Early Endocrine and Metabolic Changes After Bariatric Surgery in Grade III Morbidly Obese Patients: A Randomized Clinical Trial Comparing Sleeve Gastrectomy and Gastric Bypass.
BACKGROUND
We compared the early endocrine and metabolic changes associated with sleeve gastrectomy (SG) and gastric bypass (GB) in grade III obese patients.


METHODS
Fifty morbidly obese patients were randomized into two groups on the basis of their position in the queue-group A comprised SG and group B was GB. Comparison between the two groups was based on clinical and laboratory variables such as fasting blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), lipids, albumin, and ferritin. Patients were assessed after 7, 14, 30, 60, and 90 days and additional laboratory tests were done on the 90(th) day.


RESULTS
The following mean values were recorded for groups A and B, respectively: Age (years), 36.4 and 31.1; weight (kg), 123.2 and 128.3; and body mass index (BMI; kg/m(2)), 45.6 and 47.3. In the first postoperative week, group B showed a greater weight loss (P=0.047) that was not observed after 14, 30, 60, and 90 days (P>0.05). Group A had an average excess weight loss of 31.09 kg compared to 32.69 kg in group B (P=0.222). Glycemic control was better in group B (P=0.023), whereas the control of systemic arterial pressure was better in group A (P=0.026). There were no significant differences in early lipid control and micronutrient deficiencies between the two groups.


CONCLUSIONS
SG and GB were equally effective in promoting weight loss after 90 days. However, whereas SG was associated with better early remission rates for hypertension, GB was more effective in fasting blood glucose control but not in HOMA-IR and HbA1c levels. There was no difference in the protein or vitamin deficiencies of the two groups.
1 FIOCRUZ, Rio de Janeiro, RJ, Brazil, and Postgraduate Program in Medical Sciences, Fluminense Federal University (UFF) , Niterói, RJ, Brazil .
Fernando
F
de Barros
2 Postgraduate Program in Medical Sciences, Fluminense Federal University (UFF) , Niterói, RJ, Brazil .
Sérgio
S
Setúbal
3 Department of General and Specialized Surgery, Fluminense Federal University (UFF) , Niterói, RJ, Brazil .
José Manoel
JM
Martinho
4 Department of Statistics, Fluminense Federal University (UFF) , Niterói, RJ, Brazil .
Ana Beatriz Soares
AB
Monteiro
D000328:Adult; D062186:Arterial Pressure; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D001938:Brazil; D005260:Female; D005293:Ferritins / Q000097:blood; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
D015415:Biomarkers; D001786:Blood Glucose; D005293:Ferritins; D006442:Glycated Hemoglobin; D007328:Insulin; D008055:Lipids; D012709:Serum Albumin; D000075462:Serum Albumin, Human; C422455:ALB protein, human