Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

Objectives: The growing prevalence of obesity rates worldwide is associated with an upsurge in its comorbidities, particularly type 2 diabetes mellitus (T2DM). Bariatric surgery is a proven treatment modality for producing sustained weight loss and resolution of associated T2DM providing marked improvement in quality of life with rapid recovery. This study aims to investigate the effects of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) on obese patients suffering from T2DM in the Indian population and their long-term association with regard to diabetes remission, resolution of comorbidities, and percentage EWL. Methods: Retrospective data of obese patients with T2DM (preoperative BMI 45.37 ± 8.1) who underwent bariatric surgery (RYGB, LSG, and MGB) were analyzed in this study over a period of 9 years. The mean follow-up period was 2.2 years. Following surgery, the clinical outcome on BMI, resolution of percentage weight loss, and T2DM were studied. The predictive factors of diabetic remission after surgery were determined. Student’s t test and ANOVA and McNemar’s test were applied. Results: Out of a total of 274 patients, complete remission of T2DM was achieved in 52.9% (n = 145) with mean fasting blood glucose and glycated hemoglobin values being 6.1 ± 0.769 (p = 0.00) at 1 year after surgery. The independent predictive factors of remission were age, gender, BMI, preoperative comorbidities, and % EWL. Gender had no correlation with the chance of achieving disease remission. Conclusion: Based on our results, bariatric surgery proves to be a successful treatment option resulting in sustained weight loss in obese patients suffering from T2DM. It is found to be beneficial for the long-term resolution of T2DM and improving comorbidities such as hypertension and dyslipidemia. The outcome of the different surgical methods is found to be similar for all patients irrespective of the independent predictors of complete remission.

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Abstract 12368: Impact of Weight Trends on Long-term Outcomes After Atrial Fibrillation Ablation in Obese Patients

Circulation ◽

10.1161/circ.132.suppl_3.12368 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

T J Bunch ◽

Heidi T May ◽

Tami L Bair ◽

Victoria Jacobs ◽

Brian G Crandall ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Weight Loss ◽

Catheter Ablation ◽

Obese Patients ◽

Long Term Outcomes ◽

Sustained Weight Loss ◽

Index Weight ◽

Af Recurrence

Introduction: Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. Obesity is a dominant driver of AF recurrence after ablation. Weight reduction strategies lower general AF burden and as such may be critical to long-term success rates after ablation. Hypothesis: Long-term outcomes after AF ablation will be better in obese patients with sustained weight loss. Methods: All patients that underwent an index ablation with a BMI recorded and >30 kg/m 2 and at least 3 years of follow-up were included (n=407). The group was separated and compared by weight trends over the 3 years (1. Lost >3% of index weight, n=141; 2. Maintained index weight ±3%, n=147; 3. Gained >3% of index weight at 3 years, n=119). Long-term outcomes included AF recurrence and a composite defined as major adverse clinical events, MACE (stroke/TIA, heart failure (HF) hospitalization, and death). Results: The average age was 63.6±10.4 years, 59.3% were male and 51.7% had paroxysmal AF. AF comorbidities include: hypertension (79.5%), heart failure (36.0%), sleep apnea (35.2%), diabetes (28.9%), and stroke/TIA (5.9%). Those that maintained their weight (HR: 1.45, p=0.05) and those that gained weight (HR 1.54, p=0.07) were more likely to have AF recurrence compared to those that lost weight. Similarly, MACE increased from 18.4% in those that lost weight at 3 years compared to 18.6% (HR 1.32, p=0.29) in those that maintained their weight and 26.5% in those that gained weight (HR 2.01, p=0.02). A small group of patients (n=5), lost >3% then gained it back and ultimately increased their weight by 3%. This group had the highest rates of AF recurrence (100%). Conclusion: Maintained weight loss is a critical component in reducing AF recurrence rates after index catheter ablation in obese patients. Sustained weight loss also results in a reduction in AF-related comorbidities and mortality.

