The timing of pregnancies after bariatric surgery has no impact on children’s health—a nationwide population-based registry analysis

Purpose Bariatric surgery has a favorable effect on fertility in women. However, due to a lack of data regarding children’s outcomes, the ideal time for conception following bariatric surgery is unknown. Current guidelines advise avoiding pregnancy during the initial weight loss phase (12–24 months after surgery) as there may be potential risks to offspring. Thus, we aimed to analyze health outcomes in children born to mothers who had undergone bariatric surgery. The surgery-to-delivery interval was studied. Materials and Methods A nationwide registry belonging to the Austrian health insurance funds and containing health-related data claims was searched. Data for all women who had bariatric surgery in Austria between 01/2010 and 12/2018 were analyzed. A total of 1057 women gave birth to 1369 children. The offspring’s data were analyzed for medical health claims based on International Classification of Diseases (ICD) codes and number of days hospitalized. Three different surgery-to-delivery intervals were assessed: 12, 18, and 24 months. Results Overall, 421 deliveries (31%) were observed in the first 2 years after surgery. Of these, 70 births (5%) occurred within 12 months after surgery. The median time from surgery to delivery was 34 months. Overall, there were no differences noted in frequency of hospitalization and diagnoses leading to hospitalization in the first year of life, regardless of the surgery-to-delivery interval. Conclusion Pregnancies in the first 24 months after bariatric surgery were common. Importantly, the surgery-to-delivery interval had no significant impact on the health outcome of the children.publishedVersio

Sex‑Specifc Diferences in Mortality of Patients with a History of Bariatric Surgery: a Nation‑Wide Population‑Based Study

Purpose Bariatric surgery reduces mortality in patients with severe obesity and is predominantly performed in women. Therefore, an analysis of sex-specific differences after bariatric surgery in a population-based dataset from Austria was performed. The focus was on deceased patients after bariatric surgery. Materials and Methods The Austrian health insurance funds cover about 98% of the Austrian population. Medical health claims data of all Austrians who underwent bariatric surgery from 01/2010 to 12/2018 were analyzed. In total, 19,901 patients with 107,806 observed years postoperative were eligible for this analysis. Comorbidities based on International Classification of Diseases (ICD)-codes and drug intake documented by Anatomical Therapeutical Chemical (ATC)-codes were analyzed in patients deceased and grouped according to clinically relevant obesity-associated comorbidities: diabetes mellitus (DM), cardiovascular disease (CV), psychiatric disorder (PSY), and malignancy (M). Results In total, 367 deaths were observed (1.8%) within the observation period from 01/2010 to 04/2020. The overall mortality rate was 0.34% per year of observation and significantly higher in men compared to women (0.64 vs. 0.24%; p < 0.001(Chi-squared)). Moreover, the 30-day mortality was 0.19% and sixfold higher in men compared to women (0.48 vs. 0.08%; p < 0.001). CV (82%) and PSY (55%) were the most common comorbidities in deceased patients with no sex-specific differences. Diabetes (38%) was more common in men (43 vs. 33%; p = 0.034), whereas malignant diseases (36%) were more frequent in women (30 vs. 41%; p = 0.025). Conclusion After bariatric surgery, short-term mortality as well as long-term mortality was higher in men compared to women. In deceased patients, diabetes was more common in men, whereas malignant diseases were more common in women.publishedVersio

HbA1c and Glucose Management Indicator Discordance Associated with Obesity and Type 2 Diabetes in Intermittent Scanning Glucose Monitoring System

