Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects

Sjöström, Lars; Narbro, Kristina; Sjöström, C. David; Karason, Kristjan; Larsson, Bo; Wedel, Hans; Lystig, Theodore C.; Sullivan, Marianne; Bouchard, Claude; Carlsson, Björn; Bengtsson, Calle; Dahlgren, S; Gummesson, Anders; Jacobson, Peter; Karlsson, Jan; Lindroos, Anna‐Karin; Lönroth, Hans; Näslund, Ingmar; Olbers, Torsten; Stenlöf, Kaj; Torgerson, Jarl; Ågren, Göran I.; Carlsson, Lena

doi:10.1056/nejmoa066254

Cited by 4,149 publications

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References 34 publications

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“…Surgical approaches should be reserved for morbid obese patients (BMIX40 kg m -2 ) with hypertension and other major comorbidities. 80 In the prospective, controlled Swedish Obese Subjects study, 82 subjects who underwent bariatric surgery had lower overall mortality and long-term weight loss, during an average of 10.9 years of follow-up, compared with a matched control group that received conventional treatment. The surgery group had lower 10-year incidence rates of diabetes, hypertriglyceridemia and hyperuricemia, but not of hypertension than the control group.…”

Section: Endothelial Dysfunction and Changes In Vascular Structurementioning

confidence: 99%

Mechanisms of obesity-induced hypertension

et al. 2010

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The relationship between obesity and hypertension is well established both in children and adults. The mechanisms through which obesity directly causes hypertension are still an area of research. Activation of the sympathetic nervous system has been considered to have an important function in the pathogenesis of obesity-related hypertension. The arterial-pressure control mechanism of diuresis and natriuresis, according to the principle of infinite feedback gain, seems to be shifted toward higher blood-pressure levels in obese individuals. During the early phases of obesity, primary sodium retention exists as a result of increase in renal tubular reabsorption. Extracellular-fluid volume is expanded and the kidney-fluid apparatus is resetted to a hypertensive level, consistent with a model of hypertension because of volume overload. Plasma renin activity, angiotensinogen, angiotensin II and aldosterone values display significant increase during obesity. Insulin resistance and inflammation may promote an altered profile of vascular function and consequently hypertension. Leptin and other neuropeptides are possible links between obesity and the development of hypertension. Obesity should be considered as a chronic medical condition, which is likely to require long-term treatment. Understanding of the mechanisms associated with obesity-related hypertension is essential for successful treatment strategies. Hypertension Research (2010) 33, 386-393; doi:10.1038/hr.2010.9Keywords: leptin; obesity; pressure natriuresis; rennin-angiotensin-aldosterone system; sympathetic nervous system INTRODUCTION Obesity is a common disorder that develops from the interaction between the genotype and the environment and involves social, behavioral, cultural, physiological, metabolic and genetic factors. A large number of studies have shown that obesity has an important negative impact on health in a population, leading to the recommendation for general practitioners to have an important function in the management of this condition and of its associated comorbidities such as hypertension, hyperlipidemia and hyperinsulinemia/insulin resistance. The relationship between obesity and hypertension is well established both in adults and children. 1,2 Obese individuals exhibit higher levels of office as well as ambulatory blood pressure (BP) from childhood to old age. Obese subjects display higher BP levels than non-obese individuals even in the normotensive range. The combination of obesity, hypertension and other cardiovascular risk factors significantly increases the probability of adverse cardiovascular outcomes, and raises considerations for aggressive treatment strategies. 3 The mechanisms through which obesity directly causes hypertension are still an area of research. Human and animal studies have elucidated the function of adipose tissue derivatives (adipokines and cytokines), neurohumoral pathways, metabolic functions and modulation of pressor/depressor mechanisms. Although obesity-related hypertension may be the result of a combinatio...

