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Published in: Obesity Surgery 3/2015

01-03-2015 | Original Contributions

Long-Term Effects of Bariatric Surgery on Type II Diabetes, Hypertension and Hyperlipidemia: A Meta-Analysis and Meta-Regression Study with 5-Year Follow-Up

Authors: Cristian Ricci, Maddalena Gaeta, Emanuele Rausa, Emanuele Asti, Francesco Bandera, Luigi Bonavina

Published in: Obesity Surgery | Issue 3/2015

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Abstract

Background

The first aim of the study was to estimate weight loss and major modifiable risk factors after bariatric surgery. The second aim was to investigate the relationship between the reduction in cardiovascular risk and weight loss over time.

Methods

A random effect of meta-analysis and dose–response meta-regression was used to evaluate weight loss and the risk of type II diabetes, hypertension and hyperlipidemia, 2–5 years after surgery.

Results

A search of the literature led to the selection of 22 papers. The body mass index (BMI) at the end of the observation period was 31.7 (95 % CI = 29.7–33.7; I2 = 6 %). The risk of type II diabetes, hypertension and hyperlipidemia decreased after bariatric surgery, with relative risks of, respectively, 0.33 (95 % CI = 0.26–0.41; I2 = 42 %), 0.54 (95 % CI = 0.46–0.64; I2 = 68 %) and 0.33 (95 % CI = 0.22–0.46; I2 = 74 %). Nonlinear meta-regression revealed different patterns of risk: Hypertension risk reached a minimum when the BMI fell 10 units. The risks of all cardiovascular outcomes reached a plateau, 20–40 months after surgery.

