Bariatrik Cerrahi Geçirmiş Hastaların Kardiyometabolik Risk Belirteçlerinin Değerlendirilmesi

Abstract

Amaç: Bu çalışma, bariatrik cerrahi geçirmiş bireylerin cerrahi öncesine göre, cerrahi sonrasındaki kardiyometabolik risk belirteçlerinin değişimini belirlemek amacıyla yürütülmüştür. Gereç ve Yöntemler: Çalışma; Kasım 2017 – Ağustos 2020 tarihleri arasında Aksaray Üniversitesi Eğitim ve Araştırma Hastanesi’nde sleeve gastrektomi geçiren 102 hasta ile retrospektif olarak yapılmıştır. Araştırma verilerinin toplanmasında, Aksaray Üniversitesi Eğitim ve Araştırma Hastanesi Hastane Bilgi Yönetim Sistemi ve Postoperatif Hasta Değerlendirme Formu kullanılmıştır. Çalışma, tanımlayıcı retrospektif araştırma niteliğindedir. Bulgular: Tüp mide operasyonu geçiren hastaların cerrahi öncesi serum trigliserid ortalamaları 155,1±80,17 mg/dL, cerrahi sonrası ise 94,8±39,59 mg/dL; cerrahi öncesi serum CRP ortalamaları 9,6±7,91 mg/dL, cerrahi sonrası ise 4,9±6,82 mg/dL; cerrahi öncesi serum demir ortalamaları 66,4±29,33 ug/dL, cerrahi sonrası 84,8±36,7 ug/dL olarak belirlenmiş ve bu değişimler istatistiksel olarak anlamlı bulunmuştur (p<0,05). Hastaların antropometrik ölçümlerine bakıldığında ise cerrahi öncesi vücut ağırlığı ortalamaları 120,9±17,00 kg ve BKİ ortalamaları 44,6±5,47 kg/m2 olarak belirlenmiştir. Bu ölçümler cerrahi sonrası sırasıyla 83,1±11,54 kg ve 30,7±4,12 kg/m2 olarak tespit edilmiş ve cerrahi öncesine göre cerrahi sonrası her iki ölçümün de anlamlı olarak azaldığı sonucuna ulaşılmıştır (p<0,05). Sonuç: Bu çalışmaya göre, antropometrik ölçümler üzerinde anlamlı olarak azalma kaydedilmesine rağmen kan parametrelerinden sadece serum trigliserid ve serum CRP düzeylerinin anlamlı olarak azalması, serum demirin anlamlı olarak artması ve diğer parametrelerin anlamlı olarak değişmemesi, tüp mide operasyonunun kardiyometabolik risk faktörleri açısından çelişkili sonuçlar içerdiğini göstermektedir.

Keywords

• Bariatrik cerrahi
• obezite
• kardiyometabolik risk faktörleri

Assessment of Cardiometabolic Risk Markers of Patients Who Have Had Bariatric Surgery

Abstract

Aim: This study was carried out to determine the change of cardiometabolic risk markers after surgery compared to pre-surgery of individuals who had bariatric surgery. Material and Methods: The study was conducted with 102 patients who underwent bariatric surgery at Aksaray University Training and Research Hospital between November 2017 and August 2020. Aksaray University Training and Research Hospital Hospital Information Management System and Postoperative Patient Evaluation Form were used to collect the research data. The study is a descriptive retrospective research. Results: The mean serum triglyceride levels of patients who underwent sleeve gastrectomy were 155,1±80,17 mg/dL before surgery and 94,8±39,59 mg/dL after surgery; serum CRP averages before surgery were 9,6±7,91 mg/dL and after surgery were 4,9±6,82 mg/dL; serum iron averages were determined as 66,4±29,33 ug/dL before surgery and 84,8±36,7 ug/dL after surgery, and these changes were found to be statistically significant (p<0,05). Considering the anthropometric measurements of the patients, the average body weight before surgery was determined as 120,9±17,00 kg and the average BMI was 44,6±5,47 kg/m2. These measurements were determined as 83,1±11,54 kg and 30,7±4,12 kg/m2, respectively, after surgery, and it was concluded that both measurements decreased significantly after surgery compared to before surgery (p<0,05). Conclusion: According to this study, although there was a significant decrease in anthropometric measurements, only serum triglyceride and serum CRP levels decreased significantly among blood parameters, serum iron increased significantly, and other parameters did not change significantly, indicating that sleeve gastrectomy has contradictory results in terms of cardiometabolic risk factors.

Keywords

• Bariatric surgery
• obesity
• cardiometabolic risk factors.

