Correlation Between Age and Weight Loss after Bariatric Surgery

Background

Conflicting evidence exists regarding age as a predictive factor in excess weight loss after bariatric surgery. The objective of this cross-sectional study is to evaluate differences in excess BMI loss (%EBMIL) 1 year after surgery in patients older and younger than 45 years.

Methods

Adult obese patients fulfilling selection criteria underwent either Roux-en-Y gastric bypass or sleeve gastrectomy and were grouped according to age < and ≥45 years with follow-up at least 1 year. Both groups were compared in terms of excess BMI loss (%EBMIL) and other clinical outcomes. Possible relationship between %EBMIL, age, surgical technique, and presence of comorbidities such as diabetes mellitus, hypertension (HT), and dyslipidemia (DL) was searched.

Results

Three hundred thirty-seven patients (72.5 % female), 196 (50.1 %) younger than 45 years and 141 (49.9 %) with age ≥45 years. There was significant difference between age group and %EBMIL 12 months after surgery (p?<?0.001), showing better results in younger patients. No differences were found in terms of gender, preoperative body mass index (BMI), surgical technique, nor presence of DL. Using multiple regression, we found significant interaction effect between age group (p?<?0.001), presence of HT (p?=?0.001), and %EBMIL at follow-up.

Conclusions

Patients younger than 45 years lose greater amount of excess BMI than older patients after bariatric surgery. This tendency might be useful as a preoperative weight loss predictor in bariatric patients.     

Greater Short-Term Weight Loss in Women 20–45 versus 55–65 Years of Age Following Bariatric Surgery

Background

Whether and how sex and age affect bariatric-surgery outcome is poorly understood. Estrogens regulate body composition in women and animals, and increase weight loss in a rodent model of gastric bypass, suggesting that premenopausal women may lose more weight following bariatric surgery.

Methods

One thousand three hundred fifty-six female gastric-bypass or gastric-banding patients were retrospectively grouped as 20–45 years old (presumptively premenopausal; n?=?1,199) and 55–65 years old (presumptively postmenopausal; n?=?157). Mixed-model ANCOVA followed by Bonferroni-corrected t tests were used to categorically test the effect of age on percent excess body weight loss (%EBWL) at 1 and 2 years post-surgery, controlling for preoperative EBW and surgery type. Age effects were also tested dimensionally in all women and in 289 male patients.

Results

Twenty- to forty-five-year-old women showed greater %EBWL 1 and 2 years post-surgery than 55–65-year-old women (p’s?<?0.0005). No age effect was detected in 20–25- vs. 30–35-, 30–35- vs. 40–45-, or 20–25- vs. 40–45-year-old women (p’s?>?0.2) This age effect was detected only after gastric banding, with 20–45-year-old women losing ～7 kg more than 55–65-year-old women after 2 years. Dimensional analysis confirmed a significant inverse effect of age on bariatric surgery outcome in women, but did not detect any effect in men.

Conclusions

Results indicate that 55–65-year-old women lose less weight than 20–45-year-old women in the initial 2 years after bariatric surgery, especially gastric banding; this may be mediated by age- or menopause-associated changes in physical activity, energy expenditure, or energy intake.     

Laparoscopic Greater Curvature Plication (LGCP) for Treatment of Morbid Obesity in a Series of 244 Patients

Background

Laparoscopic greater curvature plication (LGCP) is a new metabolic/bariatric surgical procedure that requires no resection, bypass, or implantable device. We report LGCP outcomes in 244 morbidly obese patients.

Methods

Between 2010 and 2011, patients underwent LGCP. Body mass index (BMI, kilogram per square meter) evolution, excess BMI loss (%EBMIL), excess weight loss (%EWL), complications, and type 2 diabetes mellitus (T2DM) changes were recorded. Repeated-measures analysis of variance (ANOVA) was used to assess weight change at 6, 12, and 18?months. Subgroup analyses were conducted to provide benchmark outcomes at 6?months. Logistic regression was used to identify characteristics predictive of suboptimal weight loss.

