Bariatric surgery does not reduce risk for cancer, heart disease among older adults
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Key takeaways:
- Bariatric surgery did not reduce risk for obesity-related cancer or cardiovascular disease among people aged at least 60 years.
- Gastric bypass did reduce risk for both outcomes.
Bariatric surgery did not reduce risk for obesity-related cancer or cardiovascular disease compared with nonoperative treatment among adults aged at least 60 years, according to results of a population-based cohort study.
Older adults who underwent gastric bypass exhibited a small but statistically significant decrease in risk for both outcomes.
“These findings suggest the preventive association between bariatric surgery and obesity-related cancer and cardiovascular disease may be limited to younger individuals,” Peter Gerber, MD, PhD, general surgeon at Capio St. Göran’s Hospital in Sweden, and colleagues wrote.
Background and methods
More than a billion people around the world have obesity, defined as BMI of 30 kg/m2or greater, according to study background.
Bariatric surgery can induce quick, dramatic weight loss.
Prior research also showed bariatric surgery reduced risk for obesity-related cancer, cardiovascular disease and cardiovascular mortality by more than 40% for people aged less than 60 years.
“There is controversy regarding whether patients aged older than 60 years should undergo bariatric surgery, as the benefits of bariatric surgery — including weight loss and resolution of obesity-related comorbidities — seem to attenuate with older age,” researchers wrote.
Gerber and colleagues aimed to evaluate whether bariatric surgery reduced risk for obesity-related cancer or cardiovascular disease among people aged 60 years or older.
The analysis included 2,550 people (median age, 63 years; 66.4% women) from Denmark, Finland or Sweden who underwent gastric bypass, sleeve gastrectomy, gastric banding or and duodenal shunt with biliopancreatic diversion. Researchers excluded people with history of cancer or cardiovascular disease.
Researchers matched each surgery recipient by sex, age and country of origin to five individuals who had nonoperative treatment for obesity.
Diagnosis of obesity-related cancer — classified as breast, endometrial, esophageal, colon, rectal or kidney cancers — served as the primary endpoint. Cardiovascular disease — defined as myocardial infarction, ischemic stroke and cerebral hemorrhage — served as the secondary endpoint.
Results and next steps
After median follow-up of 5.8 years, results showed a slightly higher rate of obesity-related cancer (4.9% vs. 4.4%), and a marginally lower rate of cardiovascular disease (8.8% vs. 9.5%) among bariatric surgery recipients vs. those who had nonoperative treatment.
Overall, researchers observed no significant reduction in risk for obesity-related cancer (adjusted HR = 0.81; 95% CI, 0.64.1.03) or cardiovascular disease (HR = 0.86; 95% CI, 0.74-1.01) for those who underwent bariatric surgery.
However, women who had bariatric surgery did exhibit a lower risk for obesity-related cancer (HR = 0.76; 95% CI, 0.58-0.99).
Bariatric surgery reduced risk for cardiovascular disease within the first year after surgery (HR = 0.55; 95% CI, 0.33-0.91) and for patients who had the procedure between the ages of 60 and 65 years (HR = 0.83; 95% CI, 0.7-0.99).
Individuals who underwent gastric bypass had lower risk for obesity-related cancer (HR = 0.74; 95% CI, 0.56-0.97) and cardiovascular disease (HR = 0.82; 95% CI, 0.69-0.99) vs. those who had nonoperative treatment.
Researchers acknowledged study limitations, including lack of data on BMI and smoking history, and the study’s observational design.
“[It is] possible that future studies with larger sample sizes and lower risk of random error will provide statistically significant results supporting bariatric surgery as a method to reduce incidence of obesity-related cancer and cardiovascular disease in older patients,” Gerber and colleagues wrote.
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