Main Article Content
Bariatric surgeries, Obesity, Metabolic changes, laparoscopic sleeve gastrectomy
Introduction: Obesity is associated with diabetes, dyslipidemia, and increased cardiovascular disease risks. Bariatric surgeries are one of the most reliable ways to treat obesity. Bariatric Surgical procedures started in Basra in 2009 and since then, thousands of surgeries had been made, mainly in Al-Sadr Teaching Hospital.
Objective: To prospectively evaluate the short-term effect of bariatric surgical procedures on body mass index (BMI), lipid profile, and glycosylated hemoglobin (HbA1C) and compare the effects of various types of these surgical procedures.
Methods: A 12-month prospective study on 73 patients who underwent three types of bariatric surgeries, laparoscopic sleeve gastrectomy surgery (LSG), laparoscopic REUX-EN-Y gastric bypass surgery (LRYGB), and mini-gastric bypass surgery (MGB). Body mass index (BMI), HbA1C, total cholesterol (TC), High-Density-Lipoprotein cholesterol (HDL), Low-Density-Lipoprotein cholesterol (LDL), and triglycerides (TG) levels were evaluated before a surgery and at 3 and 6 months postoperatively.
Results: All bariatric procedures show significant improvement in all parameters (increment in HDL, reduction in BMI, A1C, HDL, LDL, TC, TG) at 3 months that continue to improve more at 6 months postoperatively (p<0.001), however, bypass surgeries (LRYGB and MGB) has an additional favorable independent effect on A1C and LDL seen at 6 months postoperatively.
Conclusion: All of the studied bariatric surgeries improve BMI, HbA1C, and lipid profile significantly, however, bypass procedures have more effect on LDL and HbA1C that seem to be procedure-related and independent from weight loss or other changes.
2. Mattison DR. Environmental exposures and development. Curr Opin Pediatr. 2010;22(2):208–218.
3. Gandhi MK, Chaudhi UR, Thakor N. A study on incidence of congenital anomalies in new borns and their association with fetal factors: a prospective study. Int J Res Med Sci. 2016;4(4):1200–1203.
4. Prajkta B, Gund P, Kar A. Prevalence of congenital anomalies in an Indian maternal cohort: healthcare, prevention, and surveillance implications. PLoS One. 2016;11(11):66–40.
5. Egbe AC. Birth defects in the newborn population: Race and ethnicity. Pediatrics & Neonatology. 2014;56(3):183–188.
6. Ritz B. Air pollution and congenital anomalies. Occup Environ Med. 2010;67(4):221–222.
7. Tripathy K, Nanda T, Sudharani OV. The influence of environmental and genetic factors on various disorders and diseases. Journal of Genetic Syndromes & Gene Therapy. 2011;15(1):15–20.
8. Vargesson N. Thalidomide-induced teratogenesis: history and mechanisms birth defects. Res C Embryo Today. 2015;105(2):140–156.
9. Al-Shammari AM. Environmental pollutions associated to conflicts in Iraq and related health problems. Rev Environ Health. 2016;31(2):245–250.
10. Marshall AC. Gulf war depleted uranium risks. J Expo Sci Environ Epidemiol. 2008;18(1):95–108.
11. Al-Sadoon I, Hassan GG, Yacoub A. Depleted uranium and health of people in Basrah: epidemiological evidence. Medical Journal of Basrah University. 1999;17:27–33.
12. Al-Alwani M, Alnuaimi AS. Prevalence of major fetal defects in Fallujah, Iraq. Open Journal of Obstetrics and Gynecology. 2014;4:569–577.
13. Alaani S, Savabieasfahani M, Tafash M, Manduca P, et al. Four polygamous families with congenital birth defects from Fallujah, Iraq. Int J Environ Res Publ Health. 2011;8(1):89–96.
14. Fathi RA, Matti L, Al-Salih H, Godbold D. Environmental pollution by depleted uranium in Iraq with special reference to Mosul and possible effects on cancer and birth defect rates. Med Confl Surviv. 2013;29(1):7–25.
15. Ansari TM, Marr IL, Tariq N. Heavy metals in marine pollution perspective – a mini review. J. of Applied Sciences. 2004;4(1):1–20.
16. Sadek ME, Seheimy AE, El-Tokhy TT, MA Allah. Management process of oil spill in water plants. J Pollut Eff Cont. 2017;5(4):205.
17. AbdolRazak T, Abdul Hameed M, Hisham M.Cobalt-60 and cesium-137 soil contamination in Al Tuwaitha nuclear site, using GIS technique. Engineering Technol J. 2014;32(13):3209–3215.
18. Al-Ansari N, Knutsson P, Almuqdadi S. Isolation of radioactive military wastes in Iraq. J Earth Sciences and Geotechnical Engineering. 2013;3(3):1–10.
19. Habib SA. The incidence of congenital malformation and associated risk factors in Basrah city. Fellowship of Iraqi Commission of Medical Specializations (ICMS) dissertation. ICMS Scientific Council of Pediatrics, Iraq; 1994.
