Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF
  • Original article
  • Open access
  • Published:

The significance of bariatric surgery in Egyptian patients with metabolic syndrome: a multicenter study

The Egyptian Journal of Internal Medicine volume 31, pages 580–586 (2019)Cite this article

Abstract

Background

Obesity and metabolic syndrome (MS) are global health concerns, with high rates of cardiovascular morbidity and mortality. The current guidelines recommend lifestyle modifications as the best initial treatment for obesity and MS. However, lifestyle interventions have modest effects and high 1-year failure rates. Bariatric surgery offers more weight loss with sustained effect in the long term.

Aim

The aim was to assess the effect of bariatric surgery on MS and all its components and to detect the probable risk factors for persistent MS after bariatric surgery in Egyptian patients.

Patients and methods

This prospective multicenter study included 250 obese patients who underwent bariatric surgery and completed 1 year of postoperative follow-up. The patients were evaluated preoperatively and at 1, 6, and 12 months postoperatively for presence of MS and its components according to criteria of the third report of National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III).

Results and discussion

After 1 year of follow-up, the percentages of patients who had MS, obesity, type 2 diabetes mellitus, hypertension, hypertriglyceridemia, and low high-density lipoprotein-cholesterol were significantly decreased from 92, 100, 84, 50, 74, and 50% to 17, 2, 8, 17, 42, and 25%, respectively. Smoking, family history of obesity, and less percentage of excess weight loss were the most important risk factors for persistence of MS after bariatric surgery.

References

  1. Dieli-Conwright C, Courneya K, Demark-Wahnefried W, Sami N, Lee K, Buchanan T, et al. Effects of aerobic and resistance exercise on metabolic syndrome, sarcopenic obesity, and circulating biomarkers in overweight or obese survivors of breast cancer: a randomized controlled trial. J Clin Oncol 2018; 36:875–883.

    Article  CAS  Google Scholar 

  2. Barclay S, Forwell J. Occupational performance issues of adults seeking bariatric surgery for obesity. Am J Occup Ther 2018; 72:1–10.

    Article  Google Scholar 

  3. González K, Fuentes J, Márquez J. Physical inactivity, sedentary behavior, and chronic diseases. Korean J Fam Med 2017; 38:111–115.

    Article  Google Scholar 

  4. Assari S. The link between mental health and obesity: role of individual and contextual factors. Int J Prev Med 2014; 5:247–249.

    PubMed  PubMed Central  Google Scholar 

  5. Kyle T, Kuehl B. Prescription medications and weight gain. Available at. https://www.obesityaction.org/community/article-library/prescriptionmedicationsweight-gain/2018. [Cited 22 May 2019].

  6. Allison K, Goelb N. Timing of eating in adults across the weight spectrum: Metabolic factors and potential circadian mechanisms. Physiol Behav 2018; 192:158–166.

    Article  CAS  Google Scholar 

  7. Lim S, Eckel H. Pharmacological treatment and therapeutic perspectives of metabolic syndrome. Rev Endocrin Metab Disord 2014; 15:329–341.

    Article  CAS  Google Scholar 

  8. Cordero P, Li J, Oben A. Bariatric surgery as a treatment of metabolic syndrome. J R Coll Physicians Edinb 2017; 47:364–368.

    Article  CAS  Google Scholar 

  9. Jensen D, Ryan H. New obesity guidelines: promise and potential. J Am Med Assoc 2014; 311:23–24.

    Article  CAS  Google Scholar 

  10. Billeter A, Herrera J, Scheurlen K, Nickel F, Billmann F, Müller-Stich P. Management of endocrine disease: which metabolic procedure? Comparing outcomes in Sleeve Gastrectomy and Roux-en Y Gastric Bypass. Eur J Endocrinol 2018; 179:77–93.

