Cover Image

Effects of Laparoscopic Roux-en-Y Gastric Bypass on Anthropometric Characteristics, Hypertension, Type 2 Diabetes Mellitus and Metabolic Syndrome: An Iranian Experience

Morteza Ghoghaei, Elias Khajeh, Foad Taghdiri, Mohammad Mahdi Zamani, Soudeh Taghdiri, Mojtaba Sedaghat, Karamollah Toolabi

 

Background: Surgically induced weight loss is a treatment option for the management of obesity and the related common disorders. This study evaluated the beneficial effects of bariatric surgery on metabolic profile and the prevalence of metabolic syndrome (MetS) among Iranian patients.

Materials and Methods: A prospective observational study was performed on 26 morbidly obese patients scheduled for bariatric surgery, using laparoscopic Roux-en-Y gastric bypass (LRYGB). The parameters of hypertension, type 2 diabetes mellitus (T2DM), hyperlipidemia, MetS prevalence, and anthropometric measurements of Iranian patients, were recorded, at the preoperative visit and in follow-ups. The follow-up was performed for a median of 12 months, and the change in MetS prevalence and its componnts were assesed.

Results: LRYGB induced a mean weight loss of 69.0±21.2%, after 12 months. Preoperative MetS was diagnosed in 21 patients (84%) and decreased to 6 patients (24%) after LRYGB (P=0.001). Likewise, the prevalence of hypertension was significantly decreased from 76% (pre-LRYGB values) to 20% (post-LRYGB values) (P=0.001). The prevalence of T2DM was also decreased from 20% to 8% (P=0.5).

Conclusion: According to our results, RYGB produced a rapid and significant weight loss and improvement in hypertension and MetS within one year but there was a controversy about the improvement of T2DM, in Iranian morbidly obese patients.

Body Weight; Bariatric Surgery; Diabetes; Hypertension; Metabolic Syndrome; Obesity

Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, et al. A potential decline in life expectancy in the United States in the 21st century. New England Journal of Medicine. 2005;352(11):1138-45.

Kilpi F, Webber L, Musaigner A, Aitsi-Selmi A, Marsh T, Rtveladze K, et al. Alarming predictions for obesity and non-communicable diseases in the Middle East. Public Health Nutr. 2013:1-9.

Azizi F. Bariatric Surgery for Obesity and Diabetes. Arch Iran Med. 2013;16(3):182.

Ternovits CA, Tichansky DS. Metabolic syndrome: yet another co-morbidity gastric bypass helps cure. Surgery for Obesity and Related Diseases. 2006;2:48-51.

Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Sugarman H, et al. Meta-analysis: surgical treatment of obesity. Annals of internal medicine. 2005;142(7):547.

Pories WJ. Bariatric surgery: risks and rewards. Journal of Clinical Endocrinology & Metabolism. 2008;93(11 Supplement 1):s89-s96.

Noria SF, Grantcharov T. Biological effects of bariatric surgery on obesity-related comorbidities. Can J Surg. 2013;56(1):47.

Jones KB, Afram JD, Benotti PN, Capella RF, Cooper CG, Flanagan L, et al. Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obesity surgery. 2006;16(6):721-7.

Delavari A, Forouzanfar MH, Alikhani S, Sharifian A, Kelishadi R. First Nationwide Study of the Prevalence of the Metabolic Syndrome and Optimal Cutoff Points of Waist Circumference in the Middle East The National Survey of Risk Factors for Noncommunicable Diseases of Iran. Diabetes Care. 2009;32(6):1092-7.

National Heart L, Institute B. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Bethesda, National Institutes of Health, NIH publication 00–4084.

Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obesity surgery. 2007;17(5):565-8.

Alberti KG, Zimmet P, Shaw J. The metabolic syndrome--a new worldwide definition. Lancet. 2005;366(9491):1059-62.

Esteghamati A, Ashraf H, Rashidi A, Meysamie A. Waist circumference cut-off points for the diagnosis of metabolic syndrome in Iranian adults. Diabetes research and clinical practice. 2008;82(1):104-7.

Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze M, Overvad K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359(20):2105-20.

Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67(5):968-77.

Avenell A, Brown T, McGee M, Campbell M, Grant A, Broom J, et al. What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomized controlled trials of adding drug therapy, exercise, behaviour therapy or combinations of these interventions. J Hum Nutr Diet. 2004;17(4):293-316.

Curioni C, Lourenco P. Long-term weight loss after diet and exercise: a systematic review. Int J Obes. 2005;29(10):1168-74.

Crea N, Pata G, Della Casa D, Minelli L, Maifredi G, Di Betta E, et al. Improvement of metabolic syndrome following intragastric balloon: 1 year follow-up analysis. Obes Surg. 2009;19(8):1084-8.

Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery. JAMA. 2004;292(14):1724-37.

DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002;235(5):640.

Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A. 2001;11(6):377-82.

Toolabi K, Arefanian S, Golzarand M, Arefanian H.

Effects of Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) on Weight Loss and Biomarker Parameters in Morbidly Obese Patients: A 12-Month Follow-Up. Obesity surgery. 2011:1-9.

Adami GF, Camerini GG, Ravera NS, Marinari GM. Metabolic syndrome in severely obese patients. Obes Surg. 2001;11(5):543-5.

Rossi M, Barretto Ferreira da Silva R, Chaves Alcantara G, Regina PF, Martin Bianco Rossi F, Serpa Neto A, et al. Remission of metabolic syndrome: a study of 140 patients six months after Roux-en-Y gastric bypass. Obesity surgery. 2008;18(5):601-6.

Lee WJ, Huang MT, Wang W, Lin CM, Chen TC, Lai IR. Effects of obesity surgery on the metabolic syndrome. Arch Surg. 2004;139(10):1088.

Case C, Jones P, Nelson K, O'Brian Smith E,

Ballantyne C. Impact of weight loss on the metabolic syndrome. Diabetes, Obesity and Metabolism. 2002;4(6):407-14.

Ashraf H, Rashidi A, Noshad S, Khalilzadeh O, Esteghamati A. Epidemiology and risk factors of the cardiometabolic syndrome in the Middle East. Expert Review of Cardiovascular Therapy. 2011;9(3):309-20.

Marantos G, Daskalakis M, Karkavitsas N, Matalliotakis I, Papadakis JA, Melissas J. Changes in metabolic profile and adipoinsular axis in morbidly obese premenopausal females treated with restrictive bariatric surgery. World J Surg. 2011;35(9):2022-30.

Cameron AJ, Boyko EJ, Sicree RA, Zimmet PZ, Söderberg S, Alberti KGMM, et al. Central obesity as a precursor to the metabolic syndrome in the AusDiab study and Mauritius. Obesity. 2008;16(12):2707-16.

Pouliot MC, Després JP, Nadeau A, Moorjani S,

Prud'Homme D, Lupien PJ, et al. Visceral obesity in men: associations with glucose tolerance, plasma insulin, and lipoprotein levels. Diabetes. 1992;41(7):826-34.

Després JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C. Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arterioscler Thromb Vasc Biol. 1990;10(4):497-511.

Poirier P, Després JP. Waist circumference, visceral obesity, and cardiovascular risk. J Cardiopulm Rehabil Prev. 2003;23(3):161-9.

Ikramuddin S, Buchwald H. How bariatric and metabolic operations control metabolic syndrome. Br J Surg. 2011;98(10):1339-41.

Folli F, Pontiroli AE, Schwesinger WH. Metabolic aspects of bariatric surgery. Med Clin North Am. 2007;91(3):393-414.

Maher JW, Martin HL, Pucci A, Wolfe LG, Meador JG, Kellum JM. Four hundred fifty consecutive laparoscopic Roux-en-Y gastric bypasses with no mortality and declining leak rates and lengths of stay in a bariatric training program. J Am Coll Surg. 2008;206(5):940.

Cunneen SA. Review of meta-analytic comparisons of bariatric surgery with a focus on laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2008;4(3):S47-S55.

Rossi M, Serpa Neto A, Rossi FMB, Amarante RDM, Alc ntara GC, da Silva RBF, et al. Percentage of excess BMI lost correlates better with improvement of metabolic syndrome after Roux-en-Y gastric bypass in morbidly obese subjects: anthropometric indexes and gastric bypass. Surg Obes Relat Dis. 2009;5(1):11-8.

Frezza EE, Wei C, Wachtel MS. Is Surgery the Next Answer to Treat Obesity‐Related Hypertension? J Clin Hypertens (Greenwich). 2009;11(5):284-8.

Inabnet WB, Winegar DA, Sherif B, Sarr MG. Early outcomes of bariatric surgery in patients with metabolic syndrome: an analysis of the bariatric outcomes longitudinal database. J Am Coll Surg. 2012.

Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467.

Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248.

Cohen RV, Schiavon CA, Pinheiro JS, Correa JL, Rubino F. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m2: a report of 2 cases. Surg Obes Relat Dis. 2007;3(2):195-7.

Bohdjalian A, Prager G, Aviv R, Policker S, Schindler K, Kretschmer S, et al. One-year experience with Tantalus™: a new surgical approach to treat morbid obesity. Obes Surg. 2006;16(5):627-34.

Weber M, Müller MK, Bucher T, Wildi S, Dindo D, Horber F, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. 2004;240(6):975.

Buchwald H, Moore RB, Varco RL. Surgical treatment of hyperlipidemia. 3. Clinical status of the partial ileal bypass operation. Circulation. 1974;49(5 Suppl):I22.

Refbacks

  • There are currently no refbacks.