Bedia Fulya ÇALIKOĞLU, Gulsah YALIN, Nurettin Umut BARBAROS

BARİYATRİK CERRAHİ SONRASI KİLO KAYBI MİKTARI KARDİYOMETABOLİK RİSK AZALMASINI BELİRLEYEN BİR FAKTÖR MÜDÜR?

Amaç: Bu çalışma, bariyatrik cerrahi geçiren hastalarda farklı miktarda kilo kaybının kardiyometabolik sağlıktaki gelişmeleri uygun şekilde yansıtıp yansıtmadığını araştırmayı amaçlamıştır. Gereç ve Yöntem: Bariyatrik cerrahi (BC) geçiren ve altı ay takip edilen hastalar geriye dönük olarak kilo kayıplarına göre üç gruba ayrıldı (Grup-1:Düsük kilo kaybı; Grup-2:Orta kilo kaybı; Grup-3: Yüksek kilo kaybı). Cerrahi öncesinde ve sonrasında hastalar, bel çevresi, kan basıncı, glukoz, HDL-K ve trigliserid verileri kullanılarak hem metabolik sendrom (MetS) varlığı açısından değerlendirildi hem de literatürde mevcut bir hesaplayıcı kullanılarak, her hasta için kümelenmiş bir kardiyometabolik risk (KMR) skoru elde edildi. Her bir MetS kriteri ve KMR skorunun, operasyondan önce ve sonra gruplardaki değişimleri ve birbirleriyle ilişkileri karşılaştırıldı. Bulgular: Çalışmaya 66 hasta dahil edildi. Operasyon öncesi %74,2 olan MetS sıklığının operasyondan sonra %25,8’e düştüğü görüldü. Gruplar arasında kilo, bel çevresi, yağ kütlesi, açlık kan şekeri ve HOMA-IR değerlerindeki düşüşte anlamlı farklılık gözlendi. Ancak hem MetS parametrelerindeki hem de KMR skorundaki değişimde gruplar arası anlamlı bir farklılık bulunamadı. Kilo kaybı miktarıyla KMR skorundaki değişim arasında anlamlı negatif korelasyon saptanırken, ayrı ayrı MetS parametreleriyle kilo kaybı miktarı arasında herhangi bir ilişki gözlenmedi. Ayrıca kilo kaybındaki her %1’lik artışın, KMR skorunda %57’lik bir azalma ile ilişkili olduğu tespit edildi. Sonuç: Bariyatrik cerrahi sonrası kardiyometabolik risk parametrelerinde anlamlı azalma olmasına rağmen hastaların kilo kayıp miktarı, ayrı ayrı parametreleri etkilememektedir. Ancak hastaların kardiyometabolik küme risklerini değerlendirmek ve izleme için bir skorlama sistemi kullanmak, hastalarda ameliyat sonrasındaki kademeli değişiklikleri takip etmeyi mümkün kılacak, hekim ve beslenme uzmanlarının müdahalelerini daha hedefe yönelik ve verimli hale getirecektir.

Anahtar Kelimeler:

Metabolik sendrom, bariyatrik cerrahi, kardiyometabolik risk skoru, kilo kaybı miktarı, obezite

IS THE AMOUNT OF WEIGHT LOSS AFTER BARIATRIC SURGERY A FACTOR DETERMINING CARDIOMETABOLIC RISK REDUCTION?

Objective: This study aimed to investigate whether differential weight loss amount appropriately reflects improvements in cardiometabolic health in patients undergoing bariatric surgery. Materials and Methods: Patients who underwent bariatric surgery (BS) and were followed up for six months were divided into three groups according to their weight loss (Group-1: Low weight loss; Group-2: Moderate weight loss; Group-3: High weight loss). Before and after surgery, patients were evaluated for metabolic syndrome (MetS) using waist circumference, blood pressure, glucose, HDL-C, and triglyceride data, and a clustered cardiometabolic risk (CMR) score was obtained for each patient using a calculator available in the literature online. Changes in each MetS criterion and CMR score in the groups before and after the operation, and their relations with each other were compared. Results: Sixty-six patients were included in the study. It was observed that the prevalence of MetS, which was 74.2% before the operation, decreased to 25.8%. A significant difference was observed between the groups in the decrease in weight, waist circumference, fat mass, fasting blood sugar, and HOMA-IR values. However, no significant difference was found between the groups in the change in MetS parameters and CMR scores. While a significant negative correlation was found between the amount of weight loss and the difference in the CMR score, no relation was observed between each MetS parameter and the amount of weight loss. It was also found that each 1% increase in weight loss was associated with a 57% decrease in the CMR score. Conclusion: Although there is a significant decrease in cardiometabolic risk parameters after bariatric surgery, the amount of weight loss of the patients does not affect the individual parameters. However, using a scoring system to evaluate and monitor patients’ cardiometabolic cluster risks will make it possible to follow the gradual changes in patients after surgery, making interventions by physicians and nutritionists more targeted and efficient.