Results

Mean baseline BMI (±SD) was 41.4?±?5.5 (80.7?% women, mean age 46.1?±?11.0?years, 68 [27.9?%] patients had T2DM). Mean operative time was 70.6?min; mean hospitalization, 36?h (24?C72). Sixty-eight patients (27.9?%) experienced postoperative nausea and/or vomiting that was controlled within 36?h. There was no mortality. Major complication rate was 1.2?% (n?=?3). Repeated-measures ANOVA indicated significant weight loss across time points (p?n?=?105), BMI, %EBMIL, and %EWL were 36.1?±?4.7, 34.8?±?17.3, and 31.8?±?15.9. Preoperative BMI was the only predictor of weight loss. Patients with BMI <40 lost more weight than those ??40, although by 9?months, differences were no longer significant. In patients with preoperative BMI <40, 18-month %EWL approached 50?% and %EBMIL exceeded 50?%. At 6?months, 96.9?% of patients?? T2DM was significantly improved/resolved.

Conclusions

Over the short term, LGCP results in effective weight loss and significant T2DM reduction with a very low rate of complications.     

Excess Body Weight Loss is Associated with Nonpathological Gait Patterns in Women 4 to 5 Years After Bariatric Surgery

Background

This study examined relationships between excess body weight (EBW) loss and current gait and functional status in women 5 years after Roux-en-Y gastric bypass surgery.

Methods

Gait data were analyzed in nine female bariatric patients for relationships with longitudinal changes in weight, body composition, and physical function assessed by the Short Musculoskeletal Functional Assessment (SMFA) questionnaire and the timed “get-up-and-go” (TGUG) test. Gait characteristics in the bariatric sample were also compared to an age- and BMI-matched nonsurgical reference sample from the Fels Longitudinal Study.

Results

Bariatric patients lost an average of 36.4 kg (61.1 %) of EBW between preoperative and 5-year follow-up visits (P?<?0.01); SMFA function index scores and TGUG times also decreased (both P?<?0.01). Degree of EBW loss was correlated with less time spent in initial double support and more time in single support (both P?=?0.02), and for all gait variables, the bariatric sample fell within the 95 % confidence intervals of gait/EBW relationships in the reference sample.

Conclusions

Gait and function 5 years after bariatric surgery were characteristic of current weight, not preoperative obesity, suggesting that substantial, sustained recovery of physical function is possible with rapid surgical weight loss.     

Lack of Adherence to Follow-Up Visits After Bariatric Surgery: Reasons and Outcome

Background

A substantial number of patients undergoing bariatric surgery are lost to follow-up for unknown reasons, which may cause an overestimation of the benefits of operation. The aim of this study was to identify the reasons of failure to attend controls after bariatric surgery and the relationship with poor weight loss.

Methods

A retrospective analysis of a prospective database including all patients undergoing bariatric surgery from January 2004 to February 2012 was performed. Nonadherence was defined as missing any scheduled control visit for more than 6 months. Contact was attempted (mail, telephone, and e-mail), and responders were requested to complete a questionnaire.

Results

Forty-six (17.5 %) out of 263 patients were considered nonadherent. Thirty-three (71.7 %) of these patients completed the questionnaire. The main reasons for nonadherence were work- (36.4 %) and family-related (18.2 %) problems or having moved outside the city or to the country (15.2 %). The percentage of nonadherent patients aged ≤45 years was greater as compared with those aged >45 years [28 (60.1 %) vs 18 (42.2 %), respectively, P?=?0.034]. Likewise, of the 30 patients with unsuccessful weight loss (<50 % EWL), seven (30.4 %) were in the nonadherent group while 23 (10.6 %) in the adherent group (P?=?0.046). Finally, 96.9 % of patients were completely satisfied with surgery and would recommend the procedure to other morbid obese patients.

