BACKGROUND:Patients with type 2 diabetes (T2D) and obesity are prone to gastroesophageal reflux disease (GERD) due not only to obesity itself but also to gastroparesis, digestive neuropathy, and antidiabetic treatment. Nissen sleeve gastrectomy (NSG) achieves satisfactory long-term weight loss and significantly reduces GERD incidence. However, its results in this population remain to be compared with those of standard sleeve gastrectomy (SG) given the potential impact of the Nissen wrap on GERD outcomes. OBJECTIVES:To compare the 5-year results of NSG on patients with T2D and obesity in terms of weight loss, T2D remission, and GERD incidence, with those of SG. SETTING:Montpellier University Hospital, France. METHODS:This is a comparative, nonrandomized, single-center cohort study analyzing prospectively collected data from patients who underwent SG or NSG between January 2017 and December 2019. RESULTS:A total of 105 patients with T2D and obesity underwent either an SG (N = 61) or an NSG (N = 44), with 82 (SG: 44; NSG: 36) completing 5-year follow-up. The groups were comparable for sex, age, and T2D severity. At 5 years, total weight loss was 19.1% versus 19.6% (effect size: -.77, P = .86), mean hemoglobin A1C 6.5% versus 6.3% (effect size: -.43, P = .12), and clinical GERD incidence 57.9% versus 18.8% (effect size: .23 [.07; .73], P = .01) for the SG and NSG groups, respectively. CONCLUSIONS:NSG could be a valuable alternative to SG for patients with T2D and obesity, providing comparable weight loss and diabetes remission at 5 years, with the added benefit of significantly reducing the incidence of GERD.

Bariatric surgery induces a decrease in areal BMD (aBMD), but the long-term effect on trabecular and cortical volumetric BMD (vBMD) has not been well assessed. The main aim of this 5-yr longitudinal study was to investigate the changes following sleeve gastrectomy (SG) in aBMD, bone turnover markers, and trabecular and cortical vBMD. Forty-five patients with obesity were assessed before and 1, 2, and 5 yr after SG. Trabecular and cortical vBMD, cortical thickness, and structural parameters were assessed by 3D-Shaper software at the hip. Values of bone turnover markers peaked after 1 yr and decreased after 2 and 5 yr, but without returning to baseline values. aBMD decreased mostly at the femoral neck (-9.7%) and total hip (-10.7%) over the 5 yr, with the greatest loss occurring at 1 yr (-5.9% and -6.3%, respectively). A similar profile of decrease was observed for integral hip vBMD with significant decreases of 6.6%, 7.7%, and 10.7% after 1, 2, and 5 yr, mainly due to a reduction in the trabecular (10.5%, 12.0%, and 17.2%, respectively) rather than cortical (1.4%, 1.9%, and 2.9%, respectively) component. A modest decrease in mean cortical thickness (2.5%, 2.8%, and 3.9%, respectively) and an alteration in the structural parameters were concomitantly observed. Older age and greater body weight loss were the factors most associated with an increased loss of aBMD and vBMD. In conclusion, the study demonstrates that SG induces not only an alteration in bone turnover and aBMD, but also a reduction in vBMD at the hip, predominantly due to trabecular component deterioration as determined by 3D-Shaper software. The maintenance of bone deterioration for at least 5 yr-ie, after 4 yr of relative body weight stabilization or minimal weight regain-suggests the need for a therapeutic approach to preserve bone health in patients who undergo SG. Bariatric surgery induces a decrease in areal BMD (aBMD), but the long-term effect on bone architecture has not been well assessed. This 5-yr longitudinal study using new 3D-Shaper software showed that concomitantly to the aBMD loss, an alteration in bone architecture, mainly due to a decrease in the trabecular rather than cortical component, was also observed. These bone deteriorations might explain the reduction in structural parameters. For the majority of the bone parameters, the deterioration occurred mainly in the first year but continued more slowly for at least 5 yr after SG, when body weight had stabilized or mild weight regain was observed. These results suggest the need for long-term monitoring and the development of a therapeutic approach to preserve bone health in patients who undergo SG.

