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Co-morbidities

Nine of 27 of our acceptable articles had data on co-morbidities; however, none had co-morbidity data on persons over the age of 65. Of the seven TAs we reviewed, none had co-morbidity data on persons over age 65 and four of seven had data on co-morbidities in the general population.

Regarding the prevalence of co-morbidities in the population eligible for bariatric surgery, Pope demonstrated that the percentage of persons that had obesity surgery and had at least one major pre-operative co-morbidity was estimated to be 20.8% in 1990 and 31.4% in 1997. Yet in Gonzalez’ cohort study, for persons 50 years old or older, 47 of 52 (90%) had co-morbidities such as: degenerative joint disease (60%), diabetes and gastroesophageal reflux disease (GERD) (40%), and hypertension (56%). Approximately 90% of each type improved post-operatively with the exception of hypertension, where 56% improved. In a study by Residori, 57% of patients had at least one metabolic complication, with 30% having diabetes, 38% dyslipidemia, and 38% hypertension.²⁹ Approximately one-third of the diabetes cases and one-half of the dyslipidemia and hypertension cases were previously undiagnosed. Dindo calculated, after adjustment for BMI and age, that the occurrence of dyslipidemia was higher in Caucasians than Hispanics or African Americans, while hypertension rates were about the same.³⁰

In the Swedish Obesity Study (SOS), ten-year follow-up of 1,006 post-bariatric surgery patients aged 37 to 57 years showed that the two-year incidence rates of diabetes, hypertension, and low high density lipoprotein (HDL) were statistically significantly higher in the control group (diabetes 16% vs. 0.5%, hypertension 23% vs. 6.0%, and elevated HDLs 16% vs. 5.0%). From the SOS, Sjostrom⁸ reported that the post-op prevalence of hypertension, after 8 years follow-up, showed no difference between VBG cases and controls, while there was a statistically significant lowering of hypertension in the group that had GBP as compared to the control group. One important study, the Adelaide Study (Dixon-1988), showed that medical co-morbidities either improved (47%) or resolved (43%) in all but 4 cases (9% of patients had unsatisfactory weight loss). They reported that 60 percent of the patients who initially had any obesity-related co-morbidity were free of medication for those co-morbidities 3 years after surgery.² Buchwald reported that for all types of bariatric surgery, diabetes completely resolved in 77% of cases, and improved or resolved in 86%; hypertension completely resolved in 62% and improved or resolved in 78%; hyperlipidemia improved in 70%; and obstructive sleep apnea (OSA) was resolved in 85%.¹⁵ In Dolan’s case-control study the resolution of co-morbidities was similar across groups having BPD/DS as compared to those having LAGB, ranging from 66% in hypertension to 100% of OSA.


This is from the NIH website: (page 44-45) 
http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf

1.a.Hypertension

Data from NHANES III show that the ageadjusted

prevalence of high blood pressure

increases progressively with higher levels of BMI

in men and women (Figure 2). 2 High blood

pressure is defined as mean systolic blood pressure

³ 140 mm Hg, or mean diastolic blood

pressure ³ 90 mm Hg, or currently taking antihypertensive

medication. The prevalence of high

blood pressure in adults with BMI ³ 30 is 38.4

percent for men and 32.2 percent for women,

respectively, compared with 18.2 percent for

men and 16.5 percent for women with BMI

< 25, a relative risk of 2.1 and 1.9 for men and

women, respectively. The direct and independent

association between blood pressure and

BMI or weight has been shown in numerous

cross-sectional studies 3-5, including the large

international study of salt (INTERSALT) carried

out in more than 10,000 men and women. 6

INTERSALT reported that a 10 kg (22 lb) higher

body weight is associated with 3.0 mm Hg

higher systolic and 2.3 mm Hg higher diastolic

blood pressure. 6 These differences in blood pressure

translate into an estimated 12 percent

increased risk for CHD and 24 percent

increased risk for stroke. 132 Positive associations

have also been shown in prospective studies. 76-80

Obesity and hypertension are co-morbid risk

factors for the development of cardiovascular

disease. The pathophysiology underlying the

development of hypertension associated with

obesity includes sodium retention and associated

increases in vascular resistance, blood volume,

and cardiac output. These cardiovascular abnormalties

associated with obesity are believed to be

related to a combination of increased sodium

retention, increased sympathetic nervous system

activity, alterations of the renin-angiotensin system

and insulin resistance.