20. Hameed NN. Analytic study of congenital malformations in four hospitals in Baghdad, Iraq. J Fac Med Baghdad. 2007;49:32–36.
21. Al Hosani HA, Czeizel AE. Congenital abnormalities in the United Arab Emirates. Teratology 2018;61(3):161–2.
22. Dastgiri S, Imani S, Kalankesh L, Barzegar M, Heidarzadeh M. Congenital anomalies in Iran: a cross-sectional study on 1574 cases in the north-west of country. Child Care Health Dev. 2007;33(3):257–261.
23. Al-Rabbaty A. Birth defects among neonates admitted to neonatal intensive care unit – Erbil Children and Maternity Hospital. Zanko Med J. 2001;5:66–78.
24. Feldkamp ML, Carey JC, Byrne JL, Krikov S, Botto LD. Etiology and clinical presentation of birth defects: population based study. BMJ. 2017;35(7):22–49.
25. Mohammed B, Mohammed A. congenital malformation pattern in Duhok city. J of Biology. 2015;5(8):120.
26. Abdurrahman KN. The prevalence of neural tube defects among newborns delivered in Azadi hospital in Duhok city, Kurdistan region, Iraq. Duhok Med J. 2007;1(1):42–48.
27. Al-Shammosy MM. Neural tube defects in Diwaniah: increasing incidence. In proceedings of the conference on the Effects of the Use of DU Weaponry on Human and Environment in Iraq: 26–27 March. Baghdad; 2002.
28. Al-Hadithi T, Al-Diwan J, Saleh A, Shabila N. Birth defects in Iraq and the plausibility of environmental exposure: a review. Confl Health. 2012;6:3.
29. Moorthie S, Blencowe H, Darlison M, Lawn J, Morris J, Modell B, et al. Estimating the birth prevalence and pregnancy outcomes of congenital malformations worldwide. J Phanum Fury Community Genet 2018;9(4):387–396.
30. Alaani S, Tafash M, Busby C, Hamdan M, Blaurock E. Uranium and other contaminants in hair from the parents of children with congenital anomalies in Fallujah, Iraq. Confl Health. 2011;5:15.
31. Feldkamp M, Carey J, Byrne J, Krikov S, Botto L. Etiology and clinical presentation of birth defects: population based study. BMJ. 2017;357:22–49.
32. Devi K, Devi R, Priya J, Sanaton A, Singh L, Murray L. Study of congenital anomalies in a tertiary care hospital in north east region, India. Int J Reprod Contracept Obstet Gynecol. 2018;7(7):2899–2903.
33. Ahmed M, Redondo S, Hamdan M. Nondisjunction and chromosomal anomalies. Salud Uninorte Barranquilla. 2010;26(1):117–133.
34. Taboo AZ. Prevalence and risk factors for congenital anomalies in Mosul city. The Iraqi Postgraduate Medical J. 2012;11(4):458–470.
35. Eke CB, Uche EO, Chinawa JM, Obi IE, Obu HA, Ibekwe RC. Epidemiology of congenital anomalies of the central nervous system in children in Enugu, Nigeria: a retrospective study. AnnAfr Med. 2016;15(3):126–132.
36. Sallout S, Al Reham A, Abdelmane A, Al Sulemat. Antenatal diagnosis, prevalence and outcome of major congenital anomalies in Saudi Arabia: a hospital-based study. Ann Saudi Med. 2010;28:272–76.
37. Tain YL, Luh H, Lin CY, Hsu CN. Incidence and risks of congenital anomalies of kidney and urinary tract in newborns: a population-based case-control study in Taiwan. Medicine. 2016;95(5):e2659.
38. Anwar WA, Khyatti M, Hemminki K. Consanguinity and genetic diseases in North Africa and immigrants to Europe. European J Public Health. 2014;24(1):57–63.
39. Arfsten DP, Still KR, Ritchie GD. A review of the effects of uranium and depleted uranium exposure on reproduction and fetal development. Toxicology and Industrial Health. 2001;17(10):180–191.
40. Caporali P, Cutuli D, Gelfo F, Laricchiuta D, Foti F, De Bartolo P. Pre-reproductive maternal enrichment influences offspring developmental trajectories: motor behavior and neurotrophin expression. Front Behav Neurosci. 2014;8(1):195.
41. Hon Z, Osterreicher J, Navratil L. Review depleted uranium and its effects on humans. Sustainability. 2015;7(1):4063–4077.
42. Edmands J, Brabander D, Coleman D. Uptake and mobility of uranium in black oaks: implications for biomonitoring depleted uranium-contaminated groundwater. Chemosphere. 2001;44(4):789–795.
43. Danesi E. Kinetic energy penetrator long term strategy study. US Army Armament, Munitions, and Chemical Command. 1990;5(1):20-25.
44. Bem H, Bou-Rabee F. Environmental and health consequences of depleted uranium use in the 1991 Gulf War. Environ Int. 2004;30(1):123–34.