Objective: Developing a scoring assessment tools for the determination of low bone mass for age at lumbar spine and hip in patients with anorexia nervosa (AN). Methods: The areal bone mineral density (aBMD) was determined with dual-energy X-ray absorptiometry (DXA). In 331 women with AN and 121 controls, aged from 14.5 to 34.9 years, univariate and multivariate logistic regression analyses were performed to address the association of Z-score aBMD evaluated at lumbar spine and hip with several parameters. Results: For the lumbar spine and hip, the three risk factors significantly and independently associated with Z-score aBMD were age of patients (variable in class >= 20 year vs. <20 year), minimal disease-related BMI (continuous variable), and duration of amenorrhea without contraceptive use (variable in class >= 18 months vs. <18 months), with close values for the odds ratio for the two bone sites. A simple risk score equation was developed and tested combining only these three parameters. The AUC's measuring the score's performance were, respectively, 0.85 [95% CI: 0.79-0.90] with a sensitivity of 83% and specificity of 71%, and 0.82 [95% CI: 0.76-0.86] with a sensitivity of 92% and specificity of 55% to detect low aBMD in lumbar spine and hip. The cut-off values for low bone mass for age were 0.9 and 1.33 for the two bone sites. The prediction model revealed that a minimum of 83% of the patients presenting low bone mass for age were correctly identified. Conclusions: the study presents for the first time a risk score for diagnosing low bone mass for age in young patients with AN. Considering its excellent sensitivity, and its ease of use, requiring only three parameters that are well identified in this disease, this new score may be useful in clinical settings when DXA scans are not feasible.

Introduction: Bariatric surgery is increasingly proposed for grade 2 or 3 obesity, yet the failure rate remains around 20-25%. The role of psychological and nutritional factors in this unfavorable outcome remains controversial. This study investigates whether the existence of residual psycho-nutritional difficulties after well-managed preoperative care is associated with reduced effectiveness of bariatric surgery. METHODS:Between 2017 and 2020, 57 patients with residual psycho-nutritional difficulties after multidisciplinary preparation for bariatric surgery were included in this observational study. These patients were matched with 57 controls without such difficulties, based on age, sex, history of bariatric surgery, type of bariatric surgery planned, and date of validation of surgical indication. To prevent introducing bias into the routine follow-up process, the patients were not informed of the objective of the study. Weight was measured at the time of surgery and at 1, 6, 12, and 24 months after surgery. The percentage of excess weight loss (PEWL) was assessed using a linear mixed model. RESULTS:At 2 years, the mean PEWL was 70.2% (95% CI [59.6; 80.8]) in patients with residual psycho-nutritional difficulties, compared with 71.4% (95% CI [63.4; 79.4]) in the control group. The rate of change in PEWL over time did not differ significantly between groups in the multivariate model (p = 0.54). No significant difference was found in adherence to surgical follow-up, quality of life at one and 2 years, or evolution of diabetes and hypertension at 2 years. CONCLUSION:Residual psycho-nutritional difficulties did not impact bariatric surgery outcome at 2 years. Therefore, these patients should not automatically be considered at higher risk of failure. Further follow-up at 5 years is ongoing. .

