STUDY ROUNDUP

Published in December/January Issue             


Weight Loss and Health Status 3 Years after Bariatric Surgery
in Adolescents
(NEJM)

A study on the efficacy and safety of weight-loss surgery analyzed 242 adolescents undergoing RYGB and LSG at five U.S. centers. The average age was 17 and the mean BMI was 53. At three years, the mean weight had decreased by 28% among those who had RYGB and 26% among those who had LSG. Remission of disease occurred at the following rates:

  • Type 2 diabetes: 95%
  • Prediabetes: 76%
  • Abnormal kidney function: 86%
  • Elevated blood pressure: 74%
  • Dyslipidemia: 66%
Weight-related quality of life also improved significantly. However, iron deficiency was found in 57% of the participants, and 13% had undergone one or more additional procedures.

Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy (JAMA Surgery)


A retrospective cohort study investigated the long-term effects of LSG on weight loss, diabetes, hypertension and dyslipidemia in 443 patients, with 1, 3 and 5 years of follow-up. LSG induced EWL of 76.8%, 69.7% and 56.1%, respectively. The percentage of patients maintaining complete diabetes remission during follow up was 46.3%, 48% and 45.5%, respectively. The changes in high-density lipoprotein levels and triglyceride levels were significant compared with preoperative and postoperative measurements. The decrease of low-density lipoprotein was significant only at 1 year. Total changes in cholesterol did not reach statistical significance. The researchers concluded undergoing LSG induced efficient EWL and a major improvement in obesity-related comorbidities with mostly no correlation to percentage of EWL. There was a significant weight regain and a decrease in remission rates of diabetes and, to a lesser extent, other comorbidities over time.


Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment (JAMA Surgery)


A study compared remission rates of T2DM in 61 patients using RYGB, LAGB or intensive lifestyle weight loss intervention. Participants were randomized to either an intensive lifestyle intervention for 1 year followed by a low-level lifestyle intervention for 2 years, or surgical treatment followed by low-level lifestyle intervention in years 2 and 3. Partial or complete T2DM remission was achieved by 40% of RYGB, 29% of LAGB and none of the non-surgical group. Diabetes medications were reduced more in the surgical than non-surgical group, with 65% of RYGB and 33% of LAGB discontinuing use of all insulin or oral medication at year 3. This was achieved in none of the non-surgical group. Mean reductions in percentage of body weight at 3 years was greatest in after RYGB at 25%, followed by LAGB at 15% and lifestyle treatment at 5.7%.


Remission of Type 2 Diabetes Mellitus in Patients After Different Types of Bariatric Surgery (JAMA Surgery)


A retrospective cohort study matched 569 patients with T2DM and obesity who had bariatric surgery, to 1,881 patients with diabetes who did not have bariatric surgery. The patients with diabetes who had bariatric surgery had a 18-fold increased chance for T2DM remission, compared with the matched patients. The greatest effect was seen in the gastric bypass group, where remission was 43 times more likely, and sleeve gastrectomy where remission was 16.6 more likely, followed by gastric banding where remission was 6.9 times more likely. Researchers concluded while risks and possible adverse effects of surgery should be weighed against benefits, gastric bypass or sleeve gastrectomy may be considered treatment options for T2DM.


Cardiovascular Disease and Mortality in Patients with Type 2 Diabetes After Bariatric Surgery in Sweden (The Lancet Diabetes & Endocrinology)


A nationwide observational study in Sweden examined the risks of cardiovascular disease and mortality by matching 6,132 patients with obesity and T2DM who had undergone RYGB to an equal number who had not, with a median follow-up of 3 – 5 years. The researchers found a 58% relative risk reduction in overall mortality in the RYGB group compared with control. The risk of fatal or non-fatal myocardial infarction was 49% lower and cardiovascular death was 59% lower in RYGB group. 5 year absolute risks of death were lower, at 1 – 8% in the RYGB group compared to 5 – 8% in the control group.


Outcomes of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Patients Older than 60 (Obesity Surgery)


A retrospective study of 83 patients evaluated the safety and efficacy of bariatric surgery in patients who were more than 60 years old. Thirty patients had LSG and 53 had RYGB. The pre-existing comorbid conditions included hypertension (90.4%), diabetes mellitus (63.9%), hyperlipidemia (50.6%), obstructive sleep apnea (34.9%) and asthma (30.1%). The average EWL at 3 months, 6 months and 12 months was 37%, 51.3% and 65.2%, respectively. A significant number of patients reported resolution or improvement in comorbid conditions. When results were compared to the general population, there were no significant differences in the number of complications that occurred within each of the two groups. The difference in percentage of EWL at 12-month follow-up was not significantly different, which the study authors say suggests both groups lost a similar amount of weight, and bariatric surgery on patients over age 60 is effective.


Laparoscopic Sleeve Gastrectomy Leads the U.S. Utilization of Bariatric Surgery at Academic Medical Centers (SOARD)


An analysis of a recent single state bariatric surgery registry found LSG was the most common bariatric procedure starting in 2012. The analysis examined a total of 54,953 bariatric procedures and found LSG increased from 23.7% of all procedures during the fourth quarter of 2011, to 60.7% during the second quarter of 2014, while RYGB decreased in the second quarter of 2013 from 50.6% to 45.8%. During that same time, open gastric bypass fell from 6.6% to 1.5% and LAGB decreased from 7.5% to .8%. The researchers concluded laparoscopic sleeve gastrectomy is now the most commonly performed bariatric procedure at the national level within academic centers.


The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma (The Journal of Bone & Joint Surgery)


A study looking to determine if obesity is associated with an increased burden to the healthcare system in patients with orthopaedic polytrauma, examined 301 patients with polytrauma who had orthopaedic injuries and intensive care admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans measuring truncal adiposity volume were also used to create a truncal three-dimensional reconstruction BMI, with a BMI of less than 30 denoting patients without obesity, and over 30 denoting patients with obesity. Of the 301 patients, 21.6% were classified as having obesity. The researchers found a higher BMI was associated with longer hospital length of stay, more days spent in the intensive care unit, more frequent discharge to a long-term care facility, higher rates of orthopaedic intervention, and increased total hospital charges. The researchers also concluded that computed tomographic scans, routinely obtained at the time of admission, can be used to calculate truncal adiposity and investigate the impact of obesity of patients with polytrauma.