Pre-operative Predictors of Weight Loss at 1-Year after Lap-Band® Surgery

Dixon, John; Dixon, Maureen Elizabeth; O'Brien, Paul Edmond

doi:10.1381/096089201321577884

Cited by 149 publications

(110 citation statements)

References 23 publications

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“…%ΔL: H) shows a predictive capacity as strong as the initial BMI, which, up to now, was considered one of the best predictors of weight loss after surgery [25]. In fact, when separately analysed, %ΔL: H, as well as preoperative BMI, explained over 40% of the weight reduction variability (Figs.…”

Section: Discussionmentioning

confidence: 83%

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The effect of insulin on cardiac autonomic balance predicts weight reduction after gastric bypass

et al. 2005

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Aims/hypothesis: The aim of this study was to assess the predictive role of autonomic reactivity in body weight loss induced by gastric bypass. Methods: A group of 22 morbidly obese subjects, who were due to undergo a gastric bypass, were submitted, before surgery, to a euglycaemic-hyperinsulinaemic clamp, during which a continuous recording of the ECG was performed. The effect of insulin on cardiac autonomic balance was evaluated by performing power spectral analysis of heart rate variability. The low-to-high frequency ratio was calculated before and during the clamp and its modifications were expressed as % delta low-to-high frequency ratio (%Δ L: H). Results: Preoperative %Δ L: H showed a significant (p=0.0009, r 2 =0.43), positive relationship to the reduction of body weight, measured 1 year after surgery and expressed as % excess weight loss (% EWL). Preoperative BMI was also significantly (p=0.0009, r 2 =0.43) negatively related to the 12-month % EWL. In a multiple regression analysis, %Δ L: H remained a significant (p=0.003), independent predictor of body weight loss, even when preoperative BMI or age, % fat mass, insulinaemia and glucose disposal were taken into account. Conclusions/ interpretation: The best correction of excess body weight was achieved by those obese subjects who had a preserved capacity to shift their cardiac autonomic balance towards a sympathetic prevalence in response to an euglycaemichyperinsulinaemic clamp. Further studies are needed to elucidate the mechanisms through which the autonomic nervous system influences weight reduction.

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Section: Discussionmentioning

confidence: 83%

“…Thus, BMI plays a major role during the early postoperative period, whereas its influence becomes much weaker later on. Dixon et al [25] demonstrated that preoperative BMI is strongly related to BMI measured 1 year, but not 2 years, after surgery. This suggests that initial BMI does not influence weight maintenance or regain.…”

Section: Discussionmentioning

confidence: 99%

The effect of insulin on cardiac autonomic balance predicts weight reduction after gastric bypass

et al. 2005

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“…Hence, younger subjects realize the largest weight reduction, when compared to their respective older counterparts (P < 0.0001 between the groups with initial body weight higher than 120 kg P < 0.0005 between the groups with an initial body weight lower than 120 kg). Younger subjects have been reported to achieve a more satisfactory body weight loss (Dixon et al, 2001). However, to our knowledge, no study has related a better capacity of younger patients either in reducing food intake after bariatric surgery or in complying with a hypocaloric diet.…”

Section: Discussionmentioning

confidence: 95%

Factors influencing energy intake and body weight loss after gastric bypass

et al. 2002

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Objective: The gastric bypass-induced quantitative and qualitative modifications of energy intake (En In, kcal=day) and their impact on body weight (bw) loss were evaluated. The factors influencing energy intake and body weight loss were also investigated. Design: Longitudinal study. Setting: University Hospital of Geneva. Subjects: Fifty obese women undergoing a Roux-en-Y gastric bypass. Results: The reduction of EnIn was significantly related to bw loss expressed either in kg or as percentage correction of excess bw (P < 0.01 for both), whereas the post-operative modifications of diet composition did not play a role. Age and initial bw significantly influenced bw loss (P < 0.0001 and P < 0.001, respectively), as shown by multiple regression analysis. Patients were divided into four sub-groups according to their age (under or over 35 y) and initial bw (under or over 120 kg). ANOVA showed that under 35-y-old subjects reduced their EnIn significantly more than their older counterparts having similar bw (P < 0.02 and P < 0.05); consequently, bw loss, expressed in kg, was significantly (P < 0.0001 and P < 0.0005) larger in younger patients. Subjects with an initial bw over 120 kg lost significantly (P < 0.001 and P < 0.02) more weight as compared to patients with a smaller degree of obesity (under 120 kg) and similar age. Conclusions: Gastric bypass-induced body weight loss is mainly due to the reduction of EnIn, whereas the qualitative modifications of the diet do not play a role. Younger subjects have a greater capacity to reduce EnIn and, therefore, lose more weight. Pre-operative high degree of obesity leads to a larger weight reduction, probably because of a greater energy deficit.