Conclusion

The nonadherence rate to follow-up visits after bariatric surgery was 17.5 %, mainly associated with work-related problems. Nonadherence was greater in patients aged ≤45 years and in those with poor weight loss.     

Do Preoperative Eating Behaviors Influence Weight Loss After Biliopancreatic Diversion?

Background

The presence of disturbed eating patterns can affect the short- and long-term outcomes after bariatric surgery. Data about the influence of preoperative eating patterns on outcomes after biliopancreatic diversion (BPD) are lacking. The aim of the present study was to assess the role of preoperative eating behavior in patients’ selection for biliopancreatic diversion.

Methods

Sixty-one consecutive patients who underwent BPD were evaluated for the present study. For each patient, the following preoperative eating patterns were evaluated: sweet eating, snacking, hyperphagia, and gorging. The primary outcome measure was the percentage of excess weight loss (%EWL) at 3, 6, and 12 months in the groups of patients with different eating patterns at the preoperative evaluation.

Results

At the preoperative evaluation, snacking was found in 31 patients (50.8 %), sweet eating in 15 patients (24.6 %), hyperphagia in 48 patients (78.7 %), and gorging in 45 patients (73.8 %). For each eating behavior, there was no significant difference in mean preoperative BMI and weight loss at 3, 6, and 12 months between the group of patients with and the group of patients without the eating pattern considered. At the analysis of variance in the four groups of patients presenting the eating patterns considered, there was no difference in mean preoperative BMI (P?=?0.66), %EWL at 3 months (P?=?0.62), %EWL at 6 months (P?=?0.94), and %EWL at 12 months (P?=?0.95).

Conclusions

Preoperative eating behaviors do not represent reliable outcome predictors for BPD, and they should not be used as a selection criterion for patients who are candidates to this operation.     

Is Social Deprivation Associated with Weight Loss Outcomes Following Bariatric Surgery? A 10-Year Single Institutional Experience

Background

Social deprivation is associated with a greater morbidity and shorter life expectancy. This study evaluates differences in weight loss following bariatric surgery and deprivation, based on UK deprivation measures in a London bariatric centre.

Methods

All patients undergoing bariatric surgery between 2002 and 2012 were retrospectively identified. Demographic details, type of surgery and percentage excess weight loss data were collected. UK Index of Multiple Deprivation (IMD, 2010) and IMD domain of the Health Deprivation and Disability (HDD) scores were used to assess deprivation (where 1 is the most deprived in rank order and 32,482 is the least deprived). Two-way between-subjects analysis of variance (ANOVA) was performed to examine the effect of IMD score, deprivation, procedure type and gender on percentage excess weight loss.

Results

Data were included from 983 patients (178 male, 805 female) involving 3,663 patient episodes. Treatments comprised laparoscopic gastric bands (n?=?533), gastric bypass (n?=?362) and gastric balloons (n?=?88). The average percentage excess weight loss across all procedures was 38 % over a follow-up period (3 months–9 years). There was no correlation between weight loss and IMD/HDD rank scores. Gastric bypass was significantly more effective at achieving weight loss than the other two procedures at 3-, 6- and 9-month and 1-year follow-up.

Conclusions

Social deprivation does not influence weight loss after bariatric surgery, suggesting that all socioeconomic groups may equally benefit from surgical intervention. Social deprivation should not therefore negatively influence the decision for surgical intervention in these patients.     

Predictors of Weight Loss at 1 Year After Laparoscopic Adjustable Gastric Banding and the Role of Presurgical Quality of Life

Background

There is uncertainty regarding preoperative predictors of a successful outcome for bariatric surgery (BarSurg), on which to determine appropriateness for such a procedure. Our aims were to identify preoperative clinical and psychosocial predictors of success following BarSurg and to explore the influence of body mass index (BMI) on these parameters.

