Long-term Effects Of Bariatric Surgery Research Articles

Understanding the Long-term Effects of Bariatric Surgery

Understanding the Long-term Effects of Bariatric Surgery

Re: The Long-Term Effects of Bariatric Surgery on Female Urinary Incontinence.

Re: The Long-Term Effects of Bariatric Surgery on Female Urinary Incontinence.

Short- and Long-Term Effects of Bariatric Surgery on Vascular Phenotype.

Retinal microvascular diameters and large artery stiffness are valid biomarkers of cardiovascular risk. This study assessed short- and long-term micro- and macrovascular improvements after bariatric surgery (BS). Sixteen patients (44 ± 12years) underwent BS in this observational study. Two weeks before as well as 6weeks and 4years after surgery, retinal vessel analysis and assessment of brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI), and anthropometry were performed. Three patients were lost to follow-up. Six weeks after BS, retinal arteriolar diameters (CRAE) were wider (180.1μm vs. 188.1μm; p = 0.001), and the arteriolar-to-venular diameter ratio (AVR) was higher (0.82 vs. 0.86; p < 0.001) compared to baseline levels. During the 4years of follow-up, the retinal changes sustained but further improvements did not occur. Both indices of large artery stiffness, baPWV and CAVI, remained unchanged 6weeks and 4years after surgery. Retinal microvascular phenotype improved 6weeks after BS. The improvements in microvascular health were maintained during 4years of follow-up but, despite significant further reductions in body mass index, did not improve further long-term. baPWV and CAVI were unaffected after surgery indicating that BS primarily affects microvascular phenotype rather than large artery stiffness. Retinal vessel imaging seems to be a feasible diagnostic tool to monitor microvascular health after BS. Normalization of BMI and blood pressure may be necessary to achieve long-term improvement of large artery phenotype after BS.

Long-term effect of bariatric surgery versus conventional therapy in obese Korean patients: a multicenter retrospective cohort study

PurposeLong-term results following bariatric surgery compared to conventional treatments has never been reported in morbidly obese Korean patients. This study aimed to evaluate the long-term efficacy of bariatric surgery in morbidly obese Korean patients compared to conventional medical treatments.MethodsIn this multicenter retrospective cohort study, we reviewed 137 obese subjects between January 2008 and February 2011 with a body mass index (BMI) > 30 kg/m2 who had more than 5 years of follow-up clinical data after bariatric surgery (surgery group, n = 49) or conventional treatment (conventional treatment group, n = 88). Anthropometric data and the status of comorbidities were compared between the 2 groups.ResultsThe median follow-up period was 72.1 months (range 19.3–109.7 months). At the last follow-up, the surgery group showed a greater amount of total weight loss than the conventional treatment group (24.9% vs. 2.8%, P < 0.001). The prevalence of diabetes and hypertension significantly decreased in the surgery group, while the conventional treatment group showed a marked increase in these comorbidities. In the surgery group, Roux-en-Y gastric bypass and sleeve gastrectomy achieved comparable long-term weight loss (26.5% vs. 22.4%, respectively; P = 0.087).ConclusionIn the long-term, bariatric surgery achieved and maintained significantly greater weight reduction, as well as a decrease in obesity-related comorbidities, than did conventional medical therapy in morbidly obese Korean patients.

The long-term effect of bariatric surgery on depression and anxiety.

