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There is evidence that bariatric procedures impact not only obesity, but also glycemic control, non-alcoholic fatty liver disease (NAFLD), hypertension, chronic kidney disease (CKD), and even cancer.
This Masterclass provides an overview of the benefits of bariatric/metabolic surgery beyond glycemic control.
NAFLD
Obesity plays a significant role in chronic inflammation, which can manifest in various ways. NAFLD results not only in liver disease (fatty liver, NASH, cirrhosis), but also in cardiovascular disease. Patients with NAFLD are prone to peripheral vascular disease, coronary artery disease and increased cardiac mortality. Evidence from case reports and case series as well as gathered in meta-analysis shows that, through its effect on reduction of inflammation, metabolic surgery improves NAFLD and can even slow and stop the evolution of cirrhosis.
Hypertension
The role of metabolic surgery in hypertension has been studied in a few RCTs, together with obesity. Level 1 evidence suggests metabolic surgery can have an impact on blood pressure control and can lead to anti-hypertensive drug reduction and suspension.
CKD
Chronic Kidney Disease is mostly caused by diabetes and high blood pressure. Reports suggest that 40% of diabetic patients will develop CKD, with 30% reaching end-stage disease and dialysis. Metabolic surgery improves CKD by promoting early glycemic control, weight loss, blood pressure control, a decrease in LDL-cholesterol, and a raise in HDL-cholesterol. The MOMS trial, an RCT that compared RYGB to optimal medical treatment and evaluated CKD, blood pressure and HbA1c and cholesterol (total, LDL) levels, favored surgery after a 2-year follow-up.
Cancer
Obesity is a known oncogenic factor, associated with some of the most common types of cancer: breast and uterine in women, colorectal and kidney in men. Evidence suggests that the greater the weight loss after metabolic surgery, the higher the rate of cancer-free survivorship.
There is some controversy regarding the real relation between metabolic surgery (mostly RYGB) and colorectal cancer, with some reports documenting a protective effect, while others consider it a risk factor.
Without a question, metabolic surgery has beneficial effects on glycemic control, hypertension, NAFLD, CKD and cancer, but there are still some questions to be answered and level 1 evidence to be obtained.
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