The influence of gender and age on laparoscopic sleeve gastrectomy short-term outcomes in type 2 diabetic obese patients

Abstract

Background: Bariatric surgery has come out as an effective treatment for morbid obesity due to its effects as stabilized weight loss and remission of obesity related comorbidities like type 2 diabetes. Postoperative weight loss is affected by many factors and predictors of weight loss after bariatric surgery are controversial.This study has been performed to evaluate the impact of gender and age on the short-term outcomes of laparoscopic sleeve gastrectomy (LSG) in type 2 diabetic(T2D) obese patients. Material and Methods: In this retrospective study, the records of morbidly obese patients with a body mass index(BMI)≥40 kg/m2, aged between 18-65 years old who underwent LSG and were followed-up for at least 6 months postoperatively were reviewed.Patients were subdivided into two groups according to age(≥50 y,<50 y),gender(female, male) and compared. Results: The study included 25 patients, 17(68%) female and 8(32%) male, 14(56%) were in <50 years old group and 11(44%) were in ≥50 years old group.At the postoperative 6th month, there was a significant decrease in weight, BMI, diastolic blood pressure, fasting blood glucose, postprandial glucose and HbA1c in both gender and age groups (p<0.05).A significant decrease was observed in Triglyceride(TG) at 6th month in both gender.While a significant increase in High-density Lipoprotein (HDL) was observed in patients aged ≥50 (p=0.028),no significant change was observed in the younger group.There was a positive correlation between change in Total Cholesterol(TCh),TG and age (respectively;r=0.436,p=0.030, r=0.528,p=0.007). Conclusions: LSG is an effective treatment method for morbid obesity for younger(<50 y) and advanced aged(≥50 y) T2D patients in both genders. The percentage changes in the decreament of TG in male gender and TCh in younger age were more prominent in short-term follow-up.

Keywords

• laparoscopic sleeve gastrectomy
• age
• gender
• obesity
• T2DM

References

1. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28:169-80.
2. Palikhe G, Gupta R, Behera BN, Sachdeva N, Gangadhar P, Bhansali A. Efficacy of laparoscopic sleeve gastrectomy and intensive medical management in obese patients with type 2 diabetes mellitus. Obes Surg 2014;24:529-35.
3. Perrone F, Bianciardi E, Benavoli D, Tognoni V, Niolu C, Siracusano A, et al. Gender Influence on Long-Term Weight Loss and Comorbidities After Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: a Prospective Study With a 5-Year Follow-up. Obes Surg Doı 10.1007/S11695-015-1746-Z.
4. Kennedy-Dalby A , Adam S, Ammori BJ, et al. Weight loss and metabolic outcomes of bariatric surgery in men versus women — A matched comparative observational cohort study. European Journal of Internal Medicine 25 (2014) 922–5.
5. Farinholt GN, Carr AD, Chang EJ, Ali MR. A call to arms: obese men with more severe comorbid disease and underutilization of bariatric operations. Surg Endosc 2013;27:4556-63.
6. Padwal RS, Klarenbach SW,Wang X, Sharma AM, Karmali S, Birch DW, et al. A simple prediction rule for all-cause mortality in a cohort eligible for bariatric surgery. JAMA Surg 2013;148:1109-15.
7. Smith JA, Braunack-Mayer A, Wittert G.What dowe knowaboutmen's help-seeking and health service use? Med J Aust 2006;184:81-3.
8. Galdas PM, Cheater F,Marshall P.Men and health help-seeking behaviour: literature review. J Adv Nurs 2005;49:616-23.