It was widely acknowledged that patients with anorexia nervosa (AN) present a decrease in areal bone mineral density (aBMD), but the effect on bone microarchitecture and other parameters associated with fracture risk have been less well investigated. The two aims of this study were to (i) compare aBMD at various bone sites as determined by DXA, as well as trabecular and cortical volumetric BMD (vBMD) at femoral regions using 3D-Shaper® software, in young women with AN and normal-weight controls (CON) and (ii) determine the factors potentially associated with aBMD and vBMD. Three hundred young women from 18 to 35 years old were enrolled in this study: 209 patients with AN and 91 age-matched normal-weight controls. aBMD was determined with DXA and vBMD by 3D-Shaper® software. Compared with controls, patients with AN presented significantly lower aBMD at all bone sites, but the difference was greater at hip and lumbar spine compared with radius. In whole proximal femur and all femoral compartments, vBMD was also lower in patients, but the difference between groups was greater for cortical vBMD compared with trabecular vBMD. Cortical thickness was also altered but to a lower extent. The bone deterioration induced a decrease in bone structural parameters. In the patients, the independent variables for determining aBMD and vBMD were principally minimal disease-related BMI, menstrual disorder status and duration of amenorrhea. This study confirmed not only that young women with AN present lower aBMD across the skeleton, but it also showed for the first time a concomitant deterioration in trabecular and cortical vBMD and cortical thickness as measured by 3D-Shaper®, leading to a decrease in bone structural parameters. In future, it will be interesting to determine whether 3D-Shaper® parameters are more sensitive than aBMD for monitoring skeletal changes due to weight variations or during therapeutic interventions. It will also be relevant to assess whether these new bone parameters are more predictive of fracture risk than aBMD in these patients.

Objectives: Weight suppression (WS) defines the difference between the highest weight in adulthood and the current weight. WS at lowest weight is the difference between the highest and the lowest ever weight. Weight rebound is the difference between the past lowest weight and current weight. The distinction in the capacities of WS, weight rebound, and WS at the lowest weight remains unclear regarding their efficacy in forecasting clinical endpoints. This study assessed the relationship between WS, WS at lowest weight and/or weight rebound and eating disorder (ED) clinical severity. Methods: In this retrospective cohort study, adult participants were selected at the Outpatient Unit for multidisciplinary assessment of ED, Montpellier, France, between February 2012 and October 2014 and May 2017 and January 2020. ED clinical severity was evaluated using the Eating Disorder Examination Questionnaire (EDE-Q). Results: The sample included 303 patients: 204 with anorexia nervosa (AN) and 99 with bulimia nervosa (BN). The EDE-Q total score was positively correlated with WS at lowest weight in patients with AN (Spearman's rho = 0.181, p = 0.015) and with BN (Spearman's rho = 0.377; p < 0.001). It was also positively correlated with weight rebound (Spearman's rho = 0.319; p = 0.003) in patients with BN. In the multivariate analysis, EDE-Q total score was associated with WS at lowest weight only in patients with BN (beta = 0.265; p = 0.03). Conclusion: WS at lowest weight seems to be a good measure of ED clinical severity. More research is needed for better understanding WS at lowest weight in assessment and treatment of patients with ED.

Introduction: Obesity is a chronic disease that increases cardiovascular and metabolic morbidity and mortality, decreases quality of life, and increases health care costs. While the role of lifestyle behavioral factors in the development of obesity is well established, the role of traumatic life events, including abuse, is unclear. To describe situations of violence and hardship reported by patients undergoing a bariatric surgery program, with a particular focus on sexual violence and its clinical correlates Methods: In this cross-sectional study, patients with grade II or III obesity, admitted to our digestive surgery department for bariatric surgery from 01/08/2019 to 31/12/2020, underwent a structured interview by a trained psychologist to describe the history of distressing life events self-reported by the patients. The primary endpoint was the presence of a history of sexual abuse. Multivariate logistic regressions were applied to identify independent risk factors for sexual violence (SV). Results: Of the 408 patients interviewed, 87.1% reported at least one distressing life event and 33.1% reported having had an SV in the past. Female gender (aOR =7.44, 95% CI: 3.85 - 15.73; p<0.001) and higher body mass index (1.05, 1.02 - 1.08; p=0.002) were associated with an increased risk of SV. Male gender was associated with a higher risk of difficulties including sports cessation, depression and work-related distress. Conclusion: In the context of obesity, psychosocial trauma is characterized by a high frequency and several gender specificities that must be taken into account in the management of these patients.