Keywords:

Metabolic syndrome, bariatric surgery, cardiometabolic risk score, amount of weight loss, obesity,

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1. Ruız-Fernandez NA, Leal U, Espinoza M. Comparison of scores for the classification of cardiometabolic risk in adult patients enrolled in a Venezuelan program for chronic non-communicable diseases: a cross-sectional study. Sao Paulo Med J 2020;138(1):69-78. [CrossRef] google scholar
2. Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120(16):1640-5. [CrossRef] google scholar
3. Reuter CP, Renner JDP, Silveira JFC, Silva PT, Lima RA, Pfeiffer KA et al. Clustering of cardiometabolic risk factors and the continuous cardiometabolic risk score in children from Southern Brazil: a cross-sectional study. J Diabetes Metab Disord 2021;20(2):1221-8. [CrossRef] google scholar
4. Wijndaele K, Beunen G, Duvigneaud N, Matton L, Duquet W, Thomis M, et al. A continuous metabolic syndrome risk score: utility for epidemiological analyses. Diabetes Care 2006;29(10):2329. [CrossRef] google scholar
5. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA. Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes. N Engl J Med 2017;376(7):641-51. [CrossRef] google scholar
6. Schiavon CA, Santos RN, Santucci EV, Noujaim PM, Cavalcanti AB, Drager LF. Does the RYGB common limb length influence hypertension remission and cardiometabolic risk factors? Data from the GATEWAY trial. Surg Obes Relat Dis 2019;15(2):211-7. [CrossRef] google scholar
7. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005;142(7):547-59. [CrossRef] google scholar
8. Hyde PN, Sapper TN, Crabtree CD, LaFountain RA, Bowling ML, Buga A, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight 2019;4(12):e128308. [CrossRef] google scholar
9. Ross R, Dagnone D, Jones PJ, Smith H, Paddags A, Hudson R, et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med 2000;133(2):92-103. [CrossRef] google scholar
10. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28(2):169-80. [CrossRef] google scholar
11. Arslan M, Atmaca A, Ayvaz G, Başkal N, Beyhan Z, Bolu E et al. Türkiye Endokrinoloji ve Metabolizma Derneği Metabolik Sendrom Kılavuzu; 2009.p.8. google scholar
12. Kamel M, Smith BT, Wahi G, Carsley S, Birken CS, Anderson LN. Continuous cardiometabolic risk score definitions in early childhood: a scoping review. Obes Rev 2018;19(12):1688-99. [CrossRef] google scholar
13. Gurka MJ, Lilly CL, Oliver MN, DeBoer MD. An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: a confirmatory factor analysis and a resulting continuous severity score. Metabolism 2014;63(2):218-25. [CrossRef] google scholar
14. DeMers D; Wachs D. Physiology, Mean Arterial Pressure Copyright © 2022, StatPearls Publishing LLC. Bookshelf ID: NBK431128 Available form: URL: https://www.ncbi.nlm.nih. gov/books/NBK538226/ google scholar
15. Pujante P, Hellın MD, Fornovi A, Camblor PM, Ferrer M, Garcıa-Zafra V, et al. Modification of cardiometabolic profile in obese diabetic patients after bariatric surgery: changes in cardiovascular risk. Rev Esp Cardiol (Engl Ed) 2013;66(10):812-8. [CrossRef] google scholar
16. Gil S, Goessler K, Dantas WS, Murai IH, Merege-Filho CAA, Pereira RMR et al. Constraints of Weight Loss as a Marker of Bariatric Surgery Success: An Exploratory Study. Front Physiol 2021;12:640191. [CrossRef] google scholar
17. Lee WJ, Huang MT, Wang W, Lin CM, Chen TC, Lai IR. Effects of obesity surgery on the metabolic syndrome. Arch Surg 2004;139(10):1088-92. [CrossRef] google scholar
18. Batsis JA, Romero-Corral A, Collazo-Clavell M, Sarr MG, Somers VK, and Lopez-Jimenez F. The Effect of Bariatric Surgery on the Metabolic Syndrome: A Population-based, Long-term Controlled Study. Mayo Clin Proc 2008;83(8):897-907. [CrossRef] google scholar
19. Guilbert L, Ortiz CJ, Espinosa O, Sepulveda EM, Pina T, Joo P et al. Metabolic syndrome 2 years after laparoscopic gastric bypass. Int J Surg 2018;52:264-8. [CrossRef] google scholar
20. Alomar AO, Shaheen MF, Abdallh S. Almaneea AS, Althaqeb EK, Alshahrani ZM et al. The Effect of Bariatric Surgery on Metabolic Syndrome: A Three-center Experience in Saudi Arabia. Obesity Surgery 2021;31:3630-6. [CrossRef] google scholar
21. Domienik-Karlowicz J, Dzikowska-Diduch O, Lisik W, Chmura A, Pruszczyk P. Short-term cardiometabolic risk reduction after bariatric surgery. Hellenic J Cardiol 2015;56(1):61-5. google scholar
22. Goday A, Benaiges D, Parri A, Ramon JM, Flores-Le Roux JA, Botet JP. Can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient? Surg Obes Relat Dis 2014;10(5):871-6. [CrossRef] google scholar
23. Hong YR, Kelly AS, Johnson-Mann C, Lemas DJ, Cardel MI. Degree of Cardiometabolic Risk Factor Normalization in Individuals Receiving Bariatric Surgery: Evidence From NHANES 2015-2018. Diabetes Care 2021;44(3):e57-8. [CrossRef] google scholar
24. Isbell JM, Robyn A, Tamboli RA, Hansen EN, Saliba J, Dunn JP, et al. The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery. Diabetes Care 2010;33(7):1438-42. [CrossRef] google scholar
25. Hyde PN, Sapper TN, Crabtree CD, LaFountain RA, Bowling ML, Buga A. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight 2019;4(12):e128308. [CrossRef] google scholar
26. Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC. Long-term Weight Regain after Gastric Bypass: A 5-year Prospective Study. Obes Surg 2008;18:648-51. [CrossRef] google scholar