Supplementary Online Content

Transcription

1 Supplementary Online Content Chang S-H, Stoll CRT, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, JAMA Surg. Published online December 18, doi: /jamasurg eappendix. efigure 1. Network diagram. efigure 2. Funnel plots with pseudo 95% confidence limits and Egger s test results. etable 1. Definitions of comorbid s and comorbidity improvement. etable 2. Summary of surgery types and classes. etable 3. Meta-analyses of surgery risk and comorbidities remission outcomes. etable 4. Meta-analyses of weight change outcomes. etable 5. Meta-regression results. etable 6. MTC Model 1 estimates: relative surgery effects ( BMI) to LRYGB. etable 7. MTC Model 2 estimates: relative surgery effects ( BMI) to LRYGB. etable 8. MTC Model 3 estimates: relative surgery category effects ( BMI) to GB. etable 9. MTC Model 4 estimates: time-varying relative surgery effects ( BMI) to LRYGB. etable 10. A comparison of findings across the systematic reviews and metaanalyses of bariatric surgery. This supplementary material has been provided by the authors to give readers additional information about their work. 1

2 eappendix Authors: Su-Hsin Chang PhD 1, Carolyn R.T. Stoll MPH, MSW 1, Jihyun Song PhD 2, J. Esteban Varela MD MPH FACS 3, Christopher J. Eagon MD 3, Graham A. Colditz MD DrPH 1 1. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine 2. School of Management, New York Institute of Technology 3. Minimally Invasive and Bariatric Surgery, Department of Surgery, Washington University School of Medicine Corresponding Author: Su-Hsin Chang, PhD Division of Public Health Sciences, Department of Surgery Washington University School of Medicine 660 S. Euclid Avenue, Campus Box 8100 St. Louis, MO changsh@wudosis.wustl.edu Phone: (314) Cell phone: (410) Search terms 2. Models used to estimate operative mortality and complication rates and remission rate of the obesity-attributable comorbidities 3. Mixed treatment comparison (MTC) of repeated measurement meta-analysis 4. Estimation results 1. Search terms PubMed Bariatric surgery [Mesh] OR bariatric surgery OR bariatric surgeries OR Gastric bypass [Mesh] OR roux-en-y gastric bypass OR greenville gastric bypass OR gastroileal bypass OR gastrojejunostomy OR gastrojejunostomies OR gastroplasty [Mesh] OR gastroplasties OR collis gastroplasty OR vertical-banded gastroplasty OR vertical banded gastroplasty OR vertical-banded gastroplas OR Jejunoileal bypass [Mesh] OR jejunoileal bypass OR jejunoileal bypass OR jejuno-ileal bypasses OR ileojejunal bypass OR ileojejunal bypasses OR intestinal bypass OR intestinal bypasses OR lipectomy [Mesh] OR lipectomies OR aspiration lipectomy OR aspiration lipolysis OR suction lipectomy OR suction lipectomies OR suction lipolysis OR liposuction OR liposuctions OR lipoplasty OR lipoplasties OR biliopancreatic bypass OR biliopancreatic diversion OR duodenal switch OR pancreatobiliary bypass OR gastric banding OR Stomach banding OR swedish gastric banding OR swedish adjustable gastric banding OR laparoscopic adjustable gastric banding OR laparoscopic adjustable silicone banding OR bariatric operation OR bariatric operations OR bariatric procedure OR bariatric procedures OR bariatric surgical procedure OR bariatric surgical procedures OR obesity surgery Or sleeve gastrectomy OR gastric sleeve "Body Mass Index"[Mesh] OR "Body Mass Index" OR Quetelet Index OR Quetelets Index OR BMI OR body ban mass Comorbidities diabetes, coronary heart disease, hypertension, dyslipidemia, stroke, sleep apnea 2

