Towards precision medicine in bariatric surgery prescription

Abstract

Obesity is a complex, multifactorial and chronic disease. Bariatric surgery is a safe and effective treatment intervention for obesity and obesity-related diseases. However, weight loss after surgery can be highly heterogeneous and is not entirely predictable, particularly in the long-term after intervention. In this review, we present and discuss the available data on patient-related and procedure-related factors that were previously appointed as putative predictors of bariatric surgery outcomes. In addition, we present a critical appraisal of the available evidence on which factors could be taken into account when recommending and deciding which bariatric procedure to perform. Several patient-related features were identified as having a potential impact on weight loss after bariatric surgery, including age, gender, anthropometrics, obesity co-morbidities, eating behavior, genetic background, circulating biomarkers (microRNAs, metabolites and hormones), psychological and socioeconomic factors. However, none of these factors are sufficiently robust to be used as predictive factors. Overall, there is no doubt that before we long for precision medicine, there is the unmet need for a better understanding of the socio-biological drivers of weight gain, weight loss failure and weight-regain after bariatric interventions. Machine learning models targeting preoperative factors and effectiveness measurements of specific bariatric surgery interventions, would enable a more precise identification of the causal links between determinants of weight gain and weight loss. Artificial intelligence algorithms to be used in clinical practice to predict the response to bariatric surgery interventions could then be created, which would ultimately allow to move forward into precision medicine in bariatric surgery prescription.

Diabetic Markers, Five Years after Bariatric Surgery

“… 40 However, the diabetic remission mechanism is attributed to several factors, such as gastrointestinal hormones, patient adherence and compliance with treatment, and patient lifestyle. 41 Gloy et al found that bariatric surgery had a major impact on diabetic improvement, HDL level, obesity, metabolic syndrome, and quality of life compared with drug medications. 42 Among metabolic surgeries, RYGB was superior to other types of surgery.…”

The Impact of Early-Stage Chronic Kidney Disease on Weight Loss Outcomes After Gastric Bypass

“…The weight loss efficacy of bariatric metabolic surgery is known to be influenced by a variety of pre-operative factors. Several patient characteristics were identified as being determinants of weight loss and obesity-associated medical problem remission after bariatric metabolic surgery, among these diabetes is one of the most impactful [ 1 , 3 ]. Additionally, previous reports also suggest that patients with an eGFR under 30 mL/min/1.73m 2 tend to have worse weight loss outcomes after bariatric surgery [ 15 , 18 ].…”

“…Additionally, previous reports also suggest that patients with an eGFR under 30 mL/min/1.73m 2 tend to have worse weight loss outcomes after bariatric surgery [ 15 , 18 ]. However, the available evidence is derived from studies that presented some limitations, namely, the concomitant presence of dysglycemia, which could have impacted on data interpretation [ 1 , 3 ]. The aim of this study was to investigate whether bariatric metabolic surgery weight loss is influenced by creatinine clearance rate, eGFR, proteinuria, or albuminuria, in patients without the concomitant presence of dysglycemia.…”

“…The weight loss and obesity-associated medical problems improvements achieved through bariatric metabolic surgery are known to be influenced both by pre-operative and post-operative patient characteristics [ 1 ]. The pre-operative factors recognized to have the greatest impact on weight loss are pre-operative body weight and body mass index (BMI), presence of eating disorders, such as binge eating or food addiction [ 2 , 3 ], presence of type 2 diabetes mellitus [ 3 ], residual β-cell function [ 4 ], glycated hemoglobin (HbA1c), and fasting blood glucose levels [ 1 ]; additionally, genetic, dietary, and anatomic factors were also shown to have a potential impact on bariatric metabolic surgery weight loss outcomes, although the evidence is less robust [ 3 , 5 ].…”