BACKGROUND:Nissen sleeve gastrectomy is a new bariatric procedure based on the combination of 2 well-known surgical techniques (vertical sleeve gastrectomy and Nissen fundoplication). It was conceived as a means to prevent the major drawback of the sleeve gastrectomy (SG), the gastroesophageal reflux disease (GERD), while preserving the advantages of SG in terms of weight loss, and remission of obesity-related comorbidities. OBJECTIVES:The objectives of this study are to present the long-term (5 years) follow-up results on weight loss, evolution of GERD and other comorbidities, and the complication rate of the Nissen sleeve gastrectomy. SETTING:Montpellier University Hospital, France. METHODS:This is a prospective analysis of patients who underwent Nissen sleeve gastrectomy as a first-line bariatric procedure between January 2018 and February 2019. A subgroup analysis of patients with no further surgery during follow-up was also performed. RESULTS:A total of 144 patients underwent Nissen sleeve gastrectomy: After adjusting for exclusion criteria, 133 patients comprised the initial study population, 81.9% of whom had complete follow-up for weight and GERD clinical symptom outcomes at 5 years. The mean total weight loss (TWL%) was 22 (±12.3)% and the mean excess weight loss percentage (EWL%) was 59.4% (±34.2)%. Of the 63 patients with preoperative clinical symptoms of GERD, we observed an 85.5% 5-year clinical remission rate; however, only 25 patients had a gastroscopy at 5 years. The cumulative short- and long-term reoperation rate was 8.1% and the mortality rate was zero. CONCLUSIONS:The Nissen sleeve gastrectomy achieves a satisfactory long-term TWL% and a significant improvement in comorbidities, particularly regarding the incidence of GERD. The rate of complications requiring surgical reoperation is low.

Sleeve gastrectomy (SG) induces weight loss but its effects on body composition (BC) are less well known. The aims of this longitudinal study were to analyse the BC changes from the acute phase up to weight stabilization following SG. Variations in the biological parameters related to glucose, lipids, inflammation, and resting energy expenditure (REE) were concomitantly analysed. Fat mass (FM), lean tissue mass (LTM), and visceral adipose tissue (VAT) were determined by dual-energy X-ray absorptiometry in 83 obese patients (75.9% women) before SG and 1, 12 and 24 months later. After 1 month, LTM and FM losses were comparable, whereas at 12 months the loss of FM exceeded that of LTM. Over this period, VAT also decreased significantly, biological parameters became normalized, and REE was reduced. For most of the BC, biological and metabolic parameters, no substantial variation was demonstrated beyond 12 months. In summary, SG induced a modification in BC changes during the first 12 months following SG. Although the significant LTM loss was not associated with an increase in sarcopenia prevalence, the preservation of LTM might have limited the reduction in REE, which is a longer-term weight-regain criterion.

Bariatric surgery induces bone loss, but the exact mechanisms by which this process occurs are not fully known. The aims of this 2-year longitudinal study were to (i) investigate the changes in areal bone mineral density (aBMD) and bone turnover markers following sleeve gastrectomy (SG) and (ii) determine the parameters associated with the aBMD variations. Bone turnover markers, sclerostin, periostin and semaphorin 4D were assessed before and 1, 12 and 24 months after SG, and aBMD was determined by DXA at baseline and after 12 and 24 months in 83 patients with obesity. Bone turnover increased from 1 month, peaked at 12 months and remained elevated at 24 months. Periostin and sclerostin presented only modest increases at 1 month, whereas semaphorin 4D showed increases only at 12 and 24 months. A significant aBMD decrease was observed only at total hip regions at 12 and 24 months. This demineralisation was mainly related to body weight loss. In summary, reduced aBMD was observed after SG in the hip region (mechanical-loading bone sites) due to an increase in bone turnover in favour of bone resorption. Periostin, sclerostin and semaphorin 4D levels varied after SG, showing different time lags, but contrary to weight loss, these biological parameters did not seem to be directly implicated in the skeletal deterioration.

