Treatment of the Metabolic Syndrome by Bariatric Surgery
Bariatric surgery is regarded as “metabolic surgery” due to its effects on the metabolic syndrome and type 2 diabetes. At present an estimated 350,000 bariatric operations are performed worldwide per year. Laparoscopic adjustable gastric banding (LAGB) an
- PDF / 632,991 Bytes
- 29 Pages / 439.37 x 666.142 pts Page_size
- 68 Downloads / 181 Views
14
Sten Madsbad
14.1
Introduction
The increase in obesity has generated a secondary epidemic of the metabolic syndrome with hypertension, dyslipidaemia, abdominal obesity and increased risk of type 2 diabetes and cardiovascular diseases [1–5]. The aetiological connections between obesity and the metabolic syndrome seem to be multiple. Insulin resistance, abdominal obesity and an excess of visceral adipose tissue are key abnormalities in people with metabolic syndrome [3–5]. The aetiology includes elevated levels of free fatty acids (FFA), suppressed adiponectin, elevated levels of cytokines, i.e. tumour necrosis factor (TNF) α, interleukin (IL) 6 and fibrinogen [3, 6]. The cytokines and FFA induce insulin resistance, beta-cell dysfunction and “low-grade” inflammation in the vascular system and increase triglyceride content in the liver, pancreas, and skeletal and heart muscles [3–5, 7]. The metabolic syndrome also includes a prothrombotic state with, i.e., elevation of C-reactive protein and plasma activator inhibitor (PAI)-1 [3, 6]. Patients with metabolic syndrome have an increased risk of cardiovascular diseases and of developing type 2 diabetes [1–3, 5, 6]. Additional metabolic comorbidities include polycystic ovary syndrome (PCOS) and non-alcoholic steatohepatitis (NASH) [8, 9]. Morbid obesity is also related to obstructive sleep apnoea and several forms of cancers [10]. The treatment of the metabolic syndrome is lifestyle changes focusing on weight loss and increased physical activity. It is possible to lose 5–10 % in weight by lifestyle changes, but most patients will start to gain weight after 3–6 months, and after 1–5 years about 90 % will have relapse to the weight or a higher weight than before the start of lifestyle treatment, indicating that obesity in most cases is
S. Madsbad (*) Department of Endocrinology, Hvidovre University Hospital, University of Copenhagen, Kettegaard Alle´ 30, 2650 Hvidovre, Denmark e-mail: [email protected] H. Beck-Nielsen (ed.), The Metabolic Syndrome, DOI 10.1007/978-3-7091-1331-8_14, # Springer-Verlag Wien 2013
191
192
S. Madsbad
Table 14.1 Effects of bariatric surgery on the metabolic syndrome and cardiovascular risk factors Obesity
Hypertension Dyslipidaemia
Type 2 diabetes
Metabolic syndrome Cardiovascular diseases
Weight loss Reduction in abdominal obesity Reduction on waist Lowering of systolic and diastolic blood pressure Lowering of low-density lipoprotein cholesterol Lowering of triglycerides Lowering of total cholesterol Increase in high-density lipoprotein cholesterol Prevention of type 2 diabetes Remission of prediabetes Improvement in HbA1c Remission of type 2 diabetes Improvement in insulin sensitivity and insulin secretion Resolution of metabolic syndrome Reduction in cardiovascular risk factors Reduction in cardiovascular events Reduction in cardiovascular mortality
refractory to lifestyle therapy. By use of anti-obesity agents 2–8 kg further weight loss can be added, but with the agents at present on the market or in the phase of develop
Data Loading...
