Metabolic syndrome prevalence and associations in a bariatric surgery cohort from the Longitudinal Assessment of Bariatric Surgery-2 study

Abstract

Background: Metabolic syndrome is associated with higher risk for cardiovascular disease, sleep apnea, and nonalcoholic steatohepatitis, all common conditions in patients referred for bariatric surgery, and it may predict early postoperative complications. The objective of this study was to determine the prevalence of metabolic syndrome, defined using updated National Cholesterol Education Program criteria, in adults undergoing bariatric surgery and compare the prevalence of baseline co-morbid conditions and select operative and 30-day postoperative outcomes by metabolic syndrome status.

Methods: Complete metabolic syndrome data were available for 2275 of 2458 participants enrolled in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), an observational cohort study designed to evaluate long-term safety and efficacy of bariatric surgery in obese adults.

Results: The prevalence of metabolic syndrome was 79.9%. Compared to those without metabolic syndrome, those with metabolic syndrome were significantly more likely to be men, to have a higher prevalence of diabetes and prior cardiac events, to have enlarged livers and higher median levels of liver enzymes, a history of sleep apnea, and a longer length of stay after surgery following laparoscopic Roux-en-Y gastric bypass (RYGB) and gastric sleeves but not open RYGB or laparoscopic adjustable gastric banding. Metabolic syndrome status was not significantly related to duration of surgery or rates of composite end points of intraoperative events and 30-day major adverse surgical outcomes.

Conclusions: Nearly four in five participants undergoing bariatric surgery presented with metabolic syndrome. Establishing a diagnosis of metabolic syndrome in bariatric surgery patients may identify a high-risk patient profile, but does not in itself confer a higher risk for short-term adverse postsurgery outcomes.

FIG. 1.

Metabolic syndrome was defined as present if three or more of the following five criteria were positive: fasting blood glucose ≥100 mg/dL; elevated blood pressure [systolic blood pressure (SBP) ≥130 and/or diastolic blood pressure (DBP) ≥85 mmHg) or medication for hypertension; fasting triglyceride (TG) levels (≥150 mg/dL); fasting high-density lipoprotein cholesterol (HDL-C) values (<50 mg/dL for females, <40 mg/dL for males), or central obesity (waist circumference >88 cm for females, >102 cm for males). Non–metabolic syndrome was defined as having two or less of the above criteria. (Left) Percentage of morbidly obese subjects who met one, two, three, four, or five metabolic syndrome criteria prior to surgery by metabolic syndrome status. (Right) Percentage of subjects meeting National Cholesterol Education Program (NCEP) metabolic syndrome criteria for hypertension, impaired glucose, central obesity, low HDL-C, and high triglyceride levels (metabolic syndrome vs. non–metabolic syndrome for hypertension, impaired glucose, low HDL-C, and high triglyceride levels, P<0.001).