Detailed description of early response of metabolic syndrome after laparoscopic Roux-en-Y gastric bypass.
BACKGROUND
Previous outcome research in bariatric surgery has been unable to document quantitative changes in co-morbidities associated with obesity owing to a lack of a standardized instrument to grade the severity. We report a detailed description of the early resolution of the metabolic syndrome using our novel scheme for assessing co-morbidities. This study was performed at a tertiary care university hospital.


METHODS
Co-morbidity data were prospectively collected for 827 patients who underwent laparoscopic Roux-en-Y gastric bypass during a 4-year period using the Assessment of Obesity-Related Co-morbidities (AORC) scale. This scale assigns a score of 0-5 for the major medical conditions associated with obesity. The co-morbid conditions of obesity and biochemical markers of the metabolic syndrome were examined preoperatively and at the follow-up visits.


RESULTS
Of the 827 patients who underwent laparoscopic Roux-en-Y gastric bypass, 72 (8.7%) met the AORC criteria for the metabolic syndrome (AORC score >2 for diabetes mellitus [DM], hypertension [HTN], and dyslipidemia [DYS]). Overall, 75% of patients with DM, 69.4% of patients with HTN, and 76.4% of patients with DYS showed improvement in these co-morbidities (decrease from the preoperative AORC score) within 2 months after surgery. Within this period, DM, HTN, and DYS resolved in 65.3%, 51.4%, and 73.6% of patients, respectively. Concurrent decreases in hemoglobin A1c, serum lipids, and blood pressure were observed (P <.05). Patients exhibited a modest excess body weight loss of 27.7% during this period. However, the mean AORC score for the whole group decreased significantly for DM, DYS, and HTN (P <.001) before significant weight loss occurred.


CONCLUSIONS
We have demonstrated a new and novel approach to categorize and more accurately define the magnitude of improvement in co-morbidities after laparoscopic Roux-en-Y gastric bypass. This improvement preceded the weight loss effects on the metabolic syndrome.
Ali
Mohamed R
MR
Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California 95817, USA. mohamed.ali@ucdmc.ucdavis.edu <mohamed.ali@ucdmc.ucdavis.edu>
Fuller
William D
WD
Rasmussen
Jason
J
D000328:Adult; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D024821:Metabolic Syndrome / Q000517:prevention & control*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
D015415:Biomarkers