Article

Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery

Louisiana State University, Baton Rouge, Louisiana, United States
New England Journal of Medicine (Impact Factor: 54.42). 01/2005; 351(26):2683-93. DOI: 10.1056/NEJMoa035622
Source: PubMed

ABSTRACT Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown.
The prospective, controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. We now report follow-up data for subjects (mean age, 48 years; mean body-mass index, 41) who had been enrolled for at least 2 years (4047 subjects) or 10 years (1703 subjects) before the analysis (January 1, 2004). The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years.
After two years, the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group (P<0.001). After 10 years, the weight had increased by 1.6 percent and decreased by 16.1 percent, respectively (P<0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Two- and 10-year rates of recovery from diabetes, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricemia were more favorable in the surgery group than in the control group, whereas recovery from hypercholesterolemia did not differ between the groups. The surgery group had lower 2- and 10-year incidence rates of diabetes, hypertriglyceridemia, and hyperuricemia than the control group; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable.
As compared with conventional therapy, bariatric surgery appears to be a viable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolemia, amelioration in risk factors that were elevated at baseline.

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    • "underscoring the favorable effects of bariatric surgery on diabetes control ( Sjöström et al . , 2004 ) . Overall mortality during a follow - up period up to 15 years was lower in the surgical group with an adjusted cumulative hazard ratio of 0 . 71 ( Sjöström et al . , 2007 ) ."
    02/2015, Degree: PhD, Supervisor: Francisco Castro e Sousa
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    • "Morbid obesity has become a major burden on the western health system especially due to its associated systemic disorders. Currently, bariatric surgery is the only effective treatment for morbid obesity [1] [2] [3]. In recent years, laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) have been the 2 most common bariatric operations performed worldwide [4]. "
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    ABSTRACT: Background Despite its worldwide popularity, laparoscopic adjustable gastric banding (LAGB) requires revisional surgery for failures or complications, in 20-60 % of cases. The purpose of this study was to compare in terms of efficacy and safety, the conversion of failed LAGB to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic gastric sleeve (LGS). Methods The bariatric database of our institution was reviewed to identify patients who had undergone conversion of failed LAGB to LRYGB or to LGS, from November 2007 to June 2012. Results A total of 108 patients were included. Of these, 74 (68.5%) underwent conversion to LRYGB and 34 to LSG. All the procedures were performed in two-stage and laparoscopically. The mean follow-up for the LRYGB group was 29.1 ± 17.9 months while for the LGS patients was 24.2 ± 14.3months. The mean body mass index (BMI) prior LRYGB and LGS was 45.6 ± 7.8 and 47.5 ± 5.6 (p=0.09), respectively. Post-operative complications occurred in 16.2 % of the LRYGB patients and in 2.9 % of the LGS group (p=0.04). Mean %EWL was 59.9% ± 16.2% and 70.2% ± 16.7% in LRYGB, and it was 52.2% ± 11.4% and 59.9% ± 14.4% in LSG at 12 months (p=0.007) and 24 months (p=0.01) after conversion. Conclusions In this series, LRYGB and LSG are both effective and adequate revisional procedure after failure of LAGB. While LRYGB seems to ensure greater weight loss at 24 months follow-up, LSG is associated with a lower postoperative morbidity.
    Surgery for Obesity and Related Diseases 03/2014; 10(6). DOI:10.1016/j.soard.2014.03.017 · 4.94 Impact Factor
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    • "Weight outcomes are better with surgical interventions. " Success " in terms of weight outcomes in the surgical literature has been described as 50–75% excess weight loss (% EWL), 20–30% loss of initial weight, and achieving a BMI less than 35 kg/m 2 [6] [7] [8] [9] [10] [11] [12]. Weight regain is a risk for all patients after bariatric surgery. "
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    ABSTRACT: Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20-30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20-25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.
    Gastroenterology Research and Practice 11/2013; 2013:256145. DOI:10.1155/2013/256145 · 1.50 Impact Factor