BACKGROUND:The perioperative effect of preoperative administration of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in individuals with obesity scheduled to receive metabolic and bariatric surgery (MBS) remains uncertain. OBJECTIVES:The objective of this systematic review and meta-analysis was to evaluate the efficacy of preoperative GLP-1 RAs in patients with obesity undergoing MBS. SETTING:All over the world. METHODS:Original studies were searched from the inception of PubMed, Embase, and Web of Science up to September 2025. Primary outcomes were the variation of weight from the initial to the preoperative period and postoperative total weight loss percentage (TWL%). Secondary outcomes included the incidence of postoperative complications, postoperative glycated hemoglobin level, and the proportion of patients with remission of diabetes. RESULTS:After screening, 10 studies consisting of 5461 subjects were included in the final meta-analysis. The results showed that preoperative GLP-1 RAs were associated with a moderate reduction in preoperative weight (total median of weight reduction: 4.87 kg vs 3.84 kg; SMD: .4, 95% CI: -.37 to 1.18, P < .01) but did not significantly affect postoperative TWL% (SMD: -.20, 95% CI: -.27 to -.13, P = .21). Preoperative administration of GLP-1 RAs did not significantly increase the incidence of postoperative complications (RR: 1.62, 95% CI: .76-3.45, P = .12) nor improve the comorbidities (P = .23). CONCLUSIONS:Our study indicates that preoperative GLP-1 RAs are generally safe for patients with obesity undergoing MBS. However, this benefit only correlates with a certain degree of preoperative weight loss, and its effect on postoperative weight loss and improvement of comorbidities are limited.

BACKGROUND:The efficacy of metabolic and bariatric surgery (MBS) in the treatment of sarcopenic obesity (SO) remains unclear. OBJECTIVES:The purpose of this systematic review and meta-analysis was to evaluate the efficacy of MBS in the SO population to provide some reference value for the implementation of reasonable intervention in this population. SETTING:All over the world. METHODS:PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched for relevant articles up to September 2025. The standard mean difference (SMD) and its 95% confidence interval (CI) were used for the quantitative synthesis of continuous variables, and the risk ratio (RR) and its 95% CI were used for the quantitative analysis of categorical variables. The primary outcomes were the variations of body weight and body mass index from initial to follow-up, the proportion of total weight loss, the proportion of excess weight loss, and the remission of comorbidities. RESULTS:After screening, 7 studies involving 1704 patients were included in our final meta-analysis. The results of our analysis showed that the SO group had more significant variations in body weight (SMD = .89, 95% CI: .32-1.46, P = .002) and body mass index (SMD = 1.08, 95% CI: .41-1.76, P = .0016). There was a trend toward higher percentage of total weight loss and percentage of excess weight loss in the SO versus non-SO groups (SMD = .30, 95% CI: .06-.66, P = .09; SMD = .57, 95% CI: .28-1.42, P = .08). In terms of the remission of comorbidities, the 2 groups were similar (all P values > .05). In addition, the incidence of postoperative complications was similar between the 2 groups (RR = 1.78, 95% CI: .93-3.41, P > .05). CONCLUSIONS:In the SO population, MBS was associated with comparable efficacy and safety outcomes, including moderate weight loss, improvement in comorbidities, and no significant increase in postoperative complications.

Metabolic dysfunction-associated steatohepatitis (MASH) is a systemic metabolic disease involving coordinated alterations across multiple organs. Here, we established a diet-induced murine model of MASH and performed integrated transcriptomic, proteomic, and metabolomic profiling across seven metabolic tissues and the circulation, encompassing the liver, white and brown adipose tissues, skeletal muscle, gallbladder, pancreas, and plasma. Multi-omics analyses identified coordinated molecular changes across tissues, including altered immune, metabolic, and fibrotic programs. Metabolomic profiling further revealed widespread changes in lipid and amino acid metabolism, together with altered gut-derived metabolites in tissues and plasma. Several candidates showing concordant transcript and protein changes in mouse tissues, particularly in the liver, were also supported by independent human liver datasets. This study provides a multi-tissue, multi-omics resource for diet-induced MASH and offers a framework for investigating molecular interactions among metabolically connected organs.

