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Metabolic syndrome

Bypass predicts remission from metabolic syndrome

The discontinuation rate of the use drugs at 36 months after surgery was 51.2% for anti-diabetics
The remission rate of MS was 32.7% (n=103) at six months, 69.7% (n=43) at 12 months

Long limb laparoscopic Roux-en-Y gastric bypass in obese patients is a safe procedure that results in significant and sustained percentage of excess BMI lost (%EBMIL), which predicts a high remission rate of metabolic syndrome and allows discontinuation of drug therapy for associated metabolic disturbances, according to a paper published in the journal Diabetology & Metabolic Syndrome.

It has been demonstrated that LRYGB with a 200cm biliopancreatic limb in obese patients is associated with a high remission rate of diabetes and improvement of the metabolic control, the purpose of the current study was to evaluate the efficacy and safety of the long-limb gastric bypass on the remission of metabolic syndrome criteria associated with morbid obesity.

The study evaluated body weight, BMI, percentage of excess BMI lost, fasting glucose, blood pressure and lipid profile up to 36 months after surgery.

Study

Patients were selected from the prospective database of patients referred for bariatric surgery at the Department of General Surgery of Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Portugal. The database included 696 patients that underwent laparoscopic gastric bypass, of which 153 patients met diagnostic criteria for metabolic syndrome and were submitted to LRYGB for the primary treatment of obesity.

The patients were assessed for the presentation of metabolic syndrome parameters at each time point of the study and no time limit has been defined for normalization of the metabolic parameters. Patients were classified as being in remission if no longer had diagnostic criteria of metabolic syndrome.

Results

Patients enrolled included 84.3% of females (n=129), a mean age of 48.5±0.7 years and a mean BMI of 44.3±0.5 at the time of the surgery. All patients met at least three diagnostic criteria for metabolic syndrome with 66.0% (n=101) taking anti-diabetic drugs, 78.4% (n=120) presented with hypertension and 44.3% (n=66) dyslipidemia. The mean follow-up time after surgery was 2.4±0.1 years, and every patient included in the statistical analysis had a minimum follow-up time of six months.

The morbidity associated with the surgical procedure included a major early complications rate of 12.4% (n=14), late minor complications rate was 35% (n=53). The rate of surgical re-intervention was of 4.5% (n=7) and the 30 days the mortality rate was of 0.65% (n=1).

After surgery, the investigators said that there was a ‘significant reduction’ in BMI and increase in the percentage excess of BMI lost from six months onwards. The BMI was reduced to 32.7±0.4 at six months, reaching its maximum at 12 months (30.8±0.4), and was followed by a non-significant increase to 31.2±0.5 and 32.2±0.7 at 24 and 36 months, respectively.

The percentage excess of BMI lost increased after the surgery from 63.5 ± 1.5% at six months, to 73.4±1.7% at 12 months, followed by a non-significant decrease to 71.6±1.8% at 24 months and 67.8±2.4% at 36 months of follow-up. There was also a significant improvement of all analytical parameters of fasting glucose, systolic and diastolic blood pressure, and triglycerides, as well as an increase in HDL-cholesterol levels, used in the diagnosis of metabolic syndrome.

In addition, the discontinuation rate of the use drugs at 36 months after surgery was 51.2% for anti-diabetics, 44.6% for anti-hypertensives and 64.3% for anti-dyslipidaemic drugs.

The number of patients that met diagnostic criteria for MS decreased gradually and significantly after the gastric bypass surgery, the remission rate of MS was 32.7% (n=103) at six months, 69.7% (n=43) at 12 months, followed by a non-significant increase to 63.4% (n=41) at 24 months and to 59.2% (n=31) at 36 months after surgery. The prevalence of metabolic syndrome in our population of patients submitted to bariatric surgery was 22% before surgery and decreased to 4.4% 36 months after gastric bypass.

Table 1: Morbidity, surgical re-intervention and mortality rate of gastric bypass

Conclusions

“Our data showed that the %EBMIL and BMI were the best parameters for predicting MS remission, suggesting that in contrast to what is observed regarding diabetes, weight loss is a major determinant of MS remission in the clinical setting, as supported by previous studies,” the authors write. “The %EBMIL has been shown to be the best parameter to predict MS improvement in obese subjects after Roux-en-Y gastric bypass , while the resolution of MS was demonstrated to be independent of preoperative BMI.”

To access this paper, please click here

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