Metabolic syndrome remission after Roux-en-Y gastric bypass or sleeve gastrectomy

Figures & data

Table 1 Patients’ demographics and baseline comorbidities

Characteristics	Overall cohort			Matched cohort
	RYGB (n = 141)	SG (n = 97)	P-value	RYGB (n = 65)	SG (n = 65)	Standardized difference	P-value
Age, years	51.1 (8.1)	51.9 (10.4)	0.53	50.9 (9.1)	51.5 (10.1)	0.06	0.72
Males, n (%)	80 (56.7)	61 (62.9)	0.35	37 (56.9)	29 (60.0)	0.06	0.86
Race, n (%)			0.11				0.78
Caucasian	104 (73.8)	60 (61.9)		40 (61.5)	44 (67.7)	0.13
African American	24 (17.0)	21 (21.7)		16 (24.6)	14 (21.5)	0.07
Other	13 (9.2)	16 (16.5)		9 (13.9)	7 (10.8)	0.09
Weight, kg	137 (26)	124 (23)	<0.01	126 (20)	126 (22)	0.01	0.95
BMI, kg/m^2	45.5 (6.4)	40.7 (4.8)	<0.01	42.0 (4.8)	42.1 (4.6)	0.01	0.95
Hyperglycemia, n (%)	103 (73.1)	77 (79.4)	0.29	50 (76.9)	49 (75.4)	0.04	1.0
Type 2 diabetes, n (%)	78 (55.3)	47 (48.5)	0.36	33 (50.8)	30 (46.2)	0.09	0.73
HbA1c, %	6.6 (1.2)	6.7 (1.2)	0.73	6.7 (1.3)	6.6 (1.2)	0.15	0.50
Fasting plasma glucose, mg/dL	125 (48)	121 (43)	0.57	120 (38)	120 (37)	0.004	0.98
Oral diabetes medication, n (%)	63 (44.7)	37 (38.1)	0.35	26 (40.0)	24 (36.9)	0.06	0.86
Insulin treatment, n (%)	26 (18.4)	22 (22.7)	0.51	12 (18.5)	14 (21.5)	0.08	0.83
Insulin total daily dose, U	139 [80–-169] n = 24	90 [60–155] n = 18	0.54	140 [80–190] n = 11	110 [65–190] n = 12	0.16	0.74
Hypertension, n (%)	136 (96.5)	85 (87.6)	0.02	61 (93.9)	62 (95.4)	0.07	1.0
Systolic blood pressure, mm Hg	132 (16)	131 (14)	0.52	133 (18)	130 (13)	0.19	0.30
Diastolic blood pressure, mm Hg	73 (11)	75 (10)	0.15	75 (11)	75 (11)	0.05	0.76
Hypertension medication, n (%)	116 (82.3)	70 (72.2)	0.08	50 (76.9)	51 (78.5)	0.04	1.0
Hypertriglyceridemia, n (%)	83 (59.7)	36 (37.9)	<0.01	32 (50.0)	31 (49.2)	0.02	1.0
Triglycerides, mg/dL	174 [108–229]	122 [89–200]	0.01	162 [92–239]	153 [102–216]	0.04	0.82
Low high-density lipoprotein, n (%)	70 (50.4)	46 (48.4)	0.79	33 (51.6)	31 (49.2)	0.05	0.86
HDL, mg/dL	44 (12)	43 (13)	0.6	42 (11)	44 (12)	0.10	0.58
Lipid-lowering medication, n%	82 (58.2)	59 (60.8)	0.69	38 (58.5)	40 (61.5)	0.06	0.86

Notes: Continuous variables are summarized as mean (standard deviation) or median [25th–75th percentile]. For skewed variables, the parametric and nonparametric comparisons are very similar (nonparametric reported for insulin dose and triglycerides).

Abbreviations: BMI, body mass index; HDL, high-density lipoprotein; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.

Table 2 Prevalence of metabolic syndrome and its components before (“pre”) and 4 years following (“post”) RYGB and SG for the entire cohort

	RYGB (n = 141)		Paired test P-value (McNemar)	SG (n = 92)		Paired test P (McNemar)	Interaction P-value
	Pre, n (%)	Post, n (%)		Pre, n (%)	Post, n (%)
Obesity	141 (100)	96 (68.1)	<0.01	97 (100)	80 (82.5)	<0.01	0.02
Hyperglycemia	106 (75.2)	89 (63.1)	<0.01	74 (81.3)	67 (73.6)	0.09	0.53
Hypertriglyceridemia	83 (60.1)	30 (21.7)	<0.01	35 (37.2)	28 (29.8)	0.18	<0.01
Low HDL-C	69 (50)	31 (22.5)	<0.01	45 (48.4)	15 (16.1)	<0.01	0.38
Hypertension	136 (96.5)	118 (83.7)	<0.01	85 (87.6)	65 (67.0)	<0.01	0.45
Metabolic syndrome	125 (88.7)	72 (51.1)	<0.01	82 (84.5)	56 (57.7)	<0.01	0.09

Abbreviations: HDL-C, high-density lipoprotein cholesterol; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.