No previous review has comprehensively assessed long-term changes in anxiety and depressive symptoms in bariatric surgery patients. This systematic review assessed the effects of bariatric surgery on long-term reductions (≥ 24 months) in anxiety and depressive symptom severity in morbidly obese (≥ 35 BMI kg/m2) participants. Short term effects (< 24 months) are briefly reviewed for context. PsychINFO, Google Scholar and PubMed databases were systematically searched for prospective cohort studies published from inception to 14 June 2018 that evaluated long-term (≥ 24 months) changes in anxiety and depressive symptom severity in bariatric surgery patients with a BMI ≥ 35 kg/m2 using a combination of the following search terms: bariatric surgery (and surgical approaches included under this term), obesity, depression, depressive disorder, anxiety, anxious, psychiatric disorders, mood disorders. We reviewed 2058 articles for eligibility; 14 prospective studies were included in the systematic review. 13 studies (93%) reported significant reductions in depressive symptom severity 2-3 years after bariatric surgery. However, all studies recorded statistically significant reductions in depressive symptoms at the conclusion of the study. Similarly, there were reductions in overall anxiety symptom severity at ≥ 24 months follow-up (k = 8 studies, n = 1590 pooled). Pre-operative anxiety or depression scores did not predict outcomes of post-operative BMI. Similarly, post-surgery weight loss did not predict changes in anxiety symptoms. Very few studies assessed anxiety or depression as a primary outcome. Therefore, we cannot suggest bariatric surgery as a stand-alone therapeutic tool for anxiety and depression based on our findings. Currently available evidence suggests that bariatric surgery is associated with long-term reductions in anxiety and depressive symptoms. This supports existing literature showing that metabolic treatments may be a viable therapeutic intervention for mood disorders.

Concomitant Hiatal Hernia Repair Is more Common in Laparoscopic Sleeve Gastrectomy than During Laparoscopic Roux-en-Y Gastric Bypass: an Analysis of 130,772 Cases.

Obesity is associated with the development of gastroesophageal reflux disease (GERD) and hiatal hernia (HH). This study aimed to assess practice patterns regarding concomitant HH repair (HHR) during laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The incidence of concomitant HHR with LSG or LRYGB was analyzed using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. One hundred thirty thousand, seven hundred seventy-two patients underwent RYGB (30.5%) and LSG (69.5%). Concomitant HHR was more common, despite less GERD, in SG patients compared to RYGB (21.0% vs 10.8%, p < 0.0001; adjusted OR 2.14, 95% CI 2.06-2.22). This marked difference in the intraoperative management of HH during bariatric surgeries may hinder our ability to evaluate the long-term effects of bariatric surgery on GERD.

The long-term effects of bariatric surgery on female urinary incontinence

IntroductionObesity has been shown to negatively impact pelvic floor support and associated urinary incontinence (UI), however little is known regarding the long-term effect of bariatric surgery on urinary incontinence. ObjectiveThe aim of this study is to determine the impact of bariatric surgery on female UI at twelve months post-operatively. Study DesignA prospective cohort study was performed of all patients undergoing bariatric surgery who reported UI between January 2008 to January 2017. ResultsThree hundred and sixty-six women undergoing bariatric surgery and filled out the ICIQ-UI SF questionnaire. Of these 44% (151/366) had UI pre-operatively, and of these 40% (61/151) completed the questionnaire at one year post-operatively. The mean pre-operative weight and body mass index (BMI) were 136 (21.3)kg and 51 (7.1) kg/m2 respectively. The percentage excess weight loss was 74%. Sixty-six percent underwent laparoscopic gastric bypass, and the remainder underwent sleeve gastrectomy. Thirty-four percent reported stress incontinence (SUI), 21% reported overactive bladder (OAB), and 44% reported mixed incontinence. The cure rates post-operatively for SUI, OAB and mixed incontinence, were 41%, 38% and 48% respectively, and there was a 40% improvement in UI when assessing pad use (p < 0.001). Using the ICIQ-UI SF, the mean score was reduced by 4.8 (5), from 9.3 (4) pre-operatively to 4.5 (5) post-operatively. ConclusionBariatric surgery results in a clinically significant long-term improvement in UI, with a significant cure rate at one year post bariatric surgery. The improvement in severity score, based on the Incontinence Questionnaire used, did not correlate with reduction in post-operative BMI.

