title: Metabolic score: insights on the development and prediction of remission of metabolic syndrome after gastric bypass.
abstract: BACKGROUND
  Metabolic syndrome (MetS) clusters the most dangerous cardiovascular disease risk factors. Although insulin resistance and central obesity play an important role in the pathogenesis, the factors that determine its development and ultimate remission after Roux-en-Y gastric bypass (RYGB) are not fully understood.
  
  
  METHODS
  We recruited a prospective cohort of 210 consecutive patients after RYGB between January 2010 and December 2011. Patients were evaluated clinically and with a biochemical profile preoperatively and at 12 months after surgery. Visceral adipose tissue and subcutaneous abdominal adipose tissue samples were collected at surgical intervention. We aimed to identify factors associated with MetS in morbidly obese patients and predictors of its remission 12 months after RYGB.
  
  
  RESULTS
  Increasing age (>40 years), male sex, alanine aminotransferase levels and visceral adipose tissue/subcutaneous adipocyte size ratio were independently related to the expression of MetS at the moment of surgery.One year after RYGB, there was a significant decrease in the prevalence of MetS (63.3%-10%; P < 0.001) and in each of its components. A multivariable analysis for the remission of MetS identified that only fasting glucose levels (OR = 13.4; P = 0.01) and duration of obesity (OR = 1.08; P = 0.04) were independently related to the persistence of MetS. A metabolic score (scale of 1-10), consisting of duration of obesity, fasting blood glucose levels, the presence of high blood pressure and low levels of high-density lipoprotein identified 4 different risk categories for the persistence of MetS (area under the curve = 0.848).
  
  
  CONCLUSIONS
  The metabolic score can be used to predict the remission of MetS after RYGB with high accuracy. Patients in high-risk groups might be managed more aggressively and low-risk patients may have their medication discontinued earlier with extra safety.
authors.affiliation: *Surgery Department and †Biochemistry Department, Faculty of Medicine, University of Porto, Porto, Portugal ‡Surgery Department, Sao Joao Medical Center, Porto, Portugal §CINTESIS, Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal ¶Clinical Pathology Department, Sao Joao Medical Center Porto, Portugal; and ‖Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Gil
authors.initials: G
authors.lastname: Faria
authors.forename: Diogo
authors.initials: D
authors.lastname: Pestana
authors.forename: Marisa
authors.initials: M
authors.lastname: Aral
authors.forename: John
authors.initials: J
authors.lastname: Preto
authors.forename: Sónia
authors.initials: S
authors.lastname: Norberto
authors.forename: Conceição
authors.initials: C
authors.lastname: Calhau
authors.forename: João T
authors.initials: JT
authors.lastname: Guimarães
authors.forename: Antonio
authors.initials: A
authors.lastname: Taveira-Gomes
mesh_terms: D050153:Abdominal Fat / Q000033:anatomy & histology; D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D006973:Hypertension / Q000150:complications; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D009767:Obesity, Morbid / Q000601:surgery*; D011174:Portugal / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008075:Lipoproteins, HDL; D000410:Alanine Transaminase