Conclusions

The reduction in arterial hypertension reached a nadir earlier than the risk of diabetes and hyperlipidemia, thus indicating a possible link between weight reduction and positive hemodynamic effects.
Literature
1.
go back to reference Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.CrossRefPubMed Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.CrossRefPubMed
4.
go back to reference Van Gaal LF, Maggioni AP. Overweight, obesity, and outcomes: fat mass and beyond. Lancet. 2013. Van Gaal LF, Maggioni AP. Overweight, obesity, and outcomes: fat mass and beyond. Lancet. 2013.
5.
go back to reference Klein S, Burke LE, Bray GA, et al. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation. Circulation. 2004;110(18):2952–67.CrossRefPubMed Klein S, Burke LE, Bray GA, et al. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation. Circulation. 2004;110(18):2952–67.CrossRefPubMed
6.
go back to reference Renehan AG. Bariatric surgery, weight reduction, and cancer prevention. Lancet Oncol. 2009;10(7):640–1.CrossRefPubMed Renehan AG. Bariatric surgery, weight reduction, and cancer prevention. Lancet Oncol. 2009;10(7):640–1.CrossRefPubMed
7.
go back to reference Singh GM, Danaei G, Farzadfar F, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One. 2013;8(7):e65174.CrossRefPubMedCentralPubMed Singh GM, Danaei G, Farzadfar F, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One. 2013;8(7):e65174.CrossRefPubMedCentralPubMed
8.
go back to reference Borrell LN, Samuel L. Body mass index categories and mortality risk in us adults: the effect of overweight and obesity on advancing death. Am J Public Health. 2014;104(3):512–9. REV2 COMM4.CrossRefPubMed Borrell LN, Samuel L. Body mass index categories and mortality risk in us adults: the effect of overweight and obesity on advancing death. Am J Public Health. 2014;104(3):512–9. REV2 COMM4.CrossRefPubMed
9.
go back to reference Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRefPubMed Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRefPubMed
10.
go back to reference Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.CrossRefPubMedCentralPubMed Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.CrossRefPubMedCentralPubMed
11.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMed Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMed
12.
go back to reference Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev. 2011;12(8):602–21.CrossRefPubMed Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev. 2011;12(8):602–21.CrossRefPubMed
13.
go back to reference Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. 215–357, iii-iv.CrossRef Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. 215–357, iii-iv.CrossRef
15.
go back to reference Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. REV2 COMM4.CrossRefPubMedCentralPubMed Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. REV2 COMM4.CrossRefPubMedCentralPubMed
16.
go back to reference Guo X, Liu X, Wang M, et al. The effects of bariatric procedures versus medical therapy for obese patients with type 2 diabetes: Meta-analysis of randomized controlled trials. Biomed Res Int. 2013;2013:410609.PubMedCentralPubMed Guo X, Liu X, Wang M, et al. The effects of bariatric procedures versus medical therapy for obese patients with type 2 diabetes: Meta-analysis of randomized controlled trials. Biomed Res Int. 2013;2013:410609.PubMedCentralPubMed
17.
go back to reference Avenell A, Broom J, Brown TJ, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess. 2004;8(21):1–182. iii-iv.CrossRef Avenell A, Broom J, Brown TJ, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess. 2004;8(21):1–182. iii-iv.CrossRef
18.
19.
go back to reference Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379(9833):2300–11.CrossRefPubMed Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379(9833):2300–11.CrossRefPubMed
20.
go back to reference Fridman A, Moon R, Cozacov Y, et al. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. J Am Coll Surg. 2013;217(4):614–20.CrossRefPubMed Fridman A, Moon R, Cozacov Y, et al. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. J Am Coll Surg. 2013;217(4):614–20.CrossRefPubMed
21.
go back to reference Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2013;149(3):275–87. REV2 COMM4.CrossRef Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2013;149(3):275–87. REV2 COMM4.CrossRef
22.
go back to reference Ricci C, Gaeta M, Rausa E, et al. Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6587 patients. Obes Surg. 2014;24(4):522–8. REV2 COMM4.CrossRefPubMed Ricci C, Gaeta M, Rausa E, et al. Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6587 patients. Obes Surg. 2014;24(4):522–8. REV2 COMM4.CrossRefPubMed
23.