Long-term impact of bariatric surgery in diabetic nephropathy

Bariatric surgery has been shown to improve and resolve diabetes. However, limited literature about its impact on end-organ complications of diabetes is available. The aim of this study was to examine the long-term effect of bariatric surgery on albuminuria. We studied 101 patients with pre-operative diabetes and albuminuria [defined as urine albumin:creatinine ratio (uACR) > 30mg/g] who underwent bariatric surgery at an academic center from 2005 to 2014. Fifty-seven patients (56%) were female with a mean age of 53 (± 11)years. The mean pre-operative BMI and glycated hemoglobin (HbA1c) were 43.1 (± 7.6)kg/m2 and 8.4 (± 1.8)%, respectively. The median pre-operative uACR was 80.0 (45.0-231.0)mg/g. Bariatric procedures included Roux-en-Y gastric bypass (n = 75, 74%) and sleeve gastrectomy (n = 26, 26%). The mean follow-up period was 61 (± 29)months. At last follow-up, the mean BMI was 33.8 (± 8.3)kg/m2. The overall glycemic control improved after bariatric surgery. At last follow-up, 73% had good glycemic control (HbA1c < 7%) and 27% met diabetes remission criteria. The mean HbA1c at last follow-up was 6.7 (± 1.0)% and the median uACR was 30 (IQR 7-94)mg/g. Albuminuria improved in 77% and resolved in 51% of patients at long-term. Bariatric surgery has a significantly positive impact on albuminuria in patients with obesity and type 2 diabetes. Our data showed almost an 80% improvement in albuminuria at the short- and long-term period after bariatric surgery.

Bariatric Surgery in Patients with Type 1 Diabetes and Obesity—A Three-Year Observational Matched Cohort Study

Recent data show that ∼50% of patients with type 1 diabetes (T1D) are overweight or obese. Few patients with T1D and obesity resort to bariatric surgery (BS) for weight reduction and possible improvement in glycemic control. However, previous studies reported conflicting long-term effects of BS on glycemic control and other cardiovascular risk factors in this population. Meanwhile, no previous study compared BS outcomes in patients with T1D to a matched cohort receiving standard care. In our electronic health records, we identified 20 patients with T1D and obesity who underwent BS and received diabetes care at our center (baseline mean age 41±10 years, T1D duration 24±12 years, all female, HbA1c 8.4±1.3%, BMI 43.6±6.3 kg/m2, weight 119.2±18.0 kg, systolic BP 128±11 mmHg, diastolic BP 75±8 mmHg, LDL-C 104±34 mg/dL, HDL-C 59±18 mg/dL, triglycerides 121±61mg/dL). We matched them in a 1:1 ratio with a similar cohort of patients who received standard diabetes care at the same center (baseline mean age 43±12 years, T1D duration 22±11 years, HbA1c 8.4±1.0%, BMI 43.9±6.3 kg/m2, weight 116.1±19.3 kg, systolic BP 123±17 mmHg, diastolic BP 71±9 mmHg, LDL-C 81±22 mg/dL, HDL-C 57±20 mg/dL, triglycerides 103±62mg/dL). T1D was confirmed based on the presence of antibodies, history of DKA and clinical criteria. There were no differences between cohorts at baseline, except that more patients used insulin pump therapy in the BS cohort (55% vs. 35%, p&amp;lt;0.05). At 3 years, body weight changed by -33.5±2.6 kg (-28.1±2.2%) in the BS cohort and by +2.6±2.8 kg (+2.2±2.4%) in the matched cohort (p&amp;lt;0.0001). However, HbA1c, BP and LDL-C did not change from baseline in both cohorts. HDL-C increased and triglycerides decreased in the BS cohort in comparison to the matched cohort (p&amp;lt;0.for both). These results show that despite significant reduction in body weight and improvements in HDL-C and triglyceride levels, bariatric surgery has no long-term impact on glycemic control, BP and LDL-C in patients with T1D and obesity. Disclosure A. Mottalib: None. K. Alsibai: None. S. Tomah: None. T. Elseaidy: None. J.R. Holley-Cuthrell: None. R. Middelbeek: None. N. Mahmoud: None. S. Ashrafzadeh: None. F.M. Brown: None. O. Hamdy: Research Support; Self; Abbott. Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck &amp; Co., Inc.. Research Support; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Healthimation, LLC.. Consultant; Self; Sanofi-Aventis.

