A comparative study of the effect of two procedures of classic Roux-en-Y and omega bariatric surgery on the control and management of diabetes

Background:

Patient management after bariatric surgery is important in controlling patients’ diabetes and recurrence prevention. This study aimed to meet the medical managements of patients with diabetes 6 months after the bariatric surgery.

Materials and Methods:

This cross-sectional study was performed on 77 type 2 diabetes patients’ candidates for bariatric surgery (Roux-en-Y [RYGP] and Omega). Postoperative implementation protocol was one-third of insulin for patients taking long-term insulin and the discontinuation of medications for patients of oral antidiabetic agents. Blood glucose (BG) level was checked regularly by the patients at home and the necessary medical management was applied. The weight, BG and HbA1C levels, and use of oral antidiabetic agents and insulin were assessed and recorded before 1, 3, and 6 months after the surgery.

Results:

BG levels and HbA1C percentage in the 1^st, 3^rd, and 6^th months after the intervention in Omega group were significantly lower than RYGB group (P value < 0.05). At 1 and 3 months after surgery, the mean insulin dose received by the Omega and RYGB groups was reduced to <30 units/day and 10 units/day, respectively, following the management protocol in this study. Moreover, 23.1% and 7.7% of patients in RYGB group and 12.1% and 3% of patients in Omega group took oral antidiabetic agents 1and 3 months after surgery, respectively. Insulin and oral antidiabetic agents were completely discontinued 6 months after the surgery.

Conclusion:

The long-term management and support of the patients by the implementation of a standard protocol after surgery are of great significance in obtaining the optimal outcome after bariatric surgery.

Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Bone Mineral Density in Zucker Diabetic Fatty Rats: A Short-Term Comparative Study

BACKGROUND

While bariatric surgery could result in weight loss as well as glycaemia improvement, the short-term impact on bone health in a high glycemic environment following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) remains intriguing.

OBJECTIVE

The aim of this study was to compare the short-term effects of RYGB and SG procedures on bone health in Zucker diabetic fatty (ZDFfa/fa) rats.

METHODS

Thirty age-matched male ZDFfa/fa rats were randomized into RYGB, SG, and sham groups after establishment of the diabetic model. Body weight, blood glucose, bone mineral density (BMD), the level of bone turnover markers (BTM), vitamin D, and serum calcium and phosphorus were measured 4 weeks after the operation.

RESULTS

The RYGB procedure brought about lower blood glucose, BMD, serum calcium and phosphorus levels, as well as a relatively higher bone turnover rate and 1,25(OH)2VD level, compared to the SG and sham groups, while the influences of the SG procedure were not significant. 25(OH)VD demonstrated no significant difference among the 3 groups.

CONCLUSIONS

Despite its excellent ability to provide short-term glycemic control, the RYGB procedure could led to more severe impairment of bone health compared to the SG procedure. Bone health should be procured after bariatric surgery, especially with the RYGB procedure. Early detection of BMD and BTM may help to avoid deterioration of bone.

Changes in serum lipid levels after laparoscopic sleeve gastrectomy in morbidly obese dyslipidemic and normolipidemic patients

BACKGROUND

This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) performed for morbid obesity on serum lipid levels of dyslipidemic and normolipidemic patients.

METHODS

141 patients who underwent LSG between September 2014 and January 2016 were included in the study.

RESULTS

The patients' mean body mass index was 46.27 ± 6.79 kg/m² preoperatively, 31.60 ± 5.37 kg/m² in the 6th month postoperatively and 27.80 ± 4.25 kg/m² in the 12th month (p < .001). Preoperatively and 12 months after the operation, mean total cholesterol (TC) levels and mean LDL cholesterol, mean HDL cholesterol, and mean triglyceride (TG) levels were statistically significantly decreased (p < .01). Comparing TC levels in the 12th month with preoperative levels, dyslipidemic patients showed a statistically more significant decrease than normolipidemic patients. LDL cholesterol levels were significantly decreased in both the groups. HDL cholesterol levels increased significantly in both groups while mean TG levels decreased significantly in patients with high preoperative TG levels, but not in patients with normal preoperative TG levels.

