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Diversity of Bariatric Surgery and Practice in East Asia Peng (Charles) Zhang, MD, PhD Shanghai Pudong Hospital Fudan University Pudong Medical Center March 7, 2014 Orlando, FL
Transcript of Diversity of Bariatric Surgery and Practice in East Asia › surgery › 2014_Bariatric_masters ›...
Diversity of Bariatric Surgery and Practice
in East Asia
Peng (Charles) Zhang, MD, PhD Shanghai Pudong Hospital
Fudan University Pudong Medical Center
March 7, 2014
Orlando, FL
Prevalence of Obesity (age 20yr +) Year 2008
Data source: WHO
Prevalence (%) of Diabetes in (20-79 years), 2011
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Data source: WHO
Countries/Territories of Number of People with Diabetes (20-79 years), 2011 & 2030
February 24, 2014 4
Data source: WHO report
Asia 29.5% of the total land area 60% of the world‘s current human population
Roadmap of Bariatric Surgery in Asia
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1974
Taiwan
1982
Japan
1987
Singapore
1996
Malaysia
1999
China
2000
India
2001
Hong Kong
2002
Philippines
2003
S. Korea
2005
Thailand
Number of Bariatric Procedures Performed in Year 2012 v.s. Population
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1915 1807
1359
270 270 250 180 176
0
500
1000
1500
2000
2500
China Taiwan S. Korea Thailand Hong Kong Singapore Japan Malysia
# o
f B
aria
tric
Pro
ced
ure
s
Pe
rfo
rme
d in
20
12
1357.4
23.4 50.4 67.4 7.1 5.4
127.2 98
0
300
600
900
1200
1500
China Taiwan S. Korea Thailand Hong Kong Singapore Japan Malysia
Po
pu
lati
on
(M
illio
n)
Data source: IFSO 2013
Procedures Performed by Percentage in 2012
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0%
20%
40%
60%
80%
China Taiwan S. Korea Thailand Hong Kong Singapore Japan Malysia
5% 2%
76%
10%
6%
35%
7%
13% 15%
47%
5%
61%
76%
40%
56%
45%
80%
26%
14%
24%
5%
10% 13%
27%
LAGB
LSG
RYGB
Data source: IFSO 2013
East v.s. West = “Apple” v.s. “Pear”
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BMI Classification
WHO WHO (Asian) China
Underweight <18.5 <18.5 <18.5
Normal Weight 18.5 – 24.9 18.5-22.9 18.5-23.9
Over Weight 25.0-29.9 23.0-24.9 24-27.9
Obesity >30.0 >25.0 >28.0
Class I Obesity 30.0-34.9 25.0-29.9 28.0-29.9
Class II Obesity 35.0-39.9 30.0-39.9 30-39.9
Class III Obesity >40 >40 >40
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Eligibility of Bariatric Surgery
NIH (USA) NHMRC (Australia)
NICE (UK) European ADA SIGN (Scotland)
China
Year 1991 2003 2006 2007 2010 2010 2011
Recommended: BMI
>50
Eligible (A): BMI
>40 >40 >40 >40 >40 >35
Eligible (B): BMI
35-40 with 1 serious weight loss responsive comorbidity
35-40 with 1 serious weight loss responsive comorbidity
35-40 with disease that could improve with weight loss
35-40 with 1 weight loss responsive comorbidity
35-40 if control of diabetes and comorbidity is difficult
>35 with 1 serious weight loss responsive domorbidity
30-35 if control of diabetes and comorbidity is difficult 28-29.9 with T2DM, Central obesity, and two other metabolic syndrome
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Meta-Analysis of Bariatric Surgery in East Asia
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Male 53.0%
Female 47.0% Male
Female
Clinical studies published by east Asian researchers between 2000-2013: 24
Total # of procedures reported: 2901 Age: 38.2 (16-64) years
Post-Op Follow-up: 29 (3-48) months
24 Clinical Studies Published by East Asian Researchers between 2000-2013
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RYGB 417(14.4%)
MiniGB 745(25.7%)
AGB 741(25.5%)
VBG 652(22.5%)
SG 346(11.9%)
RYGB
MiniGB
AGB
VBG
SG
Total # of Procedures Reported: 2901
Weight Loss: GB > SG > AGB in Asians
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0
10
20
30
40
5041.2 42.2
40.0
27.8 32.6
30.0
BM
I (kg
/m2
)
Pre-Op
Post-Op
0
20
40
60
80
100
120
140111.4 115.6 114.8
74.7 89.3 86.4
Bo
dy
We
igh
t (k
g)
Pre-Op
Post-Op
Weight Loss: GB > SG > AGB in Asians
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0%
20%
40%
60%
80%
100%
RYGB+MiniGB AGB+VBG SG
71.9%
48.7%
64.0%
% E
WL
Buchwald, 2004 61.6% 47.5% 68.2%
Fasting Plasma Reduction in Asians
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0
50
100
150
200
RYGB only AGB only SG
182.8
134.4
199.4
90.4 94.1
120.3
Fast
ing
Pla
sma
Glu
cose
(m
g/d
L)
HbA1c Reduction in Asians
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0
2
4
6
8
10
RYGB only AGB only SG
6.8
8.0 8.9
5.4 5.5
6.7
Hb
A1
c (%
)
Summary
• Obesity and diabetes are becoming epidemics in east Asia
• Given the same BMI, Asians have higher susceptibility to developing T2DM
• Bariatric surgery in Asians is as effective as in the western Populations
• Sleeve gastrectomy is gaining popularity in east Asia
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Thanks for your attention !
Questions
1. Why are Asian at higher risk for diabetes?
A. Genetic Influence
B. Culture influence
C. Diet influence
D. Less exercise
2. In terms of body fat distribution, which two descriptions are true in Asian?
A. Greater central adiposity
B. More subcutaneous fat
C. Greater hip adiposity
D. More visceral fat
3. In terms of weight loss, which procedure gives the best outcome in Asian?
A. Sleeve Gastrectomy
B. Gastric Bypass
C. Gastric Banding
Answer: 1. A; 2. A,D; 3. B
February 24, 2014