Nephrological aspects of surgical weight correction in morbid obesity.

Obesity, including morbid obesity, is a growing worldwide problem. The adverse effect of obesity on the kidneys is associated with the development of comorbid conditions, such as insulin resistance (IR), metabolic syndrome (MS), diabetes mellitus (DM), arterial hypertension (AH), which are the recognized risk factors of chronic kidney disease (СKD). Obesity also causes direct kidney damage with the development of non-immune focal segmental glomerulosclerosis. The leading pathophysiological mechanisms of kidney damage in obesity are intrarenal hemodynamic disorders with the formation of hyperfiltration and damaging effects of adipokines produced by adipose tissue. Bariatric surgery (BS) has taken a leading position in the treatment of morbid obesity, demonstrating its effectiveness not only in long-term weight loss, but also in the correction of IR, MS, DM, AH. Nephroprotective effect of significant and persistent weight loss is caused by the elimination of hyperfiltration and damaging effect of adipokines. Results of the observational studies of the immediate and long-term effects of BS have demonstrated positive renal outcomes, in particular, the decrease in albuminuria/proteinuria, the improvement or stabilization of glomerular filtration rate, the delay of end-stage renal failure development; surgical correction of body weight in dialysis patients with morbid obesity lets them realize subsequent kidney transplantation. Large, randomized prospective studies with a longer follow-up are needed; analysis of the long-term renal consequences of BS in obesity patients with pre-existing renal impairment, including dialysis patients, is required; stratification of the BS risk of renal complications (acute kidney damage, nephrolithiasis, nephrocalcinosis) and effective strategy for managing these risks need to be developed.

Long-term effect of bariatric surgery on resolution of nonalcoholic steatohepatitis (NASH): An external validation and application of a clinical NASH score

BackgroundNonalcoholic steatohepatitis (NASH) is an important etiology of end-stage liver disease. Long-term effect of bariatric surgery in improvement of NASH is not clear. ObjectivesTo validate a scoring system for predicting NASH in morbidly obese patients and using it to evaluate the long-term effect of bariatric surgery on NASH. SettingTertiary referral hospital, Taiwan. MethodsA new 5-point clinical NASH (C-NASH) score incorporating body mass index, alanine aminotransferase, and triglyceride was validated in a group of 307 bariatric patients (mean age 30.2 years, incorporating body mass index 45.0 kg/m2) with concurrent liver biopsy from 2003 to 2008. Remission of NASH in 5741 obese patients undergoing bariatric/metabolic surgery with long-term follow-up was then evaluated using the C-NASH score. ResultsAmong 307 patients with liver biopsy, the prevalence of NASH was 44.0%. At baseline, the NASH group had significantly worse fasting glucose levels, triglycerides, uric acid, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase, and glycated hemoglobin. The diagnostic sensitivity of C-NASH score was 84.4%, and the accuracy was 68.4%. Among 5741 bariatric patients, the prevalence of high risk for NASH evaluated by C-NASH score was 40.9%. Postoperative follow-up showed good weight loss and almost complete remission of high risk for NASH up to 10 years. Patients with gastric banding had less weight loss, higher mean level of C-NASH score, and a higher incidence of high risk for NASH compared with other procedures at follow-up. ConclusionThis study demonstrated that improvement in C-NASH score suggesting remission of NASH is durable up to 10 years in all kinds of bariatric procedures.

Long-term effects of bariatric surgery on acute kidney injury: a propensity-matched cohort in the UK Clinical Practice Research Datalink

ObjectiveBariatric surgery is an effective method of weight reduction and has been associated with acute kidney injury (AKI) as a perioperative event. However, the long-term effects of the weight reduction...

Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study.

