Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention.
OBJECTIVE
Weight reduction improves several obesity-related health conditions. We aimed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors.


METHODS
One-year controlled clinical trial (ClinicalTrials.gov identifier NCT00273104).


METHODS
Morbidly obese subjects (19-66 years, mean (s.d.) body mass index 45.1 kg/m(2) (5.6), 103 women) were treated with either Roux-en-Y gastric bypass surgery (n=80) or intensive lifestyle intervention at a rehabilitation centre (n=66). The dropout rate within both groups was 5%.


RESULTS
Among the 76 completers in the surgery group and the 63 completers in the lifestyle group, mean (s.d.) 1-year weight loss was 30% (8) and 8% (9) respectively. Beneficial effects on glucose metabolism, blood pressure, lipids and low-grade inflammation were observed in both groups. Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group; 70 vs 33%, P=0.027, and 49 vs 23%, P=0.016. The improvements in glycaemic control and blood pressure were mediated by weight reduction. The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome, albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group. Gastrointestinal symptoms and symptomatic postprandial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention. There were no deaths.


CONCLUSIONS
Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies. However, the improvements were greatest in those patients treated with gastric bypass surgery.
Hofsø
D
D
Department of Medicine, Morbid Obesity Centre, Vestfold Hospital Trust, PO Box 2168, 3103 Tønsberg, Norway. dag.hofso@siv.no
Nordstrand
N
N
Johnson
L K
LK
Karlsen
T I
TI
Hager
H
H
Jenssen
T
T
Bollerslev
J
J
Godang
K
K
Sandbu
R
R
Røislien
J
J
Hjelmesaeth
J
J
D000328:Adult; D031204:Caloric Restriction / Q000379:methods / Q000523:psychology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000523:psychology / Q000628:therapy; D005260:Female; D015390:Gastric Bypass / Q000523:psychology; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000523:psychology / Q000601:surgery*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
JAMA. 1995 Apr 12;273(14):1093-8
7707596
Diabetologia. 1997 Feb;40(2):125-35
9049471
J Am Coll Surg. 2005 Apr;200(4):593-604
15804474
Diabetes Care. 2009 Nov;32(11):2133-5
19875608
JAMA. 1991 Jul 10;266(2):231-6
1829117
JAMA. 2003 Apr 9;289(14):1799-804
12684358
Circulation. 2005 Oct 25;112(17):2735-52
16157765
JAMA. 2005 Apr 20;293(15):1861-7
15840860
BMJ. 2010 Jan 08;340:b4909
20061358
Diabetes Care. 2005 Apr;28(4):888-94
15793191
JAMA. 2008 Jan 23;299(3):316-23
18212316
Am J Clin Nutr. 1992 Feb;55(2 Suppl):582S-585S
1733132
Arch Intern Med. 2010 Jan 25;170(2):146-54
20101009
N Engl J Med. 2005 Jul 21;353(3):249-54
16034010
BMJ. 1997 Oct 11;315(7113):912-6
9361540
Lancet. 1999 Aug 21;354(9179):617-21
10466661
Clin Chem. 1992 Sep;38(9):1802-8
1526018
Ann Surg. 2003 Jun;237(6):751-6; discussion 757-8
12796570
Am J Epidemiol. 1999 Jul 1;150(1):75-87
10400557
J Hum Hypertens. 2004 Jun;18(6):403-9
15057252
Hypertension. 1998 Dec;32(6):989-97
9856962
Diabetes Care. 2005 Feb;28(2):391-7
15677798
Hypertension. 2003 Dec;42(6):1206-52
14656957
N Engl J Med. 2007 Aug 23;357(8):741-52
17715408
Lancet. 2002 Dec 14;360(9349):1903-13
12493255
N Engl J Med. 2004 Dec 23;351(26):2683-93
15616203
Obesity (Silver Spring). 2010 Jul;18(7):1348-53
19834466
Diabetes Care. 2007 Jun;30(6):1374-83
17363746
Public Health. 2007 Jul;121(7):492-6
17399752
Diabetes Care. 2009 Apr;32(4):720-5
19131464
Am J Clin Nutr. 2009 Jul;90(1):15-22
19439456
JAMA. 1999 Oct 27;282(16):1523-9
10546691
N Engl J Med. 1989 Nov 23;321(21):1421-5
2811957
Am J Clin Nutr. 2007 Aug;86(2):301-7
17684198
J Am Soc Nephrol. 2006 Dec;17(12 Suppl 3):S213-7
17130264
J Am Soc Nephrol. 2006 Aug;17(8):2120-6
16825331
N Engl J Med. 2009 Jul 30;361(5):445-54
19641201
Eur J Endocrinol. 2009 Sep;161(3):451-8
19542241
Am J Clin Nutr. 2008 May;87(5):1128-33
18469230
Circulation. 2007 Aug 28;116(9):1081-93
17671237
Obes Surg. 2009 Dec;19(12):1605-11
19885707