go back to reference Frigg A, Peterli R, Peters T, et al. Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding. Obes Surg. 2004;14(2):216–23.CrossRefPubMed Frigg A, Peterli R, Peters T, et al. Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding. Obes Surg. 2004;14(2):216–23.CrossRefPubMed
24.
go back to reference Ponce J, Haynes B, Paynter S, et al. Effect of lap-band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg. 2004;14(10):1335–42.CrossRefPubMed Ponce J, Haynes B, Paynter S, et al. Effect of lap-band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg. 2004;14(10):1335–42.CrossRefPubMed
25.
go back to reference Adami GF, Papadia F, Carlini F, et al. Effect of biliopancreatic diversion on hypertension in severely obese patients. Hypertens Res. 2005;28(2):119–23.CrossRefPubMed Adami GF, Papadia F, Carlini F, et al. Effect of biliopancreatic diversion on hypertension in severely obese patients. Hypertens Res. 2005;28(2):119–23.CrossRefPubMed
26.
go back to reference Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243(2):181–8.CrossRefPubMedCentralPubMed Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243(2):181–8.CrossRefPubMedCentralPubMed
27.
go back to reference Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of weight loss on predicted cardiovascular risk: Change in cardiac risk after bariatric surgery. Obesity (Silver Spring). 2007;15(3):772–84.CrossRef Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of weight loss on predicted cardiovascular risk: Change in cardiac risk after bariatric surgery. Obesity (Silver Spring). 2007;15(3):772–84.CrossRef
28.
go back to reference Ikonomidis I, Mazarakis A, Papadopoulos C, et al. Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study. J Hypertens. 2007;25(2):439–47.CrossRefPubMed Ikonomidis I, Mazarakis A, Papadopoulos C, et al. Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study. J Hypertens. 2007;25(2):439–47.CrossRefPubMed
29.
go back to reference Larrad-Jimenez A, Diaz-Guerra CS, de Cuadros BP, et al. Short-, mid- and long-term results of Larrad biliopancreatic diversion. Obes Surg. 2007;17(2):202–10.CrossRefPubMed Larrad-Jimenez A, Diaz-Guerra CS, de Cuadros BP, et al. Short-, mid- and long-term results of Larrad biliopancreatic diversion. Obes Surg. 2007;17(2):202–10.CrossRefPubMed
30.
go back to reference Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following Roux-en-Y gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity. Obes Surg. 2007;17(2):176–84.CrossRefPubMed Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following Roux-en-Y gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity. Obes Surg. 2007;17(2):176–84.CrossRefPubMed
31.
go back to reference Goergen M, Arapis K, Limgba A, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty: Results of a 2-year follow-up study. Surg Endosc. 2007;21(4):659–64.CrossRefPubMed Goergen M, Arapis K, Limgba A, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty: Results of a 2-year follow-up study. Surg Endosc. 2007;21(4):659–64.CrossRefPubMed
32.
go back to reference Pinheiro JS, Schiavon CA, Pereira PB, et al. Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Surg Obes Relat Dis. 2008;4(4):521–5. discussion 526–527.CrossRefPubMed Pinheiro JS, Schiavon CA, Pereira PB, et al. Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Surg Obes Relat Dis. 2008;4(4):521–5. discussion 526–527.CrossRefPubMed
33.
go back to reference Muller MK, Rader S, Wildi S, et al. Long-term follow-up of proximal versus distal laparoscopic gastric bypass for morbid obesity. Br J Surg. 2008;95(11):1375–9.CrossRefPubMed Muller MK, Rader S, Wildi S, et al. Long-term follow-up of proximal versus distal laparoscopic gastric bypass for morbid obesity. Br J Surg. 2008;95(11):1375–9.CrossRefPubMed
34.
go back to reference Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.CrossRefPubMed Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.CrossRefPubMed
35.
go back to reference Yan E, Ko E, Luong V, et al. Long-term changes in weight loss and obesity-related comorbidities after Roux-en-Y gastric bypass: a primary care experience. Am J Surg. 2008;195(1):94–8.CrossRefPubMed Yan E, Ko E, Luong V, et al. Long-term changes in weight loss and obesity-related comorbidities after Roux-en-Y gastric bypass: a primary care experience. Am J Surg. 2008;195(1):94–8.CrossRefPubMed
36.
go back to reference Csendes A, Maluenda F, Burgos AM. A prospective randomized study comparing patients with morbid obesity submitted to laparotomic gastric bypass with or without omentectomy. Obes Surg. 2009;19(4):490–4.CrossRefPubMed Csendes A, Maluenda F, Burgos AM. A prospective randomized study comparing patients with morbid obesity submitted to laparotomic gastric bypass with or without omentectomy. Obes Surg. 2009;19(4):490–4.CrossRefPubMed
37.
