Effects of bariatric surgery on metabolic and nutritional parameters in severely obese Korean patients with type 2 diabetes: A prospective 2‐year follow up

Abstract

Aims/Introduction: Little is known about the long-term effects of Roux-en-Y gastric bypass (RYGB) in severely obese Asian individuals. Methods and Materials: A total of 33 severely obese patients with type 2 diabetes underwent RYGB. All patients were followed up for 2 years. Visceral and abdominal subcutaneous fat areas were assessed using computed tomography (CT) before, and 12 and 24 months after RYGB. The muscle attenuation (MA) of paraspinous muscles observed by CT were used as indices of intramuscular fat. Results: The mean percentage weight loss was 22.2 -5.3% at 12 months, and 21.3 -5.1% at 24 months after surgery. Compared with the baseline values, the visceral fat area was 53.6 -17.1% lower 24 months after surgery, and the abdominal subcutaneous fat area was 32.7 -16.1% lower 24 months after surgery. The MA increased from 48.7 -10.0 at baseline to 52.2 -8.9 (P = 0.009) 12 months after surgery. The MA after the first 12 months maintained changes until 24 months. Triglycerides and free fatty acids were reduced after surgery, whereas the high-density lipoprotein cholesterol levels were increased significantly after surgery. At the last follow-up visit, 18 patients (55%) had diabetes remission. The percentage of iron and vitamin D deficiency was 30% and 52%, respectively. Conclusions: We found that patients subjected to RYGB had significant sustained reductions in visceral and intramuscular fat. There were durable improvements in the cardiometabolic abnormalities without any significant comorbidities. However, there were mild nutritional deficiencies in these patients despite daily supplementation with multivitamins and minerals.

Transumbilical Roux-en-Y gastric bypass in morbidly obese patients: A systematic review

“…In these cases, a 41% mean weight loss was reported and the mean follow-up time after surgery was 10 months. These results are comparable with those of conventional laparoscopic gastric bypass, however there is a need of studies with a longer follow-up in order to draw more definite conclusions regarding the efficacy of SILS-RYGB [23,24].…”

Adipose Tissue Distribution, Inflammation and Its Metabolic Consequences, Including Diabetes and Cardiovascular Disease

“…Within the first year of surgery, some patients experience the loss of around half of their adipose tissue mass (607), often with roughly equivalent losses from subcutaneous and visceral WAT (608,609). As weight loss progresses, studies have shown that later weight loss is largely from visceral depots (610)(611)(612), an effect that correlates with the degree of diabetes remission (609). It has also been reported that ectopic skeletal muscle and pancreatic fat are reduced following bariatric surgery (610,613,614), which could contribute to improved glucose metabolism.…”

Iron deficiency after bariatric surgery: what is the real problem?

“…In light of the risk to develop iron deficiency, different studies have examined the preoperative and postoperative nutritional status of iron after RYGB and SG. Postoperatively, the prevalence of iron deficiency varies between 18•0 and 53•3 % during a follow-up of maximal 11•6 years after RYGB, while the prevalence of anaemia ranges between 6•0 and 63•6 % (30,31,(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68) . To elucidate the contribution of iron deficiency to the development of anaemia, two studies evaluated the prevalence of iron deficiency anaemia during a follow-up of maximal 10 years after RYGB.…”