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Section: Endothelial Dysfunction and Changes In Vascular Structurementioning

confidence: 99%

Mechanisms of obesity-induced hypertension

et al. 2010

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“…in 1995 82. Strong evidence has shown that bariatric surgery is an effective treatment for severe obesity (BMI >35 kg/m 2 ) and results in marked improvement of T2DM control 10, 83, 84. Derived from bariatric surgery, metabolic surgery is focused on T2DM treatment in mildly obese or overweight patients (BMI <35 kg/m 2 ) 85.…”

Section: From Bariatric To Metabolic Surgerymentioning

confidence: 99%

“…Unfortunately, current medical treatment has been relatively unsatisfactory in the treatment of obesity as well as T2DM 7, 8. Bariatric surgery, a weight reduction surgery, has been shown as not only an effective treatment for severe obesity (BMI >35 kg/m 2 ) but has also resulted in marked improvement of T2D control 9, 10. Encouraged by the success of bariatric surgery, gastrointestinal metabolic surgery has been recently proposed as a new treatment modality for obesity‐related T2DM in patients with BMI <35 kg/m 2.…”

Section: Introductionmentioning

confidence: 99%

Recent advancements in bariatric/metabolic surgery

Lee

Almalki

2017

Annals of Gastroent Surgery

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Obesity and type 2 diabetes mellitus (T2DM) are currently two pan‐endemic health problems worldwide and are associated with considerable increase in morbidity and mortality. Both diseases are closely related and very difficult to control by current medical treatment, including diet, drug therapy and behavioral modification. Bariatric surgery has proven successful in treating not just obesity but also in significantly decreasing overall obesity‐associated morbidities as well as improving quality of life in severely obese patients (body mass index [BMI] >35 kg/m2). A rapid increase in bariatric surgery started in the 2000s when the laparoscopic surgical technique was introduced into this field. Many new procedures had been developed and changed the face of modern bariatric surgery. Recently, bariatric surgery played as gastrointestinal metabolic surgery has been proposed as a new treatment modality for obesity‐related T2DM for patients with BMI >35 kg/m2. Strong evidence has demonstrated that bariatric/metabolic surgery is an effective and durable treatment for obese T2DM patients. Bariatric/metabolic surgery is now becoming an important surgical division. The present article examines and discusses recent advancements in bariatric/metabolic surgery and covers four major fields: (i) the rapid increase in numbers and better safety; (ii) new procedures with better outcomes; (iii) from bariatric to metabolic surgery; and (iv) understanding the mechanisms and personalized treatment.

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“…Current anti-obesity drugs are moderately effective at achieving weight loss, but considerable adverse effects can occur. Presently, the only effective treatment with a proven mortality benefit is bariatric surgery (7,8) . The mechanisms underlying the effectiveness of these surgical techniques are not completely understood but alterations in circulating gut hormone levels have been shown to be an important factor (9)(10)(11) .…”

Section: Bariatric Surgery: Appetite Control Model: Gut Hormones: Obementioning

confidence: 99%

Sir David Cuthbertson Medal Lecture Bariatric surgery as a model to study appetite control

Bueter

Roux

2009

Proc. Nutr. Soc.

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The obesity epidemic and its associated morbidity and mortality have led to major research efforts to identify mechanisms that regulate appetite. Gut hormones have recently been found to be an important element in appetite regulation as a result of the signals from the periphery to the brain. Candidate hormones include ghrelin, peptide YY, glucagon-like peptide-1 and gastric inhibitory polypeptide, all of which are currently being investigated as potential obesity treatments. Bariatric surgery is currently the most effective therapy for substantial and sustained weight loss. Understanding how levels of gut hormones are modulated by such procedures has greatly contributed to the comprehension of the underlying mechanisms of appetite and obesity. The present paper is a review of how appetite and levels of gastrointestinal hormones are altered after bariatric surgery. Basic principles of common bariatric procedures and potential mechanisms for appetite regulation by gut hormones are also addressed.

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Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects

Abstract: Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.

Cited by 4,149 publications

References 34 publications

Mechanisms of obesity-induced hypertension

Mechanisms of obesity-induced hypertension

Recent advancements in bariatric/metabolic surgery

Sir David Cuthbertson Medal Lecture Bariatric surgery as a model to study appetite control

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