    Google Scholar 

  11. Miras D, Le-Roux W. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol 2013; 10:575–584.

    Article  Google Scholar 

  12. Nannipieri M, Baldi S, Mari A, Colligiani D, Guarino D, Camastra S, et al. Roux-en-Y gastric bypass and sleeve gastrectomy: mechanisms of diabetes remission and role of gut hormones. J Clin Endocrinol Metab 2013; 98:4391–4399.

    Article  CAS  Google Scholar 

  13. Zoller H, Tilg H. Nonalcoholic fatty liver disease and hepatocellular carcinoma. Metabolism 2016; 65:1151–1160.

    Article  CAS  Google Scholar 

  14. Lassailly G, Caiazzo R, Buob D, Pigeyre M, Verkindt H, Labreuche J, et al. Bariatric surgery reduces features of nonalcoholic steatohepatitis in morbidly obese patients. Gastroenterology 2015; 149:379–388

    Article  Google Scholar 

  15. Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg 2015; 25:1822–1832.

    Article  CAS  Google Scholar 

  16. Higa J, Welbourn R, Dixon J, Kinsman R, Walton P. Third IFSO Global Registry Report. 2017. Available at https://www.ifso.com/pdf/fnal-3rd-ifso-report-at-21st-august-2017.pdf. [Cited 30 May 2019].

  17. Grundy M, Cleeman I, Daniels R, Donato A, Eckel H, et al. Diagnosis and management of the metabolic syndrome An American Heart Association/ National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112:2735–2752.

    Article  Google Scholar 

  18. Ahluwalia V. Metabolic outcomes of bariatric surgery in obesity management: Indian perspective. Curr Res Diabetes Obes J 2018; 8:555744.

    Google Scholar 

  19. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen D, Pories J, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009; 122:248–256.

    Article  Google Scholar 

  20. Cohen R, Pinheiro J, Schiavon C, Salles J, Wajchenberg B, Cummings D. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care 2012; 35:1420–1428.

    Article  Google Scholar 

  21. Panunzi S, De Gaetano A, Carnicelli A, Mingrone G. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A meta-analysis. Ann Surg 2015; 261:459–467.

    PubMed  Google Scholar 

  22. Sjöström L, Lindroos A, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardi-ovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351:2683–2693.

    Article  Google Scholar 

  23. Schauer P, Bhatt D, Kirwan J, Wolski K, Brethauer S, Nava-neethan S, et al. STAMPEDE investigation group. Bariatric surgery versus intensive medical therapy for diabetes-3-year outcomes. N Engl J Med 2014; 370:2002–2013.

    PubMed  Google Scholar 

  24. Ugale S, Gupta N, Modi K, Kota S, Satwalekar V, Naik V, et al. Prediction of remission after metabolic surgery using a nov-el scoring system in type 2 diabetes: a retrospective cohort study. J Diabetes Metab Disord 2014; 13:89

    Article  Google Scholar 

  25. Schiavon C, Drager L, Bortolotto L, Amodeo C, Ikeoka D, Ber-wanger O, et al. The role of metabolic surgery on blood pressure control. Curr Atheroscler Rep 2016; 18:50.

    Article  Google Scholar 

  26. Lee S, Heo Y, Park J, Kim Y, Kim S, do Park J, et al. Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy vs. Gastric Banding: the first multicenter retrospective comparative cohort study in obese Korean patients. Yonsei Med J 2016; 57:956–962.

    CAS  PubMed  Google Scholar 

  27. Boström A, Mwinyi J, Voisin S, Wu W, Schultes B, Zhang K, et al. Longitudinal genome-wide methylation study of RYGB patients reveals novel CpG sites associated with essential hypertension. BMC medical Genomics 2016; 9:20.

    Article  Google Scholar 

  28. Polovina S, Mici D, Bjelovic M, Sumarac-Dumanovic M, Kendereski A. Metabolic surgery and obesity-related comorbidities. Vojnosanit Pregled 2018; 75:213–218.

