Roux-en-Y and One-Anastomosis Gastric Bypass Surgery Are Superior to Sleeve Gastrectomy in Lowering Glucose and Cholesterol Levels Independent of Weight Loss: a Propensity-Score Weighting Analysis

Yi-Cheng Chang; Chih-Neng Hsu; Keong Chong; Po-Jen Yang; Kong-Han Ser; Po-Chu Lee; Shu-Chun Chen; Chin-Feng Hsuan; Yi-Chih Lee; Chih-Cheng Hsu; Hsiao-Lin Lee; Karen Chia-Wen Liao; Meng-Lun Hsieh; Gwo-Tsann Chuang; Wei-Shun Yang; Shao-Lun Chu; Wen-Yi Li; Lee-Ming Chuang; Wei-Jei Lee

doi:10.1007/s11695-023-06656-6

Roux-en-Y and One-Anastomosis Gastric Bypass Surgery Are Superior to Sleeve Gastrectomy in Lowering Glucose and Cholesterol Levels Independent of Weight Loss: a Propensity-Score Weighting Analysis

Obes Surg. 2023 Oct;33(10):3035-3050. doi: 10.1007/s11695-023-06656-6. Epub 2023 Aug 24.

Authors

Yi-Cheng Chang^{1

2

3

4

5}, Chih-Neng Hsu⁶, Keong Chong⁷, Po-Jen Yang^{4

8

9}, Kong-Han Ser¹⁰, Po-Chu Lee⁸, Shu-Chun Chen¹¹, Chin-Feng Hsuan^{12

13

14}, Yi-Chih Lee¹⁵, Chih-Cheng Hsu¹⁶, Hsiao-Lin Lee², Karen Chia-Wen Liao¹⁷, Meng-Lun Hsieh^{2

18}, Gwo-Tsann Chuang^{1

19}, Wei-Shun Yang²⁰, Shao-Lun Chu²¹, Wen-Yi Li²², Lee-Ming Chuang^{23

24

25}, Wei-Jei Lee^{26

27}

Affiliations

¹ Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100, Taiwan.
² Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan.
³ Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan.
⁴ Center for Obesity, Lifestyle, and Metabolic Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan.
⁵ Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, 100, Taiwan.
⁶ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, 640, Taiwan.
⁷ Department of Medicine, Min-Sheng General Hospital, Taoyuan, 330, Taiwan.
⁸ Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan.
⁹ Department of Surgery, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.
¹⁰ Department of Surgery, Ten-Chen General Hospital, Taoyuan, 326, Taiwan.
¹¹ Department of Nursing, Ming-Sheng General Hospital, Taoyuan, 330, Taiwan.
¹² Department of Internal Medicine, Division of Cardiology, E-Da Hospital, Kaohsiung, 824, Taiwan.
¹³ Department of Internal Medicine, Division of Cardiology, E-Da Dachang Hospital, Kaohsiung, 824, Taiwan.
¹⁴ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 840, Taiwan.
¹⁵ Department of International Business, Chien Hsin University of Science and Technology, Taoyuan, 320, Taiwan.
¹⁶ Institute of Population Health Sciences, National Health Research Institutes, Zhunan, 350, Taiwan.
¹⁷ Biological Sciences Division, University of Chicago, Chicago, IL, 60637, USA.
¹⁸ Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, 32610, USA.
¹⁹ Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.
²⁰ Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, 302, Taiwan.
²¹ Department of Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.
²² Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, 640, Taiwan.
²³ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan. leeming@ntu.edu.tw.
²⁴ Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, 100, Taiwan. leeming@ntu.edu.tw.
²⁵ Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, 100, Taiwan. leeming@ntu.edu.tw.
²⁶ Department of Medicine, Min-Sheng General Hospital, Taoyuan, 330, Taiwan. wjlee_obessurg_tw@yahoo.com.tw.
²⁷ Department of Surgery, Min-Sheng General Hospital, Taoyuan, 330, Taiwan. wjlee_obessurg_tw@yahoo.com.tw.

PMID: 37612578
DOI: 10.1007/s11695-023-06656-6

Abstract

Background: The superior effects of gastric bypass surgery in preventing cardiovascular diseases compared with sleeve gastrectomy are well-established. However, whether these effects are independent of weight loss is not known.

Methods: In this retrospective cohort study, we compared the change in cardiometabolic risks of 1073 diabetic patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 265), one-anastomosis gastric bypass (OAGB) (n = 619), and sleeve gastrectomy (SG) (n = 189) with equivalent weight loss from the Min-Shen General Hospital. Propensity score-weighting, multivariate regression, and matching were performed to adjust for baseline differences.

Results: After 12 months, OAGB and, to a lesser extent, RYGB exhibited superior effects on glycemic control compared with SG in patients with equivalent weight loss. The effect was significant in patients with mild-to-modest BMI reduction but diminished in patients with severe BMI reduction. RYGB and OAGB had significantly greater effects in lowering total and low-density lipoprotein cholesterol than SG, regardless of weight loss. The results of matching patients with equivalent weight loss yielded similar results. The longer length of bypassed biliopancreatic (BP) limbs was correlated with a greater decrease in glycemic levels, insulin resistance index, lipids, C-reactive protein (CRP) levels, and creatinine levels in patients receiving RYBG. It was correlated with greater decreases in BMI, fasting insulin, insulin resistance index, and C-reactive protein levels in patients receiving OAGB.

Conclusion: Diabetic patients receiving OAGB and RYGB had lower glucose and cholesterol levels compared with SG independent of weight loss. Our results suggest diabetic patients with cardiovascular risk factors such as hypercholesterolemia to receive bypass surgery.

Keywords: Cardiovascular diseases; One-anastomosis gastric bypass; Roux-en-Y gastric bypass; Sleeve gastrectomy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

C-Reactive Protein
Cholesterol, LDL
Diabetes Mellitus*
Gastrectomy
Gastric Bypass*
Glucose
Humans
Insulin
Insulin Resistance*
Obesity, Morbid* / surgery
Propensity Score
Retrospective Studies
Weight Loss

Substances

C-Reactive Protein
Insulin
Cholesterol, LDL
Glucose