3 diabetes mellitus type 2 [Mesh] OR Ketosis-Resistant Diabetes Mellitus OR Diabetes Mellitus Maturity-Onset OR Diabetes Mellitus Maturity Onset OR Non-Insulin-Dependent Diabetes Mellitus OR Type 2 Diabetes Mellitus OR Slow-Onset Diabetes Mellitus OR Stable Diabetes Mellitus OR Diabetes Mellitus Type II OR MODY OR NIDDM OR Adult-Onset Diabetes Mellitus OR lipoatrophic diabetes mellitus OR type 2 diabetes OR type II diabetes OR dm 2 OR insulin independent diabetes OR insulin independent diabetes mellitus OR ketosis resistant diabetes mellitus OR non insulin dependent diabetes OR non insulin dependent diabetes mellitus OR type 2 diabetes mellitus cardiovascular diseases [Mesh] OR cardiovascular diseases OR cardiovascular disease OR cardiovascular abnormalities OR cardiovascular infections OR Heart diseases OR vascular diseases OR coronary artery insufficiency OR coronary artery occlusive disease OR coronary heart disease OR coronary insufficiency OR coronary occlusive disease OR ischemic heart disease OR ischaemic heart disease OR ischemic heart disease OR ischemic cardiac disease OR ischemic cardial disease OR ischemic cardiopathy sleep apnea obstructive [Mesh] OR obstructive sleep apnea OR obesity hypoventilation syndrome OR Upper Airway Resistance Sleep Apnea Syndrome OR obstructive sleep apnea syndrome OR sleep apnea OR nocturnal apnea OR obstructive sleep apnea hypopnea syndrome OR obstructive sleep apnoea hypertension [Mesh] OR hypertension OR high blood pressure OR high blood pressures OR hypertension malignant OR hypertension renal OR hypertensive retinopathy OR masked hypertension OR white coat hypertension OR acute hypertension OR arterial hypertension OR cardiovascular hypertension OR controlled hypertension OR endocrine hypertension OR high renin hypertension OR hypertensive disease OR hypertensive effect OR hypertensive response OR increased blood pressure OR neurogenic hypertension OR preexistent hypertension OR refractory hypertension OR salt high blood pressure OR salt hypertension OR secondary hypertension OR systemic hypertension dyslipidemais [Mesh] OR dyslipidemia OR hyperlipidemias OR Hypolipoproteinemias OR Smith-Lemli-Opitz Syndrome OR dyslipoproteinemias OR dyslipoproteinemia OR dys lipidemia stroke [Mesh] OR stroke OR strokes OR cerebral stoke OR cerebral strokes OR brain vascular accident OR brain vascular accidents OR cerebrovascular apoplexy OR cerebrovascular stroke OR cerebralvascular strokes OR CVA OR CVAs OR apoplexy OR ceberovascular accident OR cerebrovascular accidents OR acute cerebrovascular accident OR acute cerebrovascular accidents OR brain infarction OR lacunar stroke OR acute cerebrovascular lesion OR acute focal cerebral vasculopathy OR apoplectic stroke OR apoplexia OR brain blood flow disturbance OR brain accident OR brain attack OR brain insult OR brain insults OR brain ischemic attack OR cerebral apoplexia OR cerebral insult OR cerebral vascular accident OR cerebral vascular insufficiency OR cerebro vascular accident OR cerebrovascular arrest OR cerebrovascular failure OR cerebrovascular injury OR cerebrovascular insufficiency OR cerebrovascular insult OR cerebrovascular trauma OR cerebrum vascular accident OR ischaemic seizure OR ischemic cerebral attack OR ischemic seizure Study design controlled clinical trial OR randomized controlled trial OR controlled clinical trial OR randomized controlled trial OR groups OR trial OR randomly OR randomized Limits NOT (( animals [Mesh] NOT ( Animals [Mesh] AND humans [Mesh])) 3

