Changes in body weight, glucose homeostasis, lipid profiles, and metabolic syndrome after restrictive bariatric surgery.
OBJECTIVE
Bariatric surgery is an established therapy for morbid obesity. We evaluated the effects of sleeve-gastrectomy on weight, glucose and lipid metabolism and prevalence of metabolic-syndrome for up to 2 years.


METHODS
In 52 morbidly obese patients weight, BMI, total-cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, Lipoprotein(a), glucose, HbA1c, insulin, and criteria defining the metabolic-syndrome were determined preoperatively and 6 (n=52), 12 (n=41) and 24 (n=5) months after surgery.


RESULTS
BMI decreased from 51±8 kg/m² to 40±7, 39±8, and 38±9 kg/m² at 6, 12, and 24 months postoperatively. Glucose and HbA1c changed from 116±44 to 93±21 and 94±18 mg/dl and 6.0±1.3 to 5.4±0.8 and 5.4±0.8% at 6 and 12 months postoperatively. Triglycerides decreased from 159±87 to 116±41 and 116±62 mg/dl, while HDL--cholesterol increased from 46±12 to 50±12 and 56±13 mg/dl at 6 and 12 months. None of the changes correlated with changes in weight. Prevalence of metabolic syndrome decreased from 81% to 36% and 34% at 6 and 12 months, with individual criteria (central obesity, triglycerides, HDL-cholesterol, hypertension, and fasting glucose) being reduced by 8/12%, 31/28%, 12/37%, 27/30%, and 38/31% at 6/12 months, respectively. The decrease in triglycerides and HbA1c was more pronounced in hypertriglyceridemic patients compared to normo-triglyceridemic patients, while there was no significant difference between diabetic and non-diabetic patients.


CONCLUSIONS
This is the first study evaluating sleeve-gastrectomy in German patients. Our data indicate that sleeve-gastrectomy induces a similar metabolic improvement as malabsorptive surgery. Although metabolic improvement did not correlate with weight reduction, improvement almost exclusively occurred within the first 6 months, when significant weight reduction occurred. It is unclear whether this relates to the operative techniques or to the selection of patients.
Medical Department II - Grosshadern, Ludwig-Maximilians University Munich, Munich, Germany.
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Hüttl
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Lang
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Piotrowski
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Parhofer
D000328:Adult; D050110:Bariatric Surgery; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy; D015391:Gastroplasty; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control; D015228:Hypertriglyceridemia / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy; D008055:Lipids / Q000097:blood*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D015431:Weight Loss
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids; C517652:hemoglobin A1c protein, human