Effect of bariatric surgery on adiposity and metabolic profiles: A prospective cohort study in Middle-Eastern patients

Results of Bariatric Surgery in Sana'a, Yemen, in 2019: A Prospective Cohort Study

Background The incidence of obesity and related comorbidities, such as diabetes, gastroesophageal reflux disease (GERD), and osteoarthritis, is increasing. Many patients with obesity do not respond to conservative treatments. For these patients, bariatric surgery, also known as metabolic bariatric surgery (MBS), has emerged as an effective option. This study aimed to evaluate the impact of laparoscopic bariatric surgery on weight loss, diabetes remission, and improvement in other comorbidities among patients in Sana'a, Yemen, in 2019. Methods This prospective study included 50 patients who underwent laparoscopic MBS between January and December 2019 at three tertiary hospitals in Sana'a, Yemen. The procedures included sleeve gastrectomy (SG), single anastomosis sleeve ileal bypass (SASI), and single anastomosis duodenal ileal bypass with sleeve (SADI-S). Patients were followed for six months postoperatively. Data on demographics, baseline comorbidities, and preoperative anthropometrics were collected. Weight loss was measured using multiple metrics, including percentage excess weight loss (EWL), percentage excess body mass index lost (EBMIL), and percentage total body weight loss (TBWL). Diabetes remission was defined as achieving glycated hemoglobin (HbA1c) < 6% without the use of medications. Results The study included 50 patients, with a mean age of 37.45 ± 10.25 years, and 28 (56%) were female. The mean preoperative weight was 121.5 ± 25.3 kg, and the mean height was 162.8 ± 8.5 cm, resulting in a mean body mass index (BMI) of 45.43 ± 7.3 kg/m². Among the patients, 15 (30%) had diabetes, 38 (76%) had GERD, and 45 (90%) had joint pain. At the six-month follow-up, the mean BMI significantly decreased to 32.46 ± 4.03 kg/m² (p < 0.001). The mean percentage of EBMIL was 63.5%, and the mean percentage of TBWL was 28.5%. Among the 15 patients with diabetes, 12 (80%) achieved diabetes remission, with HbA1c improving from 8.1 ± 2.3% to 5.3 ± 1.2% (p < 0.001). GERD improved in 30 (78.9%) of 38 patients, with complete resolution in 8 (21.1%). Joint pain improved in 39 (86.6%) of 45 patients, with complete resolution in six (13.4%). Conclusion Laparoscopic bariatric surgery is an effective intervention for achieving substantial weight loss, diabetes remission, and improvements in comorbidities among Yemeni patients. These findings are consistent with global literature and underscore the importance of bariatric surgery in addressing the increasing rates of obesity and metabolic disorders in Yemen. Further studies are needed to evaluate the long-term outcomes in this population.

Significant Promising Effects of Bariatric Surgery on the Biochemical Control of Glycemia and Lipidemia in Diabetic Patients in Western Saudi Arabia: A Tertiary Center Experience and a Retrospective Study

BACKGROUND

The prevalence of obesity has increased globally and is associated with many comorbidities such as type 2 diabetes and fatty liver and cardiovascular diseases. Bariatric surgery is considered an effective intervention for achieving weight loss and controlling lipidemia and glycemia.

OBJECTIVES

This Saudi retrospective observational study evaluates the clinical and biochemical benefits following bariatric surgery to obese diabetic patients.  Methodology: After gaining ethical committee approval, data was collected from the patients' medical records at a tertiary medical center (King Fahad General Hospital, Al-Madinah Al-Munawwarah, Saudi Arabia). The total sample size was 61 patients, of whom 78.33% (n=48) had a body mass index (BMI) of 40 or greater (obese class III).

RESULTS

Following bariatric surgery, there were statistically significant reductions (p<0.001) in BMI and HbA1C (decreased from 45.53±7.791 kg/m2 and 7.9±1.82% to 33.42±6.18 kg/m2 and 6.06±1.35%, respectively, after surgery). Likewise, significant reductions (p<0.001) occurred to serum total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides that decreased from 234.4±26.7 mg/dl, 152.2±19.4 mg/dl, and 187.3±24.6 mg/dl to 158.4±17.3 mg/dl, 95.6±15.7 mg/dl, and 132.5±19.5 mg/dl, respectively. Interestingly, serum high-density lipoprotein (HDL) significantly increased (p<0.001) from 43.8±6.2 mg/dl to 52.3±4.6 mg/dl. Using the novel clinical therapeutic index, bariatric surgery decreased BMI by about 26.6%. Using the novel biochemical therapeutic index, bariatric surgery decreased HbA1C, serum total cholesterol, serum LDL cholesterol, and serum triglycerides by about 22.99%, 32.42%, 37.18%, and 29.26%, respectively, while serum HDL increased by about 19.4%.

CONCLUSION

Bariatric surgery is an effective intervention for obese diabetic patients resulting in weight loss, better control of diabetes and hyperlipidemia, and the metabolic profile. It is also recommended in Saudi Arabia for the high prevalence of obesity and diabetes mellitus.

Changes in adiposity and other cardiometabolic risk factors following Roux-en-Y gastric bypass: A 12-month prospective cohort study in Chinese patients

AIM

We aimed to investigate the changes in adiposity and other cardiometabolic risk factors in the year following Roux-en-Y gastric bypass (RYGB) in patients of Chinese ethnicity.

METHODS

The study recruited 209 patients who met the indications for bariatric surgery. Adiposity and cardiometabolic risk factors were assessed at baseline and over the 12 months following surgery in all participants. SPSS® software was used for statistical analysis.

RESULTS

The mean body mass index (BMI) was 29.98 kg/m² at baseline and steadily decreased to 25.32 kg/m² at 12 months, giving a relative change of -15.5% (p < 0.001). All of the lipid profile fractions except high-density lipoprotein (HDL) declined during the first 12 months of follow up; serum HDL increased during this time (all ANOVA p < 0.001). The mean fasting plasma glucose was 9.49 mmol/L at baseline and gradually decreased to 5.69 mmol/L at 12 months, giving a relative change of -40.0% (p < 0.001).

CONCLUSION

Following the RYGB procedure, changes in measures of adiposity were paralleled by a significant improvement in cardiometabolic factors for 12 months after surgery.