cell cycle arrest and apoptosis in human thyroid cancer.

Tectonic family member 1 (TCTN1) is one of the tectonic family members, and a regulator of the hedgehog signaling pathway, which has been studied in various cancer types, including prostate and pancreatic cancer. However, its function in thyroid cancer has not been well documented. Therefore, the present study investigated the function of TCTN1 in thyroid cancer using a loss-of-function assay. Lentivirus-mediated RNA interference was applied to downregulate TCTN1 in the thyroid cancer cell lines, CAL62 and 8305C. A series of functional properties, including cell viability, colony formation, cell cycle and apoptosis were determined using MTT, colony formation assay and flow cytometry analyses, respectively. The results demonstrated that lentivirus-medicated RNAi could specifically suppress the expression of TCTN1 at the mRNA and protein levels in CAL62, and 8305C cells. Knockdown of TCTN1 inhibited cell growth and proliferation via inducing S phase arrest, and apoptosis. Mechanistically, the S phase arrest was accompanied by the upregulation of cyclin dependent kinase 2, cyclin A2 and downregulation of cyclin B1. Knockdown of TCTN1 induced apoptosis through increasing the expression of Bcl2-associated agonist of cell death, cleaved caspase-3 and poly(ADP-ribose)polymerase, and decreasing apoptosis regulator Bcl-2 expression. The current study highlights the essential role of TCTN1 in promoting thyroid cancer cell proliferation, and its knockdown may serve as a potential therapeutic treatment for thyroid cancer.

Lactobacillus plantarum LP­Onlly alters the gut flora and attenuates colitis by inducing microbiome alteration in interleukin­10 knockout mice.

The association between inflammatory bowel disease (IBD) and gut microbes has been widely investigated. Our previous study demonstrated that Lactobacillus plantarum LP­Onlly (LP) applied as a probiotic altered the gut flora and attenuated colitis in interleukin (IL)­10 knockout (IL­10­/­) mice. In the present study, metagenome sequencing was performed to investigate the gut microbiome in IL­10­/­mice and the influence of oral administration of LP on microbial composition. Metagenomics sequencing was performed to investigate the influence of IBD on the gut microbiome with and without LP treatment. The alteration of the abundances of various taxonomic and functional groups were investigated across these gut microbiomes. The present study demonstrates that Akkermansia muciniphila was significantly enriched in IL­10­/­ mice, and bacteroides were significantly increased following LP administration. In addition, the phylum Bacteroidetes and Firmicutes were significantly influenced by LP administration. Further characterization of functional capacity revealed that in the gut metagenomes of IL­10­/­mice, genes encoding cell cycle control, replication, recombination, repair and cell envelope biogenesis were decreased, but intracellular trafficking, secretion, and vesicular transport were increased. The present findings indicate that the gut metagenome is associated with IBD, and oral administration of LP contributes to prevention of gut inflammation, providing insight into the treatment of IBD.

Effect of Roux-en-Y Gastric Bypass on Remission of T2D: Medium-Term Follow-up in Chinese Patients with Different BMI Obesity Class.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is an effective treatment for patients with type 2 diabetes mellitus (T2D) with obesity. However, T2D remission after surgery has not been adequately studied in Chinese patients with different obesity classes. The purpose of this study is to evaluate the medium-term metabolic results of RYGB in T2D patients with body mass index (BMI) >25 kg/m2 compared by obesity class. METHODS: We retrospectively divided 120 Chinese patients with T2D and BMI >25 kg/m2 into four groups from overweight to obesity class III and reviewed their medical records for metabolic outcomes 36 months after RYGB. T2D remission was defined as glycated hemoglobin <6.0 % and no current medications. Hypertension, dyslipidemia, cardiovascular risk, and medications were also evaluated. RESULTS: Sixty-two patients (62/120, 51.6 %) were female. All surgeries were performed laparoscopically without mortality or major complications. Mean follow-up duration was 38.7 ± 9.1 months and follow-up compliance was 86.7 %. Patients with BMI ≥28 kg/m2 benefitted more from weight loss following RYGB. Medication and remission results for hypertension and dyslipidemia did not differ significantly between groups. There was a significant reduction in the need for oral medication or insulin in all four groups. T2D remission occurred in 44-66.7 % of all patients at 36 months with no significant difference between groups. Initial BMI was correlated with A1C 36 months after surgery (r = -0.217, P = 0.027). CONCLUSIONS: RYGB effectively treated T2D patients in our study, even in low-BMI patients, and resulted in diabetes remission and metabolic disorder control, reducing cardiovascular risk.

