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Incidence of Diabetes Mellitus, Cardiovascular Diseases, and Cancer in Patients Undergoing Malabsorptive Surgery (Biliopancreatic Diversion and Biliointestinal Bypass) vs Medical Treatment

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Abstract

Background and Aims

Bariatric surgeries such as gastric banding (LAGB), gastric bypass (RYGB), vertical banded gastroplasty (VBG), and sleeve gastrectomy (LSG) decrease body weight in morbid obesity, leading to the resolution of coexisting diabetes mellitus and arterial hypertension in the majority of cases as well as improvements of renal function and liver steatosis. BS (LAGB, RYGB, VBG, and LSG) also reduce incident cases of diabetes, of cardiovascular diseases, and of cancer; these therapeutic and preventive effects on comorbidities of obesity have not been analyzed for malabsorptive surgeries such as biliopancreatic diversion (BPD) or biliointestinal bypass (BIBP). The aim of this study was to analyze the incidence of comorbidities, i.e., diabetes, cardiovascular diseases, and cancer, in obese subjects undergoing BPD and BIBP, in comparison with standard medical treatment of obesity.

Patients and Methods

Medical records of 1983 obese patients (body mass index (BMI) > 35 kg/m2, aged 18–65 years, undergoing surgery (n = 472, of which 111 with diabetes) or medical treatment (n = 1511, of which 422 with diabetes), during the period 1999–2008 (visit 1)) were collected; incident cases of comorbidities were ascertained through December 31, 2016.

Results

Observation period was 12.0 ± 3.48 years (mean ± SD). Compared to non-surgical patients matched for age, body mass index, and blood pressure, malabsorptive surgeries were associated with reduced new incident cases of diabetes (p = 0.001), cardiovascular diseases (p = 0.001), hyperlipidemia (p = 0.001), oculopathy (p = 0.021), and cancer (p = 0.001). The preventive effect of BS was similar in both nondiabetic and diabetic patients for cardiovascular diseases and hyperlipidemia (both p = 0.001). The preventive effect was significant in nondiabetic subjects for coronary heart disease and for cancer, not significant in diabetic subjects.

Conclusion

Patients undergoing malabsorptive bariatric surgery show less incident cases of diabetes, cardiovascular diseases, hyperlipidemia, oculopathy, and cancer than controls receiving medical treatment.

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Acknowledgements

The LAGB10 working group includes people from Ospedale San Paolo and Università degli Studi di Milano (Annamaria Veronelli, MD; Barbara Zecchini, BSc; Ahmed Zakaria, PhD; Francesca Frigè, BSc; Luca Rossetti, MD; Alberto Benetti, MD; Maurizio Cristina, MD; Ermanno Mantegazza, BSc; Marco Fanchini, BSc; Alberto Morabito, PhD; Franco Folli, MD; Antonio E. Pontiroli, MD); from IRCCS Policlinico (Enrico Mozzi, MD); from Ospedale San Raffaele (Alessandro Saibene, MD; Michele Paganelli, MD; Paola Vedani, MD); from Istituto Clinico Sant’Ambrogio (Giancarlo Micheletto, MD; Alessandro Giovanelli, MD); from Istituto Multimedica (Valerio Ceriani, Chiara Osio); from Ospedale Civile, Magenta (Giuliano Sarro, MD); from Istituto Humanitas Gavazzeni (Italo Nosari, MD); and from the Health Districts (Maria Grazia Angeletti, MD; Mariangela Autelitano, MD; Luca Cavalieri d’Oro, MD; Piergiorgio Berni, MD; Antonio G. Russo, MD).

The authors wish to thank Dr. Antonio G. Russo, Osservatorio Epidemiologico, ATS, Città Metropolitana di Milano, for the precious help in identifying causes of exemptions of patients in the study.

Funding

Università degli Studi di Milano, Ospedale San Paolo, Istituto Multimedica, Ospedale di Magenta, Istituto Humanitas Gavazzeni, INCO-Istituto Clinico Sant’Ambrogio. Grant “Ricerca Corrente” to Istituto Multimedica from Ministero della Salute (Ministry of Health), Italy

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Authors and Affiliations

  1. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy

    Antonio E. Pontiroli & Franco Folli

  2. ASST Santi Paolo e Carlo, Milan, Italy

    Antonio E. Pontiroli, Ahmed S. Zakaria, Marco Fanchini, Anna Maria Veronelli & Franco Folli

  3. Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy

    Antonio E. Pontiroli & Anna Maria Veronelli

  4. IRCCS Multimedica, Milan, Italy

    Valerio Ceriani & Chiara Osio

  5. Ospedale Civile, Magenta, Milan, Italy

    Giuliano Sarro

  6. INCO e Dipartimento di Chirurgia Generale, Istituto Clinico Sant’Ambrogio, Milan, Italy

    Giancarlo Micheletto & Alessandro Giovanelli

  7. Istituto Humanitas Gavazzeni, Bergamo, Italy

    Italo Nosari

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  1. Antonio E. Pontiroli
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  2. Valerio Ceriani
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  3. Giuliano Sarro
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  10. Anna Maria Veronelli
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  11. Franco Folli
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Consortia

on behalf of the LAGB10 working group

Contributions

VC, GS, CO, GM, and AG performed all bariatric procedures, searched data, and contributed to discussion; ASZ, MF, IN, AMV, FF searched data, prepared the database, contributed to analysis, and contributed to discussion; AEP planned the research, contributed to discussion, and wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Antonio E. Pontiroli.

Ethics declarations

The study protocol was approved by local Ethics Committees in 2015 (Coordinating Center: Ospedale San Paolo, Comitato Etico Interaziendale di Milano Area A, official approval SC: 2015 ST 125). Being a retrospective study, informed consent was obtained from all individual participants included in the study who could be reached by interview, phone, or letter.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Pontiroli, A.E., Ceriani, V., Sarro, G. et al. Incidence of Diabetes Mellitus, Cardiovascular Diseases, and Cancer in Patients Undergoing Malabsorptive Surgery (Biliopancreatic Diversion and Biliointestinal Bypass) vs Medical Treatment. OBES SURG 29, 935–942 (2019). https://doi.org/10.1007/s11695-018-3601-5

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