Comparison of Weight Loss Induced by Bariatric Surgery vs Conventional Treatment

Obesity Clinical Trial

Official title:

Comparison of Weight Loss Induced by Bariatric Surgery vs Conventional Treatment on Body Composition, Adipokines, Gastro-intestinal Hormones and Cardiometabolic Risk Factors

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT01572090
• Other study ID #: OBECUN-WL-01
• Status: Active, not recruiting
• Phase: N/A
• First received: March 28, 2012
• Last updated: October 24, 2016
• Start date: January 2006
• Est. completion date: December 2017

Study information

• Verified date: October 2016
• Source: Clinica Universidad de Navarra, Universidad de Navarra
• Contact: n/a
• Is FDA regulated: No
• Health authority: Spain: Ministry of Health
• Study type: Interventional

Clinical Trial Summary

Patients with overweight or obesity are in need to loose weight and represent a particularly challenging medical condition. Undoubtedly, any intervention achieving a negative energy balance over an extended time period will result in weight loss. Although several treatment modalities are available, currently the most extended approaches are lifestyle changes, pharmacotherapy, and bariatric surgery. Given the limited approved anti-obesity drugs, the main therapeutic strategies involve either conventional treatment or bariatric surgery. Conventional weight-reduction programs pursue a safe weight loss rate of 0,5-1,0 kg per week. The main modifiable factors affecting energy balance are dietary energy intake and energy expended through physical activity. In spite of the difficulty in achieving relevant and sustained weight loss via the conventional approach, some patients are successful in reducing weight and obesity-associated complications. Bariatric surgery has proved to be the most effective long-term treatment for weight loss and comorbidity improvement. While some of the surgery-induced benefits are directly dependent on adipose tissue reduction, others are due to specific gastrointestinal changes that take place early on and before any significant effects on body weight are observed. The present study contemplates the determination and comparison of the anthropometric and metabolic changes produced by the conventional and surgery-induced treatment modalities. Particular emphasis will be placed on the potential differential effects between conventional and surgical weight loss on body composition changes, circulating adipokines and gastrointestinal hormones together with their subsequent impact on cardiometabolic risk factors.

Description:

In spite of the recognition of obesity as a serious public health problem due to its well-known increased risk for the development of type 2 diabetes hypertension, coronary heart disease, sleep-breathing disorders, and certain forms of cancer, among others, it is proving extraordinarily difficult to halt this pandemia. Strictly speaking obesity does not refer to an excess weight or weight to height ratio. In fact, the World Health Organization defines obesity as a state of increased adipose tissue of sufficient magnitude to produce adverse health consequences. Thus, in order to better define the effects and benefits of weight loss it is important to address the impact on body fat changes. Given the limited approved anti-obesity drugs, the main therapeutic strategies involve either conventional treatment or bariatric surgery. The main modifiable factors affecting energy balance are dietary energy intake and energy expended through physical activity. In spite of the difficulty in achieving relevant and sustained weight loss via the conventional approach, some patients are successful in reducing weight and obesity-associated complications. Bariatric surgery has proved to be the most effective long-term treatment for weight loss and comorbidity improvement. While some of the surgery-induced benefits are directly dependent on adipose tissue reduction, others are due to specific gastrointestinal changes that take place early on and before any significant effects on body weight are observed. Noteworthy, currently available bariatric procedures differ on their impact on these aspects. The present study contemplates the determination and comparison of the anthropometric and metabolic changes produced by the conventional and surgery-induced treatment modalities. Particular emphasis will be placed on the potential differential effects between conventional and surgical weight loss on energy intake, energy expenditure, body composition changes, circulating adipokines and gastrointestinal hormones together with their subsequent impact on cardiometabolic risk factors. The conventional weight-reduction program (CONV) will pursue a safe weight loss rate of 0,5-1,0 kg per week. The surgery-induced weight loss will be achieved by two of the most frequently used bariatric operations, the sleeve gastrectomy [SG (which implies a restrictive component)] and the Roux-en-Y gastric bypass [RYGB (which combines a restrictive and a malabsorptive component)].

The purpose of the study is to determine the effect of three weight loss procedures that differ on their manipulation of the anatomical and functional characteristics of the gastrointestinal tract. While in the conventional treatment the gastrointestinal system remains intact, in the SG only the stomach is manipulated as opposed to the RYGB, where both the stomach and the small intestine are operated on. Since bariatric surgery is well known to induce partial or total remission of type 2 diabetes mellitus, the effects of the three different weight loss procedures will be assessed separately in obese normoglycemic and obese type 2 diabetic individuals.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 600
• Est. completion date: December 2017
• Est. primary completion date: December 2016
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 21 Years to 65 Years

Eligibility

Inclusion Criteria:

• Age between 21 and 65 years.