CONCLUSIONS

Although this technique exerts its effect primarily by reducing gastric volume, besides its metabolic and hormonal effects, it also improves serum lipid levels (decreasing TC, LDL cholesterol and TG levels, and increasing HDL cholesterol levels). It therefore contributes to decreasing cardiovascular diseases.

Evolution of Liver Steatosis Quantified by MR Imaging and MR Spectroscopy, in Morbidly Obese Patients Undergoing Sleeve Gastrectomy: Short-Term Outcomes

BACKGROUND

Currently, the standard procedure used to evaluate hepatic steatosis is the liver biopsy. This is an invasive practice that presents inherent risks. Increasing evidence suggests that magnetic resonance imaging (MRI) and MR spectroscopy (MRS) may represent an accurate method to determine the hepatic lipid content. The aim of this study was to evaluate the effect of sleeve gastrectomy on liver steatosis, quantified by MRI and MRS.

PATIENTS AND METHODS

A prospective observational study of patients undergoing laparoscopic sleeve gastrectomy was performed. All patients underwent a MRI and a MRS study 2 weeks before the intervention and 6 months after the surgery. Anthropometric, biochemical, and radiological parameters were analyzed.

RESULTS

Twenty-three patients were included, 21 females and 2 males, with a mean age of 47.6 ± 10.6 years and mean pre-op BMI 47.6 ± 6.7 Kg/m². Six months after surgery, mean BMI was 32.2 ± 5.1 Kg/m², with a mean excess weight loss of 68.2 ± 18.6%. Mean preoperative hepatic volume was 1999.9 ± 436.2 ml and 6 months after surgery it decreased to 1568 ± 170.3 ml (p = 0.005). Mean preoperative percentage of lipid content was 14.2 ± 15.4% and 6 months after surgery, it decreased to 4.3 ± 3.2% (p = 0.007). A significant reduction of steatosis grade was observed, with disappearance of preoperative steatosis in 54.9% of the patients.

CONCLUSION

Six months after sleeve gastrectomy, a significant reduction of liver steatosis is observed, as demonstrated by reduction in the percentage of intrahepatocitary lipids and liver volume, determined by MRS and MRI. These imaging techniques can be considered as noninvasive, accurate methods for monitoring liver steatosis in morbidly obese patients undergoing bariatric surgery.

Improvement of nonalcoholic fatty liver disease in morbidly obese patients after sleeve gastrectomy: association of ultrasonographic findings with lipid profile and liver enzymes

BACKGROUND

After bariatric surgery an improvement or even complete resolution of nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients is achieved, but little is known about the effect of laparoscopic sleeve gastrectomy (LSG).

PATIENTS AND METHODS

A prospective observational study of patients undergoing LSG was performed. An abdominal ultrasonography and blood sample extraction (investigating liver enzymes and lipid profile) were performed preoperatively and 12 months after surgery.

RESULTS

Fifty patients were included in the study. Preoperatively, 84% of the patients presented liver steatosis. A significant reduction of steatosis could be observed 12 months after surgery (p < .001). Preoperative degree of steatosis showed a direct correlation with AST (p = .008) and ALT (p = .007) and an inverse correlation with HDL-cholesterol (p = .019). The reduction of liver steatosis showed an inverse correlation with the increase of HDL-cholesterol between pre- and postoperative determinations (p = .008).

CONCLUSIONS

Liver steatosis, as measured by ultrasonography, improves after sleeve gastrectomy, achieving a complete resolution in 90% of the cases. Preoperative steatosis correlates directly with AST and ALT levels and inversely with HDL-cholesterol. The postoperative increase of HDL-cholesterol shows an inverse correlation with liver steatosis improvement, suggesting that it could be a good marker for monitoring the postoperative liver status.

