Understanding the Benefits of Bariatric Surgery on Gut Physiology: Implications for Obesity, Type 2 Diabetes, and Cardiovascular Disease

2014 ◽  
pp. 343-370
Author(s):  
Steven K. Malin ◽  
John P. Kirwan
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Bariatric Surgery ◽  
Gut Physiology

Abstract 018: Two-year Changes of Adiponectin after Bariatric Surgery and Their Association with Incident Type 2 Diabetes, Cardiovascular Disease, Cancer and Mortality: Results from the Swedish Obese Subjects Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Christian Herder ◽  
Markku Peltonen ◽  
Per-Arne Svensson ◽  
Maren Carstensen ◽  
Peter Jacobson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Control Group ◽  
Incident Type ◽  
Surgery Group ◽  
Obese Subjects

Introduction: Adiponectin has anti-inflammatory, insulin-sensitising and atheroprotective effects in rodents. Although serum adiponectin is uniformly downregulated in obesity, its clinical relevance in humans seems more complex. It is not known whether changes in circulating adiponectin predict type 2 diabetes, cardiovascular disease, cancer and mortality in an obese population. Hypothesis: We hypothesised that adiponectin levels are upregulated substantially after weight loss following bariatric surgery and that pronounced increases of adiponectin should offer better protection for individuals against type 2 diabetes. In addition, findings for type 2 diabetes should be compared to associations with cardiovascular disease, myocardial infarction, stroke, cancer and mortality. Methods: Serum concentrations of total adiponectin were measured in 3,223 participants of the Swedish Obese Subjects (SOS) Study (1,533 in the bariatric surgery group: 229 with gastric bypass, 1056 with vertical banded gastroplasty, 248 with adjustable gastric banding; 1,690 in the control group without surgery) at study baseline and after 2 years. Hazard ratios (HR) and 95% confidence intervals (CI) per 1 standard deviation (SD) of 2-year changes (concentration at year 2 - concentration at baseline) in adiponectin were calculated for incident type 2 diabetes, cardiovascular disease, myocardial infarction, stroke, cancer and mortality in the combined surgery group. Numbers of cases were 93, 122, 78, 55, 82 and 179, respectively. Median follow-up times ranged from 10 years for diabetes up to 16 years for mortality. Results: Mean (SD) levels of adiponectin at baseline were 7,453 (4,150) ng/ml in the combined surgery group and 8,247 (4,846) ng/ml in the control group. During the first 2 years of follow-up, adiponectin levels increased in the surgery group by 4,850 (5,387) ng/ml (parallel to a loss of 24% of body weight) and decreased slightly by 270 (2,650) ng/ml in the control group (parallel to a slight gain of 0.1% body weight). The degree of correlation between changes in adiponectin and weight loss in kg was more pronounced in the surgery groups compared with the control group (p=0.001 for interaction). Two-year increases in adiponectin in the surgery group were associated with decreased risk of type 2 diabetes (HR [95% CI] 0.61 [0.38-0.98], adjusted for baseline data for age, sex, BMI, lipids, blood pressure, alcohol consumption, smoking, anti-hypertensive drugs, glucose, insulin), but not with cardiovascular disease, myocardial infarction, stroke, cancer and mortality (adjusted HR between 0.89 and 1.05). Conclusions: Weight loss after bariatric surgery is paralleled by a substantial increase in circulating adiponectin. The degree of upregulation of adiponectin is associated with protection against future type 2 diabetes, but not with the incidence of cardiovascular outcomes, cancer or mortality.

Abstract 15004: Bariatric Surgery is Associated With Reduced Atherosclerotic Cardiovascular Disease Burden in Obese Patients With Type 2 Diabetes: A Propensity-matched Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Francesca Watson ◽  
Maddalena Ardissino ◽  
Ravi J Amin ◽  
Chanpreet Arhi ◽  
Peter Collins ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Bariatric Surgery ◽  
Disease Burden ◽  
Atherosclerotic Cardiovascular Disease ◽  
Obese Patients ◽  
Matched Cohort ◽  
All Cause Mortality

