Predictors of weight loss and reversal of comorbidities in malabsorptive bariatric surgery.
BACKGROUND
Cardiovascular and metabolic comorbidities are dramatically increased in severe obesity, a condition highly resistant to nonsurgical therapy.


OBJECTIVE
The objective was to identify predictors of weight loss and reversal of comorbidity in obese patients undergoing malabsorptive bariatric surgery.


METHODS
Morbidly obese men and women (n = 107) were studied before and 2 y after biliopancreatic diversion (BPD). Body composition, serum lipid profile, oral glucose tolerance, and blood pressure were measured. Insulin sensitivity was determined by use of a euglycemic clamp. The length of the small intestine was measured during surgery.


RESULTS
Intestinal length was 671 +/- 99 cm, and the residual absorbing intestine after BPD ranged from 54% to 24% of initial length. Patients lost an average of 36% of their initial weight, with approximately 50% of them reaching a body mass index (in kg/m(2)) < 30. Serum cholesterol decreased (from 4.58 +/- 1.11 to 3.34 +/- 0.73 mmol/L; P < 0.0001), as did serum triacylglycerols (from 1.52 +/- 0.59 to 0.88 +/- 0.35 mmol/L; P < 0.0001), whereas insulin sensitivity rose 150% (from 26 +/- 4 to 64 +/- 11 micromol . min(-1) . kg fat-free mass(-1); P < 0.0001). Diabetes (in 23% of patients before surgery) and hypertension (in 83%) were reduced (by 88% and 96%, respectively) after surgery. In a multivariate model (including sex, age, intestinal length, presence of diabetes, insulin sensitivity, and initial fat mass), age and diabetes were independent, negative predictors of weight loss, whereas initial fat mass was a strong positive predictor (r(2) = 0.51).


CONCLUSIONS
Two years after BPD in morbidly obese patients, comorbidities are largely corrected and insulin resistance is fully reversed despite persistent obesity. Initial fat mass, but not residual intestinal length, is the strongest predictor of weight loss after BPD.
Valera-Mora
Maria E
ME
Department of Internal Medicine, Catholic University of Rome, Rome, Italy.
Simeoni
Benedetta
B
Gagliardi
Lucilla
L
Scarfone
Antonino
A
Nanni
Giuseppe
G
Castagneto
Marco
M
Manco
Melania
M
Mingrone
Geltrude
G
Ferrannini
Ele
E
D000273:Adipose Tissue / Q000378:metabolism*; D000328:Adult; D049088:Bariatrics; D015904:Biliopancreatic Diversion; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D005260:Female; D015309:Glucose Clamp Technique; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control; D007333:Insulin Resistance; D007421:Intestine, Small / Q000033:anatomy & histology / Q000502:physiology; D008286:Malabsorption Syndromes / Q000209:etiology; D008297:Male; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss / Q000502:physiology*
D014280:Triglycerides; D002784:Cholesterol