4 Search: (("controlled clinical trial" OR "randomized controlled trial" OR "controlled clinical trial" OR "randomized controlled trial" OR "groups" OR "trial" OR "randomly" OR "randomized")) AND ((((((((("diabetes mellitus type 2"[Mesh] OR "Ketosis-Resistant Diabetes Mellitus" OR "Diabetes Mellitus Maturity-Onset" OR "Diabetes Mellitus Maturity Onset" OR "Non-Insulin-Dependent Diabetes Mellitus" OR "Type 2 Diabetes Mellitus" OR "Slow-Onset Diabetes Mellitus" OR "Stable Diabetes Mellitus" OR "Diabetes Mellitus Type II" OR "MODY" OR "NIDDM" OR "Adult-Onset Diabetes Mellitus" OR "lipoatrophic diabetes mellitus" OR "type 2 diabetes" OR "type II diabetes" OR "dm 2" OR "insulin independent diabetes" OR "insulin independent diabetes mellitus" OR "ketosis resistant diabetes mellitus" OR "non insulin dependent diabetes" OR "non insulin dependent diabetes mellitus" OR "type 2 diabetes mellitus ")) OR ("cardiovascular diseases"[mesh] OR "cardiovascular diseases" OR "cardiovascular disease" OR "cardiovascular abnormalities" OR "cardiovascular infections" OR "Heart diseases" OR "vascular diseases" OR "coronary artery insufficiency" OR "coronary artery occlusive disease" OR "coronary heart disease" OR "coronary insufficiency" OR "coronary occlusive disease" OR "ischemic heart disease" OR "ischaemic heart disease" OR "ischemic heart disease" OR "ischemic cardiac disease" OR "ischemic cardial disease" OR "ischemic cardiopathy")) OR ("sleep apnea obstructive"[mesh] OR "obstructive sleep apnea" OR "obesity hypoventilation syndrome" OR "Upper Airway Resistance Sleep Apnea Syndrome" OR "obstructive sleep apnea syndrome" OR "sleep apnea" OR "nocturnal apnea" OR "obstructive sleep apnea hypopnea syndrome" OR "obstructive sleep apnoea")) OR ("dyslipidemias"[mesh] OR "dyslipidemia" OR "hyperlipidemias" OR "Hypolipoproteinemias" OR "Smith- Lemli-Opitz Syndrome" OR "dyslipoproteinemias" OR "dyslipoproteinemia" OR "dys lipidemia")) OR ("stroke"[mesh] OR "stroke" OR "strokes" OR "cerebral stoke" OR "cerebral strokes" OR "brain vascular accident" OR "brain vascular accidents" OR "cerebrovascular apoplexy" OR "cerebrovascular stroke" OR "cerebralvascular strokes" OR "CVA" OR "CVAs" OR "apoplexy" OR "ceberovascular accident" OR "cerebrovascular accidents" OR "acute cerebrovascular accident" OR "acute cerebrovascular accidents" OR "brain infarction" OR "lacunar stroke" OR "acute cerebrovascular lesion" OR "acute focal cerebral vasculopathy" OR "apoplectic stroke" OR "apoplexia" OR "brain blood flow disturbance" OR "brain accident" OR "brain attack" OR "brain insult" OR "brain insults" OR "brain ischemic attack" OR "cerebral apoplexia" OR "cerebral insult" OR "cerebral vascular accident" OR "cerebral vascular insufficiency" OR "cerebro vascular accident" OR "cerebrovascular arrest" OR "cerebrovascular failure" OR "cerebrovascular injury" OR "cerebrovascular insufficiency" OR "cerebrovascular insult" OR "cerebrovascular trauma" OR "cerebrum vascular accident" OR "ischaemic seizure" OR "ischemic cerebral attack" OR "ischemic seizure")) OR ("quality of life"[mesh] OR "life style" OR "sickness impact profile" OR "value of life" OR "karnnofsky performance status" OR "activities of daily living"[mesh] OR "daily living activities" OR "daily living activity" OR "ADL" OR "chronic limitation of activity" OR "self care" OR "self cares" OR "walking"[mesh] OR "walking " OR "ambulation" OR "mobility limitations"[mesh] OR "mobility limitations" OR "ambulation difficulty" OR "difficulty walking" OR "ambulatory difficulty"))) AND ((("Bariatric surgery"[mesh] OR "bariatric surgery" OR "bariatric surgeries" OR "Gastric bypass"[mesh] OR "roux-en-y gastric bypass" OR "greenville gastric bypass" OR "gastroileal bypass" OR "gastrojejunostomy" OR "gastrojejunostomies" OR "gastroplasty"[mesh] OR "gastroplasties" OR "collis gastroplasty" OR "vertical-banded gastroplasty" OR "vertical banded gastroplasty" OR "vertical-banded gastroplas" OR "Jejunoileal bypass"[mesh] OR "jejunoileal bypass" OR "jejunoileal bypass" OR "jejuno-ileal bypasses" OR "ileojejunal bypass" OR "ileojejunal bypasses" OR "intestinal bypass" OR "intestinal bypasses" OR "lipectomy"[mesh] OR "lipectomies" OR "aspiration lipectomy" OR "aspiration lipolysis" OR "suction lipectomy" OR "suction lipectomies" OR "suction lipolysis" OR "liposuction" OR "liposuctions" OR "lipoplasty" OR "lipoplasties" OR "biliopancreatic bypass" OR "biliopancreatic diversion" OR "duodenal switch" OR "pancreatobiliary bypass" OR "gastric banding" OR "Stomach banding" OR "swedish gastric banding" OR "swedish adjustable gastric banding" OR "laparoscopic adjustable gastric banding" OR "laparoscopic adjustable silicone banding" OR "bariatric operation" OR "bariatric operations" OR "bariatric procedure" OR "bariatric procedures" OR "bariatric surgical procedure" OR "bariatric surgical procedures" OR "obesity surgery" OR "sleeve gastrectomy" OR "gastric sleeve")) AND ("Body Mass Index"[Mesh] OR "Body Mass Index" OR "Quetelet Index" OR "Quetelets Index" OR "BMI" OR "body ban mass"))) NOT (("animals"[mesh] NOT ("animals")[mesh] AND "humans"[mesh])) 4

5 EMBASE Bariatric surgery /exp OR bariatric operation OR bariatric operations OR bariatric procedure OR bariatric procedures OR bariatric surgical procedure OR bariatric surgical procedures OR obesity surgery OR sleeve gastrectomy /exp OR sleeve gastrectomy OR gastric sleeve OR biliopancreatic bypass /exp OR biliopancreatic diversion OR duodenal switch OR pancreatobiliary bypass OR gastric banding /exp OR gastric banding OR stomach banding OR swedish gastric banding OR swedish adjustable gastric banding OR laparoscopic adjustable gastric banding OR laparoscopic adjustable silicone banding OR bariatric surgery OR bariatric surgeries OR Gastric bypass OR roux-en-y gastric bypass OR greenville gastric bypass OR gastroileal bypass OR gastrojejunostomy OR gastrojejunostomies OR gastroplasty OR gastroplasties OR collis gastroplasty OR vertical-banded gastroplasty OR vertical banded gastroplasty OR vertical banded gastroplasties OR jejunoileal bypass OR jejuno ileal bypass OR ileojejunal bypass OR ileojejunal bypasses OR intestinal bypass OR intestinal bypasses OR lipectomy OR lipectomies OR aspiration lipectomy OR aspiration lipolysis OR suction lipectomy OR suction lipectomies OR suction lipolysis OR liposuction OR liposuctions OR lipoplasty OR lipoplasties AND 'body mass'/exp OR body mass OR Body Mass Index OR Quetelet Index OR Quetelets Index OR BMI OR body ban mass AND Comorbidities - diabetes, coronary heart disease, hypertension, dyslipidemia, stroke, sleep apnea AND non insulin dependent diabetes mellitus /exp OR diabetes mellitus type 2 OR Ketosis Resistant Diabetes Mellitus OR Diabetes Mellitus Maturity Onset OR Non Insulin Dependent Diabetes Mellitus OR Type 2 Diabetes Mellitus OR