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Long term effects of gastric bypass on quality of life and bone mineral density
Örebro University, School of Medical Sciences.
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obesity is a worldwide disease. Surgery is currently the only available management option which offers an adequate long-term effect on comorbidity, quality-of-life and weight loss. It is evident that overweight and obesity are associated with low health-related quality-of life (HRQoL) and multiple comorbidities. The aim of this thesis has been to explore the long-term effect of gastric bypass surgery on HRQoL and bone mineral density.

In study 1: 486 patients (average age 50.7±10.0 years, 84 % female) operated with gastric bypass (GBP) from 1993 to 2003 at the University Hospitals of Örebro and Uppsala. Mean follow-up after GBP was 11.5±2.7 years (range 7–17). The study group was compared with two control groups. The study group scored better in the SF-36 domains and OP scale compared to obese controls, but their HRQoL scores were lower than those of the general population. HRQoL was better among younger patients and in the following subgroups: men; patients with satisfactory weight loss; those satisfied with the procedure; those free from comorbidity and gastrointestinal symptoms; employed; good oral status; and those not hospitalised or regularly followed up for non-bariatric reasons.

In study 3: Patients operated with a primary GBP between January 2008 and December 2012 were identified in the Scandinavian Obesity Surgery Register (SOReg). Patients with HRQoL data available at both baseline and 5 years after surgery were included. The study sample comprised 6998 patients (21% men). Gender differences in change in HRQoL were minor. Younger patients showed greater improvements in physical health scales. In general linear regression model analyses, age and weight loss correlated significantly with improvement in HRQoL after 5 years. Patients treated medically for depression preoperatively (13%) experienced less improvement in HRQoL than patients without such treatment. Patients with a postoperative complications (26%) had significantly less improvement in all aspects of HRQoL compared to those without any form of postoperative complication.This study confirmed the importance of weight loss for improvement in HRQoL after bariatric surgery. Preoperative medication for depression and suffering a complication during the five-year follow-up period were associated with less improvement in HRQoL.

Studies 2 and 4: Included patients operated with laparoscopic gastric bypass at the department of surgery at the Örebro University Hospital between January 2004 and December 2005. Thirty-two females were prospectively recruited for this longitudinal study. In both studies, the following were measured at baseline, 2, 5 and 10 years postoperatively: bone mineral density (BMD); weight; height; S-calcium; S-albumin; S-creatinine; S-25(OH)-vitamin D; and fP-PTH. In study 4: Nine of the patients declined follow-up. BMD showed a statistically significant decline over the study period. The fall in BMD of the spine and femoral neck between baseline and 5 years after surgery was 19% and 25%,respectively. During the next five years period BMD continued to decline but at a lower rate. At 5 years 58 % had elevated PTH, this number declined at the next 5 years.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2020. , p. 70
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 2010
Keywords [en]
Gastric bypass, health related quality of life, RAND SF-36, obesity-related problems scale, bone mineral density, BMI, parathyroid hormone, obesity, vitamin D
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-80487ISBN: 978-91-7529-333-2 (print)OAI: oai:DiVA.org:oru-80487DiVA, id: diva2:1413119
Public defence
2020-05-29, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2020-03-09 Created: 2020-03-09 Last updated: 2020-04-28Bibliographically approved
List of papers
1. Health-Related Quality-of-Life (HRQoL) on an Average of 12 Years After Gastric Bypass Surgery
Open this publication in new window or tab >>Health-Related Quality-of-Life (HRQoL) on an Average of 12 Years After Gastric Bypass Surgery
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2015 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 7, p. 1119-1127Article in journal (Refereed) Published
Abstract [en]

It is evident that morbidly obese patients have a low health-related quality-of-life (HRQoL), and this low HRQoL has become a common reason for them to seek bariatric surgery. Several HRQoL studies demonstrate a dramatic postoperative improvement, but most of these have had a short follow-up period.

An observational, cross-sectional study for HRQoL was conducted to study 486 patients (average age of 50.7 +/- 10.0 years, with 84 % of them being female) operated with gastric bypass (GBP) in the period 1993 to 2003 at the University Hospitals of A-rebro and Uppsala. Mean follow-up after gastric bypass was 11.5 +/- 2.7 years (range 7-17). Two HRQoL instruments were used, SF-36 and the Obesity-related Problems scale (OP). The study group was compared with two control groups, both matched for age and gender, one from the general population and one containing morbidly obese patients evaluated and awaiting bariatric surgery.