Weight loss and improvement of lipid profiles in morbidly obese patients after laparoscopic one-anastomosis gastric bypass: 2-year follow-up

BACKGROUND

Obesity is the most frequent chronic metabolic disease globally. There is a direct correlation between increasing body mass index (BMI) and elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL), and triglycerides (Tg), and an inverse correlation with high-density lipoprotein cholesterol (HDL); all these lipid derangements are associated with an increased risk of cardiovascular disease. Our aim was to evaluate lipid profiles in morbidly obese patients before and after one-anastomosis gastric bypass (OAGB) performed at a single-center during a 2-year follow-up.

PATIENTS AND METHODS

A prospective, observational and descriptive study was carried out, including morbidly obese patients with at least one lipid abnormality, who underwent laparoscopic OAGB. Lipid profiles were evaluated preoperatively and at different intervals during a 2-year follow-up.

RESULTS

A total of 150 patients were included (73 % females and 27 % males). Mean age was 45.83 ± 10.65 years, mean BMI was 42.82 kg/m² ± 6.43, and mean weight was 116.23 kg ± 22.70; 2 years after surgery, the latter two decreased to 24.73 ± 4.43 (p < 0.001) and 67.34 ± 13.35 (p < 0.001), respectively, thus leading to a mean weight loss (WL) of 48.85 kg ± 15.64 and mean %excess WL of 71.87 ± 13.41. Tg, TC and LDL levels significantly decreased: 123.60 ± 56.34 versus 84.79 ± 33.67, 194.33 ± 43.90 versus 173.65 ± 34.84, and 124.47 ± 36.07 versus 97.36 ± 25.05, respectively (p < 0.001); HDL levels significantly increased: 43.61 ± 9.85 versus 61.56 ± 12.63 (p < 0.001).

CONCLUSION

OAGB leads to substantial and durable WL in morbidly obese patients after a 2-year follow-up. Postoperative lipid profiles significantly improved; these changes translate into theoretical relevant cardiovascular risk benefits.

Immediate Metabolic Response Following Sleeve Gastrectomy in Obese Diabetics

BACKGROUND

Although laparoscopic sleeve gastrectomy (LSG) has been shown to have a long-term antidiabetic effect, little is known regarding the immediate response to surgery. This study's objective was to evaluate the glycemic and lipid metabolic response in the first postoperative week.

METHODS

The study included 21 obese diabetic participants. Glycemic markers, lipids, and hepatic function tests were measured just prior to surgery and at 1 week and 3 months postoperatively. Two participants were dropped prior to all measurements due to technical reasons, and two more were lost to follow-up.

RESULTS

At 1 week after surgery, compared to preoperative baseline, we found reduced hemoglobin A1c (7.63 to 7.31, P < 0.001), insulin (24.96 to 10.92, P < 0.05), and borderline significant homeostatic model assessment insulin resistance (HOMA-IR, 9.48 to 3.91, P > 0.05). Low-density lipoprotein (LDL) cholesterol increased and high-density lipoprotein (HDL) cholesterol decreased. Three months after surgery, hemoglobin A1c, insulin, and HOMA-IR continued to decrease (6.05, 7.11, and 1.92, respectively, P < 0.05), with hemoglobin A1c correlated to weight loss (P < 0.05). Triglycerides, triglyceride to HDL ratio, and total cholesterol to HDL ratio also decreased, but there was no significant change in LDL cholesterol or HDL versus presurgery levels. Reduced triglyceride levels were correlated with reduced alanine transaminase (ALT) and gamma-glutamyl transpeptidase (GGT) (P < 0.05).

CONCLUSIONS

LSG is associated with marked antidiabetic effects as early as 1 week after surgery, unrelated to weight loss. The antidiabetic effect improves at 3 months. Triglyceride reduction was associated with improved hepatic functions, but cholesterol did not show a meaningful reduction.