Slow Onset Diabetes Mellitus OR Stable Diabetes Mellitus OR Diabetes Mellitus Type II OR MODY OR NIDDM OR Adult Onset Diabetes Mellitus OR lipoatrophic diabetes mellitus OR type 2 diabetes OR type II diabetes OR dm 2 OR insulin independent diabetes OR insulin independent diabetes mellitus OR non insulin dependent diabetes OR ischemic heart disease /exp OR ischaemic heart disease OR ischemic heart disease OR ischemic cardiac disease OR ischemia heart disease OR ischemic cardial disease OR ischemic cardiopathy OR acute coronary syndrome OR angina pectoris OR cardiac allograft vasculpathy OR coronary artery atheroscloerosis OR coronary artery constriction OR coronary artery obstruction OR cornary artery obstruction OR coronary artery thrombosis OR coronary subclavian steal syndrome OR heart infarction OR heart muscle ischemia OR ischemic cardiomyopathy OR kounis syndrome OR myocardial hibernation OR no reflow phenomenon OR silent myocardial ischemia OR takotsubo cadriomyopathy OR cardiovascular diseases OR cardiovascular disease OR cardiovascular abnormalities OR cardiovascular infections OR heart diseases OR vascular diseases OR coronary artery insufficiency OR coronary artery occlusive disease OR coronary heart disease OR Sleep Apnea Syndrome /exp OR obstructive sleep apnea OR obesity hypoventilation syndrome OR Upper Airway Resistance OR obstructive sleep apnea syndrome OR sleep apnea OR nocturnal apnea OR obstructive sleep apnea hypopnea syndrome OR obstructive sleep apnoea OR 5

6 Hypertension /exp OR apparent mineralocorticoid excess syndrome OR borderline hypertension OR borderline hypertension OR diabetic hypertension OR essential hypertension OR gordon syndrome OR hereditary hypertension OR hypertensive crisis OR intracranial hypertension OR liddle syndrome OR malignant hypertension OR maternal hypertension OR metabolic syndrome x OR ocular ischemic syndrome OR orthostatic hypertension OR posterior reversible encephalopathy syndrome OR prehypertension OR renovascular hypertension OR systolic hypertension OR hypertension OR high blood pressure OR high blood pressures OR hypertension malignant OR hypertension renal OR hypertensive retinopathy OR masked hypertension OR white coat hypertension OR acute hypertension OR arterial hypertension OR cardiovascular hypertension OR controlled hypertension OR endocrine hypertension OR high renin hypertension OR hypertensive disease OR hypertensive effect OR hypertensive response OR increased blood pressure OR neurogenic hypertension OR preexistent hypertension OR refractory hypertension OR salt high blood pressure OR salt hypertension OR secondary hypertension OR systemic hypertension OR dyslipidemias OR dyslipidemia /exp OR dyslipidemia OR hyperlipidemias OR Hypolipoproteinemias OR Smith Lemli Opitz Syndrome OR dyslipoproteinemias OR dyslipoproteinemia OR dyslipidemia OR stroke /exp OR lacunar stroke OR stroke OR cerebral stoke OR cerebral strokes OR brain vascular accident OR brain vascular accidents OR cerebrovascular apoplexy OR cerebrovascular stroke OR cerebralvascular strokes OR CVA OR CVAs OR apoplexy OR ceberovascular accident OR cerebrovascular accidents OR acute cerebrovascular accident OR acute cerebrovascular accident OR brain infarction OR acute cerebrovascular lesion OR acute focal cerebral vasculopathy OR apoplectic stroke OR apoplexia OR brain blood flow disturbance OR brain accident OR brain attack OR brain insult OR brain insults OR brain ischemic attack OR