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Long-Term Effects of Bariatric Surgery on Type II Diabetes, Hypertension and Hyperlipidemia: A Meta-Analysis and Meta-Regression Study with 5-Year Follow-Up

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Abstract

Background

The first aim of the study was to estimate weight loss and major modifiable risk factors after bariatric surgery. The second aim was to investigate the relationship between the reduction in cardiovascular risk and weight loss over time.

Methods

A random effect of meta-analysis and dose–response meta-regression was used to evaluate weight loss and the risk of type II diabetes, hypertension and hyperlipidemia, 2–5 years after surgery.

Results

A search of the literature led to the selection of 22 papers. The body mass index (BMI) at the end of the observation period was 31.7 (95 % CI = 29.7–33.7; I2 = 6 %). The risk of type II diabetes, hypertension and hyperlipidemia decreased after bariatric surgery, with relative risks of, respectively, 0.33 (95 % CI = 0.26–0.41; I2 = 42 %), 0.54 (95 % CI = 0.46–0.64; I2 = 68 %) and 0.33 (95 % CI = 0.22–0.46; I2 = 74 %). Nonlinear meta-regression revealed different patterns of risk: Hypertension risk reached a minimum when the BMI fell 10 units. The risks of all cardiovascular outcomes reached a plateau, 20–40 months after surgery.

Conclusions

The reduction in arterial hypertension reached a nadir earlier than the risk of diabetes and hyperlipidemia, thus indicating a possible link between weight reduction and positive hemodynamic effects.

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References

  1. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.

    Article  PubMed  Google Scholar 

  2. van Vliet-Ostaptchouk JV, Snieder H, Lagou V. Gene-lifestyle interactions in obesity. Curr Nutr Rep. 2012;1:184–96.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. World Health Organization. Obesity and overweight - fact sheet No. 312. Updated March 2013. Accessed June 11, 2013: http://www.who.int/mediacentre/factsheets/fs312/en/index.html.

  4. Van Gaal LF, Maggioni AP. Overweight, obesity, and outcomes: fat mass and beyond. Lancet. 2013.

  5. Klein S, Burke LE, Bray GA, et al. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation. Circulation. 2004;110(18):2952–67.

    Article  PubMed  Google Scholar 

  6. Renehan AG. Bariatric surgery, weight reduction, and cancer prevention. Lancet Oncol. 2009;10(7):640–1.

    Article  PubMed  Google Scholar 

  7. Singh GM, Danaei G, Farzadfar F, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One. 2013;8(7):e65174.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Borrell LN, Samuel L. Body mass index categories and mortality risk in us adults: the effect of overweight and obesity on advancing death. Am J Public Health. 2014;104(3):512–9. REV2 COMM4.

    Article  PubMed  Google Scholar 

  9. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.

    Article  CAS  PubMed  Google Scholar 

  10. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  12. Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev. 2011;12(8):602–21.

    Article  CAS  PubMed  Google Scholar 

  13. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. 215–357, iii-iv.

    Article  CAS  Google Scholar 

  14. Acosta A, Abu Dayyeh BK, Port JD, et al. Recent advances in clinical practice challenges and opportunities in the management of obesity. Gut. 2014. doi:10.1136/gutjnl-2013-306235.

    PubMed  Google Scholar 

  15. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. REV2 COMM4.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Guo X, Liu X, Wang M, et al. The effects of bariatric procedures versus medical therapy for obese patients with type 2 diabetes: Meta-analysis of randomized controlled trials. Biomed Res Int. 2013;2013:410609.

    PubMed Central  PubMed  Google Scholar 

  17. Avenell A, Broom J, Brown TJ, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess. 2004;8(21):1–182. iii-iv.

    Article  Google Scholar 

  18. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  PubMed  Google Scholar 

  19. Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379(9833):2300–11.

    Article  PubMed  Google Scholar 

  20. Fridman A, Moon R, Cozacov Y, et al. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. J Am Coll Surg. 2013;217(4):614–20.

    Article  PubMed  Google Scholar 

  21. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2013;149(3):275–87. REV2 COMM4.

    Article  Google Scholar 

  22. Ricci C, Gaeta M, Rausa E, et al. Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6587 patients. Obes Surg. 2014;24(4):522–8. REV2 COMM4.

    Article  PubMed  Google Scholar 

  23. Frigg A, Peterli R, Peters T, et al. Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding. Obes Surg. 2004;14(2):216–23.

    Article  PubMed  Google Scholar 

  24. Ponce J, Haynes B, Paynter S, et al. Effect of lap-band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg. 2004;14(10):1335–42.

    Article  PubMed  Google Scholar 

  25. Adami GF, Papadia F, Carlini F, et al. Effect of biliopancreatic diversion on hypertension in severely obese patients. Hypertens Res. 2005;28(2):119–23.

    Article  PubMed  Google Scholar 

  26. Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243(2):181–8.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of weight loss on predicted cardiovascular risk: Change in cardiac risk after bariatric surgery. Obesity (Silver Spring). 2007;15(3):772–84.

    Article  Google Scholar 

  28. Ikonomidis I, Mazarakis A, Papadopoulos C, et al. Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study. J Hypertens. 2007;25(2):439–47.

