Elsevier

Surgery for Obesity and Related Diseases

Volume 5, Issue 1, January–February 2009, Pages 20-26
Surgery for Obesity and Related Diseases

Original article
Relation between degree of weight loss after bariatric surgery and reduction in albuminuria and C-reactive protein

https://doi.org/10.1016/j.soard.2008.07.011Get rights and content

Abstract

Background

Bariatric surgery achieves long-term weight loss in obese adults with amelioration of diabetes and hypertension. Improvement in albuminuria and high-sensitivity C-reactive protein (hs-CRP) has also been reported. We investigated, at a weight control center in a community hospital setting, the relation between degree of surgical weight loss and reduction in the cardiovascular risk markers, albuminuria and hs-CRP.

Methods

We performed a retrospective study of 62 obese adults who had undergone Roux-en-Y gastric bypass surgery and had a median follow-up of 15 months.

Results

The baseline (preoperative) mean age was 46 years, 82% were women, 26 had a blood pressure of ≥140/90 mm Hg, and 25 had type 2 diabetes. During follow-up (postoperative), a decrease occurred in the body mass index (mean ± standard deviation 49.2 ± 8.7 kg/m2 to 34.1 ± 8.1 kg/m2; P <.0001), excess body weight (mean ± SD 76.1 ± 23.6 kg to 34.9 ± 21.7 kg; P <.0001), hemoglobin A1c (mean ± SD 6.5% ± 1.3% to 5.6% ± 0.8%; P <.0001), systolic blood pressure (mean ± SD 133.7 ± 14.3 mm Hg to 112.9 ± 14.6 mm Hg; P < .0001), urine albumin creatinine ratio (from a median of 8.0 mg/g [interquartile range 5.0–29.3] to a median of 6.0 mg/g [interquartile range 3.3–11.5]; P <.0001), and hs-CRP (mean ± SD 11.2 ± 9.8 mg/L to 4.7 ± 5.9 mg/L; P <.0001). The study sample was divided into tertiles of the percentage of excess body weight loss; the mean percentage of excess body weight loss was −37.1% ± 5.5% in the first tertile, −54.3% ± 6.8% in the second tertile, and −75.8% ± 10.9% in the third tertile. The median percentage of change in albuminuria was greatest (median −52.8%, interquartile range −79.1% to −17.5%) in the third tertile, intermediate (median −45.5%, interquartile range −72.4% to 0%) in the second tertile, and lowest (−42.6%, interquartile range −80.5% to 16.7%) in the first tertile (P = .953). The mean percentage of change in hs-CRP was greatest (−72.4% ± 30.4%) in the third tertile, intermediate (−55.4% ± 31.9%) in the second tertile, and lowest (−44.8% ± 30.6%) in the first tertile (P = .037).

Conclusion

The results of our study have shown that obese adults experience a reduction in albuminuria and hs-CRP after bariatric surgery, with a greater reduction in hs-CRP observed with more surgical weight loss.

Section snippets

Methods

The study sample consisted of 109 consecutive morbidly obese patients (BMI >40 kg/m2 without diabetes or a BMI >35 kg/m2 with diabetes) from a previous study evaluating cardiopulmonary fitness for bariatric surgery [7]. These patients were evaluated at the William Beaumont Hospital Weight Control Center (Royal Oak, MI) and underwent laparoscopic Roux-en-Y gastric bypass from December 2002 to December 2003. None of the patients had overt cardiovascular or renal disease (i.e., cardiac

Results

The 62 patients in our study had a mean age of 46.1 ± 10.1 years; 51 (82.3%) were women, and 58 (93.5%) were white (Table 1). Baseline hypertension was present in 26 patients (41.9%), and type 2 diabetes mellitus in 25 (40.3%). Table 1 lists the additional baseline characteristics of the study sample. The median follow-up duration was 14.8 months (interquartile range 9.9–23.8). After bariatric surgery, the mean weight loss was −41.2 ± 13.8 kg, and the BMI decreased from 49.2 ± 8.7 kg/m2 to 34.1

Discussion

We found a reduction in albuminuria and hs-CRP in obese patients with weight loss after bariatric surgery. In addition, the trend toward a greater reduction in the cardiovascular biomarkers with increased surgical weight loss was found to be nonsignificant for albuminuria but significant for hs-CRP.

Obesity is intimately interconnected to multiple risk factors for cardiovascular disease, including diabetes, hypertension, hyperlipidemia, the metabolic syndrome, and obstructive sleep apnea [1].

Conclusion

Obesity is a significant risk factor in the natural history of cardiovascular disease. Bariatric surgery offers patients with morbid obesity an opportunity to resolve or significantly improve diabetes, hypertension, and hyperlipidemia. In addition, albuminuria and hs-CRP decrease with weight loss after bariatric surgery, with a greater reduction in hs-CRP with increased surgical weight loss. Future prospective studies are needed to determine whether the metabolic changes with medical or

Disclosures

The authors claim no commercial associations that might be a conflict of interest in relation to this article.

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    This study was accepted in part for poster presentation at the American Society for Metabolic and Bariatric Surgery Annual Meeting, Washington DC, June 2008 (Surg Obes Relat Dis 2008;4:324).

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