Table 3 Predictors of metabolic syndrome presence at 4-year follow-up using the entire cohort

MetS at 4-year follow-up	Odds ratio	95% CI
Surgery type
RYGB	Ref
SG	1.89	0.91–3.91
Gender
Female	Ref
Male	2.28	1.14–4.56
Age	1.05	1.01–1.09
Preoperative BMI	1.03	0.97–1.09
Preoperative DM	3.33	1.71–6.50
Preoperative low HDL	2.28	1.17–4.48

Abbreviations: BMI, body mass index; DM, diabetes mellitus; HDL, high-density lipoprotein; MetS, metabolic syndrome; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.

Figure 1 Weight (kg), body mass index (kg/m²), percent weight change (%), and excess weight loss (%) per procedure type for the entire cohort.

Abbreviations: BMI, body mass index; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.

Figure 2 Weight (kg), body mass index (kg/m²), percent weight change (%), and excess weight loss (%) per procedure type for the matched cohort.

Abbreviations: BMI, body mass index; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.

Table 4 >30 day-morbidity and mortality following RYGB and SG

	Entire cohort			Matched cohort
	RYGB (total = 159), n (%)	SG (total = 107), n (%)	P-value	RYGB (total = 65), n (%)	SG (total = 65), n (%)	P-value
Mortality >30 days	7 (4.4)	3 (2.8)	0.74
Reoperations	31 (19.5)	3 (2.8)	<0.01	14 (21.9)	3 (4.8)	<0.01
Cholecystectomy	11 (6.9)	0 (0)	<0.01	7 (10.9)	0 (0)	0.01
GI bleed	2 (1.3)	0 (0)	0.52	2 (3.1)	0 (0)	0.50
Ulcer	15 (9.4)	1 (0.9)	<0.01	7 (10.9)	0 (0)	0.01
Vitamin B12 deficiency	47 (29.6)	8 (7.5)	<0.01	24 (37.5)	8 (12.9)	<0.01
Vitamin D deficiency	6 (3.8)	11 (10.3)	0.04	2 (3.1)	7 (11.3)	0.09
Iron deficiency	30 (18.9)	10 (9.4)	0.04	16 (25.0)	8 (12.9)	0.11
Other nutritional deficiencies	7 (4.4)	1 (0.9)	0.15	3 (4.7)	1 (1.6)	0.62
Chronic nausea/vomiting	11 (6.9)	3 (2.8)	0.17	7 (10.9)	3 (4.8)	0.32
Chronic pain	6 (3.8)	1 (0.9)	0.25	4 (6.3)	1 (1.6)	0.37

Abbreviations: RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.

Figure S1 Flowchart of cohort sample size for analyses.

Abbreviations: MetS, metabolic syndrome; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy; VA, Veterans Affairs.

Table S1 Prevalence of metabolic syndrome and its components before (“Pre”) and 4 years following (“Post”) RYGB and SG for the matched cohort

	RYGB (n = 65)		Paired test P-value (McNemar)	SG (n = 65)		Paired test P-value (McNemar)	Interaction P-value
	Pre n (%)	Post n (%)		Pre n (%)	Post n (%)
Obesity	65 (100)	39 (60.0)	<0.01	65 (100)	57 (87.7)	<0.01	<0.01
Hyperglycemia	51 (78.5)	40 (61.5)	0.01	49 (75.4)	45 (75.0)	0.74	0.06
Hypertriglyceridemia	32 (50)	8 (12.5)	<0.01	31 (49.2)	22 (34.4)	0.039	<0.01
Low HDL-C	33 (51.6)	10 (15.6)	<0.01	31 (49.2)	11 (17.5)	<0.01	0.68
Hypertension	61 (93.9)	55 (84.6)	0.03	62 (95.4)	43 (66.2)	<0.01	0.09
Metabolic syndrome	57 (87.7)	31 (47.7)	<0.01	57 (87.7)	39 (60.0)	<0.01	0.34

Abbreviations: HDL-C, high-density lipoprotein cholesterol; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy