Full-text resources of PSJD and other databases are now available in the new Library of Science.
Visit https://bibliotekanauki.pl


Preferences help
enabled [disable] Abstract
Number of results


2013 | 8 | 5 | 531-538

Article title

Gender effect on vascular responsiveness after bariatric surgery


Title variants

Languages of publication



Obesity, particularly abdominal obesity, is associated with increased risks of arterial hypertension, diabetes mellitus, hyperlipidemia, sleep apnea, coronary artery disease, stroke and mortality. Weight loss surgery is the most effective treatment for morbid obesity, mainly because medical and dietary treatments have been proven insufficient in the long run. Our primary end point was to study the gender effect on vascular responsiveness (endothelial function and the ankle brachial index [ABI]) 3 months post bariatric surgery. Our secondary end points were to study the effect of gender on antropometric parameters (BMI, waist circumference) and chronic diseases (diabetes mellitus type II, arterial hypertension) 3 months following bariatric surgery, and to find independent variables that may affect and predict the post-operative clinical outcome. Methods: In this prospective study, patients were evaluated one day before surgery and 3 months afterwards. Ankle brachial index was measured while the patient was supine after 15 minutes rest and measurement of the systolic blood pressure in all four extremities was done. The brachial artery method was used to measure endothelial function expressed as flow mediated diameter percent change (FMD %). FMD% more than 10% is considered a normal response. Results: Compared with diabetic females, diabetic males had a higher postoperative BMI (men with diabetes mellitus did not lose weight as much as diabetic women) (β=-0.299; P=0.04), while women with diabetes mellitus had a more significant reduction in BMI postoperatively (β=+0.287; P=0.04). Following bariatric surgery, 12 of the 21 patients with diabetes mellitus type II did not need any medications for diabetes (kept HbA1c% less than 6.5%). All other diabetic patients improved their diabetes mellitus status. Women significantly improved their ABI (average increase of 0.07, p=0.04) and their endothelial function (FMD% change was improved from -3.5±9.0% to 14.8±8.1%, an improvement of 18.3%, p<0.001). Systolic blood pressure was decreased significantly (by 6.6 mmHg, p=0.04). Men improved their endothelial function (FMD% change was improved from -1.3±10.1% to 11.7±6.2%, p<0.001), but no significant change was observed in systolic blood pressure (p=0.29) nor in ABI (P=0.8). A linear regression analysis found that a higher baseline FMD% significantly predicted a higher postoperative FMD% (β=0.294, P=0.03). In obese males, the higher the baseline BMI the worse the post operative endothelial function (β=-0.921, Pd<0.001) and the same adverse effect was documented for hypertensive men (β=-0.380, P=0.05). For females, the higher the baseline FMD% the higher the postoperative FMD% (β=+0.397; P=0.01) [a favorable outcome]. Discussion: Our study has demonstrated a possible mechanistic insight into gender effects observed in epidemiological studies through improvement in vascular response in females undergoing this operation including a better reduction in systolic blood pressure and a better weight reduction in diabetic women with improvement in ABI; unlike males, who did not improve their ABI and did not decrease systolic blood pressure, and the finding that obese diabetic males and obese hypertensive males did the worst.










Physical description


1 - 10 - 2013
18 - 9 - 2013


  • Human Health and Nutrition Sciences, MIGAL-Galilee Technology Center, Kiryat Shmona, 11016, Israel
  • Department of Surgery, Carmel Hospital, Haifa, Israel
  • Department of Medicine, Baruch-Padeh Poriya Medical Center, Lower Galilee, 15208, Israel
  • Department of Medicine, Baruch-Padeh Poriya Medical Center, Lower Galilee, 15208, Israel
  • School of Public Health, Department of Epidemiology, Haifa University, Haifa, 31905, Israel
  • Human Health and Nutrition Sciences, MIGAL-Galilee Technology Center, Kiryat Shmona, 11016, Israel
  • Department of Surgery, Baruch-Padeh Poriya Medical Center, Lower Galilee, 15208, Israel


