Medical Bulletin 25/October/2022

Two of the world's leading authorities on bariatric and metabolic surgery have issued new evidence-based clinical guidelines for patients with type 2 diabetes beginning at a body mass index (BMI) of 30. The ASMBS/IFSO Guidelines on Indications for Metabolic and Bariatric Surgery - 2022, published online in the journals, Surgery for Obesity and Related Diseases (SOARD) and Obesity Surgery, are meant to replace a consensus statement developed by National Institutes of Health (NIH) more than 30 years ago that set standards most insurers and doctors still rely upon to make decisions about who should get weight-loss surgery, what kind they should get, and when they should get it.

In the 1991 consensus statement, bariatric surgery was confined to patients with a BMI of at least 40 or a BMI of 35 or more and at least one obesity-related condition such as hypertension or heart disease. There were no references to metabolic surgery for diabetes or references to the emerging laparoscopic techniques and procedures that would become mainstay and make weight-loss surgery as safe or safer than common operations including gallbladder surgery, appendectomy, and knee replacement. The statement also recommended against surgery in children and adolescents even with BMIs over 40 because it had not been sufficiently studied.

Reference:

Teresa LaMasters et al,2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery,Surgery for Obesity and Related Diseases

New clues to genetic causes of high cholesterol found

The discovery of a genetic variant that is relatively common among people of Polynesian ancestry, but incredibly rare in most other populations, is giving clues to the genetic underpinnings of high cholesterol in all people, according to new research led by University of Pittsburgh School of Public Health geneticists in partnership with several other groups, including the University of Otago and the Samoan health research community.

The surprising finding, published this week in the journal Human Genetics and Genomics Advances, demonstrates the importance of ensuring diversity in genetic databases.

High cholesterol is a major cause of disease burden in countries of all income levels, is a risk factor for heart disease and stroke, and is estimated to cause 2.6 million deaths annually worldwide, according to the World Health Organization.

Reference:

JENNA CARLSON et al,Human Genetics and Genomics Advances,DOI:10.1016/j.xhgg.2022.100155

Three-dose hepatitis B vaccine regimen helpful for people with HIV

A three-dose course of the hepatitis B vaccine HEPLISAV-B fully protected adults living with HIV who had never been vaccinated against or infected with the hepatitis B virus (HBV), according to study findings presented at the IDWeek conference in Washington, D.C.

People living with HIV, including those who are taking antiretroviral therapy, are at greater risk of liver-related illness and death when co-infected with HBV. According to the Centers for Disease Control and Prevention, 10% of U.S. adults with HIV also have hepatitis B. People living with HIV are less likely to produce a protective immunological response to HBV vaccination. 3The HEPLISAV-B vaccine, was approved in 2017 by the U.S. Food and Drug Administration as a two-dose vaccine regimen for adults. However, little was known about its protective effects in people living with HIV.

Reference:

Kenneth E. Sherman et al,