Metabolic or bariatric surgery? Long-term effects of malabsorptive vs restrictive bariatric techniques on body composition and cardiometabolic risk factors.
BACKGROUND
Obesity is an increasing health problem and surgery seems to be the only treatment effective in achieving weight loss without relapse. Among bariatric techniques, many differences exist in terms of weight loss and resolution of comorbidities. Up to now, there are no prospective studies comparing long-term effects of malabsorptive vs restrictive techniques.


OBJECTIVE
In this study, cardiometabolic risk factors and body composition changes after malabsorptive biliointestinal bypass (BIBP) and restrictive laparoscopic adjustable gastric banding (LAGB) were compared during a 4-year follow-up.


METHODS
Prospective, case-control and cohort study.


METHODS
In all, 80 obese subjects, matched for weight and age. Altogether, 40 patients underwent BIBP and 40 underwent LAGB.


METHODS
Weight, body composition, fasting and post-loading plasma glucose and insulin, homeostatic model assessment index (HOMA-I), lipid profile, blood pressure (BP), erythrocyte sedimentation rate and fibrinogen were monitored at baseline, 12 and 48 months.


RESULTS
At 12 months after surgery, a significant reduction in body mass index, total fat mass (FM), trunk FM (trFM), trFM/legs FM (lFM) ratio (trFM/lFM), triglycerides, BP and inflammation markers was observed in both groups. BIBP patients showed a significant reduction in total cholesterol (Tot-C), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), whereas the LAGB group showed a significant increase of HDL-C. A further improvement of all the parameters evaluated was seen in the BIBP group at 48 months after surgery.


CONCLUSIONS
Both bariatric procedures exerted positive effects on cardiometabolic risk factors and on weight loss in the population studied, but on the long-term period, HOMA-I, Tot-C/HDL-C ratio and body composition improvements were more evident after BIBP. We conclude that malabsorptive BIBP seems to be more effective than LAGB in treating visceral obesity and its metabolic complications.
Lubrano
C
C
Internal Medicine, Department of Medical Pathophysiology, I Faculty of Medicine, Sapienza University, Rome, Italy.
Mariani
S
S
Badiali
M
M
Cuzzolaro
M
M
Barbaro
G
G
Migliaccio
S
S
Genovesi
G
G
Rossi
F
F
Celanetti
M
M
Fiore
D
D
Pandolfo
M M
MM
Specchia
P
P
Spera
G
G
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D009765:Obesity / Q000097:blood / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D013995:Time; D015431:Weight Loss / Q000502:physiology*