cerebral apoplexia OR cerebral insult OR cerebral vascular accident OR cerebral vascular insufficiency OR cerebro vascular accident OR cerebrovascular arrest OR cerebrovascular failure OR cerebrovascular injury OR cerebrovascular insufficiency OR cerebrovascular insult OR cerebrovascular trauma OR cerebrum vascular accident OR ischaemic seizure OR ischemic cerebral attack OR ischemic seizure Study design controlled clinical trial /it OR randomized controlled trial /it OR 'controlled clinical trial'/exp OR 'randomized controlled trial'/exp OR (groups OR trial OR randomly OR randomized):ab OR (groups OR trial OR randomly OR randomized):ti Limits Not ([animals]/lim NOT [humans]/lim) AND [English]/lim SCOPUS {Bariatric surgery} OR {bariatric operation} OR {bariatric operations} OR {bariatric procedure} OR {bariatric procedures} OR { bariatric surgical procedure} OR {bariatric surgical procedures} OR {obesity surgery} OR {sleeve gastrectomy} OR {gastric sleeve} OR {biliopancreatic bypass} OR {biliopancreatic diversion} OR {duodenal switch} OR {pancreatobiliary bypass} OR {gastric banding} OR {gastric banding} OR {stomach banding} OR {swedish gastric banding} OR {swedish adjustable gastric banding} OR {laparoscopic adjustable gastric banding} OR {laparoscopic adjustable silicone banding} OR {bariatric surgeries} OR {Gastric bypass} OR {roux-en-y gastric bypass} OR {greenville gastric bypass} OR {gastroileal bypass} OR {gastrojejunostomy} OR {gastrojejunostomies} OR {gastroplasty} OR {gastroplasties} OR {collis gastroplasty} OR {vertical-banded gastroplasty} OR {vertical banded gastroplasty} OR {vertical banded gastroplasties} OR {jejunoileal bypass} OR {jejuno ileal bypass} OR {ileojejunal bypass} OR {ileojejunal bypasses} OR {intestinal bypass} OR {intestinal bypasses} OR {lipectomy} OR {lipectomies} OR {aspiration lipectomy} OR {aspiration lipolysis} OR 6

7 {suction lipectomy} OR {suction lipectomies} OR {suction lipolysis} OR {liposuction} OR {liposuctions} OR {lipoplasty} OR {lipoplasties} {body mass} OR {body mass} OR {Body Mass Index} OR {Quetelet Index} OR {Quetelets Index} OR {BMI} OR {body ban mass} Comorbidities - diabetes, coronary heart disease, hypertension, dyslipidemia, stroke, sleep apnea {non-insulin dependent diabetes mellitus} OR {diabetes mellitus type 2} OR {Ketosis Resistant Diabetes Mellitus} OR {Diabetes Mellitus Maturity Onset} OR {non-insulin Dependent Diabetes Mellitus} OR {Type 2 Diabetes Mellitus} OR {Slow Onset Diabetes Mellitus} OR {table Diabetes Mellitus} OR {Diabetes Mellitus Type II} OR {MODY OR NIDDM} OR {Adult Onset Diabetes Mellitus} OR {lipoatrophic diabetes mellitus} OR {type 2 diabetes} OR {type II diabetes} OR {dm 2} OR {insulin independent diabetes} OR {insulin independent diabetes mellitus} OR {non-insulin dependent diabetes} {ischemic heart disease} OR {ischaemic heart disease} OR {ischemic heart disease} OR {ischemic cardiac disease} OR {ischemia heart disease} OR {ischemic cardial disease} OR {ischemic cardiopathy} OR {acute coronary syndrome} OR {angina pectoris} OR {cardiac allograft vasculpathy} OR {coronary artery atherosclerosis} OR {coronary artery constriction} OR { coronary artery obstruction} OR {cornary artery obstruction} OR {coronary artery thrombosis} OR {coronary subclavian steal syndrome} OR {heart infarction} OR {heart muscle ischemia} OR { ischemic cardiomyopathy} OR {kounis syndrome} OR {myocardial hibernation} OR {no reflow phenomenon} OR {silent myocardial