go back to reference Pontiroli AE, Laneri M, Veronelli A, et al. Biliary pancreatic diversion and laparoscopic adjustable gastric banding in morbid obesity: their long-term effects on metabolic syndrome and on cardiovascular parameters. Cardiovasc Diabetol. 2009;8:37.CrossRefPubMedCentralPubMed Pontiroli AE, Laneri M, Veronelli A, et al. Biliary pancreatic diversion and laparoscopic adjustable gastric banding in morbid obesity: their long-term effects on metabolic syndrome and on cardiovascular parameters. Cardiovasc Diabetol. 2009;8:37.CrossRefPubMedCentralPubMed
38.
go back to reference Steffen R, Potoczna N, Bieri N, et al. Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96 % follow-up. Obes Surg. 2009;19(1):3–12.CrossRefPubMed Steffen R, Potoczna N, Bieri N, et al. Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96 % follow-up. Obes Surg. 2009;19(1):3–12.CrossRefPubMed
39.
go back to reference Habib P, Scrocco JD, Terek M, et al. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol. 2009;104(9):1251–5.CrossRefPubMed Habib P, Scrocco JD, Terek M, et al. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol. 2009;104(9):1251–5.CrossRefPubMed
40.
go back to reference Prachand VN, Ward M, Alverdy JC. Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI > or = 50 kg/m2) compared with gastric bypass. J Gastrointest Surg. 2010;14(2):211–20.CrossRefPubMed Prachand VN, Ward M, Alverdy JC. Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI > or = 50 kg/m2) compared with gastric bypass. J Gastrointest Surg. 2010;14(2):211–20.CrossRefPubMed
41.
go back to reference Schouten R, Wiryasaputra DC, van Dielen FM, et al. Long-term results of bariatric restrictive procedures: a prospective study. Obes Surg. 2010;20(12):1617–26.CrossRefPubMedCentralPubMed Schouten R, Wiryasaputra DC, van Dielen FM, et al. Long-term results of bariatric restrictive procedures: a prospective study. Obes Surg. 2010;20(12):1617–26.CrossRefPubMedCentralPubMed
42.
go back to reference Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21(11):1650–6.CrossRefPubMed Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21(11):1650–6.CrossRefPubMed
43.
go back to reference Gouillat C, Denis A, Badol-Van Straaten P, et al. Prospective, multicenter, 3-year trial of laparoscopic adjustable gastric banding with the MIDBAND. Obes Surg. 2012;22(4):572–81.CrossRefPubMed Gouillat C, Denis A, Badol-Van Straaten P, et al. Prospective, multicenter, 3-year trial of laparoscopic adjustable gastric banding with the MIDBAND. Obes Surg. 2012;22(4):572–81.CrossRefPubMed
44.
go back to reference Prasad P, Tantia O, Patle N, et al. An analysis of 1-3-year follow-up results of laparoscopic sleeve gastrectomy: an Indian perspective. Obes Surg. 2012;22(3):507–14.CrossRefPubMed Prasad P, Tantia O, Patle N, et al. An analysis of 1-3-year follow-up results of laparoscopic sleeve gastrectomy: an Indian perspective. Obes Surg. 2012;22(3):507–14.CrossRefPubMed
45.
46.
go back to reference Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.CrossRefPubMed Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.CrossRefPubMed
47.
go back to reference Orsini N, Li R, Wolk A, et al. Meta-analysis for linear and nonlinear dose–response relations: Examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175(1):66–73.CrossRefPubMedCentralPubMed Orsini N, Li R, Wolk A, et al. Meta-analysis for linear and nonlinear dose–response relations: Examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175(1):66–73.CrossRefPubMedCentralPubMed
48.
go back to reference StataCorp. Stata Statistical Software: Release 12. College Station: StataCorp LP.37; 2011. StataCorp. Stata Statistical Software: Release 12. College Station: StataCorp LP.37; 2011.
49.
go back to reference SAS Institute Inc., SAS 9.1.2 Help and Documentation, Cary, NC: SAS Institute Inc. SAS Institute Inc., SAS 9.1.2 Help and Documentation, Cary, NC: SAS Institute Inc.
50.
go back to reference Vest AR, Heneghan HM, Agarwal S, et al. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98(24):1763–77.CrossRefPubMed Vest AR, Heneghan HM, Agarwal S, et al. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98(24):1763–77.CrossRefPubMed
51.
go back to reference Van de Voorde J, Pauwels B, Boydens C, et al. Adipocytokines in relation to cardiovascular disease. Metabolism. 2013;62(11):1513–21.CrossRefPubMed Van de Voorde J, Pauwels B, Boydens C, et al. Adipocytokines in relation to cardiovascular disease. Metabolism. 2013;62(11):1513–21.CrossRefPubMed
Metadata
Title
Long-Term Effects of Bariatric Surgery on Type II Diabetes, Hypertension and Hyperlipidemia: A Meta-Analysis and Meta-Regression Study with 5-Year Follow-Up
Authors
Cristian Ricci
Maddalena Gaeta
Emanuele Rausa
Emanuele Asti
Francesco Bandera
Luigi Bonavina
Publication date
01-03-2015
Publisher
Springer US
Published in
Obesity Surgery / Issue 3/2015
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-014-1442-4

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