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Short- and Long-Term Effects of Weight Loss on the Complement Component C3 After Laparoscopic Gastric Bypass in Obese Patients

Obesity Surgery ◽

10.1007/s11695-016-2195-z ◽

2016 ◽

Vol 26 (11) ◽

pp. 2756-2763 ◽

Cited By ~ 5

Author(s):

Segundo Á. Gómez-Abril ◽

Carlos Morillas-Ariño ◽

Jose L. Ponce-Marco ◽

Teresa Torres-Sánchez ◽

Fernando Delgado-Gomis ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Laparoscopic Gastric Bypass ◽

Complement Component ◽

Obese Patients ◽

Long Term Effects ◽

Complement Component C3 ◽

Short And Long Term

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Su1303 Long-Term Effects of an Interdisciplinary 52-Week Weight Loss Program on Adipokines and Nonalcoholic Fatty Liver Disease in Obese Patients – A Prospective Evaluation

Gastroenterology ◽

10.1016/s0016-5085(13)61670-4 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-453

Author(s):

Julia Martin ◽

Anke Mueller ◽

Astrid Waechtershaeuser ◽

Irina Blumenstein ◽

Jürgen Stein

Keyword(s):

Weight Loss ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Weight Loss Program ◽

Obese Patients ◽

Prospective Evaluation ◽

Long Term Effects ◽

Nonalcoholic Fatty Liver

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Impact of weight loss on the cardiovascular system after bariatric surgery

Problems of Endocrinology ◽

10.14341/probl201662543 ◽

2016 ◽

Vol 62 (5) ◽

pp. 43

Author(s):

Bianca Maria Leca ◽

Ionuț Stanca ◽

Suzana Florea ◽

Simona Fica ◽

Anca Elena Sîrbu

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Left Ventricle ◽

Cardiovascular System ◽

Negative Response ◽

Obese Patients ◽

Left Ventricle Mass ◽

Post Surgery ◽

Number Of Patients

Introduction. Obesity is a chronic disease with a great impact on the cardiovascular system through its association with type II diabetes, hypertension, dyslipidemia, metabolic syndrome (MetS) and also through direct alterations in cardiac performance and morphology. Recent long term studies prove that substantial weight loss obtained via bariatric surgery is capable of improving cardiac risk factors associated with severe obesity, decreasing the mortality rates.Aim: to assess the long-term changes in cardiovascular risk and cardiac structure in obese patients who had lost weight after laparoscopic sleeve gastrectomy (LSG).Methods. Fifty-two severe obese patients (44±9 years, 57.7% women, BMI=45±8 kg/m2) underwent clinical and biochemical examination and Doppler echocardiograms before and 5 years after LSG.Results. Pre-operatively, 78.4% of patients were hypertensive, 46.2% had diabetes, 73.1% MetS and 44.2% presented left ventricle hypertrophy (LVH), reflecting high cardio-metabolic risk. The patients reassessment was made 61.7±10.5 months after LSG, when a decrease in BMI of 21.9±10% was achieved (p<0.001). The prevalence of hypertension (64.7%), diabetes (32.7%) and MetS (28.8%) decreased compared to the pre-operative examination (p=0.019, p<0.001, p=0.036). An increase in left ventricle mass and left ventricle mass index (LVMI) (p<0.001) and in the prevalence of LVH (57.7%-p=0.001) was recorded. Patients were divided into two groups based on the decrease in LVMI (positive response-38.5%) or increase in LVMI post-surgery (negative response-61.5%), compared with pre-operative values. The group of patients with negative response had lost less weight (p=0.006), had a poor glycemic control (p=0.022), and higher systolic (p=0.004) and diastolic (p=0.030) pressure values compared to the first evaluation.Conclusion. The increase of LVMI after LSG indicates that this study should continue, including a larger number of patients. It is important to identify the factors that can predict an inappropriate response to surgery, in order to prevent and treat them.

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