Single-centre, non-randomised clinical trial at a tertiary care centre to investigate 1-year changes in social experiences and biomarkers of well-being after bariatric surgery in individuals with severe obesity: protocol for the Bariatric Surgery and Social Experiences (BaSES) study

Introduction Obesity is linked to increased loneliness and less enjoyment of social interactions. While bariatric surgery is the most effective treatment targeting severe obesity, there is limited understanding as to whether patients experience social interactions differently after surgery. The Bariatric Surgery and Social Experiences study is designed to assess potential changes in how much patients enjoy and engage in daily social interactions 1 year after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Methods and analysis Single-centre, non-randomised clinical trial carried out at the Department of Endocrinology, Obesity and Nutrition at Vestfold Hospital Trust, Norway. Eligible patients (N=113) will undergo either RYGB, SG or single anastomosis sleeve ileal (SASI) bypass. The primary outcome measure is change in the social experience score (assessed with a questionnaire) from a presurgery to a follow-up assessment 1 year after RYGB and SG. The respective changes after SASI bypass will be assessed and considered exploratory. Ethics and dissemination The most recent protocol version of this study was reviewed and approved by the Regional Committee for Medical Research Ethics South East Norway (REK sør-øst A) on 29 August 2022 (ref: 238406). The results will be disseminated to academic and health professional audiences and the public via publications in international peer-reviewed journals and conferences.publishedVersio

Investigating the human jejunal microbiota

Descriptions of the small intestinal microbiota are deficient and conflicting. We aimed to get a reliable description of the jejunal bacterial microbiota by investigating samples from two separate jejunal segments collected from the luminal mucosa during surgery. Sixty patients with morbid obesity selected for elective gastric bypass surgery were included in this survey. Samples collected by rubbing a swab against the mucosa of proximal and mid jejunal segments were characterized both quantitatively and qualitatively using a combination of microbial culture, a universal quantitative PCR and 16S deep sequencing. Within the inherent limitations of partial 16S sequencing, bacteria were assigned to the species level. By microbial culture, 53 patients (88.3%) had an estimated bacterial density of < 1600 cfu/ml in both segments whereof 31 (51.7%) were culture negative in both segments corresponding to a bacterial density below 160 cfu/ml. By quantitative PCR, 46 patients (76.7%) had less than 104 bacterial genomes/ml in both segments. The most abundant and frequently identified species by 16S deep sequencing were associated with the oral cavity, most often from the Streptococcus mitis group, the Streptococcus sanguinis group, Granulicatella adiacens/para-adiacens, the Schaalia odontolytica complex and Gemella haemolysans/taiwanensis. In general, few bacterial species were identified per sample and there was a low consistency both between the two investigated segments in each patient and between patients. The jejunal mucosa of fasting obese patients contains relatively few microorganisms and a core microbiota could not be established. The identified microbes are likely representatives of a transient microbiota and there is a high degree of overlap between the most frequently identified species in the jejunum and the recently described ileum core microbiota.publishedVersio

Single-centre, triple-blinded, randomised, 1-year, parallel-group, superiority study to compare the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function in subjects with morbid obesity: a protocol for the Obesity surgery in Tønsberg (Oseberg) study

publishedVersio

Bunndyrundersøkelser i vassdrag på Sunnmøre høsten 2020

NORCE LFI undersøkte vannkvaliteten i elleve lakseførende vassdrag på Sunnmøre ved innsamling av bunndyrprøver høsten 2020. Både forsuringsindekser og eutrofieringsindeks tydet på god vannkvalitet ved de fleste lokalitetene. Kun i Riksheimelva i Sykkylven tydet resultatene på noe forsuring, og kun i nedre del av Austefjordvassdraget i Volda virket bunndyrsamfunnet påvirket av eutrofiering. Rapporten inneholder også en sammenstilling av tidligere registrerte bunndyrindekser og vannkjemiske data fra alle anadrome vassdrag på Sunnmøre, hentet fra databasen Vannmiljø. Også disse dataene tyder på generelt god vannkvalitet i regionen, med lite forsuringspåvirkning og lite eutrofiering i de fleste undersøkte vassdrag. Enkelte elver og innsjøer virker imidlertid å være betydelig mer påvirket av eutrofiering enn andre. Det gjøres også oppmerksom på at akutte utslipp kan gi dødelighet for fisk og andre organismer uten at dette fanges opp i periodisk overvåking av vannkvalitet. I det store bildet er konklusjonen likevel at det er usannsynlig at dårlig vannkvalitet har vært en betydelig faktor i bestandsutviklingen for laks og sjøørret på Sunnmøre i nyere tid.publishedVersio

Bunndyrundersøkelser i vassdrag på Sunnmøre høsten 2020

NORCE LFI undersøkte vannkvaliteten i elleve lakseførende vassdrag på Sunnmøre ved innsamling av bunndyrprøver høsten 2020. Både forsuringsindekser og eutrofieringsindeks tydet på god vannkvalitet ved de fleste lokalitetene. Kun i Riksheimelva i Sykkylven tydet resultatene på noe forsuring, og kun i nedre del av Austefjordvassdraget i Volda virket bunndyrsamfunnet påvirket av eutrofiering. Rapporten inneholder også en sammenstilling av tidligere registrerte bunndyrindekser og vannkjemiske data fra alle anadrome vassdrag på Sunnmøre, hentet fra databasen Vannmiljø. Også disse dataene tyder på generelt god vannkvalitet i regionen, med lite forsuringspåvirkning og lite eutrofiering i de fleste undersøkte vassdrag. Enkelte elver og innsjøer virker imidlertid å være betydelig mer påvirket av eutrofiering enn andre. Det gjøres også oppmerksom på at akutte utslipp kan gi dødelighet for fisk og andre organismer uten at dette fanges opp i periodisk overvåking av vannkvalitet. I det store bildet er konklusjonen likevel at det er usannsynlig at dårlig vannkvalitet har vært en betydelig faktor i bestandsutviklingen for laks og sjøørret på Sunnmøre i nyere tid