    Article  CAS  PubMed  Google Scholar 

  29. Larrad-Jimenez A, Diaz-Guerra CS, de Cuadros BP, et al. Short-, mid- and long-term results of Larrad biliopancreatic diversion. Obes Surg. 2007;17(2):202–10.

    Article  PubMed  Google Scholar 

  30. Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following Roux-en-Y gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity. Obes Surg. 2007;17(2):176–84.

    Article  PubMed  Google Scholar 

  31. Goergen M, Arapis K, Limgba A, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty: Results of a 2-year follow-up study. Surg Endosc. 2007;21(4):659–64.

    Article  CAS  PubMed  Google Scholar 

  32. Pinheiro JS, Schiavon CA, Pereira PB, et al. Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Surg Obes Relat Dis. 2008;4(4):521–5. discussion 526–527.

    Article  PubMed  Google Scholar 

  33. Muller MK, Rader S, Wildi S, et al. Long-term follow-up of proximal versus distal laparoscopic gastric bypass for morbid obesity. Br J Surg. 2008;95(11):1375–9.

    Article  CAS  PubMed  Google Scholar 

  34. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.

    Article  CAS  PubMed  Google Scholar 

  35. Yan E, Ko E, Luong V, et al. Long-term changes in weight loss and obesity-related comorbidities after Roux-en-Y gastric bypass: a primary care experience. Am J Surg. 2008;195(1):94–8.

    Article  PubMed  Google Scholar 

  36. Csendes A, Maluenda F, Burgos AM. A prospective randomized study comparing patients with morbid obesity submitted to laparotomic gastric bypass with or without omentectomy. Obes Surg. 2009;19(4):490–4.

    Article  PubMed  Google Scholar 

  37. Pontiroli AE, Laneri M, Veronelli A, et al. Biliary pancreatic diversion and laparoscopic adjustable gastric banding in morbid obesity: their long-term effects on metabolic syndrome and on cardiovascular parameters. Cardiovasc Diabetol. 2009;8:37.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Steffen R, Potoczna N, Bieri N, et al. Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96 % follow-up. Obes Surg. 2009;19(1):3–12.

    Article  PubMed  Google Scholar 

  39. Habib P, Scrocco JD, Terek M, et al. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol. 2009;104(9):1251–5.

    Article  CAS  PubMed  Google Scholar 

  40. Prachand VN, Ward M, Alverdy JC. Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI > or = 50 kg/m2) compared with gastric bypass. J Gastrointest Surg. 2010;14(2):211–20.

    Article  PubMed  Google Scholar 

  41. Schouten R, Wiryasaputra DC, van Dielen FM, et al. Long-term results of bariatric restrictive procedures: a prospective study. Obes Surg. 2010;20(12):1617–26.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21(11):1650–6.

    Article  PubMed  Google Scholar 

  43. Gouillat C, Denis A, Badol-Van Straaten P, et al. Prospective, multicenter, 3-year trial of laparoscopic adjustable gastric banding with the MIDBAND. Obes Surg. 2012;22(4):572–81.

    Article  PubMed  Google Scholar 

  44. Prasad P, Tantia O, Patle N, et al. An analysis of 1-3-year follow-up results of laparoscopic sleeve gastrectomy: an Indian perspective. Obes Surg. 2012;22(3):507–14.

    Article  PubMed  Google Scholar 

  45. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    Article  CAS  PubMed  Google Scholar 

  46. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.

    Article  CAS  PubMed  Google Scholar 

  47. Orsini N, Li R, Wolk A, et al. Meta-analysis for linear and nonlinear dose–response relations: Examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175(1):66–73.

    Article  PubMed Central  PubMed  Google Scholar 

  48. StataCorp. Stata Statistical Software: Release 12. College Station: StataCorp LP.37; 2011.

    Google Scholar 

  49. SAS Institute Inc., SAS 9.1.2 Help and Documentation, Cary, NC: SAS Institute Inc.

  50. Vest AR, Heneghan HM, Agarwal S, et al. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98(24):1763–77.

    Article  PubMed  Google Scholar 

  51. Van de Voorde J, Pauwels B, Boydens C, et al. Adipocytokines in relation to cardiovascular disease. Metabolism. 2013;62(11):1513–21.

    Article  PubMed  Google Scholar 

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Conflict of Interest Statement

Cristian Ricci, Maddalena Gaeta, Emanuele Rausa, Emanuele Asti, Francesco Bandera and Luigi Bonavina have no conflict of interest to declare.

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Authors and Affiliations

  1. Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany

    Cristian Ricci

  2. Department of Preventive, Occupational and Community Medicine, University of Pavia, Pavia, Italy

    Maddalena Gaeta

  3. Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy

    Emanuele Rausa, Emanuele Asti & Luigi Bonavina

  4. Heart Failure Unit, San Donato University Hospital, Milan, Italy

    Francesco Bandera

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  1. Cristian Ricci
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  2. Maddalena Gaeta
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Correspondence to Cristian Ricci.

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Ricci, C., Gaeta, M., Rausa, E. et al. Long-Term Effects of Bariatric Surgery on Type II Diabetes, Hypertension and Hyperlipidemia: A Meta-Analysis and Meta-Regression Study with 5-Year Follow-Up. OBES SURG 25, 397–405 (2015). https://doi.org/10.1007/s11695-014-1442-4

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  • DOI: https://doi.org/10.1007/s11695-014-1442-4

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