Weight and metabolic outcomes 12 years after gastric bypass

Ted D. Adams, Lance E. Davidson, Sheldon E. Litwin, Jaewhan Kim, Ronette L. Kolotkin, M. Nazeem Nanjee, Jonathan M. Gutierrez, Sara Frogley, Anna R. Ibele, Eliot A. Brinton, Paul N. Hopkins, Rodrick McKinlay, Steven C. Simper, Steven Hunt

Research output: Contribution to journalArticle

152 Citations (Scopus)

Abstract

BACKGROUND: Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States. METHODS: A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (nonsurgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia. RESULTS: The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was −45.0 kg (95% confidence interval [CI], −47.2 to −42.9; mean percent change, −35.0) at 2 years, −36.3 kg (95% CI, −39.0 to −33.5; mean percent change, −28.0) at 6 years, and −35.0 kg (95% CI, −38.4 to −31.7; mean percent change, −26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was −2.9 kg (95% CI, −6.9 to 1.0; mean percent change, −2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, −3.5 to 3.5; mean percent change, −0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons). CONCLUSIONS: This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass.

Original languageEnglish
Pages (from-to)1143-1155
Number of pages13
JournalNew England Journal of Medicine
Volume377
Issue number12
DOIs
Publication statusPublished - 21 Sep 2017
Externally publishedYes

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Gastric Bypass
Weights and Measures
Confidence Intervals
Type 2 Diabetes Mellitus
Dyslipidemias
Hypertension
Bariatric Surgery
Morbid Obesity
Incidence
Insurance
Observational Studies
Weight Loss
Odds Ratio
Body Weight
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Adams, T. D., Davidson, L. E., Litwin, S. E., Kim, J., Kolotkin, R. L., Nanjee, M. N., ... Hunt, S. (2017). Weight and metabolic outcomes 12 years after gastric bypass. New England Journal of Medicine, 377(12), 1143-1155. https://doi.org/10.1056/NEJMoa1700459

Weight and metabolic outcomes 12 years after gastric bypass. / Adams, Ted D.; Davidson, Lance E.; Litwin, Sheldon E.; Kim, Jaewhan; Kolotkin, Ronette L.; Nanjee, M. Nazeem; Gutierrez, Jonathan M.; Frogley, Sara; Ibele, Anna R.; Brinton, Eliot A.; Hopkins, Paul N.; McKinlay, Rodrick; Simper, Steven C.; Hunt, Steven.

In: New England Journal of Medicine, Vol. 377, No. 12, 21.09.2017, p. 1143-1155.

Research output: Contribution to journalArticle

Adams, TD, Davidson, LE, Litwin, SE, Kim, J, Kolotkin, RL, Nanjee, MN, Gutierrez, JM, Frogley, S, Ibele, AR, Brinton, EA, Hopkins, PN, McKinlay, R, Simper, SC & Hunt, S 2017, 'Weight and metabolic outcomes 12 years after gastric bypass', New England Journal of Medicine, vol. 377, no. 12, pp. 1143-1155. https://doi.org/10.1056/NEJMoa1700459
Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN et al. Weight and metabolic outcomes 12 years after gastric bypass. New England Journal of Medicine. 2017 Sep 21;377(12):1143-1155. https://doi.org/10.1056/NEJMoa1700459
Adams, Ted D. ; Davidson, Lance E. ; Litwin, Sheldon E. ; Kim, Jaewhan ; Kolotkin, Ronette L. ; Nanjee, M. Nazeem ; Gutierrez, Jonathan M. ; Frogley, Sara ; Ibele, Anna R. ; Brinton, Eliot A. ; Hopkins, Paul N. ; McKinlay, Rodrick ; Simper, Steven C. ; Hunt, Steven. / Weight and metabolic outcomes 12 years after gastric bypass. In: New England Journal of Medicine. 2017 ; Vol. 377, No. 12. pp. 1143-1155.
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T1 - Weight and metabolic outcomes 12 years after gastric bypass

AU - Adams, Ted D.

AU - Davidson, Lance E.

AU - Litwin, Sheldon E.

AU - Kim, Jaewhan

AU - Kolotkin, Ronette L.

AU - Nanjee, M. Nazeem

AU - Gutierrez, Jonathan M.

AU - Frogley, Sara

AU - Ibele, Anna R.

AU - Brinton, Eliot A.

AU - Hopkins, Paul N.

AU - McKinlay, Rodrick

AU - Simper, Steven C.

AU - Hunt, Steven

PY - 2017/9/21

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N2 - BACKGROUND: Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States. METHODS: A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (nonsurgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia. RESULTS: The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was −45.0 kg (95% confidence interval [CI], −47.2 to −42.9; mean percent change, −35.0) at 2 years, −36.3 kg (95% CI, −39.0 to −33.5; mean percent change, −28.0) at 6 years, and −35.0 kg (95% CI, −38.4 to −31.7; mean percent change, −26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was −2.9 kg (95% CI, −6.9 to 1.0; mean percent change, −2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, −3.5 to 3.5; mean percent change, −0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons). CONCLUSIONS: This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass.

AB - BACKGROUND: Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States. METHODS: A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (nonsurgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia. RESULTS: The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was −45.0 kg (95% confidence interval [CI], −47.2 to −42.9; mean percent change, −35.0) at 2 years, −36.3 kg (95% CI, −39.0 to −33.5; mean percent change, −28.0) at 6 years, and −35.0 kg (95% CI, −38.4 to −31.7; mean percent change, −26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was −2.9 kg (95% CI, −6.9 to 1.0; mean percent change, −2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, −3.5 to 3.5; mean percent change, −0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons). CONCLUSIONS: This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass.

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