Background Sleeve gastrectomy (SG) is the most commonly performed bariatric surgery worldwide, including in China. Despite its prevalence, significant variations exist in its practice. This consensus aims to standardize SG practices in China. Methods A modified Delphi method was employed to gather expert opinions from 50 Chinese bariatric surgeons. Participants voted on 80 statements covering indications, contraindications, preoperative/postoperative management, and surgical techniques. Results Consensus was achieved on 54 out of 80 statements. Key areas include SG being the preferred choice for patients with high surgical risk and severe obesity. Agreement was reached on surgical techniques such as staple line reinforcement and the management of hiatal hernias found during surgery. Consensus was also achieved on aspects of preoperative and postoperative care, including routine endoscopy and the use of the enhanced recovery after surgery (ERAS) protocol. Conclusions This consensus provides valuable guidelines for standardizing SG practices in China. It provides evidence-based recommendations to standardize SG practice, improve outcomes, and guide future research directions.

BACKGROUND & AIMS:Fibrosis-4 Index (FIB-4) is a noninvasive tool for assessing liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD). However, its role of dynamic FIB-4 for assessing fibrosis progression and predicting clinical outcomes remains unclear. The aim of this study was to examine the association between changes in FIB-4 and changes in liver stiffness, fibrosis progression, and outcomes in MASLD. METHODS:Three cohorts were analyzed: VCTE-Prognosis cohort (n = 10,203) for stiffness progression, Paired Liver Biopsy cohort (n = 1,145) for fibrosis progression, and Wenzhou Real-World (WRW) cohort (n = 41,105) for clinical outcomes. Stiffness progression was defined as an increase in liver stiffness measurement, and fibrosis progression by a 1-stage increase. Outcomes included all-cause mortality, cardiovascular events, and liver-related events (LREs). FIB-4 was dichotomized into low (<1.3) and high (≥1.3). Increases were defined as ≥20% rise and to ≥1.3 in the low FIB-4 group, and ≥20% rise in the high FIB-4 group. RESULTS:In the VCTE-Prognosis cohort, stiffness progression was more likely with increasing vs stable FIB-4 (adjusted odds ratio [OR], 2.36; P < .001) in those with low baseline FIB-4. In the high FIB-4 group, stiffness progression rates increased from stable to increasing FIB-4 (adjusted OR, 3.42; P < .001). In the Paired Liver Biopsy cohort, fibrosis progression was more frequent with increasing FIB-4 (adjusted OR, 2.20; P = .004 in low FIB-4; adjusted OR, 3.68; P < .001 in high FIB-4). In the WRW cohort, an increase in dynamic FIB-4 was linked to higher risks for all-cause mortality, cardiovascular events, and LREs (all P < .001). CONCLUSIONS:Dynamic FIB-4 monitoring tracks fibrosis and stiffness progression and predicts clinical outcomes in MASLD.