• Obesity as defined by World Health Organization criteria.

• For bariatric surgery patients: qualified for obesity surgery by the -Multidisciplinary Obesity Team of the Clinica Universidad de Navarra

• For type 2 diabetic patients: T2D diagnosis confirmed by either fasting plasma glucose =126 mg/dL on two separate occasions, or fasting plasma glucose =126 mg/dL and plasma glucose =140 mg/dL 2 h after OGTT, or treatment with anti-diabetic medication in accordance with good clinical practice with and well-documented information on diagnosis, history, treatment(s) and HbA1c data.

• No major organ disease unrelated to excess body weight.

• Mentally able to understand the study and willingness to participate in the study.

Exclusion Criteria:

• Pregnancy/lactation

• Poor overall general health

• Drug and/or alcohol addiction

• Prior bariatric or gastrointestinal surgery

• Active gastric or intestinal tract disease

• Thyroid disease

• Type 1 diabetes mellitus

• Portal hypertension and/or cirrhosis

• Malignancies

• History of eating disorders or major psychiatric illness

• Unable to communicate with study staff

Study Design

Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Basic Science

Related Conditions & MeSH terms

• Obesity
• Weight Loss

Intervention

Behavioral:
• Lifestyle Changes
Hypocaloric diet providing a 1000 kcal/d deficit from total energy expenditure assessed by indirect calorimetry and physical activity determination. Dietetic and physical activity counselling with a dietitian.

Other:
• Adjustment of oral antidiabetics/insulin therapy
Continuation-discontinuation of medical antidiabetic therapy if needed in accordance with good clinical practice. In addition to the surgery, patients will have regular follow-up with an endocrinologist for appropriate counselling on lifestyle changes (diet, physical activity and vitamin/mineral supplementation counselling) following bariatric surgery as well for adjustment of antidiabetic medication. Adjustment of oral antidiabetics/insulin therapy consisting in continuation, adjustment or discontinuation of medical antidiabetic therapy if needed in accordance with good clinical practice.

Procedure:
• Laparoscopic sleeve gastrectomy
The Laparoscopic sleeve gastrectomy SG-NG involves the removal of the mayor curvature of the stomach via a laparoscopic approach. In addition to the surgery, patients will have regular follow-up with a dietitian and endocrinologist for appropriate counselling on lifestyle changes (diet, physical activity and vitamin/mineral supplementation counselling) following bariatric surgery.
• Laparoscopic Roux-en-Y gastric bypass
Laparoscopic Roux-en-Y gastric bypass. In addition to the surgery, patients will have regular follow-up with a dietitian and endocrinologist for appropriate counselling on lifestyle changes (diet, physical activity and vitamin/mineral supplementation counselling) following bariatric surgery.

Locations

Country	Name	City	State
Spain	Clinica Universidad de Navarra	Pamplona

Sponsors (3)

Lead Sponsor	Collaborator
Clinica Universidad de Navarra, Universidad de Navarra	Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III

Country where clinical trial is conducted

Spain, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in body fat	Body fat will be assessed by air-displacement plethysmography (Bod-Pod) over the duration of the intervention.	Baseline, 1, 6, 12, and 24 months	No
Secondary	Change in energy balance	Energy intake will be assessed by food dietary, 24-h recall, FFQ and energy expenditure will be determined by indirect calorimetry, physical activity questionnaires and accelerometry over the duration of the intervention.	Baseline, 1, 6, 12 and 24 months	No
Secondary	Change in glycemic control	Measurement of fasting plasma glucose, insulin and HbA1c concentrations over the duration of the intervention.	Baseline, 1, 6, 12 and 24 months	No
Secondary	Change in cardiovascular risk factors	Measurement of circulating total cholesterol, LDL-cholesterol, HDL-cholesterol, fibrinogen, C-reactive protein, homocysteine, von Willebrand factor and adipokines over the duration of the intervention.	Baseline, 1, 6, 12 and 24 months	No
Secondary	Change in gastrointestinal hormones	Measurement of fasting ghrelin, PYY, GLP-1, GIP, PP, amylin and oxyntomodulin over the duration of the intervention.	Baseline, 1, 6, 12 and 24 months	No
Secondary	Change in gustatory threshold	Determination of the gustatory threshold levels by the whole-mouth chemical test procedure and tongue electrogustometry over the duration of the intervention.	Baseline, 1, 6, 12 and 24 months	No
Secondary	Change in BMI	Measurement of weight and height over the duration of the intervention to calculate the BMI.	Baseline, 1, 6, 12 and 24 months	No