Top

Published in:

01-10-2008 | Research Article

Metabolic Syndrome after Laparoscopic Bariatric Surgery

Authors: Clare Nugent, ChunHong Bai, Hazem Elariny, Priya Gopalakrishnan, Caitlin Quigley, Michael Garone Jr., Mariam Afendy, Oscar Chan, Angela Wheeler, Arian Afendy, Zobair M. Younossi

Published in: Obesity Surgery | Issue 10/2008

Abstract

Background

Metabolic syndrome (MS) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study was to assess the impact and predictors of bariatric surgery on the resolution of MS.

Methods

Subjects included 286 patients [age 44.0 ± 11.5, female 78.2%, BMI 48.7 ± 9.4, waist circumference 139 ± 20 cm, AST 23.5 ± 14.9, ALT 30.0 ± 20.1, type 2 diabetes mellitus (DM) 30.1% and MS 39.2%] who underwent bariatric surgery.

Results

Of the entire cohort, 27.3% underwent malabsorptive surgery, 55.9% underwent restrictive surgery, and 16.8% had combination restrictive–malabsorptive surgery. Mean weight loss was 33.7 ± 20.1 kg after restrictive surgery (follow up period 298 ± 271 days), 39.4 ± 22.9 kg after malabsorptive surgery (follow-up period 306 ± 290 days), and 28.3 ± 14.1 kg after combination surgery (follow-up period 281 ± 239 days). Regardless of the type of bariatric surgery, significant improvements were noted in MS (p values from <0.0001–0.01) as well as its components such as DM (p values from <0.0001–0.0005), waist circumference (p values <0.0001), BMI (p values <0.0001), fasting serum triglycerides (p values <0.0001 to 0.001), and fasting serum glucose (p values <0.0001). Additionally, a significant improvement in AST/ALT ratio (p value = 0.0002) was noted in those undergoing restrictive surgery. Multivariate analysis showed that patients who underwent malabsorptive bariatric procedures experienced a significantly greater percent excess weight loss than patients who underwent restrictive procedures (p value = 0.0451). Percent excess weight loss increased with longer postoperative follow-up (p value <0.0001).

Conclusions

Weight loss after bariatric surgery is associated with a significant improvement in MS and other metabolic factors.

Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol. 2006 Feb;35:93–9.PubMedCrossRef

Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;5(295):1549–55.CrossRef

Tsai AG, Wadden TA. Systematic review: an evaluation of major commercial weight loss progams in the United States. Ann Intern Med. 2005;4(142):56–66.

Zhao Y, Encinosa W. Agency for Healthcare Research and Quality AHRQ Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Statistical Brief. #23, 2007.

Ricciardi R, Town RJ, Kellogg TA, Ikramuddin S, Baxter NN. Outcomes after open versus laparoscopic gastric bypass. Surg Laparosc Endosc Percutan Tech. 2006;16:317–20.PubMedCrossRef

Sjostrom L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. NEJM. 2007;357:741–52.PubMedCrossRef

Unknown. National Institutes of Health Consensus Development Conference Draft Statement on Gastrointestinal Surgery for Severe Obesity, 25–27 March 1991. Obes Surg. 1991;1(No.3):257–65.CrossRef

Buchwald H. Consensus Conference Statement. Bariatric surgery for morbid obesity: health implications for patients, health professionals and third party payers. Surg Obes Relat Dis. 2005:371–81.

Madan AK, Orth W, Ternovits CA, Tichansky DS. Metabolic syndrome: yet another co-morbidity gastric bypass helps cure. Surg Obes Relat Dis. 2006;2:48–51.PubMedCrossRef

10.

Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg. 2005;242:610–20.PubMed

11.

Alberti KG, Simmet PZ, for the WHO Consultation. Definition, diagnosis and classification of diabetes mellitus and its complications, Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 2002;15:539–53.CrossRef

12.

Grundy S, Cleeman J, Daniels S, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–52.PubMedCrossRef

13.

Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24:683–89.PubMedCrossRef

14.

Marchesini G, Brizi M, Bianchi G, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844–50.PubMedCrossRef

15.

Lee WJ, Huang MT, Wang W, et al. Effects of obesity surgery on the Metabolic syndrome. Arch Surg. 2004;139:1088–92.PubMedCrossRef

16.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef

17.

Valera-Mora ME, Simeoni B, Gagliardi L, et al. Predictors of weight loss and reversal of co morbidities in malabsorptive bariatric surgery. Am J Clin Nutr. 2005;81:1292–97.PubMed

18.

Kinzl JF, Schrattenecker M, Traweger C, Mattesich M, Fiala M, Biebl W. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16:1609–14.PubMedCrossRef

19.

Averbukh Y, Heshka S, El-Shoreya H, et al. Depression score predicts weight loss following gastric bypass. Obes Surg. 2003;13:833–36.PubMedCrossRef

20.

Lutfi R, Torquati A, Sekhar N, Richards WO. Predictors of success after laparoscopic gastric bypass: a multivariate analysis of socioeconomic factors. Surg Endosc. 2006;20:864–67.PubMedCrossRef

21.