AIMS:To evaluate the relationship between metabolic syndrome and the efficacy and safety of genotype-guided dual antiplatelet therapy (DAPT) in the CHANCE-2 trial. MATERIALS AND METHODS:This post hoc study used data from the CHANCE-2 trial. Patients with minor stroke or TIA who carried the CYP2C19 loss-of-function (LOF) allele were randomized to receive ticagrelor-aspirin (TIC-ASA) or clopidogrel-aspirin (CLO-ASA). The primary efficacy outcome was stroke recurrence within 90 days. The primary safety outcome was severe or moderate bleeding within 90 days. We classified patients into metabolic syndrome (MetS) and non-metabolic syndrome (non-MetS) groups. Differences in the outcome during 90-days follow-up period were assessed using the Cox proportional hazards model. RESULTS:Among 5652 patients, 3305 were non-MetS and 2347 were MetS. Compared with CLO-ASA, TIC-ASA significantly reduced the risk of stroke recurrence within 90 days among patients with MetS (6.44% vs. 9.90%; HR 0.64, 95% CI 0.48-0.85; p < 0.01); this benefit was not seen in non-MetS (6.03% vs. 5.96%; HR 1.01, 95% CI 0.77-1.34; p = 0.93), with a significant interaction effect (p for interaction = 0.03). Moreover, a linear trend was observed (p for trend = 0.04), indicating metabolic health status may modify the efficacy of genotype-guided DAPT in a dose-dependent manner. No significant difference was observed in severe or moderate bleeding events by metabolic syndrome (MetS: 0.42% vs. 0.35%, non-MetS: 0.25% vs. 0.36%; p for interaction = 0.55). CONCLUSIONS:Among CYP2C19 LOF carriers with minor stroke or TIA, patients with MetS received more clinical benefit from TIC-ASA versus CLO-ASA compared to those with non-MetS. Registry: ClinicalTrials.gov, TRN: NCT04078737.

Bariatric surgery presents a significant alleviation for non-alcoholic fatty liver disease (NAFLD), which relies in part on achieving substantial weight loss in post-surgical period. We aimed to understand the effect of bariatric surgery on NAFLD remission via metabolomics and to validate the results in a general population-based cohort. In a pilot study, ten patients with NAFLD who underwent bariatric surgery were enrolled. The remission of hepatic steatosis was assessed by MRI-derived proton density fat fraction (PDFF) before and 3-month after surgery. Temporal associations of body mass index (BMI) reduction, alteration in metabolomic biomarkers, and NAFLD remission were quantified by using cross-lagged models, which were then validated in a general population-based cohort (n = 1258). At 3-month after surgery, BMI reduction of 6.9 (SD 1.9) kg/m2 and MRI-PDFF reduction of 9.6

BACKGROUND:Distinguishing bariatric surgical effects on reversing nonalcoholic fatty liver disease (NAFLD) remain unclear. To assess discrepancies in histological response and changes in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) after bariatric surgery. METHODS:This prospective multicenter cohort included 138 NAFLD patients who underwent bariatric surgery and were followed up for 1 year. We obtained paired liver biopsy samples (n = 40), paired proteomic data (n = 23), and sequential MRI-PDFF at 3-, 6-, and 12-month (n = 80, 65, 52, respectively) follow-ups. RESULTS:At 1 year, a ≥2-point improvement in NAFLD activity score (NAS) was observed in 80.0% of patients; nonalcoholic steatohepatitis (NASH) improved without fibrosis worsening in 42.1%; fibrosis improved without NASH worsening in 78.8% (95% confidence interval [CI]: 66.0-91.2, 26.8-58.2, and 63.0-91.3) (all P <0.001). MRI-PDFF discriminated the presence and grading of hepatic steatosis (area under the curve [AUC], 0.94 and 0.95, respectively), indicating liver fat remission (<3.3% or 5.0% at 1 year) in 72.2% or 90.4% of patients (95% CI: 58.4%-83.5% or 78.9%-95.5%; all P <0.001). A ≥78.8% relative decline in MRI-PDFF within 1 year differentiated NAS improvement from non-NAS improvement (AUC, 0.912; 95% CI: 0.79-1.00). Compared to non-NASH remission, NASH remission was associated with significant pre- or postoperative regulation of protein expression levels. CONCLUSIONS:These findings can help evaluate the expected histological response, and aid in understanding the proteomic features resulting from the beneficial surgical effects on NAFLD and its advanced stages in patients with obesity.

