Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background and Aim

Obesity is one of the greatest public health concerns worldwide. Weight loss surgeries have been increased in recent decades due to the world’s epidemic of obesity. The aim of this prospective study is investigating metabolic factors of morbid obese patients following Roux-en-Y gastric bypass surgery.

Methods

This was a nonrandomized prospective cohort study conducted from 2010 to 2013 on 60 consecutive patients who had body mass index (BMI) of more than 40 kg/m2 and met the surgical indication criteria of bariatric surgery. Upon discharge, patients were followed in outpatient clinic of Qaem Hospital, Mashhad, Iran, each 3 months for 12 months. Measurement of anthropometric and metabolic indices was done in each postoperative visit.

Results

Mean BMI reduction was 15.26 ± 3.45 kg/m2 in the patients with an average value of 28.84 ± 3.94 (range from 22 to 40 kg/m2), which was significantly lower than the base value (p < 0.001). After a 12-month follow up, patients had lower low-density lipoprotein, triglycerides, and total cholesterol (p < 0.001 for all the variables), while achieving a greater high-density lipoprotein (p = 0.004). An improvement was seen in all of hypertensive patients after a 3-month follow up and blood pressure remained within normal limit in further follow ups. Complete remission was observed in all the patients with obstructive sleep apnea.

Conclusion

It appears reasonable that multidisciplinary treatment including surgical alternatives should be concerned for all morbidly obese patients, considering high rate of failure of conservative medical therapy in this setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Alberti KGMM, Eckel RH, Grundy SM, 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;120:1640–5.

    Article  CAS  PubMed  Google Scholar 

  3. Ginter E, Simko V. Diabetes type 2 pandemic in 21st century. Bratisl Lek Listy. 2010;111:134–7.

    CAS  PubMed  Google Scholar 

  4. Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62:220–33.

    Article  PubMed  Google Scholar 

  5. Tham JC, Howes N, le Roux CW. The role of bariatric surgery in the treatment of diabetes. Ther Adv Chronic Dis. 2014;5:149–57.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Allender S, Rayner M. The burden of overweight and obesity-related ill health in the UK. Obes Rev. 2007;8:467–73.

    Article  CAS  PubMed  Google Scholar 

  7. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.

    Article  PubMed  Google Scholar 

  8. Dixon JB, le Roux CW, Rubino F, Zimmet P. Bariatric surgery for type 2 diabetes. Lancet. 2012;379:2300–11.

    Article  PubMed  Google Scholar 

  9. Trakhtenbroit MA, Leichman JG, Algahim MF, et al. Body weight, insulin resistance, and serum adipokine levels 2 years after 2 types of bariatric surgery. Am J Med. 2009;122:435–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Bendewald FP, Choi JN, Blythe LS, Selzer DJ, Ditslear JH, Mattar SG. Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2011;21:1671–5.

    Article  PubMed  Google Scholar 

  11. Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309:2240–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.

    Article  CAS  PubMed  Google Scholar 

  14. Bray GA, Ryan DH. Drug treatment of the overweight patient. Gastroenterology. 2007;132:2239–52.

    Article  CAS  PubMed  Google Scholar 

  15. Csendes A, Smok G, Burgos AM. Histological findings in the liver before and after gastric bypass. Obes Surg. 2006;16:607–11.

    Article  PubMed  Google Scholar 

  16. Furuya CK Jr, de Oliveira CP, de Mello ES, et al. Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol. 2007;22:510–4.

    Article  CAS  PubMed  Google Scholar 

  17. Mancia G, Carugo S, Grassi G, et al. Prevalence of left ventricular hypertrophy in hypertensive patients without and with blood pressure control: data from the PAMELA population. Pressioni Arteriose Monitorate E Loro Associazioni. Hypertension. 2002;39:744–9.

  18. Jamal M, Wegner R, Heitshusen D, Liao J, Samuel I. Resolution of hyperlipidemia follows surgical weight loss in patients undergoing Roux-en-Y gastric bypass surgery: a 6-year analysis of data. Surg Obes Relat Dis. 2011;7:473–9.

    Article  PubMed  Google Scholar 

  19. Ikramuddin S, Kendrick M, Kellogg T, Sarr M. Open and laparoscopic Roux-en-Y gastric bypass: Our techniques. J Gastrointest Surg. 2007;11:217–28.

  20. Bambs C, Cerda J, Escalona A. Morbid obesity in a developing country: the Chilean experience. Bull World Health Organ. 2008;86:813–4.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Azizi F. Bariatric surgery for obesity and diabetes. Arch Iran Med. 2013;16:182–6.

    PubMed  Google Scholar 

  22. Garcia-Marirrodriga I, Amaya-Romero C, Ruiz-Diaz GP, et al. Evolution of lipid profiles after bariatric surgery. Obes Surg. 2012;22:609–16.

    Article  PubMed  Google Scholar 

  23. Bueter M, Lowenstein C, Olbers T, et al. Gastric bypass increases energy expenditure in rats. Gastroenterology. 2010;138:1845–53.

    Article  PubMed  Google Scholar 

  24. Miras AD, Chuah LL, Lascaratos G, et al. Bariatric surgery does not exacerbate and may be beneficial for the microvascular complications of type 2 diabetes. Diabetes Care. 2012;35:e81.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Borg CM, le Roux CW, Ghatei MA, Bloom SR, Patel AG, Aylwin SJ. Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg. 2006;93:210–5.

    Article  CAS  PubMed  Google Scholar 

  26. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85.