  • [1] Haslam DW, James WPT. Obesity. Lancet 2005;366:1197–1209 http://dx.doi.org/10.1016/S0140-6736(05)67483-1[Crossref]
  • [2] Li Z, Bowerman S, Heber D. Health ramifications of the obesity epidemic. Surg Clin North Am 2005; 85:681–701 http://dx.doi.org/10.1016/j.suc.2005.04.006[Crossref]
  • [3] Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004; 240:416–423 http://dx.doi.org/10.1097/01.sla.0000137343.63376.19[Crossref]
  • [4] Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351:2683–2693 http://dx.doi.org/10.1056/NEJMoa035622[Crossref]
  • [5] Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292: 1724–1737 http://dx.doi.org/10.1001/jama.292.14.1724[Crossref][WoS]
  • [6] Dixon J. Survival advantage with bariatric surgery: Report from the 10th International Congress on Obesity. Surg Obes Relat Dis. 2006; 2: 585–586 http://dx.doi.org/10.1016/j.soard.2006.09.010[Crossref]
  • [7] Livingston EH, Huerta S, Arthur D, Lee S, De Shields S, Heber D. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002; 236:576–582 http://dx.doi.org/10.1097/00000658-200211000-00007[Crossref]
  • [8] Marsk R, Freedman J, Tynelius P, Rasmussen F, Näslund E. Anti-obesity surgery in Sweden from 1980 to 2005: a population-based study with a focus on mortality. Ann Surg. 2008; 248: 777–781 http://dx.doi.org/10.1097/SLA.0b013e318189b0cf[Crossref][WoS]
  • [9] Poulose BK, Griffin MR, Moore DE, et al. Risk factors for post-operative mortality in bariatric surgery. J Surg Res. 2005; 127: 1–7 http://dx.doi.org/10.1016/j.jss.2004.12.017[Crossref]
  • [10] Belle SH, Chapman W, Courcoulas AP, et al. Relationship of body mass index with demographic and clinical characteristics in the Longitudinal Assessment of Bariatric Surgery (LABS). Surg Obes Relat Dis. 2008; 4: 474–480 http://dx.doi.org/10.1016/j.soard.2007.12.002[WoS][Crossref]
  • [11] Maciejewski ML, Livingston EH, Smith VA, et al. Survival Among High-Risk Patients After Bariatric Surgery. JAMA. 2011; 15; 305:2419–2426 http://dx.doi.org/10.1001/jama.2011.817[Crossref]
  • [12] Marsk R, Näslund E, Freedman J, Tynelius P, Rasmussen F. Bariatric surgery reduces mortality in Swedish men. Br J Surg. 2010; 9:877–883 http://dx.doi.org/10.1002/bjs.6985[Crossref]
  • [13] Plecka Östlund M, Marsk R, Rasmussen F, Lagergren J, Näslund E. Morbidity and mortality before and after bariatric surgery for morbid obesity compared with the general population. Br J Surg. 2011; 98:811–816 http://dx.doi.org/10.1002/bjs.7416[Crossref]
  • [14] Sjostrom L, Narbro K, Sjostrom D, et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med 2007; 357: 741–752 http://dx.doi.org/10.1056/NEJMoa066254[Crossref]
  • [15] Turner PL, Oyetunji TA, Gantt G, Chang DC, Cornwell EE, Fullum TM. Demographically associated variations in outcomes after bariatric surgery. Am J Surg. 2011; 201:475–480 http://dx.doi.org/10.1016/j.amjsurg.2010.08.035[Crossref][WoS]
  • [16] Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009; 361:445–454 http://dx.doi.org/10.1056/NEJMoa0901836[Crossref]
  • [17] Kashyap SR, Daud S, Kelly KR, et al. Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes (Lond). 2010; 34:462–471 http://dx.doi.org/10.1038/ijo.2009.254[WoS][Crossref]
  • [18] Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta analysis. The American Journal of Medicine 2009; 122: 248–256 http://dx.doi.org/10.1016/j.amjmed.2008.09.041