Glucose management indicator (GMI) is frequently used as a substitute for HbA1c, especially when using telemedicine. Discordances between GMI and HbA1c were previously mostly reported in populations with type 1 diabetes (T1DM) using real-time CGM. Our aim was to investigate the accordance between GMI and HbA1c in patients with diabetes using intermittent scanning CGM (isCGM). In this retrospective cross-sectional study, patients with diabetes who used isCGM >70% of the time of the investigated time periods were included. GMI of four different time spans (between 14 and 30 days), covering a period of 3 months, reflected by the HbA1c, were investigated. The influence of clinical- and isCGM-derived parameters on the discordance was assessed. We included 278 patients (55% T1DM; 33% type 2 diabetes (T2DM)) with a mean HbA1c of 7.63%. The mean GMI of the four time periods was between 7.19% and 7.25%. On average, the absolute deviation between the four calculated GMIs and HbA1c ranged from 0.6% to 0.65%. The discordance was greater with increased BMI, a diagnosis of T2DM, and a greater difference between the most recent GMI and GMI assessed 8 to 10 weeks prior to HbA1c assessment. Our data shows that, especially in patients with increased BMI and T2DM, this difference is more pronounced and should therefore be considered when making therapeutic decisions

Insulin-Like Growth Factor 1 Predicts Post-Load Hypoglycemia following Bariatric Surgery: A Prospective Cohort Study

<div><p>Postprandial hypoglycemia is a complication following gastric bypass surgery, which frequently remains undetected. Severe hypoglycemic episodes, however, put patients at risk, e.g., for syncope. A major cause of hypoglycemia following gastric bypass is hyperinsulinemic nesidioblastosis. Since pancreatic islets in nesidioblastosis overexpress insulin-like growth factor 1 (IGF-1) receptor α and administration of recombinant IGF-1 provokes hypoglycemia, our main objective was to investigate the occurrence of post-load hypoglycemia one year after bariatric surgery and its relation to pre- and post-operative IGF-1 serum concentrations. We evaluated metabolic parameters including 2 h 75 g oral glucose tolerance test (OGTT) and measured IGF-1 serum concentration in thirty-six non-diabetic patients (29 f/7 m), aged 41.3±2.0 y with a median (IQR) BMI of 30.9 kg/m² (27.5–34.3 kg/m²), who underwent elective bariatric surgery (predominantly gastric bypass, 83%) at our hospital. Post-load hypoglycemia as defined by a 2 h glucose concentration <60 mg/dl was detected in 50% of patients. Serum insulin and C-peptide concentration during the OGTT and HOMA-IR (homeostatic model assessment–insulin resistance) were similar in hypoglycemic and euglycemic patients. Strikingly, pre- and post-operative serum IGF-1 concentrations were significantly higher in hypoglycemic patients (p = 0.012 and p = 0.007 respectively). IGF-1 serum concentration before surgery negatively correlated with 2 h glucose concentration during the OGTT (rho = −0.58, p = 0.0003). Finally, IGF-1 serum concentrations before and after surgery significantly predicted post-load hypoglycemia with odds ratios of 1.28 (95%CI:1.03–1.55, p = 0.029) and 1.18 (95%CI:1.03–1.33, p = 0.015), respectively, for each 10 ng/ml increment. IGF-1 serum concentration could be a valuable biomarker to identify patients at risk for hypoglycemia following bariatric surgery independently of a diagnostic OGTT. Thus, IGF-1 testing could help to prevent a significant complication of gastric bypass surgery.</p></div

Glucose, insulin and C-peptide concentration during pre-operative and post-operative OGTT.

<p>(A) Glucose concentrations during the course of the pre-operative 2 h OGTT (n = 35, full lines) compared to the post-operative OGTT (n = 35, dashed lines). (B) Histogram of post-operative 2 h glucose concentrations during the OGTT (n = 35). Post-load hypoglycemia was defined by a 2 h glucose concentration<60 mg/dl. (C) Insulin and (D) C-peptide concentrations during the course of the pre-operative 2 h OGTT (n = 35, full lines) compared to the post-operative OGTT (n = 35, dashed lines).</p

IGF-1 in patients with euglycemia and post-load hypoglycemia at 2 h during the post-operative OGTT.

<p>(A) Box-plots of pre- and post-operative serum IGF-1 concentrations in patients with euglycemia (n = 17, black bars) and post-load hypoglycemia (n = 18, white bars). Outliers are represented by dots. (B) Pre-operative serum IGF-1 concentration plotted against 2 h glucose concentration during the post-operative OGTT (n = 35). (C) Post-operative serum IGF-1 concentration plotted against 2 h glucose concentration during the post-operative OGTT (n = 35). (D) ROC-AUC curve for detecting post-load hypoglycemia according to pre-operative IGF-1 concentration (n = 35). Differences between IGF-1 concentrations between the two groups were calculated by unpaired student's t-test. The association between pre- and post-operative serum IGF-1 concentration and post-operative 2 h glucose concentration during the OGTT was analyzed using Spearman's rank correlation,*p<0.05.</p

Characteristics of obese patients before and one year after bariatric surgery.

a<p>Metabolic syndrome was defined according to IDF criteria;</p><p>ALT, alanine transaminase; BP, blood pressure; FLI, fatty liver index; GGT, gamma-glutamyl-transferase; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol, WHR, waist to hip ratio.</p

Post-operative OGTT glucose, insulin and C-peptide concentration in patients with euglycemia and hypoglycemia.

<p>(A) Glucose, (B) insulin and (C) C-peptide concentrations during the course of the post-operative 2 h OGTT in patients with euglycemia (n = 17, full lines) and patients with post-load hypoglycemia (n = 18, dashed lines). Differences between pre and post-operative values were calculated with paired t-test. Differences between patients with euglycemia and hypoglycemia were calculated by unpaired student's t-test.*p<0.05.</p

Treatment with n-3 Polyunsaturated Fatty Acids Overcomes the Inverse Association of Vitamin D Deficiency with Inflammation in Severely Obese Patients: A Randomized Controlled Trial

<div><p>Obesity affects the vitamin D status in humans. Vitamin D and long-chain n-3 polyunsaturated fatty acids (PUFA) provide benefit for the prevention of fractures and cardiovascular events, respectively, and both are involved in controlling inflammatory and immune responses. However, published epidemiological data suggest a potential interference of n-3 PUFA supplementation with vitamin D status. Therefore, we aimed to investigate in a randomized controlled clinical trial whether treatment with long chain n-3 PUFA affects vitamin D status in severely obese patients and potential interrelations of vitamin D and PUFA treatment with inflammatory parameters. Fifty-four severely obese (BMI≥40 kg/m2) non-diabetic patients were treated for eight weeks with either 3.36 g/d EPA and DHA or the same amount of butter fat as control. Changes in serum 25-hydroxy-vitamin D [25(OH)D] concentrations, plasma fatty acid profiles and circulating inflammatory marker concentrations from baseline to end of treatment were assessed. At baseline 43/54 patients were vitamin D deficient (serum 25(OH)D concentration <50 nmol/l). Treatment with n-3 PUFA did not affect vitamin D status (<em>P</em> = 0.91). Serum 25(OH)D concentration correlated negatively with both IL-6 (<em>P</em> = 0.02) and hsCRP serum concentration (<em>P</em> = 0.03) at baseline. Strikingly, the negative correlations of 25(OH)D with IL-6 and hsCRP were lost after n-3 PUFA treatment. In conclusion, vitamin D status of severely obese patients remained unaffected by n-3 PUFA treatment. However, abrogation of the inverse association of 25(OH)D concentration with inflammatory markers indicated that n-3 PUFA treatment could compensate for some detrimental consequences of vitamin D deficiency.</p> <h3>Trial Registration</h3><p>ClinicalTrials.gov <a href="http://clinicaltrials.gov/show/NCT00760760">NCT00760760</a></p> </div

Characteristics of vitamin D-deficient and non-deficient study subjects at baseline.

1<p>Data presented as mean ± SEM for normally distributed data, otherwise median (IQR). No statistical significant differences between the analyzed parameters in vitamin D deficient and non-deficient patients were found, except for age plasma interleukin-6 concentration, indicated by asterisk.</p>*<p>(both <i>P</i> = 0.04, calculated by ANOVA and Mann-Whitney-U Test).</p><p>BMI, body mass index; hsCRP, high sensitive C-reactive protein; PTH, parathyroid hormone; EPA, eicosapentaenoic acid; DHA, docosahexaenoic acid; MUFA, sum of all detected monounsaturated fatty acids; VDBP, vitamin D binding protein.</p