Robotic Versus Laparoscopic Bariatric Surgery: a Systematic Review and Meta-Analysis.

We aim to summarize the available literature on patients treated with robotic bariatric surgery (RBS) or laparoscopic bariatric surgery (LBS) and compare the clinical outcomes between RBS and LBS. A systematic literature was conducted in accordance with the PRISMA guidelines. Thirty-four observational studies met our inclusion criteria, and 27 studies of 27,997 patients were included in the meta-analysis. There were no significant differences between RBS and LBS regarding overall postoperative complications, major complications, the length of hospital stay, reoperation, conversion, and mortality. Nevertheless, RBS was burdened by longer operative times and higher hospital costs when compared with LBS. On the contrary, the incidence of anastomotic leak was lower in RBS than in LBS. Further studies with a longer follow-up are recommended.

Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis.

BACKGROUND: Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. OBJECTIVE: To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. METHODS: We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. RESULTS: 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. LIMITATIONS: The main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up. CONCLUSIONS: Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed.

Effect of Roux-en-Y gastric bypass on the remission of type 2 diabetes: a 3-year study in Chinese patients with a BMI <30 kg/m2.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is an effective treatment for patients with type 2 diabetes (T2D) and morbid obesity. However, T2D remission after surgery has not been adequately studied in Chinese patients with a body mass index (BMI)<30 kg/m2. OBJECTIVES: The objective of this study was to evaluate the 3-year effect of RYGB among patients with T2D with a BMI<30 kg/m2 and elucidate the predictors of T2D remission. SETTING: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. METHODS: Sixty-six Chinese patients with T2D and a BMI 25-30 kg/m2 were retrospectively examined for metabolic outcomes 3 years after RYGB. Remission was defined as glycated hemoglobin (HbA1C)<6.5% and no medications. Binary logistic regression analysis was used to identify preoperative parameters independently predictive of diabetes remission at 1 and 3 years postoperatively [variables: sex, age, BMI, T2D duration, plasma glucose 2 hours after meal, HbA1C, fasting C-peptide, visceral fat area, free triiodothyronine, and thyroid-stimulating hormone. There was no significant difference in fasting insulin or glucose between the remission and no remission groups. RESULTS: Patients were a mean 50.4±11.4 years of age at baseline, and 57.6% were female. Mean T2D duration was 8.9±5.2 years, baseline HbA1C level was 8.3±1.9%, and baseline BMI was 28.2±1.2 kg/m2 (range: 25.5-30.0). BMI was 22.5±1.8 kg/m2 (range: 19.1-28.0) at 1 year and 23.0±1.76 kg/m2 (range: 19.7-28.0) at 3 years. Remission was achieved in 49 patients (74.2%) at 1 year and 38 patients (57.6%) at 3 years. There was a significant reduction in medication for diabetes, hypertension, and hyperlipidemia (P<.01). Compared with patients in the no remission group, patients in the remission group had higher fasting C-peptide levels (P<.01) and free triiodothyronine levels (P = .01) at 1 year. Multiple logistic regression analysis confirmed that fasting C-peptide (odds ratio = 3.795, P = .007) and free triiodothyronine (odds ratio = 4.661, P = .019) levels were predictors of T2D remission at 1 year. No significant difference was found between the 2 groups at 3 years. CONCLUSIONS: RYGB resulted in significant clinical and biochemical improvements in Chinese patients with BMI 25-30 kg/m2 and T2D. Appropriate patient selection (better ß-cell function) may produce better outcomes.