BackgroundObesity is a major public health problem leading to co-morbidities such as diabetes, hypertension and kidney failure. Bariatric surgery results in pronounced and maintained weight loss and prevention of obesity-related diseases and their complications. Most studies of bariatric surgery on kidney disease show improvements after surgery. However, long-term studies analyzing hard end-points are lacking. Here we report on the long-term effects of bariatric surgery compared to usual obesity care on incidence of end-stage renal disease (ESRD) alone and in combination with chronic kidney disease stage 4 (CKD4/ESRD).Methods4047 patients were included in the Swedish Obese Subjects (SOS) study. Inclusion criteria were age 37–60 years and BMI≥34 in men and BMI≥38 in women. Patients in the bariatric surgery group (N=2010) underwent banding (18%), vertical banded gastroplasty (69%) or gastric bypass (13%); controls (N=2037) received usual obesity care. In this analysis, patients were followed up for a median time of 18 years. The incidence of ESRD and CKD4 was obtained by crosschecking the SOS database with the Swedish National Patient Register.ResultsDuring follow-up, ESRD occurred in 13 patients in the surgery group and in 26 patients in the control group (adjusted hazard ratio (HR) = 0.27; 95% CI 0.12 – 0.60; p=0.001). The number of CKD4/ESRD events was 23 in the surgery group and 39 in the control group (adjusted HR = 0.33; 95% CI 0.18 – 0.62; p<0.001). In both analyses, bariatric surgery had a more favorable effect in patients with baseline serum insulin levels above median compared to those with lower insulin levels (interaction p=0.010). Treatment benefit of bariatric surgery was also greater in patients with macroalbuminuria at baseline compared to those without macroalbuminuria (interaction p<0.001).ConclusionsOur study showed for the first time that bariatric surgery is associated with a long-term protection against ESRD and CKD4/ESRD.

Long-Term Effects of Bariatric Surgery on Health-Related Quality of Life: A Systematic Review

Introduction: Obese patients who seek bariatric surgery (BS) have great impairment in health-related quality of life (HRQoL). Along with weight loss, BS leads to improvement in HRQoL in the short-term. However, physical, psychological and social issues that ensue after BS might impact on HRQoL in the long-term. The aim was to systematically review the literature in order to explore the impact of bariatric surgery on HRQoL of severely obese patients in the long-term. Methods: Electronic databases were searched (Pubmed/Medline, Lilacs, IBECS, Cochrane Library, SciELO) to retrieve studies of adults with BMI≥35kg/m² which assessed HRQoL five or more years after BS. Hand search of references of previous reviews was also performed. GRADE was used to assess the quality of the evidence. Results: Of the 1226 articles retrieved, nine longitudinal studies were selected. A total of 4031 patients were followed-up. Female sex was predominant in all studies. Only one study did not find improvement in HRQoL after BS. Improvement of physical aspects of HRQoL was more commonly reported than mental aspects. The quality of the evidence retrieved was rated as low mainly due to the lack of adjustment for prognostic factors that might have led to counfounding in the assessment of HRQoL and under-report of follow-up rates. Differences in the instruments to assess HRQoL and in the composition of control groups among the studies did not allow to perform meta-analysis. Conclusion: BS was associated with improvement in HRQoL in the long-term, particularly in physical aspects. The low quality of the studies selected points out to the need of controlled trials to better assess the long-term effects of BS on HRQoL.

A110 - Long-Term Effects of Bariatric Surgery in Patients with Insulin-Treated Type 2 Diabetes: 44% at Glycemic Target without Insulin use

A110 - Long-Term Effects of Bariatric Surgery in Patients with Insulin-Treated Type 2 Diabetes: 44% at Glycemic Target without Insulin use

The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis.