    Article  Google Scholar 

  29. Yang J, Wang C, Cao G, Yang W, Yu S, Zhai H, et al. Long-term effects of laparoscopic SG versus RYGB for the treatment of Chinese T2DM patients with BMI 28–35 kg/m2. BMC Surg 2015; 15:88.

    Article  Google Scholar 

  30. Zhang Y, Zhao H, Cao Z, Sun X, Zhang C, Cai W, et al. A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5-year outcome. Obes Surg 2014; 24:1617–1624.

    Article  Google Scholar 

  31. Martini F, Anty R, Schneck AS, Casanova V, Iannelli A, Gugenheim J. Predictors of metabolic syndrome persistence 1-year after laparoscopic RYGB. Surg Obes Relat dis 2015; 11:1054–1060.

    Article  Google Scholar 

  32. Boza C, Daroch D, Barros D, Leon F, Funke R, Crovari F. Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure. Surg Obes Relat Dis 2014; 10:1129–1133.

    Article  Google Scholar 

  33. Eid G, Brethauer S, Mattar S, Titchner R, Gourash W, Schauer P. Laparoscopic sleeve gastrectomy for super obese patients: forty-eight percent excess weight loss after 6 to 8 years with 93% follow-up. Ann Surg 2012; 256:262–265.

    Article  Google Scholar 

  34. Casella G, Soricelli E, Giannotti D, Collalti M, Maselli R, Genco A, et al. Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series. Surg Obes Relat Dis 2016; 12:757–762.

    Article  Google Scholar 

  35. Balhara Y. Tobacco and metabolic syndrome. Indian J Endocrinol Metab 2012; 16:81–87.

    Article  Google Scholar 

  36. Inadomi M, Iyengar R, Fischer I, Chen X, Flagler E, Ghaferi A. Effect of patient reported smoking status on short-term bariatric surgery outcomes. Surg Endosc 2018; 32:720–726.

    Article  Google Scholar 

  37. Audrain-McGovern J, Benowitz N. Cigarette smoking, nicotine, and body weight. Clin Pharmacol Ther 2011; 90:164–168.

    Article  CAS  Google Scholar 

  38. Lent M, Bailey-Davis L, Irving B, Wood G, Cook A, Hirsch A, et al. Bariatric surgery patients and their families: health, physical activity, and social support. Obes Surg 2016; 26:2981–2988.

    Article  Google Scholar 

  39. Batsis J, Romero-Corral A, Collazo-Clavell M, Sarr M, Somers V, Lopez-Jimenez F. The effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc 2008; 83:897–07.

    Article  Google Scholar 

  40. Arapis K, Macrina N, Kadouch D, Parenti L, Marmuse J, Hansel B. Outcomes of Roux-en-Y gastric bypass versus sleeve gastrectomy in super-super-obese patients. Surg Obes Relat Dis 2019; 15:23–33.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Zagazig University, Zagazig, 44519, Egypt

    Mohamed A. A. Bassiony PhD of Internal Medicine, Mohamed S. Mohamed & Marwan N. Elgohary

  2. Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Abdelrahman M. H. Nawar

  3. Department of General Surgery, Faculty of Medicine, Benha University,, Egypt

    Emad M. Abdelrahman

  4. Department of General Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt

    Ahmed A. Elshoura

Authors
  1. Mohamed A. A. Bassiony PhD of Internal Medicine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed S. Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marwan N. Elgohary
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdelrahman M. H. Nawar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emad M. Abdelrahman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmed A. Elshoura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed A. A. Bassiony PhD of Internal Medicine.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bassiony, M.A.A., Mohamed, M.S., Elgohary, M.N. et al. The significance of bariatric surgery in Egyptian patients with metabolic syndrome: a multicenter study. Egypt J Intern Med 31, 580–586 (2019). https://doi.org/10.4103/ejim.ejim_89_19

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejim.ejim_89_19

Keywords