Abstract Purpose The aim of the study was to assess the relationship between weight suppression at lowest weight (WS-LW) and eating disorder (ED) clinical severity, and to test WS-LW role as a mediator of childhood maltreatment (CM) impact on ED. Methods For this retrospective cohort study, adult participants were selected at the Daycare Unit for multidisciplinary assessment of ED in Montpellier, France, between March 2013 and January 2020. Mental health professionals assessed and recruited patients with ED (n = 321). For each patient, they collected sociodemographic characteristics, body weight and height, and the results of the Mini-International Neuropsychiatric Interview, and the self-report Eating Disorder Examination-Questionnaire (EDE-Q) and Child Trauma Questionnaire (CTQ). The collected data were assessed using descriptive bivariate, Receiver Operating Characteristics (ROC), and mediation analyses. Results Participants were mainly women (94.39%; median age: 25.67 years); 216 (67.29%) had anorexia nervosa and 105 (32.71%) bulimia nervosa. A positive correlation was found between WS-LW and EDE-Q total score (Spearman’s rho = 0.262; p < 0.001). The ROC analysis (AUC = 0.586 at 95% confidence interval; p = 0.016) identified a WS-LW cutoff of 14.99 (sensitivity = 64.6%; specificity = 51.5%) to differentiate between clinically severe and non-severe ED. WS-LW mediated the relationship between CM severity and ED clinical severity (β = 0.024; 95%CI = 0.001–0.054). Conclusion Patients with ED and history of CM have higher WS-LW, an easy-to-determine parameter and a marker of more severe eating psychopathology in ED. WS-LW is also a clinical mediator of the relationship between CM and ED.

Purpose Over the last decade, an important interest was taken to prevent the reflux following sleeve. A new variant, Nissen-sleeve, was described with the purpose to prevent GERD and to decrease the occurrence of leak. The current study reports the preliminary results of a prospective trial. Materials and Methods All consecutive patients who underwent a Nissen-Sleeve between January 2018 and September 2020 were included. Baseline characteristics including age, gender, weight, body mass index (BMI), GERD symptoms, and treatment were evaluated after 1 year. Operative time, length of stay, complication, and reoperation data were also collected. Results Three hundred sixty-five consecutive patients decided to undergo Nissen-sleeve: 75% females with median age of 41.2 years (+ / - 14.1) and an average BMI of 41.6 kg/m(2) (+ / - 5.4). There were 16 cases (4.4%) of early postoperative complications (< 30 days): six cases of acute wrap perforation (1.6%), intraabdominal bleeding for 5 patients (1.4%), one case of wrap dilatation (0.3%), one case of acute complete aphagia, one case of incarcerated umbilical hernia, and 2 cases (0.5%) of pulmonary atelectasis/pneumonia and one venous pulmonary embolism. We recorded the following complications: 16 patients (4.4%) mild dysphagia; 3 patients (0.8%) chronic dysphagia; and 2 cases of wrap perforation that have been diagnosed 8 and 9 months respectively, after the procedure due to the use of steroids not associated with PPI intake. The mean operative time was 83 min (46-125 min). The conversion and mortality rates were nil. Conclusion Following the initial learning curve and additional technical modifications, the Nissen-Sleeve appears to be a safe surgical technique with an acceptable early postoperative complication rate.

