Prevalence of low skeletal muscle mass following bariatric surgery.

BACKGROUND AND AIMS: Evidence on the occurrence of low skeletal muscle mass (low-SMM) following bariatric surgery (BS) as well as on the impact of low-SMM antedating BS on post-surgical body composition (BC) are scant. In this context, we aimed to prospectively evaluate the prevalence of low-SMM prior to and up to 5 years after BS, and to evaluate pre-surgical low-SMM as an independent risk factor for the presence of low-SMM after BS. METHODS: Retrospective analysis of prospectively collected database. BC was assessed by bioelectrical impedance analysis (BIA). A BIA-based formula was used to calculate skeletal muscle mass (SMM). Class I and class II low-SMM were defined respectively as a SMM index (SMMI = SMM/height2) value between -1 and -2, or > -2 standard deviations from the gender-specific regression line of the BMI versus the SMMI relationship in our reference group. RESULTS: A total 952 subjects were included, with BC being available for 877 (92%) subjects at 12 months and for 576 subjects (60%) at 60 months after BS. Prior to surgery, and at 12-, or at 60-months after surgery, class I and class II low-SMM was ascertained respectively in 15.6% and 4.6%, 5.3% and 1.4%, and 16.6% and 6.3% of the study participants. Logistic regression analysis showed that the occurrence of low-SMM at 12- and 60-months follow-up, was independently predicted not only by age at the time of surgery [respectively, HR: 1.052 (95% CI 1.020-1.084), p = 0.001; and 1.042 (95% CI 1.019-1.066); p < 0.001] but also by the presence of low-SMM prior to surgery [respectively, HR: 10.717 (95% CI 5.771-19.904), p < 0.001; and 5.718 (95% CI 3.572-9.153); p < 0.001]. CONCLUSIONS: Our data suggest that a low-SMM phenotype occurs not only in obesity surgery candidates but also after BS, and that low-SMM prior to surgery is an important risk factor for low-SMM throughout post-surgical follow-up.

A Propensity Score Cohort Study on the Long-Term Safety and Efficacy of Sleeve Gastrectomy in Patients Older Than Age 60.

Background: Bariatric surgery (BS) in older obese subjects (>60 years of age) has risen in the past decade and will continue to rise in the coming years due to ageing of the population. Aim: To evaluate the short- (12 months) and long-term (60 months) results of laparoscopic sleeve gastroscopy (LSG) in patients older than age 60. Methods: We performed a retrospective review of patients prospectively included in a database from January 2007 to December 2013. All patients >60 [older group (OG)] who had undergone LSG were included. The control group (CG) included patients aged 50 to 59 years who had undergone LSG during the same period. Results: 116 (8.4 % of total surgery) and 145 patients were included in the OG and CG, respectively. BS in patients >60 years increased from 2.4% in 2003 to 14% in the last 2 years of the study. After inverse probability of treatment weighting (IPTW) analysis, all absolute standardized differences were <0.15. A 60-month follow-up was attained in 90% of patients in the OG and 74% in the CG. There were no significant differences in postoperative complications between the two groups. At 12 and 60 months after LSG, both groups achieved a similar body mass index. There was no statistical difference in the percentage of resolution of type 2 diabetes, hypertension, dyslipidemia, and SAHS between the two groups. In both groups, all the nutritional parameters evaluated remained within the normal range throughout the study. Conclusions: LSG provides acceptable outcomes and is safe in older adults indicating that age should not be a limitation to perform BS in this population.

Ten-year outcomes after Roux-en-Y gastric bypass and sleeve gastrectomy: an observational nonrandomized cohort study.

BACKGROUND: Sleeve gastrectomy (SG) has replaced Roux-en-Y gastric bypass (RYGB) as the most commonly performed bariatric surgery procedure. Data on the long-term (up to 10 yr) outcomes after SG is scarce. No previous study has compared the long-term outcomes between RYGB and SG. OBJECTIVE: To compare 10-year weight lost and 10-year remission rates of type 2 diabetes, hypertension, and dyslipidemia between RYGB and SG. SETTING: University hospital, Spain. METHODS: Nonrandomized cohort study including all patients that underwent RYGB or SG at our institution between January 2005 and March 2008. Participants were followed yearly after bariatric surgery. Data obtained at the 10-year evaluation after RYGB or SG (between January 2015 and March 2018) was analyzed. Main study outcomes were 10-year percentage of total weight lost and percentage of excess weight lost. Secondary outcomes included 10-year remission rates of type 2 diabetes, hypertension, and dyslipidemia. Between-groups differences in 10-year percentage of total weight lost and percentage of excess weight lost were evaluated using analysis of covariance. Association between type of surgery and remission rates of obesity-related co-morbidities were evaluated using logistic regression analyses. RESULTS: Five hundred four patients were included in the study, 390 underwent RYGB and 134 SG. Follow-up rate was 84.5%. Mean 10-year percentage of total weight lost and percentage of excess weight lost were 25.3 ± 11.2% and 56.0 ± 25.6% in the RYGB group, and 27.5 ± 13.5% and 53.2 ± 25.1% in the SG group (P = .853 and P = .746, respectively). In logistic regression analyses RYGB was superior to SG in achieving 10-year hypertension and dyslipidemia remission. CONCLUSIONS: This study suggested comparable effectiveness between SG and RYGB on weight loss.