Effects of obesity surgery on the metabolic syndrome.

HYPOTHESIS: Individuals with the metabolic syndrome (MS), a clustering of risk factors (high levels of triglycerides and serum glucose, low level of high-density-lipoprotein cholesterol, high blood pressure, abdominal obesity) defined by the Third Report of the National Cholesterol Education Program Expert Panel of Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (ATPIII), are at high risk of developing coronary heart disease and type 2 diabetes mellitus and may benefit from surgically induced weight loss. DESIGN: Prospectively controlled clinical study. SETTING: A tertiary referral center. PATIENTS: From December 1, 1999, to March 31, 2002, 645 consecutive morbidly obese patients were enrolled in a surgically supervised weight loss program, and the efficacy of weight loss 1 year after surgery was examined. INTERVENTION: Laparoscopic weight reduction surgery. MAIN OUTCOME MEASURES: Prevalence of the MS as defined by the ATPIII (>3 of the following): waist circumference greater than 102 cm in men and 88 cm in women; serum triglyceride level of at least 150 mg/dL (1.70 mmol/L); high-density lipoprotein cholesterol level less than 40 mg/dL (1.04 mmol/L) in men and 50 mg/dL (1.30 mmol/L) in women; blood pressure of at least 130/85 mm Hg; and serum glucose level of at least 110 mg/dL (6.11 mmol/L). RESULTS: Of 645 individuals, 337 (52.2%) met the ATPIII definition of the MS. Individuals with the MS had significant differences in age (31.5 years vs 28.1 years), sex (127 [37.7%] of 337 men vs 81 [26.3%] of 308 women), and many metabolic abnormalities compared with patients without the MS. Laparoscopic vertical banded gastroplasty was performed in 528 patients (81.9%) and laparoscopic gastric bypass in 117 (18.1%). A significant decrease in weight was found in both groups, but individuals who underwent laparoscopic gastric bypass lost significantly more weight (mean +/- SD, 38.4 +/- 14.4 kg vs 35.1 +/- 16.8 kg) and achieved a lower body mass index (29.3 +/- 4.8 vs 32.0 +/- 5.4) than individuals who underwent laparoscopic vertical banded gastroplasty. Substantial mean weight reduction (31.9%) of patients with the MS resulted in a substantial reduction of systolic (11.0 mm Hg) and diastolic (11.4 mm Hg) blood pressure and levels of glucose (46.1 mg/dL [2.56 mmol/L]), triglycerides (196.6 mg/dL [2.22 mmol/L]), and total cholesterol (33.7 mg/dL [0.88 mmol/L]) 1 year after surgery. These improvements resulted in a 95.6% resolution of the MS 1 year after surgery. There was no difference between operations (laparoscopic vertical banded gastroplasty or laparoscopic gastric bypass) in the resolution rate of the MS 1 year after surgery (95.0% vs 98.4%, respectively). CONCLUSION: The MS is prevalent in 52.2% of morbidly obese individuals enrolling in an obesity surgery program. Significant weight reduction 1 year after surgery markedly improved all aspects of the MS and resulted in a cure rate of 95.6%. Obesity surgery performed by laparoscopic surgery is recommended for obese patients with the MS.

Metabolic syndrome in obese patients referred for weight reduction surgery in Taiwan.

