DOI: https://doi.org/10.22141/2308-2097.52.1.2018.130777

Characteristics of changes in lipid and carbohydrate metabolism indices in patients with morbid obesity before and after surgical treatment depending on the type of surgical intervention

Ya.S. Bereznitsky, R.V. Duka

Abstract


Background. Obesity is a chronic metabolic disease that is manifested by excessive development of adipose tissue, which has a certain range of complications and a high risk of relapse after the end of treatment. The association of obesity with various metabolic disorders makes it one of the most important health problems for both developed and developing countries. The purpose was to analyze the dynamics of changes in lipid and carbohydrate metabolism in patients with morbid obesity (MO) before and after biliopancreatic diversion (BPD) in the modification of Hess-Marceau and sleeve gastrectomy. Materials and methods. A sample of the study consisted of 82 patients with MO and concomitant metabolic syndrome aged 21 to 62 years (mean age 40.60 ± 1.09 years) who underwent surgery and were under supervision in the postoperative period in Garvis clinic which is the base of surgery department 1 of the State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine” for 2 to 3 years or more after the operation. The distribution of patients by groups was carried out depending on the surgical method. Clinical group I consisted of 30 (36.6 %) patients with BPD in the Hess-Marceau modification; group II — 52 (63.4 %) patients with sleeve gastrectomy. In different number of patients in both groups during the observation period, the features of lipid and carbohydrate metabolism were determined using common practical and clinical methods. Evaluation of the results of weight loss, changes in the markers of lipid and carbohydrate metabolism was performed in the dynamics of observation — during the first visit at the stage of preoperative preparation, 3, 6, 12, 18, 24 and 36 months after surgery. Results. Analysis of the dynamics of morbid obesity after surgical treatment showed general trends to significant (from p < 0.01 to p < 0.001) decrease in body mass parameters and body mass index (BMI) in patients of all clinical groups within 3 months after the start of treatment. In group I, a significant decrease in indicators occurred within 18 months, in group II — in the period of 6–12 months. Dyslipidemic disorders in patients with MО reliably correlated with indicators of excessive body weight with varying degrees of significance (from p < 0.05 to p < 0.01). The results of the study of carbohydrate metabolism rates prior to surgical treatment showed the significant interdependence of C-peptide, insulin and glucose blood levels on the BMI of patients (from p < 0.01 to p < 0.001). The dynamics of the study showed trends towards normalization of lipid and carbohydrate metabolism in patients of both groups within 2 years after bariatric intervention, with the greatest changes in BPD group after 3 and 6 months. Conclusions. The direct correlation of the lipid and carbohydrate metabolism indices with the BMI and overweight indicated the need for surgical treatment in these patients. Tendencies toward lipid and carbohydrate metabolism normalization in patients of both groups within 2 years after bariatric intervention demonstrated its effectiveness.

Keywords


morbid obesity; surgical treatment; biliopancreatic diversion; sleeve gastrectomy; lipid metabolism; carbohydrate metabolism

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