Introduction: Obesity is an increasingly prevalent global health issue and has a considerable disease burden, including numerous co-morbidities. Atherosclerotic cardiovascular disease (ASCVD) is one such co-morbidity associated with a high mortality rate and prevalence, especially in patients with obesity and concomitant Type 2 diabetes mellitus (T2DM). Bariatric surgery is an effective intervention for patients with obesity, shown to reduce overall cardiovascular disease risk. However, few studies have quantified the long-term impact of bariatric surgery on ASCVD outcomes in the context of key co-morbidities such as T2DM. Hypothesis: Bariatric surgery will improve long-term ASCVD outcomes in obese patients with T2DM. Methods: A nested, nationwide, propensity-matched cohort study was carried out using the Clinical Practice Research Datalink. The study cohort included 593 patients who underwent bariatric surgery and had no past history of ASCVD. A further 593 patients served as propensity-score matched controls. Patients were followed up for a median time of 47.2 months. The primary composite study endpoint was the incidence of ASCVD defined by a diagnosis of new coronary artery disease (CAD), cerebrovascular disease (CeVD), peripheral arterial disease (PAD), or other miscellaneous atherosclerotic disease. Secondary endpoints included all-cause mortality and the incidence of CAD, CeVD, and PAD individually. Results: Patients who underwent bariatric surgery had significantly lower rates of new ASCVD during follow-up (HR 0.53, CI 0.30-0.95, p=0.032). No significant difference was observed in rates of new CAD (HR 0.69, CI 0.32-1.46, p=0.331), CeVD (HR 0.23, CI 0.00-5.45, p=0.1760) and PAD (HR 0.55, CI 0.21-1.43, p=0.218). The bariatric surgery group also had a lower rate of all-cause mortality (HR 0.36, CI 0.19-0.71, p=0.003) compared to controls. Conclusions: In this study, bariatric surgery was associated with improved ASCVD outcomes, as well as lower all-cause mortality, in patients with obesity and T2DM. These findings support the use of bariatric surgery in treating obesity and reducing the burden of its related comorbidities.

Cardiovascular disease and mortality in patients with type 2 diabetes after bariatric surgery in Sweden: a nationwide, matched, observational cohort study

2015 ◽  
Vol 3 (11) ◽  
pp. 847-854 ◽  
Author(s):  
Björn Eliasson ◽  
Vasileios Liakopoulos ◽  
Stefan Franzén ◽  
Ingmar Näslund ◽  
Ann-Marie Svensson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Bariatric Surgery ◽  
Cohort Study ◽  
Observational Cohort Study ◽  
Observational Cohort

Bariatric Surgery Prevents Type 2 Diabetes in Obese

2012 ◽  
Vol 45 (15) ◽  
pp. 25-28
Author(s):  
MIRIAM E. TUCKER
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery

Abstract # P-18: Economic Burden of Type 2 Diabetes Mellitus in Patients with Cardiovascular Disease in Commercially-Insured Patients in the United States

2016 ◽  
Vol 22 ◽  
pp. 21-22
Author(s):  
Weijia Wang ◽  
Eileen M. Farrelly ◽  
Sharash Shetty ◽  
Dana Stafkey-Mailey ◽  
Stephen D. Sander ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Economic Burden ◽  
The United States ◽  
Insured Patients

Abstract #724: Bariatric Surgery Restores Both Cardiac and Sudomotor Autonomic C-Fiber Dysfunction Towards Normal in Obese Subjects with Type 2 Diabetes

2016 ◽  
Vol 22 ◽  
pp. 159
Author(s):  
Carolina Casellini ◽  
Joshua Edwards ◽  
Henri Parson ◽  
Kim Hodges ◽  
David Lieb ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
C Fiber ◽  
Obese Subjects

Type 2 diabetes remission one year after bariatric surgery - a comparison between vertical sleeve gastrectomy and gastric bypass

2018 ◽  
Author(s):  
Ines Ferreira Barros ◽  
Silvia Paredes ◽  
Fernando Manso ◽  
Costa Jose Manuel Maia da ◽  
Aline Fernandes ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Diabetes Remission ◽  
Vertical Sleeve Gastrectomy ◽  
Type 2 Diabetes Remission ◽  
One Year
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