Metabolic score: insights on the development and prediction of remission of metabolic syndrome after gastric bypass.

Introduction: Metabolic syndrome (MetS) clusters the most dangerous cardiovascular disease risk factors. Although insulin resistance and central obesity play an important role in the pathogenesis, the factors that determine its development and ultimate remission after Roux-en-Y gastric bypass (RYGB) are not fully understood.

Methods: We recruited a prospective cohort of 210 consecutive patients after RYGB between January 2010 and December 2011. Patients were evaluated clinically and with a biochemical profile preoperatively and at 12 months after surgery. Visceral adipose tissue and subcutaneous abdominal adipose tissue samples were collected at surgical intervention. We aimed to identify factors associated with MetS in morbidly obese patients and predictors of its remission 12 months after RYGB.

Results: Increasing age (>40 years), male sex, alanine aminotransferase levels and visceral adipose tissue/subcutaneous adipocyte size ratio were independently related to the expression of MetS at the moment of surgery.One year after RYGB, there was a significant decrease in the prevalence of MetS (63.3%-10%; P < 0.001) and in each of its components. A multivariable analysis for the remission of MetS identified that only fasting glucose levels (OR = 13.4; P = 0.01) and duration of obesity (OR = 1.08; P = 0.04) were independently related to the persistence of MetS. A metabolic score (scale of 1-10), consisting of duration of obesity, fasting blood glucose levels, the presence of high blood pressure and low levels of high-density lipoprotein identified 4 different risk categories for the persistence of MetS (area under the curve = 0.848).

Conclusions: The metabolic score can be used to predict the remission of MetS after RYGB with high accuracy. Patients in high-risk groups might be managed more aggressively and low-risk patients may have their medication discontinued earlier with extra safety.