Predictors of metabolic syndrome persistence 1 year after laparoscopic Roux-en-Y gastric bypass

Francesco Martini; Rodolphe Anty; Anne-Sophie Schneck; Vincent Casanova; Antonio Iannelli; Jean Gugenheim

doi:10.1016/j.soard.2015.02.019

Predictors of metabolic syndrome persistence 1 year after laparoscopic Roux-en-Y gastric bypass

Surg Obes Relat Dis. 2015 Sep-Oct;11(5):1054-60. doi: 10.1016/j.soard.2015.02.019. Epub 2015 Feb 25.

Authors

Francesco Martini¹, Rodolphe Anty², Anne-Sophie Schneck², Vincent Casanova³, Antonio Iannelli², Jean Gugenheim²

Affiliations

¹ University Hospital of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, Nice, France. Electronic address: [email protected].
² University Hospital of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France.
³ University Hospital of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, Nice, France.

PMID: 25868838
DOI: 10.1016/j.soard.2015.02.019

Abstract

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is effective in reversing the metabolic syndrome (MS) in up to 90% of patients.

Objectives: The aim of this study was to determine predictors of MS persistence 1 year after LRYGB.

Setting: University Hospital, France.

Methods: Ninety-one patients with a mean age of 44.4 years and a mean body mass index (BMI) of 43.1 kg/m² meeting the criteria for MS were enrolled in this prospective study. Anthropometric, metabolic, and inflammatory biological parameters were assessed before and 1 year after LRYGB. Patients were divided into 2 groups according to the persistence (MS nonresponders) or resolution of MS (MS responders) 1 year after LRYGB and a comparison was performed at baseline and 1 year after surgery.

Results: Sixty-nine patients (75.8%) underwent remission, while 22 (24.2%) showed persistence of MS 1 year after LRYGB. At baseline the MS nonresponders group presented significantly higher values of fasting plasma glucose (7.8 versus 5.3 mmol/L, P = .004), glycosylated hemoglobin (HbA1c, 7.3% versus 5.9%, P = .0004), triglycerides (TG, 2.37 versus 1.33 mmol/L, P = .006), and homeostasis model assessment of insulin resistance (HOMA-IR, 442.5 versus 256, P = .006). The rate of diabetes was significantly higher in this group (68.2% versus 36.8%, P = .0086), as well as the number of MS components per patient. One year after LRYGB, the MS nonresponders showed a significantly lower excess BMI lost (EBMIL) (56.1% versus 82.4%, P = .00008). On multivariate analysis, baseline levels of TG, glucose metabolism markers and EBMIL were associated with the persistence of MS.

Conclusion: Baseline levels of TG, plasma fasting glucose, and HbA1c, as well as history of type 2 diabetes and EBMIL, represent predictors of MS persistence 1 year after LRYGB.

Keywords: Excess weight loss; Glucose metabolism markers; Metabolic syndrome; Predictors; Roux-en-Y gastric bypass; Triglycerides.

MeSH terms

Adult
Aged
Body Mass Index
Cohort Studies
Confidence Intervals
Female
Follow-Up Studies
France
Gastric Bypass / adverse effects
Gastric Bypass / methods*
Humans
Insulin Resistance / physiology*
Laparoscopy / adverse effects
Laparoscopy / methods*
Logistic Models
Male
Metabolic Syndrome / epidemiology
Metabolic Syndrome / physiopathology*
Middle Aged
Obesity, Morbid / diagnosis
Obesity, Morbid / surgery*
Odds Ratio
Predictive Value of Tests
Recurrence
Retrospective Studies
Risk Assessment
Time Factors
Treatment Outcome