BACKGROUND AND PURPOSE: The inverse relation between life expectancy and obesity is in large part due to multiple metabolic and cardiovascular comorbidities. Metabolic syndrome (MS) is defined as a cluster of these comorbidities. The prevalence of MS in obesity is not clear. This investigation assessed the prevalence and inter-relationships of MS with various demographic and clinical characteristics in patients with severe obesity. METHODS: A total of 534 obese patients referred to a surgical center for weight reduction surgery were included in this retrospective study. Data collected included blood pressure, anthropometric measurements, and biochemical parameters associated with metabolic comorbidities and MS. The prevalence of MS in various subgroups was analyzed. RESULTS: The frequency of metabolic comorbidities included hypertension in 29.8%, hyperglycemia in 29.0%, hyperlipidemia in 61.0%, hyperuricemia in 57.9%, and abnormal liver function in 60.9%. The presence of any of these 4 metabolic comorbidities in the absence of others was uncommon. Only 28 patients (5.2%) had no metabolic comorbidities. The criteria for MS were met by 217 patients (50.7%). Patients with MS were significantly older (32.9 years vs 29.5 years), more likely to be male (31.9% vs 20.5%) and more likely to have metabolic comorbidities compared with patients without MS. In the multivariate analysis, male gender, age, and abnormal liver function remained significantly associated with the development of MS, while body mass index (BMI) was not. CONCLUSIONS: Metabolic comorbidities were common in the obese patients referred for weight reduction surgery. The cluster of metabolic comorbidities in MS was significantly associated with male gender, and increased age but not with BMI.

Clinical significance of central obesity in laparoscopic bariatric surgery.

BACKGROUND: Laparoscopic surgery had increased the interest and growth of bariatric surgery. Whether central obesity has any adverse effect in laparoscopic bariatric surgery is not clear. METHODS: 612 morbidly obese patients received laparoscopic bariatric surgery,in a prospectively controlled clinical trial of the outcome of the bariatric surgery. For comparison, subjects were dichotomized into either a central obesity group or peripheral obesity group, based on waist/hip ratio (WHR). Various biochemistry and blood count variables, and perioperative and postoperative results were measured. RESULTS: There were more female (458) than male patients (154). Male patients had higher BMI, and female patients were younger. 56 of 154 male patients (36.4%) belonged to the central obesity (WHR >1.0), and 321 of 458 female patients (70.1%) had central obesity (WHR >0.85). Central obesity was associated with age but not with BMI in males. In females, central obesity was associated with increased BMI. Central obesity predicted increased hyperglycemia and triglyceride levels in both male and female patients. Male patients with central obesity had higher WBC counts than the other patients. Although central obesity was associated with more intra-operative blood loss and prolonged recovery in female patients, there was no increase in complication rate or difference in postoperative weight loss. CONCLUSION: Central obesity is associated with a higher degree of hyperglycemia, hyperlipidemia and leukocytosis in morbidly obese patients who undergo bariatric surgery. Although there is increased technical difficulty in patients with severe central obesity, laparoscopic bariatric surgery is safe and effective in producing weight loss.

Gastrointestinal quality of life following laparoscopic vertical banded gastroplasty.

BACKGROUND: Laparoscopic vertical banded gastroplasty (LVBG) is a safe and effective treatment for morbid obesity. Previous studies disclosed a significant improvement in the health-related quality of life after substantial weight loss following VBG. Data regarding the specific gastrointestinal quality of life following LVBG is lacking. MATERIALS AND METHODS: 223 patients who underwent LVBG for morbid obesity were studied prospectively. Quality of life was measured by the Gastrointestinal Quality of life Index (GIQLI), a 36-item questionnaire before surgery, and at 6 months, 1 year and 2 years after surgery. The questionnaire is divided into 5 domains, and the maximum score is 144. RESULTS: After LVBG, weight loss has been good. Mean BMI decreased from 43.2 to 31.3 after 2 years. Co-morbidities were eliminated in 71%. 84.3% of patients were satisfied with the results. However, the score of GIQLI remained similar before and after surgery. Preoperative score was 106.2 +/- 19 points. The score became 116.6 +/- 9, 106.8 +/- 21, and 108.5 +/- 20 at 6 months, 1 year and 2 years after surgery respectively. The patients had improvement in 3 domains of the questionnaire (social function, physical status and psychological emotions) but decreased in domains of core symptoms and disease-specific items. CONCLUSION: Although LVBG was effective in reduction of weight and resolution of co-morbidities in morbidly obese patients, the specific gastrointestinal quality of life did not improve. Many patients developed some specific gastrointestinal symptoms in order to obtain weight reduction.