References

1. Dünya Sağlık Örgütü. Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Yayın tarihi 2024. Erişim tarihi 1 Temmuz 2024
2. Conway B, Rene A. Obesity as a disease: no lightweight matter. Obesity Rewievs. 2004; 5(3): 145-51.
3. World Health Organization. Obesity: preventing and managing the global epidemic. Report of the WHO Consultation of Obesity. Geneva, Switzerland: WHO; 1998.
4. Eknoyan G. A history of obesity, or how what was good became ugly and then bad. Advanced Chronic Kidney Disease. 2006; 13(4): 421-7.
5. World Health Organization Waist Circumference and Waist–Hip Ratio: Report of a WHO Expert Consultation. Geneva, Switzerland: WHO; 2008.
6. Türkiye Beslenme ve Sağlık Araştırması (TBSA). T.C. Sağlık Bakanlığı Yayın 2017. No:1132, Ankara
7. Keaver L, Webber L, Dee A, Shiely F, Marsh T Balanda K, et al. Application of the UK foresight obesity model in Ireland: The health and economic consequences of projected obesity trends in Ireland. Plos One. 2013; 8(11): 1-8.
8. World Health Organization. Cardiovascular diseases (CVDs). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Yayın tarihi 2021. Erişim tarihi: 1 Temmuz 2024

