Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention

D Hofsø, N Nordstrand, L K Johnson, T I Karlsen, H Hager, T Jenssen, J Bollerslev, K Godang, R Sandbu, J Røislien, J Hjelmesaeth, D Hofsø, N Nordstrand, L K Johnson, T I Karlsen, H Hager, T Jenssen, J Bollerslev, K Godang, R Sandbu, J Røislien, J Hjelmesaeth

Abstract

Objective: Weight reduction improves several obesity-related health conditions. We aimed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors.

Design: One-year controlled clinical trial (ClinicalTrials.gov identifier NCT00273104).

Methods: Morbidly obese subjects (19-66 years, mean (s.d.) body mass index 45.1 kg/m(2) (5.6), 103 women) were treated with either Roux-en-Y gastric bypass surgery (n=80) or intensive lifestyle intervention at a rehabilitation centre (n=66). The dropout rate within both groups was 5%.

Results: Among the 76 completers in the surgery group and the 63 completers in the lifestyle group, mean (s.d.) 1-year weight loss was 30% (8) and 8% (9) respectively. Beneficial effects on glucose metabolism, blood pressure, lipids and low-grade inflammation were observed in both groups. Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group; 70 vs 33%, P=0.027, and 49 vs 23%, P=0.016. The improvements in glycaemic control and blood pressure were mediated by weight reduction. The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome, albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group. Gastrointestinal symptoms and symptomatic postprandial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention. There were no deaths.

Conclusions: Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies. However, the improvements were greatest in those patients treated with gastric bypass surgery.

Figures

Figure 1
Figure 1
Flow of participants throughout the study.
Figure 2
Figure 2
Schedule of stays during the 1-year lifestyle programme at Evjeklinikken.
Figure 3
Figure 3
Mean (95% CI) percentage weight change during follow-up (A) and distribution of 1-year changes in weight (B) within the surgery and lifestyle groups. Repeated measures ANOVA was used to compare the change in weight between the two study groups.
Figure 4
Figure 4
Remission of type 2 diabetes and hypertension at 1 year correlated to percentage weight change in individuals treated with gastric bypass surgery or intensive lifestyle intervention. Red triangles represent patients treated with gastric bypass surgery, while blue circles represent subjects who chose lifestyle intervention. Open triangles/circles denote complete remission of type 2 diabetes and remission of hypertension, half filled triangles/circles denote partial remission of type 2 diabetes and filled triangles/circles denote no remission. For definitions of partial and complete remission of type 2 diabetes, see ‘Subjects and methods’ section. Mean percentage weight changes (black diamonds) within the groups are shown with bars extending from the diamonds representing 95% CI. Odds ratios (OR) were calculated using logistic regression analyses. Combined (partial and complete) remission of type 2 diabetes was used in the analysis.
Figure 5
Figure 5
The prevalence of metabolic syndrome, albuminuria and left ventricular hypertrophy in the treatment groups at both baseline and 1-year follow-up. Between-group differences at 1 year were adjusted for differences in prevalence at baseline using logistic regression analyses. P values are for comparisons between surgery and lifestyle groups.
Figure 6
Figure 6
Change in physical activity during 1-year follow-up. The proportion of participants who went from being physically active (≥150 min of moderate or ≥60 min of vigorous aerobic physical activity per week) to inactive (reduced) were still physically active or inactive (unchanged) or went from being physically inactive to active (increased). The changes were adjusted for baseline activity level using linear regression analysis. P value is for comparisons between surgery and lifestyle groups.

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Source: PubMed

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