Methods

Preoperative data, including Impact of Weight on Quality of Life—Lite (IWQOL-Lite) scores transformed to Health-Related Quality of Life (HRQOL) scores, were accrued from 76 morbidly obese adults awaiting BarSurg. Pre- and postoperative data were also accrued for 26 patients who had completed 1-year follow-up post-bariatric surgery (laparoscopic adjustable gastric banding—LAGB). Statistical analysis was performed to assess the relationships between preoperative HRQOL scores, preoperative BMI and excess weight loss 1 year following BarSurg (EWL-1 year).

Results

Preoperative BMI showed a significant independent, negative linear correlation with the public distress domain of preoperative quality of life (QOL) (r?=??0.368, p?=?0.001; β?=??0.245, p?=?0.009). Preoperative BMI had a significant, positive and independent association with EWL-1 year (r?=?0.499, p?=?0.009; β?=?0.679, p?=?0.015). Preoperative QOL scores had no association with EWL-1 year.

Conclusions

Preoperative BMI appears to predict EWL-1 year following restrictive bariatric surgery (LAGB). Preoperatively, patients with higher BMI appear to manifest greater public distress. Preoperative QOL scores, however, do not appear to have any predictive value for EWL-1 year post-LAGB. Preoperative BMI should therefore be employed as a predictor of EWL-1 year post-LAGB. Other measures of successful outcomes of bariatric surgeries (such as effects on QOL scores at 1 year) should be explored in future, larger and longer term studies.     

Long-Term Improvements in Pulmonary Function 5 Years After Bariatric Surgery

Background

Obesity is associated with reduced pulmonary function. We evaluated pulmonary function and status of asthma and obstructive sleep apnoea syndrome (OSAS) before and 5 years after bariatric surgery.

Methods

Spirometry was performed at baseline and 5 years postoperatively. Information of asthma and OSAS were recorded. Of 113 patients included, 101 had undergone gastric bypass, 10 duodenal switch and 2 sleeve gastrectomy.

Results

Eighty (71 %) patients were women, mean preoperative age was 40 years and preoperative weight was 133 kg in women and 158 kg in men. Five years postoperatively, weight reduction was 31 % (42 kg; p?<?0.001) in women and 24 % (38 kg; p?<?0.001) in men. Forced expiratory volume in 1 s (FEV1) increased 4.1 % (116 ml; p?<?0.001) in women and 6.7 % (238 ml; p?=?0.003) in men. Forced vital capacity (FVC) increased 5.8 % (209 ml; p?<?0.001) in women and 7.6 % (349 ml; p?<?0.001) in men. Gender and weight loss were independently associated with the improvements in FEV1 and FVC. At follow-up, FEV1 had increased 36 % of the difference towards the estimated normal FEV1, and there was a corresponding 70 % recovery of FVC. These improvements occurred despite an expected decline in pulmonary function by age during the study period. Of the asthmatics and OSAS patients, 48 and 80 %, respectively, were without symptoms 5 years postoperatively.

Conclusions

Pulmonary function measured with spirometry was significantly improved 5 years after bariatric surgery, despite an expected age-related decline during this period. Symptoms of asthma and OSAS also improved.     

Incidence of Venous Thromboembolism After Bariatric Surgery: A Population-Based Cohort Study

Background

The incidence of venous thromboembolism (VTE) after bariatric surgery is uncertain.

Methods

Using the resources of the Rochester Epidemiology Project and the Mayo Bariatric Surgery Registry, we identified all residents of Olmsted County, Minnesota, with incident VTE after undergoing bariatric surgery from 1987 through 2005. Using the dates of bariatric surgery and VTE events, we determined the cumulative incidence of VTE after bariatric surgery by using the Kaplan–Meier estimator. Cox proportional hazards modeling was used to assess patient age, sex, weight, and body mass index as potential predictors of VTE after bariatric surgery.

