Bariatric surgery and health outcomes: An umbrella analysis

Abstract

BackgroundThere is a relative lack of data that systematically investigates the breadth and validity of the association between bariatric surgery and health-related outcomes. We aimed to evaluate the quantity, validity, and credibility of evidence regarding the association between bariatric surgery and health-related outcomes using an umbrella review of meta-analyses.MethodsWe systematically searched PubMed, Embase, and the Web of Science databases from inception until December 2, 2021, to identify meta-analyses of observational or interventional studies that investigated the association between bariatric surgery and multiple health outcomes. We extracted the summary effect size and 95% confidence interval (CI) data. The Assessment of Multiple Systematic Reviews (AMSTAR-2) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines were used for methodological and evidence quality assessments, respectively.ResultsTwenty-eight studies with 82 different health-related outcomes were included in this umbrella review. Beneficial effects of bariatric surgery have been observed in cancer incidence, mortality, cardiovascular risk, polycystic ovary syndrome (PCOS), anxiety symptoms, depressive symptoms, gestational diabetes mellitus, gestational hypertension, large for gestational age (LGA), macrosomia, post-term birth, risk of kidney stones, albuminuria, urinary incontinence, fecal incontinence, Barrett’s esophagus, and diabetic retinopathy. However, adverse effects of bariatric surgery were observed for maternal anemia, perinatal mortality, congenital anomalies, preterm birth, neonatal intensive care unit (NICU) admission, intrauterine growth restriction, small for gestational age (SGA), fracture risk, upper limb fracture, suicide, self-harm, and alcohol use disorder (AUD).ConclusionsCurrent evidence suggests that bariatric surgery improves the majority of health-related outcomes; however, caution is advised given it may increase the risk of adverse mental effects, perinatal problems, and fractures.

A Cross-Sectional Study Based on Forty Systematic Reviews of Foods with Function Claims (FFC) in Japan: Quality Assessment Using AMSTAR 2

“…Our findings of the poor methodological quality of SRs in the food field are in line with those from assessments of the methodological quality of SRs that used the AMSTAR 2 tool in other fields, including acupuncture [16,17], dentistry [18], Tai Chi [19,20], surgery [21,22], major depression in adults [23], chronic obstructive pulmonary disease [24], cardiovascular risk [25], physical activity [26], pancreatic cancer [27], chronic heart failure [28], cancerrelated fatigue [29], Alzheimer's disease [30], chronic spinal pain [31], neonatal pain [32], hip fractures [33], and atopic eczema [34]. Although the target patients or participants and interventions in those studies differed between each study, all demonstrated that the majority of SRs included had low methodological quality ("low" or "critically low").…”

“…However, there may be considerable correlations between the certainty of the results of the evidence and the results of quality assessments based on AMSTAR 2. Recently, many umbrella reviews have been performed that used both AMSTAR 2 and GRADE in healthcare settings [22,25,27,[32][33][34]. These studies were consistently determined to be "low" and "very low" according to the GRADE evaluation when the ratings were also "low" or "critically low" in AMSTAR 2.…”

Patients who received sleeve gastrectomy have lower plasma osteopontin levels than those who did not

“…It is known that bariatric surgery is not only a restrictive surgery but also a metabolic surgery. 15 , 16 The authors suggest that the low plasma OPN levels observed in Group 1 composed of overweight individuals in the early postoperative period may be another favorable metabolic effect of bariatric surgery, independent of weight loss. This finding highlights the accuracy of the terminology “metabolically healthy obese”.…”

Association of bariatric surgery with indicated and unintended outcomes: An umbrella review and meta‐analysis for risk–benefit assessment

“…A previous umbrella review by Liao et al explored the impact of bariatric surgery on health outcomes 45 . However, they did not analyze the impact of different bariatric surgery procedures despite the variable mechanisms underlying each bariatric procedure.…”