Purpose: Laparoscopic sleeve gastrectomy (LSG) is an effective weight loss procedure, but detrimental effects on bone health have been described. We aimed to assess the dynamics of regional and total bone mineral density (BMD) in a cohort of patients undergoing LSG and to capture gender differences in terms of evolution. Materials and Methods: We conducted a retrospective study on 241 patients who underwent LSG to determine the regional and total BMD changes at 6 and 12 months after the intervention. Results: One hundred ten males and 140 females (97 pre-, 43 postmenopausal) were included. Mean baseline body mass index (BMI) was 44.16 ± 6.11 kg/m² in males and 41.60 ± 5.54 kg/m² in females, reaching 28.62 ± 4.26 kg/m² and 27.39 ± 4.2 kg/m², respectively, at 12 months. BMD showed a continuous decline, with significant loss from 6 months postoperatively. There was a positive correlation between BMD and BMI decline at 12 months (r = 0.134, p < 0.05). Total BMD loss at 12 months was significantly greater in males than premenopausal females, independent of BMI variation and age. During the first 6 months, men lost significantly more bone mass than premenopausal and postmenopausal women (BMD variation was 2.62%, 0.27%, 1.58%, respectively). The second period (6–12 months) was similar in all three groups, revealing a further steady (~ 1.4%) BMD decline. Conclusions: Our results are consistent with previous findings that LSG negatively impacts BMD, stressing the importance of bone health-oriented measures in postoperative care. Moreover, the impact that seems more significant in males warrants future exploration, as it might change clinical practice. Graphical

Over the past years, bone and adipose tissue have gained interest from researchers in the light of their secretory profiles, being able to produce active molecules, with the final effect of regulating energy homeostasis. Both adipocytes and osteoblasts originate in the pluripotent mesenchymal stem cell and this common origin has been proposed as the core of the fat-bone relationship. The central nervous system might be the third player in this association, capable of integrating signals. Numerous adipose tissue secreted factors that influence energy homeostasis and bone have been described: leptin, adiponectin, lipocalin 2, and inflammatory cytokines (e.g. IL-1, IL-6 and TNF-α). Similarly, osteocalcin, the most abundant bone protein, has been shown to elicit numerous central and peripheral endocrine functions. In this paper, we provide a review of the current literature regarding the bone-adipose tissue-central nervous system axis and a brief description of the several underlying molecular mechanisms.

Background: Insulin pumps coupled with continuous glucose monitoring sensors use algorithms to analyze real-time blood glucose levels. This allows for the suspension of insulin administration before hypoglycemic thresholds are reached or for adaptive tuning in hybrid closed-loop systems. This longitudinal retrospective study aims to analyze real-world glycemic outcomes in a pediatric population transitioning to such devices. Methods: We evaluated children with type 1 diabetes mellitus (T1D) admitted to the Pediatric Diabetes Department from a major University Hospital in Bucharest, Romania, who transitioned to hybrid closed-loop or predictive low-glucose suspend system from either non-automated insulin pumps or multiple daily injections. The primary outcome was assessing the change in glycated hemoglobin (HbA1c) after initiating these devices. Secondary outcomes analyzed changes in glucose metrics from the 90 days prior to the baseline and follow-up visit. Results: 51 children were included (58.8% girls), the mean age was 10.3 ± 3.7 years, and the mean follow-up duration was 13.2 ± 4.5 months. The analyzed parameters, such as HbA1c (6.9 ± 0.7% vs. 6.7 ± 0.6%, p = 0.023), time in range (69.3 ± 11.2% vs. 76 ± 9.9%, p < 0.001), time in tight range (47.4 ± 10.9% vs. 53.7 ± 10.7%, p < 0.001), time below range (5.6 ± 2.9% vs. 3.5 ± 1.9%, p < 0.001), time above range (25 ± 11.2% vs. 20.4 ± 9.4%, p = 0.001), and coefficient of variation (37.9 ± 4.8% vs. 35.6 ± 4.6%, p = 0.001), showed significant improvements. Conclusions: The application of these sensor-integrated insulin pumps can significantly enhance metabolic control in pediatric populations, minimizing glycemic variations to mitigate complications and enrich the quality of life.

