Abstract
BackgroundMetabolic syndrome (MS) is a condition associated with obesity that identifies individuals with increased cardiovascular risk. Gastric bypass improves several MS components, such as glucose, lipid metabolism and hypertension. The aim of this study was to evaluate the effect of long-limb gastric bypass on the remission of MS criteria associated with morbid obesity.MethodsObese patients who met the “harmonized” criteria for MS (n = 153) that underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) with a long biliopancreatic limb were prospectively evaluated with regards to body weight, body mass index (BMI), percentage of excess BMI lost (% EBMIL), fasting glucose, blood pressure and lipid profile up to 36 months after surgery.ResultsBefore surgery, patients had a BMI of 44.3 ± 0.5 kg/m2; 66% were under anti-diabetic treatment; 78.4% were under anti-hypertensive treatment and 44.3% were under anti-dyslipidemic treatment. After a mean follow-up time of 2.4 ± 0.1 years, MS remission rates were 32.7% at 6 months, 69.7% at 12 months, 63.4% at 24 months, and 59.2% at 36 months; when only 32.9%, 43.4% and 15.8% of patients were still under anti-diabetic, anti-hypertensive and anti-dyslipidemic treatment, respectively. The %EBMIL and BMI were the parameters that showed the highest accuracy to predict the MS remission at all-time points after the surgery.ConclusionsLong limb gastric bypass in obese patients results in significant and sustained weight loss which predicts a high remission rate of MS and allows the discontinuation of drug therapy for several metabolic disturbances in most patients.
Highlights
Obesity has assumed alarming worldwide proportions in the last decades [1,2]
The first descriptions of the association between type 2 diabetes mellitus (T2DM), hypertension and dyslipidemia dates from 1920; but it was Reaven in 1988, who suggested for the first time that these factors tended to occur in the same individual under the form of a syndrome “X”, which included five components: resistance to glucose uptake mediated by insulin, glucose intolerance, hyperinsulinemia, elevated triglycerides, decreased HDL cholesterol and hypertension; all five components were associated with an increased risk of coronary heart disease [12]
After having demonstrated that laparoscopic Roux-en-Y gastric bypass (LRYGB) with a 200 cm biliopancreatic limb in obese patients was associated with a high remission rate of diabetes and improvement of the metabolic control [26], the purpose of the current study was to evaluate the efficacy and safety of the same surgical technique when applied for the treatment of obese patients with metabolic syndrome
Summary
Obesity has assumed alarming worldwide proportions in the last decades [1,2]. The number of overweight and obese persons has been estimated to encompass 1.7 billion individuals [3]. The prevalence of MS varies with age and sex, studied population and criteria used for its definition. The prevalence of MS in the U.S varies; between 40–59 years is 40% in men and 34% women, while aging is accompanied by a 20% increase in the prevalence of MS [11,15,16] In highrisk populations, such as relatives of diabetic patients the prevalence of MS increases to 50%; in diabetic patients to 80% and individuals in with impaired glucose tolerance to 40% [15]. The aim of this study was to evaluate the effect of long-limb gastric bypass on the remission of MS criteria associated with morbid obesity
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