BACKGROUND & AIMS:Patients with Anorexia Nervosa (AN) present many nutritional deficiencies (macro- and often also micro-nutrients), possibly explained by their inadequate food intake. Previous studies reported that selenium (Se) deficiency is common in the general population. As Se can be easily added as a supplement, the goal of this study was to evaluate the clinical impact of Se deficiency in patients with AN.METHODS:This cross-sectional study concerned 153 patients with AN (92.9% women) followed at the Eating Disorder Unit of Lapeyronie Academic Hospital, Montpellier, France. Patients underwent an extensive neuropsychological assessment, and completed validated questionnaires. Blood samples were collected for Se quantification. Results were compared with the t-test, Mann-Whitney U, and Chi square tests, and univariate linear and multivariate logistic regression models.RESULTS:Se plasma levels were below the cut-off of 80 µg/L in 53.6% (N = 82) of patients. AN onset was earlier in patients with Se deficiency, (p = .005), whereas disease duration was comparable between groups (p = .77). General eating disorder symptomatology in the past 28 days (Eating Disorder Examination Questionnaire) was more severe in patients with Se deficiency (p = .010). The suicide risk (MINI International Neuropsychiatric Evaluation) tended to be higher (p = .037), and suicide attempt history was more frequent (28.39% vs 9.85%, p = .004) in patients with low Se levels. Se plasma concentration was negatively correlated with the performance in the temporal delayed discounting task (p = .006).CONCLUSIONS:Our findings suggest that in patients with AN, Se plasma concentration might be implicated in disease severity and suicide risk. The finding that Se deficiency in patients with AN was associated only with reward-related processes, but not with other psychological functions suggests the selective involvement of dopamine-related pathways. Our results suggest that it might be useful to monitor the plasma micronutrient profile in patients with AN. Future studies should determine whether Se supplementation in AN might improve clinical outcomes.

Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REEIC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (<0.001), and fat mass (<0.001) were associated with REEIC. Age (p < 0.001), height (p = 0.003), and AN duration (N = 46 for <3 years and N = 82 for ≥3 years; p = 0.012) were associated with the difference between estimated REE (using the Schebendach equation) and measured REEIC. Therefore, the Schebendach equation was adjusted differently in the two patients’ subgroups (AN duration ≤ or >3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.

The prevalence of sarcopenia in patients with obesity varies according to the definition used. The purpose of our study was to: (i) determine the prevalence of sarcopenia in terms of lean tissue mass in older women with obesity using the current cut-offs, (ii) redefine a specific cut-off for low lean tissue mass (LLTM), and (iii) re-determine the prevalence of LLTM using this new cut-off. Appendicular lean mass (ALM) and the ALM index [ALM/height 2 : ALMI(h 2 )] and ALMI/body mass index [ALMI(BMI)] were determined in 791 women with or without obesity. LLMM prevalence was calculated using the current cut-offs: EWGSOP2: ALM < 15 kg and ALMI(h 2 ) < 5.5 kg/m 2 ; FNIH: ALM < 15.02 kg and ALMI(BMI) < 0.51; and IWGS: ALMI(h 2 ) < 5.67 kg/m 2 and cut-offs newly determined from data provided from young women with obesity. ALM, ALMI(h 2 ) and ALMI(BMI) were lower in older compared to young obese women. Using the current cut-offs, a wide distribution of LLTM prevalence (0 to 29.2%) was observed. When the newly determined cut-offs were applied – i.e., ALM < 18.51 kg; ALMI(h 2 ) < 7.15 kg/m 2 , ALMI(BMI) < 0.483, and T-score: [(ALMI(h 2 ) measured)-(2.08 + 0.183*BMI)]/0.72] − the LLTM mass prevalence was 17.37%; 8.47, 14.8 and 12.71%. respectively. This study showed that the current cut-offs for LLTM as criteria for sarcopenia diagnosis are not adapted to the obese population. Although the new “static” cut-offs appeared to be more adapted, a “dynamic” cut-off for ALMI(h 2 ) that took into account the BMI and thus the obesity severity appeared even more relevant.

