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GENDER DIFFERENCES IN THE PREVALENCE AND REMISSION OF METABOLIC SYNDROME FOR PATIENTS UNDERGOING BARIATRIC SURGERY
Prashasti Agrawal, Habib Khoury, Katie Shpanskaya, Homero Rivas, John M. Morton*
Surgery, Stanford School of Medicine, Stanford, CA
Background: Metabolic syndrome (MetS) is characterized by the presence of various risk factors that are associated with developing cardiovascular disease and diabetes. These include elevated triglycerides, decreased HDL, increased blood pressure, elevated fasting blood glucose, and abdominal obesity, as assessed by increased waist circumference. Bariatric surgery has shown to be an effective method of resolving MetS in morbidly obese patients.
Objective: To assess sex differences in the risk factors and resolution of MetS for patients undergoing bariatric surgery
Methods: 1,053 patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy at the BMI Clinic were included in this study. Subjects were divided into two cohorts based on biological gender. Levels of triglycerides, HDL, blood pressure, fasting blood glucose, and waist circumference were measured preoperatively and at 12 months following surgery. Patients were characterized as having MetS if they met at least 3 of the 5 criteria as outlined by the NCEP-ATP III.
Results: Men were significantly more likely to have MetS pre-operatively (RR: 1.30; p=0.001) and 12 months post-operatively (RR: 2.02; p=0.0005) compared to women. Significant sex differences were found for individual components of MetS. Pre-operatively, men were more likely to have increased triglycerides (RR: 1.32; p=0.0065), blood pressure (RR: 1.21; p=0.0013), and fasting blood glucose (RR: 1.85; p=0.0001) compared to women, whereas women were more likely to have decreased HDL (RR: 1.14; p=0.0423) compared to men. Among those patients with MetS pre-operatively, men were more likely to have dysglycemia (RR: 1.42; p=0.0005) and women were more likely to have low HDL (RR: 1.11; p=0.0447). Women with MetS were 12.6% more likely to resolve the condition 12 months post-operatively compared to men (p=0.0261). Among patients with MetS and dysglycemia pre-operatively, women were 27.2% more likely than men to resolve the levels of fasting blood glucose 12 months post-operatively (p=0.0147). Logistic regression analysis revealed gender to be an insignificant determinant of resolving MetS 12 months post-surgery, after controlling for age and percent excess weight loss. Among patients with MetS, women were 2.98 years younger (p=0.008) and lost 6.30% percent more excess weight post-surgery (p=0.015) compared to men.
Conclusions: The study reveals gender differences in the prevalence and remission of MetS among patients undergoing bariatric surgery. Men have higher rates of MetS pre-operatively and 12 months following surgery. Notably, men with MetS are more likely to have higher blood glucose levels and are less likely to resolve dysglycemia post-operatively. Women are more likely to resolve MetS following surgery.
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