Association between bariatric surgery and risks of cancer among Chinese patients with type 2 diabetes mellitus: A retrospective cohort study.

BACKGROUND: To examine risks of cancers, obesity-related cancers (eg, cancers in digestive organs, breast, ovary, kidney, thyroid, and myeloma), cancer-related mortality, and all-cause mortality in patients with type 2 diabetes mellitus (T2DM) and obesity who underwent bariatric surgery. METHODS: A retrospective cohort of 1944 T2DM patients with obesity (345 bariatric surgery patients and 1599 matched controls) who were free of cancer from 2006 to 2017 was assembled. One-to-five propensity score matching followed by propensity score trimming was used to balance baseline covariates. RESULTS: During a mean follow-up period of 37 months, there are risks that in 3.2%, 1.4%, 0.9%, and 3.2% of bariatric patients cancer, obesity-related cancer, cancer-related mortality, and all-cause mortality, respectively, would occur. Surgical patients were found to have reduced incidence rates (IRs) of obesity-related cancer (0.531/100 person-years, 95% confidence interval [CI]: 0.172-1.238/100 person-years) and cancer of breast and genital organs (0.394/100 person-years, 95% CI: 0.048-1.424/100 person-years) than matched control patients whose IRs for obesity-related cancer and cancer of breast and genital organs were 0.627/100 person-years (95% CI: 0.426-0.889/100 person-years) and 0.521/100 person-years (95% CI: 0.277-0.891/100 person-years), respectively. Patients in the surgical group had a significant reduction in risk of all-cause mortality (hazard ratio [HR] = 0.508, P = .041). Effects of bariatric surgery on any cancers (HR = 1.254, P = .510), obesity-related cancers (HR = 0.843, P = .724), and cancer mortality (HR = 1.304, P = .694) were not significant. CONCLUSIONS: Bariatric surgery was not associated with risks of overall cancer, obesity-related cancer, and cancer mortality among T2DM patients with obesity at 3 years.

Effects of bariatric surgery on kidney diseases, cardiovascular diseases, mortality and severe hypoglycaemia among patients with Type 2 diabetes mellitus.

BACKGROUND: Bariatric surgery has been widely indicated for the management of obesity and related comorbidities. However, there are uncertainties pertaining to the risks of post-bariatric severe hypoglycaemia (SH), cardiovascular diseases (CVDs), end-stage kidney diseases (ESKDs) and all-cause mortality in obese patients with Type 2 diabetes mellitus (T2DM), especially among Asian populations. METHODS: A retrospective population-based cohort of 1702 obese T2DM patients who were free of CVD and ESKD were assembled based on the 2006-17 Hospital Authority database. One-to-five propensity-score matching was used to balance baseline covariates between patients in bariatric surgery and control groups. Incidence rates (IRs) of SH, CVD, Stage 4/5 chronic kidney diseases (CKD), ESKD and all-cause mortality events for two groups were calculated. Hazard ratios (HR) for SH, CVD and Stage 4/5 CKD events were assessed using Cox-proportional hazard models. Changes in estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) were measured up to 60 months. RESULTS: Over a mean follow-up period of 32 months with 5725 person-years, cumulative incidences of mortality, CVD, Stage 4/5 CKD, ESKD and SH were 0, 0.036, 0.050, 0.017 and 0.020, respectively. The surgery group had a significant reduction in risk of CVD events (HR = 0.464, P = 0.015) and no occurrence of mortality events. However, there were no significant differences in risks of SH [HR = 0.469, 95% confidence interval (CI): 0.204-1.081], Stage 4/5 CKD (HR =0.896, 95% CI: 0.519-1.545) and ESKD (HR = 0.666, 95% CI: 0.264-1.683) between two groups, although IRs were lower in the surgery group. Surgical patients had significantly higher eGFR within 12 months and had significantly lower UACR until 48 months. CONCLUSIONS: Among obese T2DM patients, bariatric surgery lowered the risk of CVD and mortality, and was beneficial towards the kidney outcomes.

Improvement in patient-reported outcomes in Chinese adults after bariatric surgery: 1-year follow-up of a prospective cohort.

BACKGROUND: Impaired health-related quality of life is commonly observed in patients with obesity who are scheduled for bariatric surgery. However, bariatric surgery tends to improve quality of life physically, with no final conclusion regarding mental domains. OBJECTIVE: To assess changes of patient-reported outcomes in terms of health-related quality of life, depression, anxiety status, and physical activity (PA) after bariatric surgery among patients with obesity. SETTINGS: Queen Mary Hospital, Tung Wah Hospital, and United Christian Hospital, Hong Kong SAR; a longitudinal study. METHODS: A multicenter, prospective, observational cohort study was conducted in Hong Kong between 2017 and 2018. Follow-up interviews at 1, 3, 6, and 12 months postoperatively were administrated via telephone. Short Form-12 Health Survey Version 2, Euroqol 5-dimension-5-level, and Impact of Weight on Quality of Life-Lite were used to assess health-related quality of life. Scores of anxiety and depression were evaluated by Hospital Anxiety and Depression Scale. Walking, moderate, and vigorous metabolic equivalent tasks and PA levels were measured by International Physical Activity Questionnaire-Short Form. Demographic and clinical characteristics, including age, sex, body mass index, and preexisting co-morbidities at baseline were collected. Comparisons of scores were made between baseline and 12 months using paired t test or McNemar test. RESULTS: A total of 25 patients who have received bariatric surgery (laparoscopic sleeve gastrectomy: 96%; laparoscopic gastric bypass: 4%) and 25 control patients matched using propensity scores derived by baseline covariates were involved. Significant improvements were observed in health-related quality of life regarding physical functioning (P < .001), role physical (P = .013), bodily pain (P = .011), general health (P < .011), vitality (P = .029), social functioning (P = .017), and physical composite summary (P < .001) of Short Form-12 Health Survey Version 2 from baseline to follow-up 12 months after surgery. Scores of physical composite summary, mental composite summary, and Short Form-6 D of surgical patients all had an overall upward trend during observation compared with those in the control group. All domains in Impact of Weight on Quality of Life-Lite were significantly higher at 12 months compared with baseline (P = .001 in sexual life domain, P < .001 in other domains). Patients experienced a decrease in depression score of Hospital Anxiety and Depression Scale 12 months after bariatric surgery (P = .026), while anxiety score was not found to differ from baseline (P = .164). No significant differences in total metabolic equivalent tasks (P = .224) and PA levels (P = .180) between baseline and 12-month follow-up were found. CONCLUSION: After 12 months of follow-up, increase in physical quality of life, reduction in depression status and less impairment caused by weight were observed, without significant changes in anxiety score and postoperative PA.