This systematic review aimed to evaluate the long-term (≥5years) outcomes of bariatric surgery on diabetes remission, microvascular and macrovascular events, and mortality among type 2 diabetes (T2D) patients. Ten articles (one randomized controlled trial and nine cohorts) met the inclusion criteria and were included in this review. Pooled estimates of nine cohort studies showed that surgery significantly increased the diabetes remission (relative risk (RR)=5.90; 95% CI 3.75-9.28), reduced the microvascular (RR=0.37; 95% CI=0.30-0.46) and macrovascular events (RR=0.52; 95% CI 0.44-0.61), and mortality (RR=0.21; 95% CI 0.20-0.21) as compared to non-surgical treatment. Available evidence suggests better remission and lower risks of microvascular and macrovascular disease and mortality in the surgery group as compared to non-surgical treatment group in T2D patients after at least 5years of follow-up.

Long-term effects of bariatric surgery in patients with obesity and chromosome 16 p11.2 microdeletion

BackgroundChromosome 16 p11.2 microdeletion is associated with early-onset obesity. Information is limited about the effect of bariatric surgery in patients with genetic obesity. ObjectiveTo examine the effects of bariatric surgery in obese patients with chromosome 16 p11.2 microdeletion. SettingAcademic research institution. MethodsThe Swedish Obese Subjects study is a prospective study with 2010 participants receiving bariatric surgery. DNA was available for 1843 participants. Multiplex ligation-dependent probe amplification was used to identify 16 p11.2 microdeletion carriers. Follow-up time was 10 years. In carriers and noncarriers, follow-up rate was 86% and 82%, respectively, at 10 years. ResultsNine carriers of the chromosome 16 p11.2 microdeletion (9/1843, .49%) were found. At baseline, most risk factors were similar; however, carriers had higher body mass index (BMI), insulin levels, and systolic blood pressure compared to noncarriers. At the 1-year examination, the percent excess BMI lost (%EBMIL) in carriers and noncarriers was 71.9 and 62.2, respectively; P = .031 (37.9 and 30.6 kg). This was followed by partial weight regain in both groups, and after 10 years %EBMIL was 25.5 and 41.5 (15.7 and 21.3 kg), respectively (P = .377). Changes in risk factors were similar in the carriers and noncarriers. Two carriers who had type 2 diabetes at baseline were both in remission at 2-year follow-up but relapsed at 10-year follow-up. Perceived health status was similar in carriers and noncarriers during follow-up (overall P = .198). ConclusionsDespite a small sample size, our results indicate that bariatric surgery is a treatment option for obese patients with chromosome 16 p11.2 microdeletion.

The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults.

Several studies have been investigated to find the long-term effect of bariatric surgery on weight loss; nevertheless, a meta-analysis can detailedly demonstrate the effect of bariatric surgery on weight in morbidly obese patients. This study aimed to assess the long- and very long-term effects of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) on weight loss in adults. An electronic search using PubMed, Scopus, and Google scholar databases was performed for all English-language articles up to May 15, 2016 with no publication date restriction. Outcome was long-term (≥5-10 years) and very long-term (≥10 years) weight reduction that reported as the mean %EWL and changes in BMI from baseline. Eighty articles with 87 arms were included in this meta-analysis. The excess weight loss percentage (%EWL) was 47.94% and 47.43% after LAGB at ≥5 and ≥10 years, respectively. After LRYGB the %EWL was 62.58% at ≥5 years and 63.52% at ≥10 years. It was 53.25% at ≥5 years after LSG. Results of subgroup analyses have indicated that LRYGB leads to higher %EWL in America and Asia compared with Europe. Meta-regression analyses have shown that there is no significant association between %EWL and baseline age, BMI and length of follow-up after three procedures. However, there is a positive association between gender and %EWL after LRYGB (β = 1.24). No publication bias was found. These findings suggest that LRYGB is an effective procedure in morbidly obese patients that leads to sustainable weight loss over the long- and very long-term periods in compared with LAGB and LSG.

