Long-term Follow-up After Bariatric Surgery
By N. Puzziferri, Thomas B. Roshek, Helen Mayo, R. Gallagher, S. Belle, E. Livingston. Journal of the American Medical Association (JAMA), 2014
775 citations recorded by the source corpus.
IMPORTANCE Bariatric surgery is an accepted treatment for obesity. Despite extensive literature, few studies report long-term follow-up in cohorts with adequate retention rates. OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss, type 2 diabetes, hypertension, and hyperlipidemia in severely obese adults. EVIDENCE REVIEW MEDLINE and Cochrane databases were searched from 1946 through May 15, 2014. Search terms included bariatric surgery, individual bariatric procedures, and obesity. Studies were included if they described outcomes for gastric bypass, gastric band, or sleeve gastrectomy performed on patients with a body mass index of 35 or greater, had more than 2 years of outcome information, and had follow-up measures for at least 80% of the initial cohort. Two investigators reviewed each study and a third resolved study inclusion disagreements. FINDINGS Of 7371 clinical studies reviewed, 29 studies (0.4%, 7971 patients) met inclusion criteria. All gastric bypass studies (6 prospective cohorts, 5 retrospective cohorts) and sleeve gastrectomy studies (2 retrospective cohorts) had 95% confidence intervals for the reported mean, median, or both exceeding 50% excess weight loss. This amount of excess weight loss occurred in 31% of gastric band studies (9 prospective cohorts, 5 retrospective cohorts). The mean sample-size–weighted percentage of excess weight loss for gastric bypass was 65.7% (n = 3544) vs 45.0% (n = 4109) for gastric band. Nine studies measured comorbidity improvement. For type 2 diabetes (glycated hemoglobin <6.5% without medication), sample-size–weighted remission rates were 66.7% for gastric bypass (n = 428) and 28.6% for gastric band (n = 96). For hypertension (blood pressure <140/90 mm Hg without medication), remission rates were 38.2% for gastric bypass (n = 808) and 17.4% for gastric band (n = 247). For hyperlipidemia (cholesterol <200 mg/dL, high-density lipoprotein >40 mg/dL, low-density lipoprotein <160 mg/dL, and triglycerides <200 mg/dL), remission rates were 60.4% for gastric bypass (n = 477) and 22.7% for gastric band (n = 97). CONCLUSIONS AND RELEVANCE Very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Gastric bypass has better outcomes than gastric band procedures for long-term weight loss, type 2 diabetes control and remission, hypertension, and hyperlipidemia. Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections.
Subfields: Endocrinology, Diabetes and Metabolism, Nutrition and Dietetics, Surgery
View Paper: https://www.semanticscholar.org/paper/ad595f6246b0e9b7c008eccdf1eec0bca42fdacd
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In Endocrinology, Diabetes and Metabolism
In Nutrition and Dietetics
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Citations in the corpus
- Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes – Mechanisms, Management, and Clinical Considerations (2016, neutral): “litus in 40% to 85% of patients, hypertension in 28% to 75% of patients, and dyslipidemia in 70% to 90% of patients.(355,356)”
- 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. (2022, background): “[13] Puzziferri N, Roshek III TB, Mayo HG, et al.”
- 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. (2016, background): “This treatment seems to induce beneficial effects not only on the overall risk factor profile, but also on CV events.(181) Weight reduction can be achieved by decreasing the consumption of energy-dense foods, inducing a caloric deficit of 300–500 kcal/day.”
- Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study (2017, background): “A systematic review reported that fewer than 3%of studies in this field reportweight lossoutcomes formore than80%of theoriginal cohort,whichmay lead tobiased and potentially overestimated reports of the effectiveness of these procedures.(4)Themost comprehensive and longest follow-up information come”