BACKGROUND & AIMS:Hypertension is common in metabolic dysfunction-associated steatotic liver disease (MASLD), but its impact on long-term clinical outcomes and disease progression remains unclear. This study investigated the association of hypertension with the risk of adverse clinical outcomes and progression of liver stiffness/fibrosis in MASLD. METHODS:Three multicenter large cohorts were analyzed: the UK Biobank (UKBB) cohort to assess the risk of adverse clinical outcomes, the VCTE-Prognosis cohort to assess liver stiffness/fibrosis progression, and the Paired Liver Biopsy cohort to assess histologic liver fibrosis progression. Adverse clinical outcomes were defined as all-cause mortality, cardiovascular events, and/or liver-related events. Liver stiffness progression was defined as an increase in liver stiffness measurement from <10 kPa to ≥10 kPa or an increase of ≥20% for baseline liver stiffness measurement ≥10 kPa. Liver fibrosis progression was defined as a 1-stage fibrosis stage increase. Cox regression and Kaplan-Meier analyses were used to evaluate the impact of baseline hypertension on outcomes. RESULTS:A total of 107,316 adults from the UKBB cohort, 8,169 from the VCTE-Prognosis cohort, and 1,670 from the Paired Liver Biopsy cohort were included. The prevalence of hypertension was 37.1%, 33.4%, and 48.9%, respectively. In the UKBB cohort, hypertension was associated with long-term adverse clinical outcomes (adjusted hazard ratio [HR] 1.30, 95% CI 1.26-1.33, p <0.001). In the VCTE-Prognosis cohort, hypertension was associated with a higher risk of liver stiffness progression (adjusted HR 1.57, 95% CI 1.30-1.90, p <0.001), while in the Paired Liver Biopsy cohort, hypertension was associated with a greater risk of histologic liver fibrosis progression (adjusted HR 1.41, 95% CI 1.12-1.78, p = 0.004). Subgroup and sensitivity analyses supported these findings. CONCLUSIONS:Hypertension is a modifiable risk factor that increases the risk of adverse clinical outcomes and progression of liver stiffness and fibrosis in MASLD. IMPACT AND IMPLICATIONS:This study provides robust evidence from three large multicenter cohorts demonstrating that hypertension is independently associated with increased risks of adverse clinical outcomes and liver fibrosis progression in individuals with MASLD. These findings reveal that hypertension, traditionally managed from a cardiovascular perspective, also plays a critical and underrecognized role in liver disease progression, making them highly relevant for hepatologists, cardiologists, and primary care providers. Incorporating non-invasive fibrosis assessments into routine care for patients with MASLD and hypertension may facilitate early risk stratification and support targeted interventions to reduce both hepatic and cardiovascular complications.

Aims: Bariatric surgery results in rapid recovery of glucose control in subjects with type 2 diabetes mellitus. However, the underlying mechanisms are still largely unknown. The present study aims to clarify how bariatric surgery modifies pancreatic cell subgroup differentiation and transformation in the single-cell RNA level.Methods: Male, 8-week-old Zucker diabetic fatty (ZDF) rats with obesity and diabetes phenotypes were randomized into sleeve gastrectomy (Sleeve, n = 9), Roux-en-Y gastric bypass (RYGB, n = 9), and Sham (n = 7) groups. Two weeks after surgery, the pancreas specimen was further analyzed using single-cell RNA-sequencing technique.Results: Two weeks after surgery, compared to the Sham group, the metabolic parameters including fasting plasma glucose, plasma insulin, and oral glucose tolerance test values were dramatically improved after RYGB and Sleeve procedures (p < .05) as predicted. In addition, RYGB and Sleeve groups increased the proportion of pancreatic beta cells and reduced the ratio of alpha cells. Two multiple hormone-expressing cells were identified, the Gcg+/Ppy + and Ins+/Gcg+/Ppy + cells. The pancreatic Ins+/Gcg+/Ppy + cells were defined for the first time, and further investigation indicates similarities with alpha and beta cells, with unique gene expression patterns, which implies that pancreatic cell transdifferentiation occurs following bariatric surgery.Conclusions: For the first time, using the single-cell transcriptome map of ZDF rats, we reported a comprehensive characterization of the heterogeneity and differentiation of pancreatic endocrinal cells after bariatric surgery, which may contribute to the underlying mechanisms. Further studies will be needed to elucidate these results.

