The preventive association between bariatric surgery and obesity-related cancer and cardiovascular disease may be limited to younger individuals, according to Scandinavian researchers. However, there is some evidence to suggest that gastric bypass may be associated with lower risk of both outcomes.
The researchers wanted to determine whether bariatric surgery is associated with a decreased risk of obesity-related cancer and cardiovascular disease in patients who underwent surgery at age 60 years or older. They collected data on patients from Denmark, Finland, and Sweden who underwent bariatric surgery at age 60 years or older without previous malignant neoplasm or cardiovascular disease between 1989 and 2019. Each patient who underwent surgery was exactly matched to five patients with nonoperative treatment for obesity of the same country, sex, and age at the date of surgery.
Outcomes
In total, 15,300 patients (median age, 63 [61-65] years; 10,152 female patients [66.4%]) were included, of which 2,550 (16.7%) had bariatric surgery at age 60 or older and 12,750 (83.3%) had nonoperative treatment. During a median 5.8 (2.8-8.5) person-years of follow-up, 658 (4.3%) developed obesity-related cancer and 1,436 (9.4%) developed cardiovascular disease. The risk of obesity-related cancer (HR, 0.81; 95% CI, 0.64-1.03) and cardiovascular disease (HR, 0.86; 95% CI, 0.74-1.01) were similar among who underwent surgery and those who did not (Figure 1).
Gastric bypass (1,930 patients) was associated with a decreased risk of obesity-related cancer (71 patients [3.7%]; HR, 0.74; 95% CI, 0.56-0.97) and cardiovascular disease (159 patients [8.2%]; HR, 0.82; 95% CI, 0.69-0.99) vs. matched controls (9,650 patients; obesity-related cancer: 442 patients [4.6%]; cardiovascular disease: 859 patients [8.9%]).
The fact that older patients with bariatric surgery did not have a decreased risk of obesity-related cancer or cardiovascular disease could be explained by the poorer weight loss and resolution of comorbidities observed in patients who underwent surgery at an older age, the researchers noted. However, they also found that women had a lower risk for obesity-related cancer after bariatric surgery. This could be explained by the fact that weight loss reduces the circulating levels of oestrogen, which could consequently reduce the risk of oestrogen-sensitive cancers such as endometrial and breast cancer.
“Women and patients undergoing gastric bypass treatment seemed to benefit from surgery to a lesser extent,” they concluded. “The findings from this study suggest a limited role of bariatric surgery in older patients for the prevention of obesity-related cancer or cardiovascular disease.”
The findings were featured in the paper, ‘Incidence of Cancer and Cardiovascular Disease After Bariatric Surgery in Older Patients’, published in JAMA Network Open. To access this paper, please click here
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