Impact of metabolic surgery on health-related quality of life and quality of alimentation

Abstract

Background: Bariatric surgery for morbidly obese patients has been shown to ameliorate their quality of life (QOL). Little data are available in mildly obese patients undergoing metabolic surgery.

Objectives: To investigate the impact of metabolic surgery for diabetic patients with body mass index <35 kg/m² on health-related QOL (HR-QOL), food tolerance, and food satisfaction in a single institution.

Setting: Private practice, Japan.

Methods: Fifty-one consecutive mildly obese, diabetic patients underwent laparoscopic sleeve gastrectomy with duodenojejunal bypass were initially enrolled. Only 46 returned for follow-up and were eventually included in the final population. Preoperatively, the mean weight and body mass index were 89.1 ± 11.9 kg and 31.7 ± 2.2 kg/m², respectively. The mean fasting plasma glucose and glycated hemoglobin were 196 ± 69 mg/dL and 9.0 ± 1.5%, respectively. The mean duration of diabetes was 9.0 ± 6.1 years. Before surgery, 40 patients (78.4%) were treated with oral hypoglycemic agents and 28 patients (54.9%) were treated with subcutaneous insulin. The 36-item Short Form Survey was used to gauge HR-QOL at the preoperative phase and at 1 year after surgery. Questionnaires regarding food tolerance, food satisfaction, and dietary intake were also distributed to the enrolled patients.

Results: The follow-up rate at 1 year was 90.2%. At this point, there was a decrease in mean weight and body mass index were 67.5 ± 11.6 kg and 23.9 ± 2.8 kg/m², respectively (P < .001). This accounted for the mean percent total weight loss of 24.4 ± 8.3%. The mean fasting plasma glucose and glycated hemoglobin were 114 ± 35 mg/dL and 6.5 ± 1.1%, respectively (P < .001). Remission of diabetes was seen in 52.2% of the patients. With regard to the HR-QOL, significant improvements were observed in the aspects of physical functioning, bodily pain, general health, vitality, and mental health. Dietary intake significantly decreased from 2679 ± 952 kcal/d at baseline to 1346 ± 483 kcal/d at 1 year (P < .001). Food tolerance score significantly decreased from 21.6 ± .6 to 18.7 ± 3.9 (P < .001). By contrast, food satisfaction score significantly increased from 3.0 ± 1.1 to 3.5 ± 1.1 (P = .015).

Conclusions: In mildly obese patients associated with severe diabetes who underwent laparoscopic sleeve gastrectomy with duodenojejunal bypass, marked amelioration in glycemic control was observed and, although the amount of food intake and food tolerance were affected, the overall HR-QOL as well as food satisfaction improved significantly.