The Role of Plasma Triglyceride/High-Density Lipoprotein Cholesterol Ratio to Predict New Cardiovascular Events in Essential Hypertensive Patients

Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) has been suggested as a simple method to identify unfavorable cardiovascular outcomes in the general population. The effect of the TG/HDL-C ratio on essential hypertensive patients is unclear. About 900 consecutive essential hypertensive patients (mean age 52.9±12.6 years, 54.2% male) who visited our outpatient hypertension clinic were analyzed. Participants were divided into quartiles based on baseline TG/HDL-C ratio and medical records were obtained periodically for the occurrence of fatal events and composite major adverse cardiovascular events (MACEs) including transient ischemic attack, stroke, aortic dissection, acute coronary syndrome, and death. Participants were followed for a median of 40 months (interquartile range, 35-44 months). Overall, a higher quartile of TG/HDL-C ratio at baseline was significantly linked with higher incidence of fatal and nonfatal cardiovascular events. Using multivariate Cox regression analysis, plasma TG/HDL-C ratio was independently associated with increased risk of fatal events (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.13-1.37; P≤.001] and MACEs (HR, 1.13; 95% CI, 1.06-1.21; P≤.001). Increased plasma TG/HDL-C ratio was associated with more fatal events and MACEs in essential hypertensive patients.

Short- and mid-term changes in bone mineral density after laparoscopic sleeve gastrectomy

BACKGROUND

Bariatric surgery is the most effective treatment for achieving a significant weight loss. Morbidities present a significant reduction after bariatric surgery, but it may also result in several health complications, related to nutritional deficiencies, including bone metabolism. Several studies have reported a decrease in bone mineral density (BMD), but most of them referring to malabsorptive procedures. Restrictive procedures do not imply changes in gastrointestinal anatomy, so that one may expect fewer metabolic disturbances.

METHODS

We performed a retrospective observational study of all morbidly obese patients undergoing LSG between 2008 and 2011 at our institution. Bone densitometry was performed before surgery and 1 and 2 years after the intervention. Body size measurements, analytical variables and densitometric values in the lumbar spine (BMD, t score and z score) were investigated.

RESULTS

Forty-two patients were included, 39 females and 3 males. Mean BMI was 51.21 kg/m(2). Mean excessive BMI loss was 79.9 % after 1 year and 80.6 % after 2 years. Mean BMD values for spine increased progressively, reaching statistical significance at 1 and at 2 years. Percentage of BMD increase was 5.7 % at 1 year and 7.9 % at 2 years. An inverse correlation was observed between BMD increase and parathyroid hormone (PTH) decrease and a direct correlation between BMD and vitamin D increase.

CONCLUSION

Bone mineral density showed a progressive increase during the first and second year after sleeve gastrectomy. BMD changes are not associated with weight loss, but showed a direct correlation with vitamin D and an inverse correlation with PTH levels.

Triglyceride/HDL ratio as a screening tool for predicting success at reducing anti-diabetic medications following weight loss

Background and Objectives

Intentional weight loss, by reducing insulin resistance, results in both better glycemic control and decreased need for anti-diabetic medications. However, not everyone who is successful with weight loss is able to reduce anti-diabetic medication use. In this retrospective cohort study, we assessed the predictive accuracy of baseline triglyceride (TGL)/HDL ratio, a marker of insulin resistance, to screen patients for success in reducing anti-diabetic medication use with weight loss.

Methods

Case records of 121 overweight and obese attendees at two outpatient weight management centers were analyzed. The weight loss intervention consisted of a calorie-restricted diet (~1000Kcal/day deficit), a behavior modification plan, and a plan for increasing physical activity.

Results

Mean period of follow-up was 12.5 ± 3.5 months. By study exit, mean weight loss and mean HbA1c% reduction were 15.4 ± 5.5 kgs and 0.5 ± 0.2% respectively. 81 (67%) in the study cohort achieved at least 1 dose reduction of any anti-diabetic medication. Tests for predictive accuracy of baseline TGL/HDL ratio ≤ 3 to determine success with dose reductions of anti-diabetic medications showed a sensitivity, specificity, positive predictive value, negative predictive value, area under the curve, likelihood ratio (LR) + and LR-of 81, 83, 90, 70, 78, 4.8 and 0.2, respectively. Reproducibility of TGL/HDL ratio was acceptable.

Conclusion

TGL/HDL ratio shows promise as an effective screening tool to determine success with dose reductions of anti-diabetic medications. The results of our study may inform the conduct of a systematic review using data from prior weight loss trials.