Sleeve gastrectomy (SG) is widely recognized as the leading bariatric procedure worldwide. However, leakage, its major complication, remains a significant concern. This study focuses on the challenges of managing leakage, especially when conventional endoscopic treatments are ineffective. Although a novel one-step approach as reported by Pulimuttil James Zachariah from Wei-Jei Lee’s team has demonstrated promise, further investigations and reports on its efficacy are currently insufficient. Between January 2021 and November 2023, we analyzed five patients treated at our center for SG leakage. Patient data include demographics, comorbidities, surgical details, and outcomes. The study details Laparo-Endoscopic Gastrostomy procedures performed post-SG leakage diagnosis, highlighting differences between acute and chronic instances. The study effectively implemented Zachariah’s one-step approach, achieving favorable results in all five cases. Patient characteristics, presentation, postoperative progression, and additional treatments were documented. The outcome supports Zachariah’s assertion that the one-step approach is a simple, safe, and cost-effective approach for SG leakage, avoiding digestive tract reconstruction. Despite potential limitations, including challenges in closing large defects and extended healing times, the procedure’s effectiveness in decompression, drainage, and nutritional support significantly contributes to its elevated healing rate. The study emphasizes the importance of timely abdominal drain removal based on clinical conditions, challenging traditional practices for better clinical outcomes.

Inflammation is critical for obesity and obesity-induced insulin resistance (IR). In this study, we reveal the function and mechanism of acarbose on adipose tissue macrophage (ATM)-mediated inflammation in obesity and obesity-induced IR. First, acarbose enhances the abundance of propionic acid-producing Parasutterella, therefore indirectly inhibiting the survival and proinflammatory function of M1-like ATMs via GPR43. Most interestingly, acarbose can directly inhibit M1-like ATM-mediated inflammation through GPR120. Diet-induced obese mice exhibit nitrobenzoxadiazoles (NBD) fluorescence-labeled ATMs, but lean mice that also orally received NBD fluorescence-labeled acarbose do not exhibit NBD fluorescence-labeled ATMs. This direct inhibition of macrophages by acarbose is validated in mouse and human macrophages in vitro. In conclusion, our study reveals that acarbose directly and indirectly inhibits proinflammatory macrophage phenotype, which contributes to the improvement of obesity and obesity-induced IR. The understanding of the immune regulatory effects of acarbose may extend its potential for further therapeutic applications.

Background: The cumulative effect of body mass index (BMI) on brain health remains ill-defined. The effects of overweight on brain health across different age groups need clarification. We analyzed the effect of cumulative BMI on neuroimaging features of brain health in adults of different ages. Methods: This study was based on a multicenter, community-based cohort study. We modeled the trajectories of BMI over 16 years to evaluate cumulative exposure. Multimodality neuroimaging data were collected once for volumetric measurements of the brain macrostructure, white matter hyperintensity (WMH), and brain microstructure. We used a generalized linear model to evaluate the association between cumulative BMI and neuroimaging features. Two-sample Mendelian randomization analysis was performed using summary level of BMI genetic data from 681,275 individuals and neuroimaging genetic data from 33,224 individuals to analyze the causal relationships. Results: Clinical and neuroimaging data were obtained from 1,074 adults (25 to 83 years). For adults aged under 45 years, brain volume differences in participants with a cumulative BMI of >26.2 kg/m2 corresponded to 12.0 years [95% confidence interval (CI), 3.0 to 20.0] of brain aging. Differences in WMH were statistically substantial for participants aged over 60 years, with a 6.0-ml (95% CI, 1.5 to 10.5) larger volume. Genetic analysis indicated causal relationships between high BMI and smaller gray matter and higher fractional anisotropy in projection fibers. Conclusion: High cumulative BMI is associated with smaller brain volume, larger volume of white matter lesions, and abnormal microstructural integrity. Adults younger than 45 years are suggested to maintain their BMI below 26.2 kg/m2 for better brain health. Trial Registration: This study was registered on clinicaltrials.gov (Clinical Indicators and Brain Image Data: A Cohort Study Based on Kailuan Cohort; No. NCT05453877; https://clinicaltrials.gov/ct2/show/NCT05453877).