9. Türkiye İstatistik Kurumu Ölüm ve Ölüm Nedeni İstatistikleri, 2023 https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2023-53709 Erişim tarihi: 15 Haziran 2024
10. Torres A, Rubio MA, Ramos-Leví AM, Sánchez-Pernaute A. Cardiovascular risk factors after single anastomosis duodeno-ıleal bypass with sleeve gastrectomy (SADI-S): a new effective therapeutic approach? Current Atherosclerosis Reports. 2017; 19(12): 58-65.
11. Fang H, Berg E, Cheng X, Shen W. How to best assess abdominal obesity? Current Opinion in Clinical Nutrition and Metabolic Care. 2018; 21(5): 360-5.
12. Kahan S. Overweight and obesity management strategies. American Journal of Managed Care. 2016; 22(7): 186-96.
13. Di Lorenzo N, Antoniou SA, Batterham RL, Busetto L, Godoroja D, Iossa A, et al. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surgical Endoscopy. 2020; 34(6): 2332-58.
14. Mechanic JI, Apovian C, Brethauer S, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by american association of clinical endocrinologists/american college of endocrinology, the obesity society, american society for metabolic & bariatric surgery, obesity medicine association, and american society of anesthesiologists. Endocrine Practice. 2019; 256(2): 1-75.
15. Quercia I, Dutia R, Kotler DP, Belsley S, Laferrère B. Gastrointestinal changes after bariatric surgery. Diabetes & Metabolism 2014; 40(2): 87-94.
16. Scopinaro N. Bariatric Metabolic Surgery. Rozhledy v Chirurgii. 2014; 93: 404-15.
17. Khalifa KA, Ansari AA, Alsayed AR, Violato C. The Impact of Sleeve Gastrectomy on Hyperlipidemia: A Systematic Review. Journal of Obesity. 2013; 2013: 1-7.
18. Aminian A, Al-Kurd A, Wilson R, Bena J, Fayazzadeh H, Singh T, et al. Association of bariatric surgery with major adverse liver and cardiovascular outcomes in patients with biopsy-proven nonalcoholic steatohepatitis, JAMA. 2021; 326(20): 2031-42.
19. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers.
20. Birsen O, Aykota MR, Kılıç O, Özgen U, Ören N, Özban M. Laparoskopik sleeve gastrektomi ameliyatlarında yașadığımız intraoperatif sorunlar ve tedavi yöntemleri. 4. Ulusal ve 1. Akdeniz Morbid Obezite ve Metabolik Hastalıklar Cerrahisi Kongresi;2015 3 Ekim; Antalya, Türkiye.
21. Çolak GA, Sağlam D. Laparoskopik sleeve gastrektomi operasyonunun kısa dönemde besin alımı, biyokimyasal kan parametreleri ve antropometrik ölçümlere etkisinin değerlendirilmesi. Acıbadem Üniversitesi Sağlık Bilimleri Derg. 2021; 12(2): 291-5.
22. Piche ME, Clavel MA, Auclair A, Rodríguez-Flores M, O'Connor K, Garceau P, et al. Early benefits of bariatric surgery on subclinical cardiac function: Contribution of visceral fat mobilization. Metabolism Clinical and Experimental. 2021; 119:1-10.
23. Ammar W, Basset HA, Faramawy AA, Hegazy T, Sharaf Y. Bariatric surgery and cardiovascular outcome. The Egyptian Heart Journal. 2020; 72(67): 1-10.
24. Sans A, Bailly L, Anty R, Sielezenef I, Gugenheim J, Tran A,et al. Baseline anthropometric and metabolic parameters correlate with weight loss in women 1-year after laparoscopic roux-en-y gastric bypass. Obesity Surgery. 2017; 27: 2940-9.
25. Vuono SD, Ricci MA, Siepi D, Boni M, Gentili A, Scavizii M, et al. Laparoscopic sleeve gastrectomy modifies cholesterol synthesis but not cholesterol absorption. Obesity Research & Clinical Practic. 2017; 11(1): 118-22.
26. Santos J, Salgado P, Santos C, Mendes P, Saavedra J, Baldaque P, et al. Effect of bariatric surgery on weight loss, inflammation, iron metabolism, and lipid profile. Scandinavian Journal of Surgery. 2013; 103(1): 21-5.
27. Azevedo FR, Santoro S, Correa-Giannella ML, Toyoshima MT, Giannella-Neto D, Calderaro D, et al. A prospective randomized controlled trial of the metabolic effects of sleeve gastrectomy with transit bipartition. Obesity Surgery. 2018; 28: 3012-19.
28. Ho JH, Adam S, Liu Y, Azmi S, Dhage S, Syed AA, et al. Effect of bariatric surgery on plasma levels of oxidised phospholipids, biomarkers of oxidised LDL and lipoprotein(a). Journal of Clinical Lipidology. 2021; 15(2): 320-31.
29. Pareek M, Schauer PR, Kaplan LM, Leiter LA, Rubino F, Bhatt DL. Metabolic Surgery. Journal of the American College of Cardiology. 2018; 71(6): 670-87.
30. Loeffelholz C, Gissey L. C, Schumann T, Henke C, Kurzbach A, Struck J, et al. The anorexigenic peptide neurotensin relates to insulin sensitivity in obese patients after BPD or RYGB metabolic surgery. International Journal of Obesity. 2018; 42: 2057-61.
31. Kruschitz R, Wakolbinger M, Schindler K, Prager G, Hoppichler P, Marcelescu R, et al. Effect of one-anastomosis gastric bypass on cardiovascular risk factors in patients with vitamin D deficiency and morbid obesity: A secondary analysis. Nutrition, Metabolism & Cardiovascular Diseases. 2020; 30: 2379-88.
32. Schmatz R, Bitencourt MR, Patias LD, Beck M, Alvarez GC, Zanini D, et al. Evaluation of the biochemical, inflammatory and oxidative profile of obese patients given clinical treatment and bariatric surgery. Clinica Chimica Acta. 2017; 465: 72-9.
33. Huang HH, Yeh C, Chena JC, Lee TH, Chen SC, Lee WJ, et al. Does bariatric surgery influence plasma levels of fetuin-A and leukocyte cell-derived chemotaxin-2 in patients with type 2 diabetes mellitus?. Peer Journal. 2018; 6: 1-17.
34. Uehara D, Seki Y, Kakizaki S, Horiguchi N, Tojima H, Yamazaki Y, et al. Long-term results of bariatric surgery for non-alcoholic fatty liver disease/non-alcoholic steatohepatitis treatment in morbidly obese japanese patients. Obesity Surgery. 2018; 29: 1195-201.
35. Seravalle G, Grassi G. Obesity and hypertension. Pharmacological Research. 2017; 122: 1-7.
36. Goday A, Benaiges D, Parri A, Ramon JM, Roux JAFL, Botet JP, et al. Can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient? Surgery for Obesity and Related Diseases. 2014; 10(5): 871-6.
37. Marrtins C, Strømmen M, Stavne OA. Bariatric surgery versus lifestyle ınterventions for morbid obesity-changes in body weight, risk factors and comorbidities at 1 year. Obesity Surgery. 2021 :841-9.
38. O’Brien PE, MacDonald L, Anderson M, Skinner S, Burton P, Crosthwaite GAS, et al. Long-term outcomes after bariatric surgery. Annals of Surgery. 2013; 257(1): 87-94.
39. Velotti N, Vitiello A, Berardi G, Lauro KD, Musella M. Roux‑en‑Y gastric bypass versus one anastomosis‑mini gastric bypass as a rescue procedure following failed restrictive bariatric surgery. A systematic review of literature with metanalysis. Updates in Surgery. 2021; 73: 639-47.