Long-term incidence of female-specific cancer after bariatric surgery or usual care in the Swedish Obese Subjects Study

ObjectiveTo examine the long-term effects of bariatric surgery on female-specific cancer in women with obesity. MethodsThe prospective, matched Swedish Obese Subjects (SOS) study was designed to examine outcomes after bariatric surgery. This study includes 1420 women from the SOS cohort that underwent bariatric surgery and 1447 contemporaneously matched controls who received conventional obesity treatment. Age was 37–60years and BMI was ≥38kg/m2. Information on cancer events was obtained from the Swedish National Cancer Registry. Median follow-up time was 18.1years (interquartile range 14.8–20.9years, maximum 26years). This study is registered with ClinicalTrials.gov, NCT01479452. ResultsBariatric surgery was associated with reduced risk of overall cancer (hazard ratio=0.71; 95% CI 0.59–0.85; p<0.001). About half of the observed cancers were female-specific, and the incidence of these were lower in the surgery group compared with the control group (hazard ratio=0.68; 95% CI 0.52–0·88; p=0.004). The surgical treatment benefit with respect to female-specific cancer was significantly associated with baseline serum insulin (interaction p value=0.022), with greater relative treatment benefit in patients with medium or high insulin levels. Separate analyses of different types of female-specific cancers showed that bariatric surgery was associated with reduced risk of endometrial cancer (hazard ratio=0.56: 95% CI 0.35–0.89; p=0.014). ConclusionsIn this long-term study, bariatric surgery was associated with reduced risk of female-specific cancer, especially in women with hyperinsulinemia at baseline. FundingThis project was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number R01DK105948 (the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health), the Swedish Research Council K2013-99X-22279-01, K2013-54X-11285-19, Sahlgrenska University Hospital ALF research grant and Swedish Diabetes Foundation.

Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity, stratified by baseline glycaemic status: a post-hoc analysis of participants from the Swedish Obese Subjects study

SummaryBackgroundBariatric surgery in patients with obesity and type 2 diabetes is associated with diabetes remission and prevention of complications. The long-term effects of bariatric surgery on microvascular complications in patients with prediabetes are unknown.MethodsThe prospective, matched Swedish Obese Subjects study examines outcomes after bariatric surgery. Patients were recruited between September 1, 1987, and January 31, 2001. Age was 37–60 years and BMI was ≥34 kg/m2 in men and ≥38 kg/m2 in women. The surgery group (n=2010) underwent gastric bypass (13·2%), banding (18·7%), or vertical banded gastroplasty (68·1%), and controls (n=2037) received usual care. After exclusion of 4 patients with suspected type 1 diabetes, and 11 patients with unknown glucose status at baseline, 4032 of the 4047 participants in the SOS study were included in the current analysis. The main outcome of this report was incidence of microvascular events (retinopathy, diabetic kidney disease, and neuropathy, whichever came first), obtained from nationwide registers, in subgroups stratified by baseline glucose status (euglycemia n=2838; prediabetes n=591; screen-detected diabetes n=246; established diabetes n=357). Data were analyzed both by intention to treat and per protocol. Median follow-up was 19 years. This study is registered with ClinicalTrials.gov, NCT01479452.FindingsThere were 374 first-time microvascular events in the control group and 224 in the surgery group (hazard ratio, 0·56; 95% CI 0·48–0·66; p<0·0001). There was a significant interaction between baseline glucose status and treatment effect (p=0.0003), and unadjusted hazard ratios for comparing the surgery group to the control group were lowest in the subgroup with prediabetes (0·18; 95% CI 0·11–0·30), followed by subgroups with screen-detected diabetes (0·39; 95% CI 0·24–0·65), established diabetes (0·54; 95% CI 0·40–0·72), and euglycemia (0·63; 95% CI 0·48–0·81). In patients with baseline prediabetes, treatment was associated with reduced incidence of microvascular events both in those who developed diabetes and in those who remained diabetes free during follow-up.InterpretationBariatric surgery was associated with reduced risk of microvascular complications in all subgroups, but the greatest relative risk reduction was observed in patients with baseline prediabetes. Our results indicate that prediabetes should be treated aggressively to prevent future microvascular events.