The study group scored better in the SF-36 domains (all four physical domains and the vitality subscore) and OP scale compared to obese controls, but their HRQoL scores were lower than those of the general population. HRQoL was better among younger patients and in the following subgroups: men, patients with satisfactory weight loss, satisfied with the procedure, free from co-morbidities and gastrointestinal symptoms, employment, good oral status and those not hospitalised or regularly followed up for non-bariatric reasons.

Long-term follow-up after GBP for morbid obesity showed better scores in most aspects of HRQoL compared to obese controls but did not achieve the levels of the general population. Patients with better medical outcome after gastric bypass operation had better HRQoL.

Keywords
Gastric bypass, Health-related quality-of-life, Long-term follow-up, SF-36, Morbid obesity
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-45292 (URN)10.1007/s11695-014-1513-6 (DOI)000355921600004 ()25566743 (PubMedID)2-s2.0-84930760360 (Scopus ID)
Available from: 2015-07-23 Created: 2015-07-20 Last updated: 2020-04-27Bibliographically approved
2. Effect of Gastric Bypass on Bone Mineral Density, Parathyroid Hormone and Vitamin D: 5 Years Follow-up
Open this publication in new window or tab >>Effect of Gastric Bypass on Bone Mineral Density, Parathyroid Hormone and Vitamin D: 5 Years Follow-up
2016 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 26, no 5, p. 1141-1145Article in journal (Refereed) Published
Abstract [en]

Background: The aim of the present study was to see if there are longitudinal changes in bone mineral density (BMD), vitamin D or parathyroid hormone (PTH) in females 5 years after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB).

Methods: Thirty-two women with mean age 41.6 ± 9.3 years and mean body mass index (BMI) 44.5 ± 4.6 kg/m(2) were included. Preoperatively, 2 and 5 years postoperatively, BMD, weight, height, S-calcium, S-albumin, S-creatinine, S-25(OH)-vitamin D and fP-PTH were measured.

Results: The mean decrease in BMI between baseline and 5 years after surgery was 29.4 %. BMD of the spine and femur measured as z- and t-scores, showed a linear, statistically significant declining trend over the years. The fall in BMD of the spine and femoral neck between baseline and 5 years after surgery was 19 and 25 %, respectively. The mean fP-PTH showed a significant increase over the study period (20.2 μg/L increase, 95 % CI:-31.99 to -8.41). S-calcium, both free and corrected for albumin, showed a decrease between baseline and 5 years after surgery. Eight patients developed osteopenia and one osteoporosis after a 5-year follow-up.

Conclusion: LRYGB is an efficient method for sustained long-term body weight loss. There is, however, a concomitant decrease in BMD and S-calcium, and an increase in fP-PTH.

Place, publisher, year, edition, pages
New York, USA: Springer, 2016
Keywords
Bone mineral density, gastric bypass, BMI, parathyroid hormone, obesity, vitamin D
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-49206 (URN)10.1007/s11695-016-2114-3 (DOI)000374400900037 ()26926187 (PubMedID)2-s2.0-84959431689 (Scopus ID)
Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2020-04-27Bibliographically approved
3. Improvements of health-related quality of life five years after gastric bypass. What is important besides weight loss? A study from Scandinavian Obesity Surgery Register
Open this publication in new window or tab >>Improvements of health-related quality of life five years after gastric bypass. What is important besides weight loss? A study from Scandinavian Obesity Surgery Register
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-81372 (URN)
Available from: 2020-04-27 Created: 2020-04-27 Last updated: 2020-04-27Bibliographically approved
4. Bone mineral density, parathyroid hormone and vitamin D after gastric bypass surgery: a 10-year longitudinal follow-up
Open this publication in new window or tab >>Bone mineral density, parathyroid hormone and vitamin D after gastric bypass surgery: a 10-year longitudinal follow-up
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-81373 (URN)
Available from: 2020-04-27 Created: 2020-04-27 Last updated: 2020-04-27Bibliographically approved

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