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Home All Specialties Chronic Disease

Gastric bypass surgery reduces cardio-metabolic risk factors

byAndrew Bishara
June 5, 2013
in Chronic Disease, Gastroenterology
Reading Time: 3 mins read
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Image: PD

1. In mild to moderately obese patients, gastric bypass surgery plus intensive lifestyle modifications demonstrates better cardio-metabolic risk factor reduction than lifestyle modification alone in one year.

2. Patients in the gastric bypass group took fewer medications in comparison to patients in the lifestyle-medical management group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: In this study, mild to moderately obese, diabetic patients study were randomized to Roux-en-Y gastric bypass surgery plus intensive lifestyle modification or intensive lifestyle modification alone. Those in the surgery group achieved significantly higher success rates in attaining a composite goal of diabetes management (incorporating HbA1c, LDL cholesterol, systolic blood pressure). While surgery such as gastric bypass seems to have an immediate positive effect on the reduction of comorbidity risk factors in metabolic syndrome, there must be caution as these remain surrogate markers.

Furthermore, there remain several limitations in our understanding that need to be better elucidated in moving forward. For example, the actual effect of gastric bypass on microvascular complications has not been well characterized. The economic implications of promoting gastric bypass surgery should be further evaluated as well. In addition to the cost of surgery, it should be noted that surgical and post-surgical complications remain significant. Unintended consequences secondary to malnutrition after anatomic gut alteration are examples of severe sequelae from gastric bypass surgery that should always be considered by patients and physicians. Given the findings of this study in the context of the literature, physicians should always attempt to have an open discussion with each patient to weigh the risks and benefits of gastric bypass surgery.

Click to read the study, published today in JAMA 

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Click to read an accompanying editorial in JAMA

Relevant Reading: Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus: Four-Year Results of the Look AHEAD Trial

In Depth [randomized study]: From 2008-2011, 120 diabetic grade 2 obese participants from 4 centers in the United States and Taiwan who met the following criteria: hemoglobin A1c (HbA1c) level of 8.0% or higher, body mass index (BMI) between 30.0 and 39.9, C peptide level of more than 1.0 ng/mL, and type 2 diabetes for at least 6 months were enrolled in the study. They were randomized to Roux-en-Y gastric bypass surgery plus lifestyle-intensive medical management or medical management alone. Lifestyle-intensive modification included diet and weight reduction counseling along with medications for hyperglycemia, hypertension, and dyslipidemia according to protocol. The primary outcome was achieved if the participant met the “triple end point”: an HbA1c of less than 7.0%, an LDL cholesterol level of less than 100 mg/dL , and systolic blood pressure less than 130 mm Hg, at the 12-month visit. 11 participants (19%) in the lifestyle-medical management group and 28 (49%) in the gastric bypass group achieved the triple end point goal.

By Mike Hoaglin and Rif Rahman

More from this author: Childhood migraine associated with infantile colic, Discharge diagnoses in the E.R. cannot retrospectively identify non-emergent visits, Regional wall thinning in CAD may be reversible, Corticosteroid injections for tennis elbow associated with poorer recovery versus placebo, Glucose but not fructose reduces cerebral blood flow in appetite and reward centers of brain, Sustained etanercept with methotrexate is effective for achieving low disease activity in moderate rheumatoid arthritis patients

© 2013 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. Content is produced in accordance with fair use copyrights solely and strictly for the purpose of teaching, news and criticism. No benefit, monetary or otherwise, is realized by any participants or the owner of this domain. 

Tags: diabetesgastric bypasslife-style changemetabolic syndromeobeseSurgery
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