The Efficacy of Selected Bariatric Surgery Methods on Lipid and Glucose Metabolism: A Retrospective 12-Month Study

By Bužga, Marek; Marešová, Petra et al. | Central European Journal of Public Health, March 2018 | Go to article overview

The Efficacy of Selected Bariatric Surgery Methods on Lipid and Glucose Metabolism: A Retrospective 12-Month Study


Bužga, Marek, Marešová, Petra, Petřeková, Karin, Holéczy, Pavol, Kuča, Kamil, Central European Journal of Public Health


INTRODUCTION

Over the past 20 years, the prevalence of obesity has increased almost twofold in most European countries, including the Czech Republic. Obesity currently affects 10 to 25% of men and 10 to 30% of women in Europe. The situation is even graver in the US, where obesity affects 34% of the adult population; 5% of the adult population in the US suffers from class III morbid obesity (1). In countries of the Central and Eastern Europe, including the Czech Republic, the prevalence of obesity stands as a forefront issue in all epidemiological studies. Results of the latest large epidemiological study, conducted in the Czech Republic, reveal 3 0% of the Czechs to be overweight and 25% as suffering from obesity. It is an alarming fact that, during the recent 6 years only, the number of obese subjects has increased by 5% in the total population of 10.3 million, what makes 425,000 people (2).

Recently, a series of epidemiologic studies has evidenced a close link between morbid obesity and type 2 diabetes mellitus (DM), hypertension, hyperlipidemia, obstructive sleep apnea, metabolic syndrome, and insulin resistance (3, 4). The scale of the problem is also confirmed by the fact that obesity, when exceeding 40 kg/m2, shortens life span, on average by 20 years, while obesity consequences are more severe than the consequences of tobacco smoking or alcohol consumption (5).

The treatment of obese patients is a demanding and long-term undertaking, in which there are no "short cuts" or "quick fixes". Literature data clearly show that no weight loss after pharmacotherapy or dietotherapy remains effective in a long run (6, 7). Today, surgical treatment of higher obesity levels is undoubtedly the most effective procedure with the best outcomes in a long time perspective (8). Dramatic weight loss leads to improvement of associated comorbidities as well. The results of studies, published in the recent decade, have demonstrated that weight reduction by 35-40%, following surgical intervention treatment of obesity, may be regarded permanent, as it is maintained for more than 5 years (9).

The purpose of this study was to evaluate the therapeutic efficacy of three bariatric surgery procedures, the laparoscopic greater curve plication (LGCP), laparoscopic sleeve gastrectomy (LSG), and Roux-en-Y gastric bypass (RYGB) methods, in obese patients with type 2 DM. The following variables were assessed 12 months after surgery versus preoperatively:

* Changes in body weight and BMI;

* Changes in serum glucose and lipid metabolism markers.

MATERIALS AND METHODS

Design

The study in patients following LSG, RYGB and LGCP was carried out between March 2012 and February 2016 at the Obesitology Research Centre of the University of Ostrava, Czech Republic, and at the Bariatric Surgery Centre, Vítkovice Hospital, Czech Republic. Inclusion criteria included BMI > 40 kg/m2 or > 35 kg/m2 with comorbidities or BMI < 35 kg/m2, and age 18-65 years, as per the International Federation for the Surgery of Obesity (IFSO) criteria (10). Exclusion criteria included BMI > 50 kg/ m2, any prior abdominal surgery, diagnoses for gastric or duodenal ulcers, thyroid gland disease, and gastrointestinal disease.

For each of the procedures, the following hypotheses were tested:

H1: There will be a total body weight and BMI reduction 12 months after surgery without a significant difference among individual procedure groups.

H2: Serum glucose and lipid metabolism markers will change by 12 months after surgery without a significant difference among individual procedure groups.

Statistical Analysis

The hypotheses were tested with the Bonferroni method (11). Normality of data distribution was assessed on the basis of skewness and kurtosis. Data with normal distribution were tested with the paired t-test, and data without normal distribution with the paired Wilcoxon test. …

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