    Article  CAS  PubMed  Google Scholar 

  27. Dixon AF, Dixon JB, O’Brien PE. Laparoscopic adjustable gastric banding induces prolonged satiety: a randomized blind crossover study. J Clin Endocrinol Metab. 2005;90:813–9.

    Article  CAS  PubMed  Google Scholar 

  28. O’Brien PE, Dixon JB. Lap-band: outcomes and results. J Laparoendosc Adv Surg Tech A. 2003;13:265–70.

    Article  PubMed  Google Scholar 

  29. Makishima M, Okamoto AY, Repa JJ, et al. Identification of a nuclear receptor for bile acids. Science. 1999;284:1362–5.

    Article  CAS  PubMed  Google Scholar 

  30. Nakatani H, Kasama K, Oshiro T, Watanabe M, Hirose H, Itoh H. Serum bile acid along with plasma incretins and serum high-molecular weight adiponectin levels are increased after bariatric surgery. Metabolism. 2009;58:1400–7.

    Article  CAS  PubMed  Google Scholar 

  31. Pournaras DJ, Glicksman C, Vincent RP, et al. The role of bile after Roux-en-Y gastric bypass in promoting weight loss and improving glycaemic control. Endocrinology. 2012;153:3613–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kashyap SR, Bhatt DL, Wolski K, et al. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care. 2013;36:2175–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Promintzer-Schifferl M, Prager G, Anderwald C, et al. Effects of gastric bypass surgery on insulin resistance and insulin secretion in nondiabetic obese patients. Obesity (Silver Spring). 2011;19:1420–6.

    Article  CAS  Google Scholar 

  34. Benaiges D, Flores-Le-Roux JA, Pedro-Botet J, et al. Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery (Roux-en-Y gastric bypass) on lipid profile. Obes Surg. 2012;22:1268–75.

    Article  CAS  PubMed  Google Scholar 

  35. Asztalos BF, Swarbrick MM, Schaefer EJ, et al. Effects of weight loss, induced by gastric bypass surgery, on HDL remodeling in obese women. J Lipid Res. 2010;51:2405–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Hanusch-Enserer U, Zorn G, Wojta J, et al. Non-conventional markers of atherosclerosis before and after gastric banding surgery. Eur Heart J. 2009;30:1516–24.

    Article  CAS  PubMed  Google Scholar 

  37. Lubrano C, Mariani S, Badiali M, et al. Metabolic or bariatric surgery? Long-term effects of malabsorptive vs restrictive bariatric techniques on body composition and cardiometabolic risk factors. Int J Obes. 2010;34:1404–14.

    Article  CAS  Google Scholar 

  38. Habib P, Scrocco JD, Terek M, Vanek V, Mikolich JR. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol. 2009;104:1251–5.

    Article  CAS  PubMed  Google Scholar 

  39. Nguyen NT, Varela E, Sabio A, Tran CL, Stamos M, Wilson SE. Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2006;203:24–9.

    Article  PubMed  Google Scholar 

  40. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  CAS  PubMed  Google Scholar 

  41. Gill RS, Karmali S, Sharma AM. Treating type 2 diabetes mellitus with sleeve gastrectomy in obese patients. Obesity (Silver Spring). 2011;19:701–2.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran

    Sahar Fallahi-shahabad, Alireza Tavasoli, Peyman Rezaie, Fatemeh Rohani, Simindokht Habibzadeh, Emadodin Darchini-Maragheh, Zohreh Sadat Sang Sefidi, Mohammad Safarian, Majid Ghayour Mobarhan, Mohammad Taghi Rajabi, Abdolreza Norouzy, Seyed Mohammad Reza Parizadeh, Saeid Akhlaghi, Shima Tavalaie, Fatemeh Firouzi & Mohsen Nematy

  2. Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang, Beijing, China

    Mohsen Mazidi

  3. Institute of Genetics and Developmental Biology, International College University of Chinese Academy of Science (IC-UCAS), West Beichen Road, Chaoyang, China

    Mohsen Mazidi

  4. Cardiovascular Research Center, Mashhad University of Medical Science, Mashhad, Iran

    Majid Ghayour Mobarhan

Authors
  1. Sahar Fallahi-shahabad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohsen Mazidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alireza Tavasoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peyman Rezaie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fatemeh Rohani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Simindokht Habibzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emadodin Darchini-Maragheh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zohreh Sadat Sang Sefidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mohammad Safarian
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Majid Ghayour Mobarhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mohammad Taghi Rajabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Abdolreza Norouzy
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Seyed Mohammad Reza Parizadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Saeid Akhlaghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Shima Tavalaie
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Fatemeh Firouzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Mohsen Nematy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohsen Nematy.

Ethics declarations

Ethical considerations

The study protocol was approved by the Ethical Committee in Research of Mashhad University of Medical Sciences.

Conflicts of interest

SF-s, MM, AT, PR, FR, SH, ED-M, ZSSS, MS, MGM, MTR, AN, SMRP, SA, ST, FF, and MN declare that they have no conflict of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008, concerning human and animal rights, and the authors followed the policy concerning informed consent as shown in springer.com.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fallahi-shahabad, S., Mazidi, M., Tavasoli, A. et al. Metabolic improvement of morbid obese patients following Roux-en-Y gastric bypass surgery: A prospective study in Mashhad, Iran. Indian J Gastroenterol 35, 195–200 (2016). https://doi.org/10.1007/s12664-016-0661-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-016-0661-0

Keywords

Search

Navigation