Results

We identified 396 residents who underwent 402 bariatric operations. The most common operation was an open Roux-en-Y gastric bypass (n?=?228). Eight patients had VTE that developed within 6 months (7 within 1 month) after surgery; five events occurred after hospital discharge but within 1 month after bariatric surgery. The cumulative incidence of VTE at 7, 30, 90, and 180 days was 0.3, 1.9, 2.1, and 2.1 %, respectively (180-day 95 % confidence interval (CI), 0.7–3.6 %). Patient age was a predictor of postoperative VTE (hazard ratio, 1.89 per 10-year increase in age; 95 % CI, 1.01–3.55; P?=?0.05).

Conclusions

In our population-based study, bariatric surgery had a high risk of VTE, especially for older patients. Because most VTE events occurred after hospital discharge, a randomized controlled trial of extended outpatient thromboprophylaxis is warranted in patients undergoing open Roux-en-Y gastric bypass for medically complicated obesity.     

Laparoscopic Sleeve Gastrectomy (LSG)—A Good Bariatric Option for Failed Laparoscopic Adjustable Gastric Banding (LAGB): A Review of 90 Patients

Background

Laparoscopic adjustable gastric banding (LAGB) is one of the most frequently performed bariatric surgeries. Even with a high failure rate, revisional procedures such as re-banding or laparoscopic Roux-en-Y gastric bypass (LRYGB) were commonly performed. Recently, conversions of LAGB to laparoscopic sleeve gastrectomy (LSG) were reported. We will review our experience on this conversion.

Methods

Between February 2007 and January 2012, 800 patients underwent LSG, with 90 as a revisional procedure for failed LAGB. A retrospective review of a prospectively collected database was performed. Data were collected through routine follow-up and weight loss data were also obtained through self-reporting via the Internet. Demographics, complications, and percentage of excess weight loss (%EWL) were determined.

Results

A total of 90 patients underwent LSG as a revisional procedure, comprising of 77 women and 13 men with a mean age of 41 years (22 to 67), a mean body mass index of 42 kg/m² (26 to 58). Among them, 15.5 % had diabetes mellitus, 35.5 % had hypertension, 20.0 % had hyperlipidemia, and 18.8 % had obstructive sleep apnea. The mean operative time was 112 min (50 to 220) and mean hospital stay was 4.2 days (1 to 180). Operative complications included 5.5 % leak and 4.4 % hemorrhage or gastric hematoma. There was no postoperative mortality. The mean postoperative %EWL was 51.8 % (n?=?82), 61.3 % (n?=?60), 61.6 % (n?=?45), 53.0 % (n?=?30), 55.3 % (n?=?20), and 54.1 % (n?=?10) at 6, 12, 18, 24, 36, and 48 months, respectively.

Conclusions

LSG after LAGB yields a positive outcome with higher complication rates than for primary LSG. We advocate this procedure as a good bariatric option for failed LAGB.     

Revisional Bariatric Surgery for Unsuccessful Weight Loss and Complications

Background

There are growing numbers of patients who require revisional bariatric surgery due to the undesirable results of their primary procedures. The aim of this study was to review our experience with bariatric patients undergoing revisional surgery.

Methods

We conducted a retrospective analysis to review the indications for revisional bariatric procedures and assess their postoperative outcomes.

Results

From 04/04 to 01/11, 2,918 patients underwent bariatric surgery at our institution. A total of 154 patients (5.3 %) of these cases were coded as revisional procedures. The mean age at revision was 49.1?±?11.3 and the mean BMI was 44.0?±?13.7 kg/m². Revisional surgery was performed laparoscopically in 121 patients (78.6 %). Laparoscopic revisions had less blood loss, shorter length of hospital stay, and fewer complications compared to open revisions. Two groups (A and B) were defined by the indication for revision: patients with unsuccessful weight loss (group A, n?=?106) and patients with complications of their primary procedures (group B, n?=?48). In group A, 74.5 % of the patients were revised to a bypass procedure and 25.5 % to a restrictive procedure. Mean excess weight loss was 53.7?±?29.3 % after revision of primary restrictive procedures and 37.6?±?35.1 % after revision of bypass procedures at >1-year follow-up (p?<?0.05). In group B, the complications prompting revision were effectively treated by revisional surgery.

Conclusions

Revisional bariatric surgery effectively treated the undesirable results from primary bariatric surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic bariatric procedures without a prohibitive complication rate. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss.     

Rebanding for Slippage After Gastric Banding: Should We Do It?

Background

Laparoscopic adjustable gastric banding (LAGB) is a commonly performed bariatric procedure. LAGB is frequently complicated by slippage. Possible treatment for slippage is rebanding, but long-term effects are unknown. The aim of this study was to investigate whether rebanding after gastric band slippage is associated with weight loss failure.

Methods

This was a post hoc analysis of a prospectively collected database of 627 consecutive LAGB patients. Rebanding for slippage was performed in 81 patients. The effect of rebanding on weight loss was evaluated by three analyses: (1) in 81 rebanded patients, weight loss was compared before and after rebanding, separately for patients in whom primary LAGB was successful or unsuccessful; (2) 81 rebanded patients were matched to 81 patients without slippage for prognostic variables and compared for weight loss after rebanding; (3) multivariate logistic regression was performed whether rebanding was independently associated with weight loss failure.

Results

The chance of a fair result of rebanding for patients following primary successful (n?=?34) and unsuccessful LAGB (n?=?22) was 62 and 27 % after median follow-up of 113 and 97 months, respectively. There was no difference in weight loss failure between 81 rebanded patients and 81 matched patients: 54 vs 59 % (P?=?0.43). In multivariate analysis, rebanding was not significantly associated with weight loss failure: adjusted odds ratio 1.42; 95 % confidence interval 0.85–2.38; P?=?0.18.

Conclusion

In general, rebanding after LAGB has no negative effect on weight loss. However, patients in whom LAGB was unsuccessful prior to rebanding have poor long-term weight loss results.     

Improvement of Exercise Capacity and Peripheral Metaboreflex After Bariatric Surgery

Background

Bariatric surgery is the only predictable method to obtain weight loss in severe obesity. Poor physical performance of obese individuals may be mediated by the peripheral metaboreflex, which controls blood flow redistribution to exercising muscles. Weight reduction improves exercise capacity through several possible mechanisms that are insufficiently understood. We hypothesized that the metaboreflex is one among the causes of improvement in exercise capacity after weight loss. This study thus aimed to examine the effect of bariatric surgery on exercise performance and metaboreflex.

Methods

Severely obese patients were assessed before and 3 months after bariatric surgery. Metaboreflex was evaluated by the technique of selective induction by post-exercise circulatory occlusion (PECO+) after isometric handgrip exercise at 30 % of maximum voluntary contraction. The exercise capacity was assessed by 6-min walking test.

Results

Seventeen patients completed the protocol. Body mass index decreased from 46.4?±?2 to 36.6?±?2 kg/m² (P?<?0.001). The distance walked in 6 min increased from 489?±?14 to 536?±?14 m (P?<?0.001). The peripheral metaboreflex activity, expressed by the area under the curve of vascular resistance, was lower after than before bariatric surgery (42?±?5 to 20?±?4 units, P?=?0.003). Heart rate, blood pressure, and vascular resistance were also significantly decreased. The correlation between change in distance walked in 6 min and change in peripheral metaboreflex activity was not significant.

Conclusions

Weight loss after bariatric surgery increases exercise capacity and reduces peripheral metaboreflex, heart rate, and blood pressure. Further investigation on the role of metaboreflex regarding mechanisms of exercise capacity of individuals with obesity is warranted.     

Osteoporosis as an independent risk factor for silent brain infarction and white matter changes in men and women: the PRESENT project

Summary

Previous studies have not demonstrated a relationship between osteoporosis and cerebral infarction in the community, especially in men. We found that osteoporosis may be an independent risk factor for brain white matter change/silent infarction in men, as well as in women.