Objectives The two-fold aim of this study was: (i) to determine the effects of undernutrition on the myokines in patients with restrictive anorexia nervosa (AN) and (ii) to examine the potential link between myokines and bone parameters. Methods In this study, 42 young women with restrictive AN and 42 age-matched controls (CON) (mean age, 18.5 ± 4.2 years and 18.6 ± 4.2 years, respectively) were enrolled. aBMD and body composition were determined with DXA. Resting energy expenditure (REEm), a marker of energy status, was indirectly assessed by calorimetry. Bone turnover markers and myokines (follistatin, myostatin and irisin) were concomitantly evaluated. Results AN patients presented low aBMD at all bone sites. REEm, bone formation markers, myostatin and IGF-1 were significantly lower, whereas the bone resorption marker and follistatin were higher in AN compared with controls. No difference was observed between groups for irisin levels. When the whole population was studied, among myokines, only myostatin was positively correlated with aBMD at all bone sites. However, multiple regression analyses showed that in the AN group, the independent variables for aBMD were principally amenorrhoea duration, lean tissue mass (LTM) and procollagen type I N-terminal propeptide (PINP). For CON, the independent variables for aBMD were principally LTM, age and PINP. Whatever the group analysed, none of the myokines appeared as explicative independent variables of aBMD. Conclusion This study demonstrated that despite the altered myokine levels in patients with AN, their direct effect on aBMD loss and bone turnover alteration seems limited in comparison with other well-known disease-related factors such as oestrogen deprivation.

AIM:Diagnosis of nonalcoholic steatohepatitis (NASH) relies on liver biopsy. Noninvasive tools would be useful to target patients to refer for a biopsy. We aimed to determine the diagnostic value of the triglycerides and glucose (TyG) index, an insulin-resistance indicator, to predict NASH. METHODS:Our study included grade II-III obese patients aged 18-65 years undergoing bariatric surgery and included in the COMET (COllection of MEtabolic Tissues) biobank (NCT02861781). Liver biopsies performed during bariatric surgery were collected from the biobank along with blood derivatives. Biopsies were analysed according to the steatosis, activity and fibrosis (SAF) scoring system to diagnose NASH, nonalcoholic fatty liver disease (NAFLD), and fibrosis. Logistic regression models were performed to identify factors predicting NASH, NAFLD, and fibrosis. RESULTS:Of 238 analysed subjects (mean age 43±12 years, 33.6% men), 29% had type 2 diabetes. Steatosis was present in 67.2%, while NASH and advanced fibrosis (stage F3) were diagnosed in 18.1% and 2.9% respectively. TyG index was independently associated with NASH (odds ratio (OR): 4.7 [95% confidence interval: 2.3;9.5] P < 0.0001), NAFLD (OR: 2.0 [1.1;3.7] P = 0.03) and stages 2-3 fibrosis (OR: 4.0 [1.5;10.8] P = 0.007). NASH was also predicted by gamma-glutamyl transferase (GGT) with an area under the ROC curve: 0.79 [0.71;0.87 P = 0.04] for GGT and TyG index combined. CONCLUSION:In our cohort of severely obese patients, TyG index, when associated with GGT level, exhibited high diagnostic performance to predict NASH. Although validation in larger populations is needed, this result may be of considerable clinical value to predict need for liver biopsy.

Eating disorders (ED) are associated with an in increased risk of suicidal behaviours. Laxative abuse might alter the gut–brain axis signaling, that might be implicated in the pathophysiology of suicide. This study aims to determine the association between laxative misuse and suicide attempt (SA) and suicidal ideation (SI) in patients with ED. 277 patients with ED were recruited from an Eating Disorder Unit of Lapeyronie Academic Hospital, Montpellier, France. Sociodemographic and clinical data were collected. Chi-square and t test were used, with Bonferroni corrections where required. Multiple regression models assessed the relationships between laxative misuse, SA, and SI. 62 (22.4%) patients reported lifetime laxative misuse. They were more likely to have a history of SA than non-misusers [43.83 vs 19.9%, p < 0.001, odds ratio (OR) 3.68]. In the multivariate model, adjusted for other confounders, lifetime laxative misuse remained associated with SA (adjusted OR 3.79, p = 0.041). In past 28 days, patients with SA history reported misusing laxatives for more days than patients without SA history (6 vs 1.5 days, p = 0.01, adjusted for vomiting and ED severity). Laxative use days during past 28 days was associated with current SI, adjusted for vomiting in the same period (p = 0.017). Current and lifetime laxative misuse were associated with SA history and current SI in patients with ED, at least in part independently of other suicide-related factors. Level III cohort, cross-sectional study.

