Purpose of Review: The review aims to describe short-chain fatty acids (SCFAs) as metabolites of bacteria, their complex influence on whole-body metabolism, and alterations in the SCFA profile in obesity and after bariatric surgery (BS). Recent Findings: The fecal profile of SCFAs in obese patients differs from that of lean patients, as well as their gut microbiota composition. In obese patients, a lower diversity of bacteria is observed, as well as higher concentrations of SCFAs in stool samples. Obesity is now considered a global epidemic and bariatric surgery (BS) is an effective treatment for severe obesity. BS affects the structure and functioning of the digestive system, and also alters gut microbiota and the concentration of fecal SCFAs. Generally, after BS, SCFA levels are lower but levels of branched short-chain fatty acids (BSCFAs) are elevated, the effect of which is not fully understood. Moreover, changes in the profile of circulating SCFAs are little known and this is an area for further research. Summary: Obesity seems to be inherently associated with changes in the SCFA profile. It is necessary to better understand the impact of BS on microbiota and the metabolome in both feces and blood as only a small percentage of SCFAs are excreted. Further research may allow the development of a personalized therapeutic approach to the BS patient in terms of diet and prebiotic intervention.
Subjects with morbid obesity have low levels of serum branched-chain fatty acids (BCFAs), which correlate inversely with insulin resistance, hypertriglyceridemia, and inflammation. Recent evidence suggests BCFAs are produced during branched-chain amino acid (BCAA) catabolism in human adipose tissue. Elevated concentrations of BCAAs are associated with insulin resistance.
The enhanced recovery after surgery (ERAS) protocol, which emphasizes preoperative interventions, is safely implemented in patients undergoing bariatric surgery. Patients are additionally encouraged to achieve weight loss preoperatively. We aimed to identify factors contributing to preoperative weight loss and assess their influence on outcomes of bariatric surgery among patients under the ERAS protocol.
Introduction: The aim of the study was to investigate the impact of the COVID-19 pandemic on bariatric care from the patients’ point of view. The COVID-19 pandemic has perturbed the functioning of healthcare systems around the world and led to changes in elective surgical care, with bariatric procedures being postponed until the end of pandemic. There is no data in the literature about the effect of a new epidemiological situation on bariatric patients. Methods: The study was designed as an online survey containing multiple open questions about bariatric care during the COVID-19 pandemic. The survey was conducted among pre- and postoperative bariatric patients. Results: Out of 800 respondents, 74.53% felt anxiety about their health in regard to the present epidemiologic state. Some (72.25%) were aware of the fact that obesity was an important risk factor that could impair the course of the COVID-19 disease. Almost 30% of respondents admitted having put on weight, significantly more in the group of preoperative patients (43.8% vs. 22.69%; p < 0.001). Only 20.92% of patients had a possibility of continuing direct bariatric care; 67.3% of patients had an opportunity of remote contact with a bariatric specialist, including online consultations, teleconsultations and social media meetings. Conclusions: Limited access to medical care and quarantine lockdown may result in a deterioration of long-time operation outcomes and lower weight losses. Patients should be encouraged to profit from online consultations with specialists and telemedicine to reduce the negative effects of the pandemic on their health.
Background: The most commonly performed bariatric operations are laparoscopic sleeve gastrectomy (LSG) and bypass surgeries (laparoscopic one-anastomosis gastric bypass (OAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB)), and predicting perioperative morbidity is crucial for early, safe patient discharge. We aimed to determine whether C-reactive protein (CRP) and white blood count (WBC) measured on the first postoperative day predicts perioperative morbidity in the first 30-days after LSG and bypass surgeries. Methods: We retrospectively analyzed data for 1400 patients who underwent bariatric surgery in seven bariatric centers from 2014 to 2018. Patients were divided into a complicated group (patients with postoperative complications) and a non-complicated group. We also performed separate analyses for LSG and bypass surgeries. Results: Patients were 929 women (66%) and 471 men (34%) with a median age of 42 years (range, 35–51 years); 1192 patients underwent LSG (85%), 120 underwent LRYGB (9%), and 80 underwent OAGB (6%). We performed ROC analyses to set cut-off points, followed by multivariate logistic regressions. CRP > 33.32 mg/L increased the odds ratio (OR) of perioperative complications after LSG 2.27 times, while WBC > 12.15 × 103/μL on postoperative day 1 was associated with a 3.34-times greater or of developing complications. WBC > 13.78 × 103/μL was associated with a 13.34-times higher or of perioperative morbidity in patients undergoing bypass surgeries. Conclusion: Even slightly elevated CRP and WBC on postoperative day 1 should alert surgeons to the potential risk of perioperative morbidity.
Morbid obesity is considered a civilization disease of the 21st century. Not only does obesity increase mortality, but it is also the most important cause of the shortening life expectancy in the modern world. Obesity is associated with many metabolic abnormalities: dyslipidemia, hyperglycemia, cardiovascular diseases, and others. An increasing number of patients diagnosed with chronic kidney disease (CKD) are obese. Numerous additional disorders associated with impaired kidney function make it difficult to conduct slimming therapy and may also be associated with a greater number of complications than in people with normal kidney function. Currently available treatments for obesity include lifestyle modification, pharmacotherapy, and bariatric surgery (BS). There are no precise recommendations on how to reduce excess body weight in patients with CKD treated conservatively, undergoing chronic dialysis, or after kidney transplantation. The aim of this study was to analyze studies on the bariatric treatment of obesity in this group of people, as well as to compare the recommendations typical for bariatrics and CKD.