Madan AK, Whitfield JD, Fain JN, et al. Are African Americans as successful as Caucasians after laparoscopic gastric bypass? Obes Surg. 2007;17:460–64.PubMedCrossRef

22.

Olbers T, Fagevik-Olsen M, Maleckas A, et al. Randomized clinical trial of laparoscopic Roux-en Y gastric bypass versus laparoscopic vertical banded gastroplasty for obesity. Br J Surg. 2005;92:557–62.PubMedCrossRef

23.

Mognol P, Chosidow D, Marmuse JP. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding in the super-obese: a comparative study of 290 patients. Obes Surg. 2005;15:76–81.PubMedCrossRef

24.

Cottam DR, Atkinson J, Anderson A, Grace B, Fisher B. Case controlled matched pair cohort study of lap roux en Y gastric bypass and Lap band patients in a single US center with three year follow up. Obes Surg. 2006;16:534–40.PubMedCrossRef

25.

Bowne WB, Julliard K, Castro AE, Shah P, Morgenthal CB, Ferzli GS. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis. Arch Surg. 2006;141:683–89.PubMedCrossRef

26.

Ternovits CA, Tichansky DS, Madan AK. Band versus bypass: randomization and patients' choices and perceptions. Surg Obes Relat Dis. 2006;2:6–10.PubMedCrossRef

27.

Lanyon RI, Maxwell BM. Predictors of outcome after gastric bypass surgery. Obes Surg. 2007;17:321–8.PubMedCrossRef

28.

Perugini RA, Mason R, Czerniach DR, et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg. 2003;138:541–45.PubMedCrossRef

29.

Chau WY, Schmidt HJ, Kouli W, Davis D, Wasielewski A, Ballantyne GH. Patient characteristics impacting excess weight loss following laparoscopic adjustable gastric banding. Obes Surg. 2005;15:346–50.PubMedCrossRef

30.

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;17:176–84.PubMedCrossRef

31.

Skroubis G, Anesidis S, Kehagias I, Mead N, Vagenas K, Kalfarentzos F. Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: prospective comparison of the efficacy and the incidence of metabolic deficiencies. Obes Surg. 2006;16:488–95.PubMedCrossRef

32.

Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):127–32.PubMedCrossRef

33.

Greenway SE, Greenway FL III, Klein S, et al. Effects of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg. 2002;137:1109–17.PubMedCrossRef

34.

Carson JL, Ruddy ME, Duff AE, Holmes NJ, Cody RP, Brolin RE. The effect of gastric bypass surgery on hypertension in morbidly obese patients. Arch Intern Med. 1994;24(154):193–200.CrossRef

35.

Nguyen NT, Varela E, Sabio A, et al. Resolution of hyperlipidemia after laparoscopic Roux en Y gastric bypass. J Am Coll Surg. 2006;203:24–9.PubMedCrossRef

36.

Brolin RE, Bradley LJ, Wilson AC, Cody RP. Lipid risk profile and weight stability after gastric resective operations for morbid obesity. J Gastrointest Surg. 2000;4:464–69.PubMedCrossRef

37.

Frutos MD, Lujan J, Hernandez Q, Valero G, Parrilla P. Results of laparoscopic gastric bypass in patients > or =55 years old. Obes Surg. 2006;16:461–64.PubMedCrossRef

38.

Shawn, et al. Impact of Advanced age of weight loss and health benefits after lap. Gastric bypass. Arch Surg. 2005;140:165–68.CrossRef

39.

Case CC, Jones PH, Nelson K, O’Brian Smith E, Ballantyne CM. Impact of weight loss on the metabolic syndrome. Diabetes Obes Metab. 2002;4:407–14.PubMedCrossRef

40.

Phelan S, Wadden TA, Berkowitz RI, et al. Impact of weight loss on the metabolic syndrome. Int J Obes. 2007;31:1442–8.CrossRef

Title: Metabolic Syndrome after Laparoscopic Bariatric Surgery
Authors: Clare Nugent
ChunHong Bai
Hazem Elariny
Priya Gopalakrishnan
Caitlin Quigley
Michael Garone Jr.
Mariam Afendy
Oscar Chan
Angela Wheeler
Arian Afendy
Zobair M. Younossi
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: Obesity Surgery / Issue 10/2008
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-008-9511-1

At a glance: The STEP trials

Springer Medicine

Metabolic Syndrome after Laparoscopic Bariatric Surgery

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2008

Laparoscopic Sleeve Gastrectomy without an Over-Sewing of the Staple Line

Single Incision Laparoscopic Sleeve Gastrectomy (SILS): A Novel Technique

One-year Readmission Rates at a High Volume Bariatric Surgery Center: Laparoscopic Adjustable Gastric Banding, Laparoscopic Gastric Bypass, and Vertical Banded Gastroplasty-Roux-en-Y Gastric Bypass

Adaptive and Neuroendocrine Procedures: A New Pathway in Bariatric and Metabolic Surgery

Sleeve Gastrectomy—A “Food Limiting” Operation

Surgery for Diabetes at Lower BMI: Some Caution