Background: Most obese women with low-trauma fractures present normal areal bone mineral density (aBMD), suggesting that other bone parameters are more determinant for fracture risk in these patients. Objectives: (i) Determine the effects of obesity in young women on areal bone mineral density (aBMD), bone geometry, strength, and volumetric BMD determined by advanced DXA-based methods; (ii) model the profiles of bone parameters for each population with age; and (iii) determine the factors related to body composition (i.e. lean tissue mass and fat mass) potentially implicated in the "bone adaptation" in the femoral region. Subjects and methods: Two hundred and twenty adolescent and young women from 18 to 35 years old were enrolled in this study: 128 patients with obesity and 92 age-matched (+/- 6 months) normal-weight controls. aBMD was determined with DXA, whereas hip geometry and strength parameters were assessed by hip structural analysis (HSA) and volumetric BMD by 3D-SHAPER (R) software. Results: Compared with controls, subjects with obesity presented significantly higher aBMD at all bone sites, but the difference was greater at hip compared with lumbar spine or radius. Bone size estimates (i.e. cortical thickness), as well as strength estimates (i.e. cross-sectional area) were higher at all femoral subregions including femoral neck, intertrochanteric region and femoral shaft in young women with obesity. In whole proximal femur and all femoral compartments, vBMD was also higher in subjects with obesity, but the difference between groups was greater for cortical vBMD compared with trabecular vBMD. When hip bone parameters were modelled for each group from individual values, maximal values were reached between 20 and 26 years in both groups but, whatever the age, subjects with obesity presented higher values than controls. In both groups, lean body mass (LBM) was the parameter most positively associated with the greatest number of bone parameters studied. Conclusion: Our study confirmed that young women with obesity presented higher aBMD, better hip geometry and greater strength compared with normal-weight controls. Additionally, cortical and trabecular compartments measured by 3D-SHAPER (R) were favourably and concomitantly modified. However, it remains to be demonstrated whether the evaluation of these new parameters would provide better prediction of fracture risk in this population than aBMD.

This study investigated the potential role of quantitative ultrasound (QUS) to assess low bone mass in anorexia nervosa patients (AN). Bone parameters from QUS and DXA were positively correlated and significantly reduced in AN compared with controls, suggesting that QUS is a pertinent technique to assess low bone mass in these patients. Purpose The aim of this study was to investigate the potential role of an alternative technique, quantitative ultrasound (QUS), to assess low bone mass in patients with anorexia nervosa (AN). Methods Two hundred seven young women (134 patients with AN and 73 healthy controls) with ages ranging from 14.4 to 38.4 years participated in this observational cross-sectional study. Bone mass was concomitantly evaluated by DXA to determine areal bone mineral density (aBMD; g/cm(2)) at hip, lumbar spine, and radius and by QUS to determine broadband ultrasound attenuation (BUA; dB/MHz) at the heel. Results BUA (66.5 +/- 4.6 dB/MHz vs 61.0 +/- 5.0 dB/MHz) and aBMD at the hip (0.916 +/- 0.013 g/cm(2) vs 0.806 +/- 0.010 g/cm(2)), lumbar spine (0.966 +/- 0.012 g/cm(2) vs 0.886 +/- 0.010 g/cm(2)), and radius (0.545 +/- 0.005 g/cm(2) vs 0.526 +/- 0.04 g/cm(2)) were significantly decreased (p < 0.01) in patients with AN compared with controls. When patient and control data were pooled, BUA was significantly correlated with aBMD at the hip (r = 0.60, p < 0.001), lumbar spine (r = 0.48, p < 0.001), and radius (r = 0.40, p<0.001). In patients with AN, BUA and aBMD were mainly and positively correlated with weight, lean tissue mass, body mass index (BMI), and minimal BMI life and negatively with the duration of both disease and amenorrhea. Better concordance between the two techniques was obtained when absolute BUA and aBMD values were used according to the WHO T score classification. Conclusion BUA measurement at the heel by QUS appears to be a pertinent nonionizing technique to assess low bone mass in patients with AN.