Stapleless Vs Stapled Gastric Bypass Vs Hypocaloric Diet: a Three-Arm Randomized Controlled Trial of Body Mass Evolution with Secondary Outcomes for Telomere Length and Metabolic Syndrome Changes

Overview

Journal Obes Surg

Date 2021 May 8

PMID 33963974

Citations 2

Authors

Oral Ospanov

Ainur Akilzhanova

J N Buchwald

Alexandr Fursov

Farida Bekmurzinova

Saule Rakhimova

Galymzhan Yeleuov

Ulan Kozhamkulov

Zhanar Abdina

Roman Fursov

Lyudmila Jumayeva

Affiliations

Soon will be listed here.

Abstract

Background: Obesity and metabolic syndrome (MetS) reduce life expectancy and are challenging to resolve. This randomized controlled trial (RCT) of patients with obesity and MetS undergoing surgical vs nonsurgical treatment compared changes in BMI, and secondarily, telomere length (as a biomarker of life expectancy) and changes in MetS components (insulin resistance, dyslipidemia, hypertension).

Methods: Study design was a single-center, prospective, three-arm RCT. Group 1 patients underwent novel unstapled laparoscopic one anastomosis gastric bypass with an obstructive stapleless pouch and anastomosis (LOAGB-OSPAN); Group 2, stapled laparoscopic mini-gastric bypass-one anastomosis gastric bypass (LMGB-OAGB); and Group 3, nonsurgical weight loss therapy via a hypocaloric diet with energy restriction (HDER). The primary outcome measure was change in BMI; secondary outcome measures included change in leukocyte telomere length and other MetS components.

Results: Of 96 participants screened, 60 were randomly allocated to 3 groups: LOAGB-OSPAN group (n = 20), LMGB-OAGB group (n = 20), and HDER group (n = 20). At post-treatment month 12, respective BMI changes: BMI -12.13 (-8.34, -15.93); -16.04 (-11.7, 20.37); -2,76 (-3.84, -9.36) (p < 0.01). The two surgical groups experienced significant change in telomere length: LOAGB-OSPAN 2.02 (1.61, 2.41), p = 0.001; LMGB-OAGB 2.07 (1.72, 2.43), p = 0.001; and HDER 0.28 (0.22, 0.78), p = 0.26. The surgical groups were also more effective in treating MetS components. There were no deaths. Adverse events: LOAGB-OSPAN (n = 2) (Clavien-Dindo grade II); LMGB-OAGB (n = 8) (grade I (n = 6) and grade II (n = 2).

Conclusions: Compared with hypocaloric diet therapy, both bariatric procedures resulted in greater BMI loss, and secondarily, a significant increase in telomere length, and greater MetS resolution.

Trial Registration: ClinicalTrials.gov , NCT03667469, registered on 11 September 2018.

Citing Articles

17-year follow-up of association between telomere length and all-cause mortality, cardiovascular mortality in individuals with metabolic syndrome: results from the NHANES database prospective cohort study.

Xiong L, Yang G, Guo T, Zeng Z, Liao T, Li Y Diabetol Metab Syndr. 2023; 15(1):247.

PMID: 38041119 PMC: 10693041. DOI: 10.1186/s13098-023-01206-7.

Calorie restriction outperforms bariatric surgery in a murine model of obesity and triple-negative breast cancer.

Camp K, Coleman M, McFarlane T, Doerstling S, Khatib S, Rezeli E JCI Insight. 2023; 8(19).

PMID: 37698918 PMC: 10629811. DOI: 10.1172/jci.insight.172868.

References

Paul L . Diet, nutrition and telomere length. J Nutr Biochem. 2011; 22(10):895-901. DOI: 10.1016/j.jnutbio.2010.12.001. View

Fasching C . Telomere length measurement as a clinical biomarker of aging and disease. Crit Rev Clin Lab Sci. 2018; 55(7):443-465. DOI: 10.1080/10408363.2018.1504274. View

Valdes A, Andrew T, Gardner J, Kimura M, Oelsner E, Cherkas L . Obesity, cigarette smoking, and telomere length in women. Lancet. 2005; 366(9486):662-4. DOI: 10.1016/S0140-6736(05)66630-5. View

Morton J, Garg T, Leva N . Association of Laparoscopic Gastric Bypass Surgery With Telomere Length in Patients With Obesity. JAMA Surg. 2018; 154(3):266-268. PMC: 6439632. DOI: 10.1001/jamasurg.2018.4830. View

Formichi C, Cantara S, Ciuoli C, Neri O, Chiofalo F, Selmi F . Weight loss associated with bariatric surgery does not restore short telomere length of severe obese patients after 1 year. Obes Surg. 2014; 24(12):2089-93. DOI: 10.1007/s11695-014-1300-4. View

Ospanov O, Yeleuov G, Kadyrova I, Bekmurzinova F . The life expectancy of patients with metabolic syndrome after weight loss: study protocol for a randomized clinical trial (LIFEXPE-RT). Trials. 2019; 20(1):202. PMC: 6454761. DOI: 10.1186/s13063-019-3304-9. View

Ospanov O . Surgical technique of laparoscopic mini-gastric bypass with obstructive stapleless pouch creation: A case series. Int J Surg. 2019; 67:70-75. DOI: 10.1016/j.ijsu.2019.05.011. View

Bhandari M, Fobi M, Buchwald J . Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement. Obes Surg. 2019; 29(Suppl 4):309-345. DOI: 10.1007/s11695-019-04032-x. View

Brethauer S, Kim J, El Chaar M, Papasavas P, Eisenberg D, Rogers A . Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015; 11(3):489-506. DOI: 10.1016/j.soard.2015.02.003. View

10.

Cawthon R . Telomere measurement by quantitative PCR. Nucleic Acids Res. 2002; 30(10):e47. PMC: 115301. DOI: 10.1093/nar/30.10.e47. View

11.

Salminen P, Helmio M, Ovaska J, Juuti A, Leivonen M, Peromaa-Haavisto P . Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA. 2018; 319(3):241-254. PMC: 5833550. DOI: 10.1001/jama.2017.20313. View

12.

Wittes J . Sample size calculations for randomized controlled trials. Epidemiol Rev. 2002; 24(1):39-53. DOI: 10.1093/epirev/24.1.39. View

13.

Cummings D, Cohen R . Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery. Lancet Diabetes Endocrinol. 2014; 2(2):175-81. PMC: 4160116. DOI: 10.1016/S2213-8587(13)70198-0. View

14.

Shantavasinkul P, Muehlbauer M, Bain J, Ilkayeva O, Craig D, Newgard C . Improvement in insulin resistance after gastric bypass surgery is correlated with a decline in plasma 2-hydroxybutyric acid. Surg Obes Relat Dis. 2018; 14(8):1126-1132. PMC: 6153057. DOI: 10.1016/j.soard.2018.03.033. View

15.

Gero D, Raptis D, Vleeschouwers W, van Veldhuisen S, San Martin A, Xiao Y . Defining Global Benchmarks in Bariatric Surgery: A Retrospective Multicenter Analysis of Minimally Invasive Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. Ann Surg. 2019; 270(5):859-867. DOI: 10.1097/SLA.0000000000003512. View