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“…We have previously shown that reduced insulin sensitivity and the conditions associated with it are associated with a lower rate of weight loss after LAGB surgery (26). The reason for this is unknown but may relate to reduced energy expenditure in diabetic subjects or an effect of hyperinsulinemia on central control of energy balance, increasing appetite and, thus, energy intake.…”

Section: Sleep Disturbancementioning

confidence: 99%

Health Outcomes of Severely Obese Type 2 Diabetic Subjects 1 Year After Laparoscopic Adjustable Gastric Banding

2002

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1OBJECTIVE -To prospectively examine the effect of weight loss 1 year after laparoscopic adjustable gastric band surgery on a broad range of health outcomes in 50 diabetic subjects.RESEARCH DESIGN AND METHODS -A total of 50 (17 men, 33 women) of 51 patients with type 2 diabetes, from a total of 500 consecutive patients, were studied preoperatively and again 1 year after surgery.RESULTS -Preoperative weight and BMI (means Ϯ SD) were 137 Ϯ 30 kg and 48.2 Ϯ 8 kg/m 2 , respectively; at 1 year, weight and BMI were 110 Ϯ 24 kg and 38.7 Ϯ 6 kg/m 2 , respectively. There was significant improvement in all measures of glucose metabolism. Remission of diabetes occurred in 32 patients (64%), and major improvement of glucose control occurred in 13 patients (26%); glucose metabolism was unchanged in 5 patients (10%). HbA 1c was 7.8 Ϯ 3.2% preoperatively and 6.2 Ϯ 2.7% at 1 year (P Ͻ 0.001). Remission of diabetes was predicted by greater weight loss and a shorter history of diabetes (pseudo r 2 ϭ 0.44, P Ͻ 0.001). Improvement in diabetes was related to increased insulin sensitivity and ␤-cell function. Weight loss was associated with significant improvements in fasting triglyceride level, HDL cholesterol level, hypertension, sleep, depression, appearance evaluation, and health-related quality of life. Early complications occurred in 6% of patients (wound infections in 4%, respiratory support in 2%), and late complications occurred in 30% of patients (gastric prolapse in 20%, band erosion in 6%, and tubing leaks in 4%). All late complications were successfully revised surgically.CONCLUSIONS -Modern laparoscopic weight-loss surgery is effective in managing the broad range of health problems experienced by severely obese individuals with type 2 diabetes. Surgery should be considered as an early intervention. Diabetes Care 25:358 -363, 2002T here is an epidemic of obesity throughout most of the developed and much of the developing world. The prevalence of obesity (BMI Ͼ30 kg/ m 2 ) has doubled in most Western countries in the last 15-20 years. Obesity is a major independent risk factor for the development of type 2 diabetes (1) and is associated with the rapid increase in the prevalence of type 2 diabetes (2). A total of 80% of individuals with type 2 diabetes are obese (3). The risk of developing type 2 diabetes increases with the degree of obesity, duration of obesity, central weight distribution, and weight gain during adult life (4). A decrease in insulin sensitivity with increasing obesity, especially central obesity, is associated with impaired glucose tolerance, dyslipidemia, and systemic hypertension, all of which are features of the metabolic syndrome and are associated with cardiovascular risk.Early intensive treatment of type 2 diabetes and its associated vascular risk factors reduces morbidity, mortality, and poor quality of life associated with long-term macrovascular and microvascular complications (5,6). Early intensive therapy may also delay the progressive deterioration of ␤-cell function, a characteristic of type...

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Pre-operative Predictors of Weight Loss at 1-Year after Lap-Band® Surgery

Cited by 149 publications

References 23 publications

The effect of insulin on cardiac autonomic balance predicts weight reduction after gastric bypass

The effect of insulin on cardiac autonomic balance predicts weight reduction after gastric bypass

Factors influencing energy intake and body weight loss after gastric bypass

Health Outcomes of Severely Obese Type 2 Diabetic Subjects 1 Year After Laparoscopic Adjustable Gastric Banding

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