Purpose

We aimed to study the relationship between low bone mineral density (BMD) and brain white matter changes and/or silent infarcts (WMC/SI).

Methods

This was a community-based, cross-sectional study supported by the regional government. Bone mineral density measurements and brain computed tomography were performed in 646 stroke- and dementia-free subjects (aged 50–75 years).

Results

After adjustment for age, hypertension, diabetes mellitus, dyslipidemia, and current smoking status, the odds ratio (OR) of risk for WMC and/or SI was 1.8 in the osteopenia group (95 % confidence interval [CI] 1.15–2.77; P?=?0.01) and 2.2 in the osteoporosis group (95 % CI 1.42–3.55; P?P?=?0.21) and 3.8 (95 % CI 1.63–8.86; P?=?0.002), and in women, the OR was 1.9 (95 % CI 1.15–2.78; P?=?0.010) and 2.2 (95 % CI 1.42–3.55; P?=?0.001), respectively.

Conclusions

Severe bone mass loss may be an independent risk factor for brain WMC/SI in men and women. Low BMD may cause brain WMC/SI in the step that leads to stroke. Although there are well-designed studies on the prevention of cerebral infarction in patients with brain WMC/SI, a specific prevention method, such as aspirin, should be used for patients with low BMD who have WMC/SI. Screening for low BMD as an independent vascular risk factor in healthy subjects may be required to prevent stroke.     

Gastric Bypass for Obesity in the Elderly: Is It as Appropriate as for Young and Middle-Aged Populations?

Background

Obesity prevalence increases in elderly population. Bariatric surgery has been underused in patients over 60 because of fears of complications and lower weight loss. We postulated worse outcomes in the elderly in comparison to young and middle-aged population 1 year after gastric bypass.

Methods

We retrospectively analyzed gastric bypass outcomes in young (<40 years), middle-aged (40 to 55 years), and elderly (>60 years) patients between 2007 and 2013. Each subject over 60 (n?=?24) was matched with one subject of both the other groups according to gender, preoperative body mass index (BMI), surgical procedure, and history of previous bariatric surgery (n?=?72).

Results

Older subjects demonstrated higher prevalence of preoperative metabolic comorbidities (70 vs 30 % in the <40-year-old group, p?p?=?0.69). Age was not predictive of weight loss failure 1 year after surgery. Remission and improvement rates of comorbidities were similar between age groups 6 months after surgery.

Conclusions

Our study confirms weight loss efficacy of gastric bypass in the elderly with acceptable risks. Further studies evaluating the benefit-risk balance of bariatric surgery in the elderly population will be required so as to confirm the relevance of increasing age limit.     

Equivalent Weight Loss with Marked Metabolic Benefit Observed in a Matched Cohort with and Without Type 2 Diabetes 12?Months Following Gastric Bypass Surgery

Background

Bariatric surgery results in dramatic weight loss and improves metabolic syndrome and type 2 diabetes (T2DM). However, previous studies have noted that morbidly obese patients with T2DM experience less weight loss benefits than non-diabetic patients following bariatric surgery. We sought to determine longitudinal effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) on percent excess body mass index (BMI) loss (%EBMIL) and clinical metabolic syndrome parameters in patients with T2DM compared with appropriately matched cohort without T2DM.

Methods

Retrospective cohort analysis of T2DM patients (n?=?126) to non-T2DM patients (n?=?126) matched on age (M?=?48.1?±?9.5), sex (81?% female), race (81?% Caucasian), and pre-surgical BMI (M?=?49.3?±?9.5). Lipids, glucose, hemoglobin A1c, blood pressure, co-morbidities of obesity, medications for co-morbidities, and T2DM medications were collected at baseline, 6?months and 12?months post-surgery. %EBMIL was collected at 1, 3, 6, 9, and 12?months post-surgery. One-way analyses of variance with effect sizes estimates were conducted to compare the two groups.