9. Horigan, G., McGuigan, K., Quinn, L., & Coates, V. (2015). Does gender make a difference to self-management of diabetes in adults ≤55 years? A pilot study. Diabetes Medicine, 32, 140–8.
10. Wannamethee, S., Papacosta, O., Lawlor, D.,Whincup, P., Lowe, G., Ebrahim, S., & Sattar, N. (2012). Do women exhibit greater differences in established and novel risk factors between diabetes and non-diabetes than men? The British Regional Heart Study and British Women's Heart Health Study. Diabetologia,55,80-7.
11. Arnold W.J.M. van de Laar Algorithm for weight loss after gastric bypass surgery considering body mass index, gender, and age from the Bariatric Outcome Longitudinal Database (BOLD). Surgery for Obesity and Related Diseases 10(2014):55–63.
12. Kitamura R, Chen R, Trickey A,et al.Positive and Negative Independent Predictive Factors of Weight Loss After Bariatric Surgery in a Veteran Population.Obesity Surgery https://doi.org/10.1007/s11695-020-04428-0
13. Ketterer C, Heni M, Stingl K, Tschritter O, Linder K, Wagner R,et al. Polymorphism rs3123554 in CNR2 reveals genderspecific effects on body weight and affects loss of body weight and cerebral insulin action. Obesity (Silver Spring). 2014;22(3):925-31.
14. Cingi A, Yardimci S, Yavuz D, et al. One Hundred Twenty-Eight Consecutive Sleeve Gastrectomies, Short-Term Outcomes, and Impacts on Type 2 Diabetes Mellitus. Indian J Surg (October 2018) 80(5):410–4.
15. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009;122(248-56e5).
16. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ 2014;349:g3961.
17. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347(20):1557-65.
18. Burns EM, Naseem H, Bottle A, Lazzarino AI, Aylin P, Darzi A,et al. Introduction of laparoscopic bariatric surgery in England: observational population cohort study. BMJ.2010;341:c4296.
19. O’Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence. Obes Surg 2010;20:1199–205.
20. Mizrahi I, Alkurd A, Ghanem M, Zugayar D, Mazeh H, Eid A,et al. Outcomes of laparoscopic sleeve gastrectomy in patients older than 60 years. Obes Surg 2014;24(6):855-60.
21. Aslaner A, Ongen A, Koşar M, Çakır T, Mayir B, Doğan U,et al.Relation between weight loss and age afterlaparoscopic sleeve gastrectomy. European Review for Medical and Pharmacological Sciences 2015;19:1398-402.
22. Ritz P, Topart P, Benchetrit S, Tuyeras G, Lepage B, Mouiel J, Becouarn G, Pattou F, Chevallier JM. Benefits and risks of bariatric surgery in patients aged more than 60 years. Surg Obes Relat Dis.2014,Jan9.pii:S1550-7289.
23. Contreras JE, Santander C, Court I, et al. Correlation Between Age and Weight Loss after Bariatric Surgery. OBES SURG (2013) 23:1286–9.
24. Chang WW, Hawkins DN, Brockmeyer JR, Faler BJ, Hoppe SW, Prasad BM. Factors influencing long-term weight loss after bariatric surgery. Surgery for Obesity and Related Diseases 15 (2019) 456–61.
25. RobertM, Pasquer A, Espalieu P, Laville M, Gouillat C, Disse E,et al. Gastric bypass for obesity in the elderly: is it as appropriate as for young and middle-aged populations? Obes Surg.2014;22:22.
26. Bhandari M, Mathur W, Fobi M,et al.Outcomes of bariatric surgery in geriatric patients ≥65 years: single institution study. Obesity Surgery https://doi.org/10.1007/s11695-019-03718-6.
27. Giordano S, Victorzon M. Laparoscopic Roux-en-Y gastric bypass is effective and safe in over 55-year-old patients: a comparative analysis. World J Surg. 2014;38(5):1121–6.
28. Burchett MA, McKenna DT, Selzer DJ, Choi JH, Mattar SG. Laparoscopic sleeve gastrectomy is safe and effective in elderly patients: a comparative analysis. Obes Surg.2014,Sep16.
29. Espeland MA, Rejeski WJ, West DS, Bray GA, Clark JM, Peters AL,et al. Action for health in diabetes research group. Intensive weight loss intervention in older individuals: results from the action for health in diabetes type 2 diabetes mellitus trial. J Am Geriatr Soc.2013;61(6):912-22.
30. Fabricatore AN, Wadden TA, Moore RH, Butryn ML, Heymsfield SB, Nguyen AM. Predictors of attrition and weight loss success: Results from a randomized controlled trial. Behav Res Ther.2009;47:685-91.