45. Zwijnenburg W. Laid to waste: depleted uranium contaminated military scrap in Iraq. PAX. 2014;6(1):12–20.
46. Heintze E. Toxicity of depleted uranium complexes is independent of p53 activity. Inorganic Biochemistry. 2010;105:142–148.
47. Briner W. The toxicity of depleted uranium. Int J Environ Res Public Health. 2010;7(1):303–313.
48. McDiarmid M, et al., Measures of genotoxicity in Gulf War I veterans exposed to depleted uranium. Environmental and Molecular Mutagenisis. 2011;52(7):569–581
49. Thiebault C, Carriere M, Milgram S, Simon A, Avoscan L, Gouget B. Uranium induces apoptosis and is genotoxic to normal rat kidney proximal cells. Toxicological Sciences. 2007;98(2):479–487.
50. Milacic S, Petrovic D, Jovicic D, Kovacevic R, Simic J. Examination of the health status of populations from depleted uranium contaminated regions. Environmental Research. 2004;75: 2–10.
51. LaCerte C, Xie H, Aboueissa A, Wise J. Particulate depleted uranium is cytotoxic and clastogenic to human lung epithelial cells. Mutation Research. 2010;697:31–37
52. Hindin R, Brugge D, Panikkar B. Teratogencity of depleted uranium aerosols: a review from an epidemiological perspective. Environ Health. 2005;4:17.
53. Webster P. Questions raised over Iraq congenital birth defects study. The Lancet. 2013;382:1156–1166.
54. Weir D. Civilian protection, environmental pollution and conflict – a role for the public health community. Medicine, Conflict and Survival. 2015;31(1):4–12.
55. Al-Mendalawi M, Mahmoud I, Obed A, Al-Ameri L. Neural tube defects in Iraq. KCMJ. 2013;9(2):3–5.
56. AL-Barazanjy JS. Epidemiological study of congenital malformations in Baghdad. MSc thesis. Iraq: Al-Mustansiryah University, College of Medicine; 1989.
57. Al-Ani Z, Al-Hiali S, Al-Mehimdi S, et al. Neural tube defects among neonates delivered in Al-Ramadi Maternity and Children’s Hospital, western Iraq. SMJ. 2010;31(2):163–169.
58. Al-Azzawi SA. Depleted uranium and radioactive contamination in Iraq: an overview. Global Research.2015;(1):1–10.
59. Busby C, Hamdan M, Ariabi E. Cancer, infant mortality and birth sex-ratio in Fallujah, Iraq 2005–2009. Int J Environ Res Public Health. 2010;7(7):2828–2837.
60. Ghabili K, Agutter P, Ghanei M. Sulfur mustard toxicity: history, chemistry, pharmacokinetics, and pharmacodynamics. Critical Reviews in Toxicology. 2011;41(5):384–403.
61. Goverman J, Montecino R, Ibrahim A, Sarhane K, Tompkins R, Fagan S. Sulfur mustard gas exposure: case report and review of the literature. Ann Burns Fire Disasters. 2014;27(3):146-150.
62. Belal M. Effects of chemical weapons on cancer development in human. Kurdistan J of Applied Research. 2016;1(1):50–56.
63. Apostoli P, Catalani S. Metal ions affecting reproduction and development. Met Ions Life Sci. 2011;8:263–303.
64. Al-Hamawandi A, Della Ali F, Al-Diwan J, Al-Hadithi T, Al-Baldawi K, Diyaiy MA. Blood lead level among children in Al-Anbar governorate, Iraq. Al-Anbar Medical J. 2004;5(1):10–13.
65. Macdonell JE, Campbell H, Stone DH. Lead level in domestic water supplies
66. and neural tube defects in Glasgow. Arch Dis Child. 2000;82(1):50–53.
67. Chen E, Navier D, Padilla C, Deguen S. Effects of air pollution on the risk of congenital anomalies: a systematic review and meta-analysis. Int J Environ Res Public Health. 2014;11:7642–7668.
68. Atheer Q, Hiba M. Determination of uranium concentration in soil of Baghdad governorate and its effect on mitotic index assay. Iraqi J Sci. 2015;56(1):140–146.
69. Rhind S, Evans N, Bellingham M, Sharpe R, Cotinot C, Mandon-Pepin B, et al. Effects of environmental pollutants on the reproduction and welfare of ruminants. Animal. 2010;4(7):1227–1239.
70. Al-Sabbak M, Ali S, Savabi O, Savabi G, Dastgiri S, Savabieasfahani M. Metal contamination and the epidemic of congenital birth defects in Iraqi cities. Bull Environ Contam Toxicol. 2012;89(5):937–944.
71. Glenn C. Timeline: the rise, spread, and fall of the Islamic state. Wilson Center. 2016;6(1)1–5.
72. Al-Ansari N, Knutsson S, Almuqdadi K. Engineering solution for radioactive waste in Iraq. J Advanced Science and Engineering Research. 2014;4(1):18–36.