Metabolic-bariatric surgery linked to reducing mortality from all causes


(Reuters Health) – Obese adults have a longer life expectancy when undergoing metabolic-bariatric surgery, regardless of whether they have comorbid type 2 diabetes, a new meta-analysis suggests.

The researchers examined data on a total of 174,772 participants in a prospective controlled trial and 16 matching cohort studies comparing longevity and all-cause mortality of people with severe obesity who received bariatric surgery (n = 65,785). or matching controls that received regular attention (n = 108,987). Overall, there were 7,712 deaths during 1.2 million patient-years of follow-up.

Metabolic-bariatric surgery was associated with a 49.2% reduction in the risk of death during follow-up compared with non-surgical care and an average life expectancy of 6.1 years longer, according to researchers at The Lancet. The therapeutic effect of surgery was more pronounced among people with type 2 diabetes (risk ratio 0.409) than in people without type 2 diabetes (HR 0.704).

“Obese people undergoing metabolic-bariatric surgery have experienced weight loss that has led to a decreased risk of developing chronic diseases such as diabetes, stroke, heart disease and decreased mortality during intensive care admission. said study author Dr. Asim Shabbir of the National University Hospital in Singapore.

“To get the health benefits, what is needed is a sustained weight loss of 15-20%, and metabolic-bariatric surgery is currently the most effective tool to achieve this goal,” said Dr. Shabbir by email.

The study also found that people with type 2 diabetes who underwent metabolic-bariatric surgery had a half-life expectancy of 9.3 years longer than those receiving regular care.

Over a ten-year period, the numbers needed to try to prevent further death were 8.4 among people with type 2 diabetes and 29.8 among people without type 2 diabetes, according to the study.

The researchers estimated that a 1% increase in metabolic-bariatric surgery use among people with severe obesity worldwide could result in an additional 5.1 million years of life for those with type 2 diabetes. and an additional 6.6 million years of life for people without type 2 diabetes.

One of the limitations of the study is that recent advances in drug treatments for severe obesity could mitigate the benefits of surgical interventions, the study team notes. In a similar vein, several recently approved classes of diabetes medications may influence the benefits of surgery over non-surgical care, they add.

Another limitation is the heterogeneity in the usual care protocols in the smaller studies included in the analysis, with practices ranging from non-intervention to intensive non-surgical treatments.

However, several major studies, such as the Honolulu Heart Program, the Framingham Heart Study, and Treating to New Targets, show that the weight of obesity is associated with all-cause mortality and higher cardiovascular mortality. say Dr. Geltrude Mingrone, a professor at the Universita Cattolica S. Cuore in Rome and King’s College London, who co-authored an editorial accompanying the study.

“Therefore, the great weight loss achieved with metabolic-bariatric surgery, which is maintained over time, reduces cardiovascular risk and mortality,” Dr. Mingrone said in an email.

“Subjects with obesity and type 2 diabetes, especially if they have a high risk of cardiovascular disease, should not only be considered, but should be prioritized in metabolic / bariatric surgery because of its great effect in the prevention of cardiovascular disease and in the increase of life expectancy “, added Dr. Mingrone.

SOURCE: and The Lancet, online May 6, 2021.

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