Introduction: Higher body mass index (BMI) has been associated with adverse renal outcomes, including chronic kidney disease (CKD), progression to end-stage renal disease (ESRD), nephrolithiasis and renal cell cancer. Several studies have shown that weight loss following bariatric surgery has a positive effect on kidney function, mediated by a reduction in proteinuria, glomerular hyperfiltration and improvements in blood pressure and insulin resistance. The aim of this study was to examine the changes in estimated glomerular filtration rate (eGFR) in a group of morbidly obese patients 6 months after laparoscopic sleeve gastrectomy (LSG). Materials and methods: 221 severely obese patients (65.2% women, mean age=41.97±11.24 years, mean BMI=44.7±8.57 kg/m²) underwent a complete clinical and biochemical assessment before and 6 months after LSG. The variation of parameter values(Δ) was expressed in percentages out of the preoperative values. Kidney function was calculated using the MDRD-4 formula. Results: Of the 221 patients, 53.4% were hypertensive, 25.4% had diabetes and 53.8% presented with metabolic syndrome (MetS). Six months after surgery BMI declined to 31.84±6.7kg/m² (P<0.001) and an excess weight loss (EWL) of 73.86±30.33% was observed. In addition, the prevalence of CKD risk factors decreased significantly to 34.3%, 8.5% and 14% for hypertension, diabetes and MetS respectively (P<0.001). Regarding the kindney function, 71.5% of patients had an eGFR lower than 90 ml/min/1.73 m², with mean eGFR=82.15±18.50 ml/min/1.73 m². Postoperatively, eGFR increased to 86.33±20.4 ml/min/1.73 m² (P<0.001) and 60.2% had an eGFR <90 ml/min/1.73 m² (P<0.001). Negative correlations were established between ΔeGFR and ΔBMI (r=−0.195, P=0.004), Δcalcium levels (r=−0.273, P=0.038). Patients were further examined after being separated by baseline eGFR (90 ml/min/1.73 m²). Comparing the two groups, the patients from the eGFR<90 group were older (44.03±10.09 vs 36.81±10.2 years, P<0.001) and had a lower BMI (43.69±7.97 vs 46.8±9.6 kg/m², P=0.014). While a slight increase in eGFR was noticed in the <90 group (73.29±10.38 preoperatively vs 79.28±15.87 ml/min/1.73 m² postoperatively, P90 group (104.38±15.48 preoperatively vs 104.02±20.13 ml/min/1.73 m² postoperatively, P=0.068). Conclusion: Bariatric surgery is an effective method of improving CKD risk factors such as hypertension and diabetes and weight loss is associated with an increase in eGFR in patients with renal impairment.

Introduction: Obesity, defined as a BMI ≥30 kg/m², is the most common chronic metabolic disease in the world and its prevalence has strongly increased. Obesity is associated with multiple comorbidities, including cardiovascular disease, hypertension, insulin resistance, dyslipidemia, type 2 diabetes, sleep apnea and certain cancers. Bariatric surgery is the most effective treatment for severe obesity and produces dramatic and durable weight loss. The aim of the study was to evaluate weight loss and changes in the metabolic profile in a period between 6 months and 5 years after laparoscopic sleeve gastrectomy (LSG). Methods: An observational study was conducted. It included 40 patients having morbid obesity and undergoing bariatric surgery, respectively LSG. Preoperative and postoperative data (6 months and 5 years) was collected and analyzed. The following parameters were measured: weight, height, waist, hip; BMI and EWL (excess weight loss) were calculated. Fasting glucose, insulin level, uric acid and lipid profile were measured and HOMA IR (homeostasis model assessment of insulin resistance) was calculated. Results: Preoperatively, the mean age was 44.55±8.95 years, mean BMI was 46.61±10.06 kg/m², mean waist was 131.25±20.30 cm, and mean cholesterol level was 210±41.47 mg/dl. After 6 months, mean BMI decreased to 33.95±7.28 kg/m² and to 35.11±7.28 kg/m² after 5 years. On average, patients had EWL of 66.71% at 6-month follow-up and 57.29% at 5-years follow-up. There were remarkable improvements in lipid profile. The mean levels of high-density lipoprotein (HDL) cholesterol after surgery were significantly higher (41.95±9.53 mg/dl vs 47.42±12.09 mg/dl six months after surgery vs 54.25±12.52 mg/dl after 5 years, P<0.05). Triglycerides, uric acid and glucose levels were significantly reduced from 159.69±66.644 mg/dl, 7.39±4.81 mg/dl and 118.64 mg/dl at baseline to 108.23±79 mg/dl, 5.07±1.55 mg/dl, and 86.08±9.72 mg/dl after 6 months and 105.24±51.86 mg/dl, 5.49±1.25 mg/dl, and 93.96±13.73 mg/dl after 5 years. After 6 months, HOMA index improved from 7.62±7.25 to 1.44±1.59 (P<0.05). Compared to baseline, improvement was maintained in the data collected after 5 years (2.97±3.58, P<0.05). Conclusion: LGS determines both short and long term improvements in weight loss and metabolic parameters.