Results

As expected, T2DM subjects had significantly greater pre-surgical HbA1c, blood glucose, blood pressure, and lipid parameters at baseline vs. non-T2DM (all p values of<0.05). At 1, 3, 6, 9, and 12?months after LRYRB, both groups had similar reduction in %EBMIL (p?>?0.10). At 6?months, there was a significant reduction in HbA1c, blood glucose, and lipid in the T2DM cohort compared with pre-surgical levels (p?<?0.0001). At 12?months, these values were not different to that of the non-T2DM subjects (p?>?0.10).

Conclusions

When matched on appropriate factors associated with weight loss outcomes, severely obese patients with T2DM have similar post-LRYGB weight loss outcomes in the first 12?months following surgery compared with non-T2DM patients. Furthermore, T2DM surgical patients achieved significant improvement in metabolic syndrome components.     

Shortening of the QT Interval is Observed Soon after Sleeve Gastrectomy in Morbidly Obese Patients

Background

Morbidly obese patients have an increased risk of sudden cardiac death. It is well known that obesity prolongs the QT interval, which in turn may cause ventricular arrhythmia and sudden cardiac death. The objective of this study was to establish whether sleeve gastrectomy shortens the QT interval.

Methods

Twenty-eight consecutive patients underwent sleeve gastrectomy at our institution between September 2010 and March 2011 and were included in the study. The indications for bariatric surgery were in accordance with French national guidelines. For each patient, an electrocardiogram was recorded before and then 3 months after surgery. The corrected QT (QTc) was determined independently by two physicians.

Results

The mean body mass index was 45.27?±?6.09 kg/m² before surgery and 38.32?±?5.19 kg/m² 3 months after surgery. The mean weight loss over this period was 20.71?±?7.57 kg. The QTc interval was 427?±?18.6 ms (415.7?±?12.06 in men and 428.4?±?18.96 in women) prior to surgery and was significantly lower 3 months after surgery (398.6?±?15.5 ms overall, 391.3?±?7.63 in men, and 399.6?±?16.02 in women). The QTc interval decreased in all individual patients (by an average of 28.5?±?15.6 ms overall, 24.3?±?8.38 in men, and 29?±?16.23 in women). Weight loss and decreased QTc interval were not significantly correlated (p?=?0.88).

Conclusion

Sleeve gastrectomy in morbidly obese patients was associated with a significantly lower QTc interval 3 months after surgery. These findings imply that bariatric surgery might reduce the risk of sudden cardiac death in this patient population.     

Reduced Circulating Androgen Levels After Gastric Bypass Surgery in Severely Obese Women

Background

Previous studies have shown a reduction of elevated androgen levels in premenopausal women after marked weight loss induced by bariatric surgery. In this study, we aimed to assess whether circulating androgen levels also decline after bariatric surgery in women displaying normal values preoperatively as well as in postmenopausal women.

Methods

In 36 severely obese women (six postmenopausal), levels of total testosterone, dehydroepiandresterone sulfate (DHEA-S), and sex hormone-binding globulin (SHBG) were assessed before and at ~1 year after gastric bypass. Free and bioavailable testosterone levels as well as the free androgen index were calculated by established formulas.

Results

After the surgery, women had lost on average 43.1?±?1.8 kg. Independently of the pre/postmenopausal state, women showed a marked reduction in all testosterone-related androgen markers and DHEA-S levels, while SHBG levels markedly increased (all P?<?0.001). Respective changes were found in both women with and without preoperatively elevated levels. Changes after the surgery in testosterone-related markers as well as in SHBG levels but not in DHEA-S levels were correlated with changes in insulin levels independently of body weight changes.

Conclusions

Data show a marked reduction of androgen levels in severely obese women after a surgically induced weight loss, which is independent from the menopausal state and preoperative levels. The mechanisms and consequences of these hormonal changes induced by bariatric surgery should be addressed in further studies.