Metabolic or bariatric surgery? Long-term effects of malabsorptive vs restrictive bariatric techniques on body composition and cardiometabolic risk factors

Abstract

Background: Obesity is an increasing health problem and surgery seems to be the only treatment effective in achieving weight loss without relapse. Among bariatric techniques, many differences exist in terms of weight loss and resolution of comorbidities. Up to now, there are no prospective studies comparing long-term effects of malabsorptive vs restrictive techniques. Objective: In this study, cardiometabolic risk factors and body composition changes after malabsorptive biliointestinal bypass (BIBP) and restrictive laparoscopic adjustable gastric banding (LAGB) were compared during a 4-year follow-up. Design: Prospective, case-control and cohort study. Patients: In all, 80 obese subjects, matched for weight and age. Altogether, 40 patients underwent BIBP and 40 underwent LAGB. Measurements: Weight, body composition, fasting and post-loading plasma glucose and insulin, homeostatic model assessment index (HOMA-I), lipid profile, blood pressure (BP), erythrocyte sedimentation rate and fibrinogen were monitored at baseline, 12 and 48 months. Results: At 12 months after surgery, a significant reduction in body mass index, total fat mass (FM), trunk FM (trFM), trFM/legs FM (lFM) ratio (trFM/lFM), triglycerides, BP and inflammation markers was observed in both groups. BIBP patients showed a significant reduction in total cholesterol (Tot-C), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), whereas the LAGB group showed a significant increase of HDL-C. A further improvement of all the parameters evaluated was seen in the BIBP group at 48 months after surgery. Conclusions: Both bariatric procedures exerted positive effects on cardiometabolic risk factors and on weight loss in the population studied, but on the long-term period, HOMA-I, Tot-C/HDL-C ratio and body composition improvements were more evident after BIBP. We conclude that malabsorptive BIBP seems to be more effective than LAGB in treating visceral obesity and its metabolic complications

Metabolic improvement of morbid obese patients following Roux-en-Y gastric bypass surgery: A prospective study in Mashhad, Iran

“…The study noted that RYGB surgery produces a clear benefit in all lipid fractions [34]. In contrast, previous studies with restrictive surgery techniques have reported no significant difference in total cholesterol levels [35][36][37]. We observed mean decrease of 71.1 mg/dL in total cholesterol after 1 year of [35,39,40].…”

Bariatric surgery and prevention of cardiovascular events and mortality in morbid obesity: Mechanisms of action and choice of surgery

“…HDL seems to be increased with most procedures 35,56 , similar to reduction of inflammatory mediators 83 .…”

“…Studies showing prevention of CV events and CV mortality are lacking for other bariatric procedures such as sleeve gastrectomy and BPD, even though the latter is associated with important reduction of CV risk factors [32][33][34][35][36][37][81][82][83] . A number of alternative procedures to bariatric surgery, such as intragastric balloons, and endobarriers, has been evaluated in short term studies.…”

Body composition changes after laparoscopic adjustable gastric banding: what is the role of −174G>C interleukin-6 promoter gene polymorphism in the therapeutic strategy?

“…Laparoscopic adjustable gastric banding (LAGB) is a restrictive comparable procedure, reversible and showing a very low rate of complication. 20 Previous data demonstrated that genetic factors, such as À174G4C IL-6 polymorphism, which have an important role in the regulation of body weight (BW), may account for differences in the therapeutic response to LAGB. 21 Because of several, but not really exhaustive, data regarding the relevance of IL-6 on body composition and adipose tissue homeostasis regulation, we investigated the role of À174G4C IL-6 polymorphism on the efficacy of weight loss, body composition and fluid distribution changes in obese subjects, evaluated by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA), at 6 months follow-up after LAGB surgery.…”