Metabolic syndrome in patients with morbid class II to III obesity can be cured by Roux-en-Y gastric bypass surgery, according to findings from a cohort study.
Moreover, the research team reports in the Mayo Clinic Proceedings for August, "Reversibility of metabolic syndrome depends more on the percentage of excess weight lost than on other clinical or demographic characteristics."
To determine the effect of major weight loss on metabolic syndrome, Dr. Francisco Lopez-Jimenez and colleagues studied patients evaluated for bariatric surgery at the Mayo Clinic in Rochester, Minnesota between 1990 and 2003.
All patients met at least three of the five criteria for metabolic syndrome -- increased triglycerides, low high-density lipoprotein, increased blood pressure, increased fasting glucose, and obesity.
The cohort included 180 patients who underwent Roux-en-Y gastric bypass, and 157 control patients who did not undergo the procedure, either because they voluntarily declined, were denied by insurance providers, or did not maintain lifestyle interventions during their evaluation. All patients received medical and dietetic care and extensive counseling about the importance of physical activity.
The mean BMI was 49 in the surgical group and 44 in the nonsurgical group.
During a mean follow-up of 3.4 years, the prevalence of metabolic syndrome decreased from 87% to 29% in the surgical group, and from 85% to 75% in the control group. The authors estimate that the number of patients needed to treat with Roux-en-Y gastric bypass surgery in order to cure one patient of metabolic syndrome was 2.1.
Weight loss averaged 44 kg in the surgical group and 0.1 kg in the nonsurgical group. Multivariable analysis showed that the percentage of excess weight lost was the primary determinant of metabolic syndrome resolution.
"Our study provides robust data to practicing clinicians about the benefits of counseling weight reduction in metabolic syndrome patients," Dr. Lopez-Jimenez and his associates conclude.
They recommend that "Roux-en-Y gastric bypass surgery should be considered as a treatment option in patients with metabolic syndrome that has not responded to conservative measures" in those eligible for bariatric surgery.
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