Early reductions in metabolic risk following Roux-en-Y gastric bypass
Cardio-metabolic syndrome (CMS) is the name given to a specific combination of risk factors which are known to increase the risk of cardiovascular disease (heart attack and stroke). The main components of CMS are:
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Large waist measurement indicating abdominal (central) fat
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Raised blood pressure (BP)
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Abnormal glucose and insulin levels
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Raised triglycerides (a form of blood fat)
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Low levels of high-density lipoprotein cholesterol (HDL-C)
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Raised inflammatory markers
Patients with CMS are at a much greater risk of premature death and disability due to heart disease and stroke.
Several studies have suggested that weight reduction following Roux-en-Y gastric bypass (RYGP) may have an important beneficial effect on CMS in obese patients. In this recent study, the authors wanted to establish an approximate timescale for the beneficial effects on CMS in a group of severely obese subjects. In all, 36 severely obese subjects were evaluated following RYGP, together with 20 normal-weight healthy volunteers. The obese subjects were evaluated within 8-weeks prior to RYGP and then again at 6- and 52-weeks following surgery.
At the commencement of the study, 55% of obese patients fulfilled criteria for CMS, whereas after the 52 weeks this number had fallen to 11%. Average baseline waist measurement was 136.7 cms (54 ins), which after 52 weeks had fallen to 104 cms (41 ins). Obese subjects demonstrated major improvements in all components of CMS, including blood pressure, blood fats, glucose and inflammatory markers. Taken together these changes represent a major reduction in disease risk which was already becoming evident 6-weeks after surgical intervention.
Comment
A number of studies have demonstrated major reductions in the risk of heart disease and stroke following RYGP. These improvements have been noted after a follow-up of 1 year or longer. In the present study, the first follow-up observations were made at 6-weeks after surgery and then at one year. Although the number of patients was relatively small, results showed that the improvement in metabolic risk factors is already well established as early as 6-weeks after RYGP, at a point where the weight loss is still relatively modest.
Morinigo R, Casamitjana R et al. Insulin resistance, inflammation, and the metabolic syndrome following Roux-en-Y Gastric Bypass surgery in severely obese patients.
Diabetes Care (in Press) published online April 27, 2007
