Psychiatric and Cognitive Functioning After Metabolic and Bariatric Surgery: A Systematic Review and Meta-Analysis.

IF 8 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity Reviews Pub Date : 2025-06-22 DOI:10.1111/obr.13968

Emma A van Reekum, Michael Darcy, Jaslyn Drage, Joshua Xu, Kimberly Ng, Benjamin Forestell, Nancy Santesso, Raed A Joundi, Jorge Wong, Aristithes Doumouras, Valerie H Taylor, Salim Yusuf, Ryan Van Lieshout

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引用次数: 0

Abstract

Objective: To evaluate psychiatric and cognitive functioning after metabolic and bariatric surgery (MBS) with a systematic review and meta-analysis. To systematically review and meta-analyze psychiatric and cognitive outcomes following metabolic and bariatric surgery (MBS).

Methods: Six databases were searched. Randomized controlled trials (RCTs) and nonrandomized studies (NRS) of people with obesity comparing MBS with any nonsurgical intervention or control condition were included. Main outcomes included symptoms of depression, anxiety, and non-normative eating, substance use disorder diagnosis, suicide death, and cognitive performance in attention, memory, and executive function. Evidence certainty was assessed with GRADE. Heterogeneity was explored with subgroup analyses of ≤ 2 years vs. > 2 years post-intervention.

Results: There were 79 studies (75 NRS and 4 RCTs) found, including 732,149 people with obesity who underwent MBS, and 7,670,770 who did not. Among RCTs, MBS may improve depressive symptoms (standardized mean difference [SMD] = -0.40, 95% CI -1.04, 0.24; very low certainty). Among NRS, there was low to very low certainty that MBS may improve depressive (SMD = 0.56, 95% CI -0.87, -0.26), anxiety (SMD = -0.60, 95% CI -1.00, -0.19), and non-normative eating symptoms (SMD = -0.75, 95% CI -0.97, -0.53) and cognitive performance in attention (SMD = -0.72, 95% CI -1.61, 0.17), but not executive function or memory. MBS may slightly increase suicide deaths (1/1000 more people, 95% CI 0 fewer to 3 more; very low certainty) and substance use disorders (4/100 more, 95% CI from 1 to 9 more; low certainty) > 2-years post-surgery.

Conclusions: Compared to nonsurgical conditions, MBS may improve depression, anxiety, non-normative eating, and attention, but slightly increase suicides and substance use disorders. There was low to very low certainty in most outcomes, therefore additionalhigh-quality studies are needed to strengthen the evidence base.

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代谢和减肥手术后的精神和认知功能：系统回顾和荟萃分析。

目的：通过系统回顾和荟萃分析评估代谢和减肥手术（MBS）后的精神和认知功能。系统回顾和荟萃分析代谢和减肥手术（MBS）后的精神和认知结果。方法：检索6个数据库。随机对照试验（rct）和非随机研究（NRS）将肥胖患者与任何非手术干预或对照条件进行比较。主要结局包括抑郁症状、焦虑、不规范饮食、物质使用障碍诊断、自杀死亡、注意力、记忆和执行功能的认知表现。证据确定性采用GRADE评价。通过亚组分析探讨干预后≤2年与bb0 2年的异质性。结果：共发现79项研究（75项NRS和4项rct），包括732,149例肥胖患者接受了MBS， 7670,770例未接受MBS。在随机对照试验中，MBS可能改善抑郁症状(标准化平均差[SMD] = -0.40, 95% CI -1.04, 0.24；非常低的确定性)。在NRS中，MBS可能改善抑郁（SMD = 0.56, 95% CI -0.87, -0.26）、焦虑（SMD = -0.60, 95% CI -1.00, -0.19）、非规范性饮食症状（SMD = -0.75, 95% CI -0.97, -0.53）和注意力认知表现（SMD = -0.72, 95% CI -1.61, 0.17）的确定性低至极低，但对执行功能或记忆没有改善作用。MBS可能会略微增加自杀死亡人数(增加1/1000人，95%可信区间0 - 3；非常低的确定性)和物质使用障碍(4/100以上，95% CI从1到9以上；低确定性)>术后2年。结论：与非手术条件相比，MBS可以改善抑郁、焦虑、不规范饮食和注意力，但会轻微增加自杀和物质使用障碍。大多数结果的确定性低至极低，因此需要额外的高质量研究来加强证据基础。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Obesity Reviews 医学-内分泌学与代谢

CiteScore

19.30

自引率

1.10%

发文量

130

审稿时长

1 months

期刊介绍： Obesity Reviews is a monthly journal publishing reviews on all disciplines related to obesity and its comorbidities. This includes basic and behavioral sciences, clinical treatment and outcomes, epidemiology, prevention and public health. The journal should, therefore, appeal to all professionals with an interest in obesity and its comorbidities. Review types may include systematic narrative reviews, quantitative meta-analyses and narrative reviews but all must offer new insights, critical or novel perspectives that will enhance the state of knowledge in the field. The editorial policy is to publish high quality peer-reviewed manuscripts that provide needed new insight into all aspects of obesity and its related comorbidities while minimizing the period between submission and publication.