  • [19] Arkin JM, Alsdorf R, Bigornia S et al. Relation of cumulative weight burden to vascular endothelial dysfunction in obesity. Am J Cardiol 2008; 101: 98–101 http://dx.doi.org/10.1016/j.amjcard.2007.07.055[Crossref]
  • [20] Steinberg HO, Chaker H, Leaming R et al. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996; 97: 2601–1026 http://dx.doi.org/10.1172/JCI118709[Crossref]
  • [21] Bergholm R, Tiikkainen M, Vehkavaara S et al. Lowering of LDL cholesterol rather than moderate weight loss improves endothelium-dependent vasodilatation in obese women with previous gestational diabetes. Diabetes Care 2003; 26: 1667–1672 http://dx.doi.org/10.2337/diacare.26.6.1667[Crossref]
  • [22] Gokce N, Vita JA, McDonnell M et al. Effect of medical and surgical weight loss on endothelial vasomotor function in obese patients. Am J Cardiol 2005; 95: 266–268 http://dx.doi.org/10.1016/j.amjcard.2004.09.016[Crossref]
  • [23] Raitakari M, Ilvonen T, Ahotupa M et al. Weight reduction with very-low-caloric diet and endothelial function in overweight adults: role of plasma glucose. Arterioscler Thromb Vasc Biol 2004; 24:124–128 http://dx.doi.org/10.1161/01.ATV.0000109749.11042.7c[Crossref]
  • [24] Sciacqua A, Candigliota M, Ceravolo R et al. Weight loss in combination with physical activity improves endothelial dysfunction in human obesity. Diabetes Care 2003; 26: 1673–1678 http://dx.doi.org/10.2337/diacare.26.6.1673[Crossref]
  • [25] Bigornia SJ, Mott MM, Hess DT, et al. Long-term successful weight loss improves vascular endothelial function in severely obese individuals. Obesity (Silver Spring). 2010; 18:754–759 http://dx.doi.org/10.1038/oby.2009.482[WoS][Crossref]
  • [26] Sturm W, Tschoner A, Engl J, et al. Effect of bariatric surgery on both functional and structural measures of premature atherosclerosis. Eur Heart J. 2009; 30:2038–2043 http://dx.doi.org/10.1093/eurheartj/ehp211[Crossref]
  • [27] Nerla R, Tarzia P, Sestito A, et al. Effect of bariatric surgery on peripheral flow-mediated dilation and coronary microvascular function. Nutr Metab Cardiovasc Dis. 2010; 1–9 [WoS]
  • [28] García de la Torre N, Rubio MA, et al. Effects of weight loss after bariatric surgery for morbid obesity on vascular endothelial growth factor-A, adipocytokines, and insulin. J Clin Endocrinol Metab. 2008; 93: 4276–4281 http://dx.doi.org/10.1210/jc.2007-1370[WoS][Crossref]
  • [29] Gokce N, Vita JA, McDonnell M, et al. Effect of medical and surgical weight loss on endothelial vasomotor function in obese patients. The American Journal of Cardiology 2005; 95: 266–68. http://dx.doi.org/10.1016/j.amjcard.2004.09.016[Crossref]
  • [30] Hanusch-Enserer U, Zorn G, Wojta J, et al. Nonconventional markers of atherosclerosis before and after gastric banding surgery. Eur Heart J. 2009; 30: 1516–1524 http://dx.doi.org/10.1093/eurheartj/ehp108[Crossref][WoS]
  • [31] Vazquez LA, Pazos F, Berrazueta JR, et al. Effects of changes in body weight and insulin resistance on inflammation and endothelial function in morbid obesity after bariatric surgery. The Journal of Clinical Endocrinology & Metabolism 2005; 90:316–322 http://dx.doi.org/10.1210/jc.2003-032059[Crossref]

Document Type

Publication order reference


YADDA identifier

JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.