Background: Obesity is associated with increased insulin resistance, type 2 diabetes and increased cardiovascular risk leading to atherosclerosis. Bariatric surgery has been shown to improve some of these factors in obese patients with glucose intolerance. A form of bariatric surgery is the Roux-en-Y procedure which can result in greater weight loss and restriction with less malabsorption than other procedures (such as the bilious-pancreatic diversion); but the effect of some metabolic parameters on patients with normal glucose tolerance is not fully known.
Aim: To examine the effect of Roux-en-Y surgery on endothelial function and metabolic parameters in patients without type 2 diabetes.
Method: Ten patients with a body mass index (BMI) >40 kg/m2 were recruited and followed up for 12 months after surgery. Fasting blood samples were taken before surgery and at 3 monthly intervals after surgery. Endothelial function (RH-PAT) was also determined at these time points using peripheral arterial tonometry (endoPAT2000) technique. A 75 g oral glucose tolerance test was performed at the start of the study to exclude diabetes.
Results: BMI reduced from 49.47±7.54 kg/m2 pre surgery to 33.32±5.21 (P≤0.001) 12 months after surgery. Fasting glucose levels reduced from 5.26±0.78 mmol/l to 4.56±0.33 (P=0.02), C-reactive protein (CRP) from 7.22±7.81 mmol/l to 2.41±4.41 (P=0.039). Systolic blood pressure reduced from 129.64±16.18 mmHg to 114.22±10.71 (P=0.05) and diastolic blood pressure reduced from 76.55±14.24 mmHg to 72.56±7.50 (P=0.95). RH-PAT improved from 1.80±0.39 to 2.01±0.54 (P=0.035).
Conclusion: Roux-en-Y surgery in patients with normal glucose tolerance improved cardiovascular risk factors. Thus is shown by a reduction in the inflammatory markers CRP, a reduction in systolic and diastolic blood pressure and also improved endothelial function 12 months after surgery.