Investigating the human jejunal microbiota

Descriptions of the small intestinal microbiota are deficient and conflicting. We aimed to get a reliable description of the jejunal bacterial microbiota by investigating samples from two separate jejunal segments collected from the luminal mucosa during surgery. Sixty patients with morbid obesity selected for elective gastric bypass surgery were included in this survey. Samples collected by rubbing a swab against the mucosa of proximal and mid jejunal segments were characterized both quantitatively and qualitatively using a combination of microbial culture, a universal quantitative PCR and 16S deep sequencing. Within the inherent limitations of partial 16S sequencing, bacteria were assigned to the species level. By microbial culture, 53 patients (88.3%) had an estimated bacterial density of < 1600 cfu/ml in both segments whereof 31 (51.7%) were culture negative in both segments corresponding to a bacterial density below 160 cfu/ml. By quantitative PCR, 46 patients (76.7%) had less than 104 bacterial genomes/ml in both segments. The most abundant and frequently identified species by 16S deep sequencing were associated with the oral cavity, most often from the Streptococcus mitis group, the Streptococcus sanguinis group, Granulicatella adiacens/para-adiacens, the Schaalia odontolytica complex and Gemella haemolysans/taiwanensis. In general, few bacterial species were identified per sample and there was a low consistency both between the two investigated segments in each patient and between patients. The jejunal mucosa of fasting obese patients contains relatively few microorganisms and a core microbiota could not be established. The identified microbes are likely representatives of a transient microbiota and there is a high degree of overlap between the most frequently identified species in the jejunum and the recently described ileum core microbiota

Bone mineral density and bone turnover after sleeve gastrectomy and gastric bypass, a randomized controlled trial

Context Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is associated with increased risk of osteoporotic fractures. It is unknown whether RYGB or sleeve gastrectomy (SG) have different effects on bone health. Objective To compare changes in bone mineral density and markers of bone turnover one year after SG and RYGB. Design, Setting, Patients, and Interventions Randomized, triple-blind, single-center trial at a tertiary care center in Norway. Primary outcome was diabetes remission. Patients with severe obesity and type 2 diabetes were randomized and allocated (1:1) to SG or RYGB. Main Outcome Measures Changes in areal bone mineral density (aBMD) and bone turnover markers. Results Femoral neck, total hip, and lumbar spine aBMD, but not total body aBMD, decreased significantly more after RYGB (n=44) than after SG (n=48) [mean (95% CI) between group differences -2.8 % (-0.8 to -4.7), -3.0 % (-0.9 to -5.0), -4.2 % (-2.1 to -6.4), and -0.5 % (0.6 to -1.6), respectively]. The increase in procollagen type 1 N-terminal propeptide (P1NP) and C-telopeptide of type I collagen (CTX-1) were approximately 100% higher after RYGB than after SG, (both time x group, P<0.001). The changes in femoral neck, total hip and lumbar spine aBMDs and the changes in P1NP and CTX-1 were independently associated with the surgical procedure (all P<0.05) and not weight change. Conclusions RYGB was associated with greater reduction in aBMD and greater increase in bone turnover markers compared with SG. This finding could suggest greater skeletal fragility after RYGB

Bone Turnover Markers After Standard and Distal Roux-en-Y Gastric Bypass: Results from a Randomized Controlled Trial

Background: Roux-en-Y gastric bypass is associated with increased risk of bone fractures. Malabsorptive procedures may be associated with secondary hyperparathyroidism and detrimental effects on bone health. We aimed to compare the effects of standard and distal gastric bypass on bone turnover markers 2 years after surgery. Methods: Patients with body mass index (BMI) 50–60kg/m2 (n=113) were randomized to standard or distal gastric bypass,105 patients (95%) completed 2-year follow-up. Serum C-terminal telopeptide of type I collagen (CTX-1), procollagen type I Npropeptide (PINP), and bone-derived alkaline phosphatase (BALP) was measured at baseline and up to 2 years after surgery. ANCOVA and linear mixed models were used to compare groups. Results: The levels of bone turnover markers increased significantly in both groups, with no statistically significant difference betweengroups.Two years after standard and distal gastric bypass mean (SD) CTX-1 were 0.81 (0.32) and 0.83 (0.31) μg/L (p= 0.38), mean PINP was 77.6 (23.2) and 77.7 (29.3) μg/L (p=0.42), and BALP 47.9 (21.9) vs. 50.7 (19.6) μg/L (p=0.38), respectively. Multiple linear regression analyses showed that PINP and BALP correlated positively (p=0.01 and p <0.001) with PTH, but only BALP was significantly higher in patients with secondary hyperparathyroidism (p=0.001). Type of surgery, vitamin D serum concentrations, and 2-year BMI were all independently associated with PTH levels. Conclusion: A comparable increase in bone turnover markers 2 years after standard and distal gastric bypass was observed. There was a higher prevalence of secondary hyperparathyroidism after distal gastric bypass, but this did not impact bone turnover markers