Abstract Background Obesity is closely associated with upper gastrointestinal disorders. The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) before bariatric surgery remains a topic of debate. This study aimed to describe the pathological endoscopic findings in individuals qualified for bariatric surgery. Methods Retrospective analysis was conducted on preoperative gastroscopy reports of patients who underwent bariatric surgery at our hospital between October 2022 and October 2023. Results A total of 405 patients were included in the study. The two most prevalent endoscopic findings during EGD in this patient cohort were chronic superficial gastritis (326/405, 80.5%) and reflux esophagitis (82/405, 20.2%). Some patients exhibited two or more abnormalities. Patients with reflux esophagitis were older, had a higher proportion of men, higher BMI, higher rates of smoking and drinking compared to those without it (P = 0.033, P < 0.001, P = 0.003, P = 0.001, and P = 0.003, respectively). Morbid obesity (P = 0.037), smoking habits (P = 0.012), and H. pylori infection (P = 0.023) were significant risk factors for reflux esophagitis in male patients, while age (P = 0.007) was the sole risk factor in female patients. No statistically significant differences were observed in surgical procedures between LA-A and B groups (P = 0.382), but statistically significant differences were noted between the nondiabetic and diabetic groups (P < 0.001). Conclusions Preoperative EGD can unveil a broad spectrum of pathologies in patients with obesity, suggesting the need for routine examination before bariatric surgery. The findings of this study can guide bariatric surgeons in developing tailored treatments and procedures, thus significantly enhancing prognosis. Gastroscopy should be performed routinely in Chinese patients planning to undergo bariatric surgery.

Multi-split backplane cooling, a typical rack-level cooling technology, has the advantage of solving local hot-spot problems with huge energy-saving potential. These systems adopt the multi-split mode, and the operation effect is affected by terminal control performance. However, there are factors in the operation process, such as superheat degree (SH), rack airflow, evaporating/condensing pressures, etc., which improve the control complication, particularly under large head load differences among different terminals. Therefore, appreciative control strategies for outlet air temperatures of terminal evaporators, including single-loop control limited by minimum stable superheat degree (SLC) and fan/electronic expansion valve (EEV) double-loop control (DLC), are proposed considering that cooling performance can be affected by both refrigerant flow and airflow. Then, comparative simulation studies are carried out to evaluate energy efficiency, control effect, and feasibility under the condition of different server heat distribution characteristics. Results indicate that the DLC strategy achieves 23 % higher energy efficiency than the SLC strategy with a better temperature control effect when the inlet air temperature (IAT) difference between terminal evaporators is within +/- 5K. The SLC strategy has better reliability by more stable control of SH at IATs below 42 degrees C, but it may lead to cooling failure when IATs exceed 42 degrees C. An insufficient liquid supply problem may happen to the evaporator adopting the DLC strategy when the IAT is too high, which can be solved by adjusting the pressure differential between the evaporator and condenser. Moreover, the DLC system exhibits intense coupling effects, and how to decouple it is worthy of further study.

Obesity and related comorbidities have negative impacts on cognitive function. Weight loss seems to be associated with the improvement of cognitive function and the recovery of brain structure, but the underlying mechanism is not clear. This meta-analysis aimed to explore the status of cognitive function including memory, executive function, attention and language ability in patients with obesity, and to further investigate whether bariatric surgery can improve overall cognitive function in these patients. A total of 11 literatures with 728 subjects were included after retrieval and exclusion. The meta-analysis showed significant improvements in memory, attention and executive function scores after undergoing bariatric surgery in the patients with obesity. However, there was no significant improvement in language ability.