ischemia} OR {takotsubo cadriomyopathy} OR {cardiovascular diseases} OR {cardiovascular disease} OR {cardiovascular abnormalities} OR {cardiovascular infections} OR {heart diseases} OR {vascular diseases} OR {coronary artery insufficiency} OR {coronary artery occlusive disease} OR {coronary heart disease} {Sleep Apnea Syndrome} OR {obstructive sleep apnea} OR {obesity hypoventilation syndrome} OR {Upper Airway Resistance} OR {obstructive sleep apnea syndrome} OR {sleep apnea} OR {nocturnal apnea} OR {obstructive sleep apnea hypopnea syndrome} OR {obstructive sleep apnoea} {hypertension} OR {high blood pressure} OR {high blood pressures} OR {hypertension malignant} OR { hypertension renal} OR {hypertensive retinopathy} OR {masked hypertension} OR {white coat hypertension} OR {acute hypertension} OR {arterial hypertension} OR {cardiovascular hypertension} OR {controlled hypertension} OR {endocrine hypertension} OR {high renin hypertension} OR {hypertensive disease} OR {hypertensive effect} OR { hypertensive response} OR {increased blood pressure} OR {neurogenic hypertension} OR {preexistent hypertension} OR {refractory hypertension} OR {salt high blood pressure} OR {salt hypertension} OR {secondary hypertension} OR {systemic hypertension} {dyslipidemias} OR {dyslipidemia} OR {hyperlipidemias} OR {Hypolipoproteinemias} OR {Smith-Lemli-Opitz Syndrome} OR {dyslipoproteinemias} OR {dyslipoproteinemia} OR {dys lipidemia} {stroke} OR {strokes} OR {cerebral stoke} OR {cerebral strokes} OR {brain vascular accident} OR {brain vascular accidents} OR {cerebrovascular apoplexy} OR {cerebrovascular stroke} OR {cerebralvascular strokes}or {CVA} OR {CVAs} OR{apoplexy} OR {ceberovascular accident} OR {cerebrovascular accidents} OR {acute cerebrovascular accident} OR {acute cerebrovascular accidents} OR {brain infarction} OR {lacunar stroke} OR {acute cerebrovascular lesion} OR {acute focal cerebral vasculopathy} OR {apoplectic stroke} OR {apoplexia} OR {brain blood flow disturbance} OR {brain accident} OR {brain attack} OR {brain insult} OR {brain insults} OR {brain ischemic attack} OR {cerebral apoplexia} OR {cerebral insult} OR {cerebral vascular accident} OR {cerebral vascular insufficiency} OR {cerebro-vascular accident} OR {cerebrovascular arrest} OR {cerebrovascular failure} OR {cerebrovascular injury} OR {cerebrovascular insufficiency} OR {cerebrovascular insult} OR {cerebrovascular trauma} OR {cerebrum vascular accident} OR {ischaemic seizure} OR {ischemic cerebral attack} OR{ischemic seizure} 7

8 Limits AND (LIMIT TO (EXACTKEYWORD, Human ) OR LIMIT-TO (EXACTKEYWORD, Humans ) AND (LIMIT-TO (LANGUAGE, English ) Your query: (({non-insulin dependent diabetes mellitus} OR {diabetes mellitus type 2} OR {Ketosis Resistant Diabetes Mellitus} OR {Diabetes Mellitus Maturity Onset} OR ' {non-insulin Dependent Diabetes Mellitus} OR {Type 2 Diabetes Mellitus} OR {Slow Onset Diabetes Mellitus} OR ' {table Diabetes Mellitus} OR {Diabetes Mellitus Type II} OR {MODY' OR 'NIDDM} OR {Adult Onset Diabetes Mellitus} OR {lipoatrophic diabetes mellitus} OR {type 2 diabetes} OR {type II diabetes} OR {dm 2} OR {insulin independent diabetes} OR {insulin independent diabetes mellitus} OR {non-insulin dependent diabetes}) OR ({ischemic heart disease} OR {ischaemic heart disease} OR {ischemic heart disease} OR {ischemic cardiac disease} OR {ischemia heart disease} OR {ischemic cardial disease} OR {ischemic cardiopathy} OR {acute coronary syndrome} OR {angina pectoris} OR {cardiac allograft vasculpathy} OR {coronary artery atherosclerosis} OR {coronary artery constriction} OR { coronary artery obstruction} OR {cornary artery obstruction} OR {coronary artery thrombosis} OR {coronary subclavian steal syndrome} OR {heart infarction} OR {heart muscle ischemia} OR { ischemic cardiomyopathy} OR {kounis syndrome} OR {myocardial hibernation} OR {no reflow phenomenon} OR {silent myocardial ischemia} OR {takotsubo cadriomyopathy} OR {cardiovascular diseases} OR {cardiovascular disease} OR {cardiovascular abnormalities} OR {cardiovascular infections} OR {heart diseases} OR {vascular diseases} OR {coronary artery insufficiency} OR {coronary artery occlusive disease} OR {coronary heart disease}) OR ({Sleep Apnea Syndrome} OR {obstructive sleep apnea} OR {obesity hypoventilation syndrome} OR {Upper Airway Resistance} OR {obstructive sleep apnea syndrome} OR {sleep apnea} OR {nocturnal apnea} OR {obstructive sleep apnea hypopnea syndrome} OR {obstructive sleep apnoea}) OR ({hypertension} OR {high blood pressure} OR {high blood pressures} OR {hypertension malignant} OR { hypertension renal} OR {hypertensive retinopathy} OR {masked hypertension} OR {white coat hypertension} OR {acute hypertension} OR {arterial hypertension} OR {cardiovascular hypertension} OR {controlled hypertension} OR {endocrine hypertension} OR {high renin hypertension} OR {hypertensive disease} OR {hypertensive effect} OR { hypertensive response} OR {increased blood pressure} OR {neurogenic hypertension} OR {preexistent hypertension} OR {refractory hypertension} OR {salt high blood pressure} OR {salt hypertension} OR {secondary hypertension} OR {systemic hypertension}) OR ({dyslipidemias} OR {dyslipidemia} OR {hyperlipidemias} OR {Hypolipoproteinemias} OR {Smith-Lemli-Opitz Syndrome} OR {dyslipoproteinemias} OR {dyslipoproteinemia} OR {dys lipidemia}) OR ({stroke} OR {strokes} OR {cerebral stoke} OR {cerebral strokes} OR {brain vascular accident} OR {brain vascular accidents} OR {cerebrovascular apoplexy} OR {cerebrovascular stroke} OR {cerebralvascular strokes} OR {CVA} OR {CVAs} OR {apoplexy} OR {ceberovascular accident} OR {cerebrovascular accidents} OR {acute cerebrovascular accident} OR {acute cerebrovascular accidents} OR {brain infarction} OR {lacunar stroke} OR {acute cerebrovascular lesion} OR {acute focal cerebral vasculopathy} OR {apoplectic stroke} OR {apoplexia} OR {brain blood flow disturbance} OR {brain accident} OR {brain attack} OR {brain insult} OR {brain insults} OR {brain ischemic attack} OR {cerebral apoplexia} OR {cerebral insult} OR {cerebral vascular accident} OR {cerebral vascular insufficiency} OR {cerebro-vascular accident} OR {cerebrovascular arrest} OR {cerebrovascular failure} OR {cerebrovascular injury} OR {cerebrovascular insufficiency} OR {cerebrovascular insult} OR {cerebrovascular trauma} OR {cerebrum vascular accident} OR {ischaemic seizure} OR {ischemic cerebral attack} OR {ischemic seizure})) AND (({Bariatric surgery} OR {bariatric operation} OR { bariatric operations} OR {bariatric procedure} OR {bariatric procedures} OR { bariatric surgical procedure} OR { bariatric surgical procedures} OR {obesity surgery} OR {sleeve gastrectomy} OR {gastric sleeve} OR {biliopancreatic bypass} OR {biliopancreatic diversion} OR {duodenal switch} OR {pancreatobiliary bypass} OR {gastric banding} OR {gastric banding} OR {stomach banding} OR {swedish gastric banding} OR {swedish adjustable gastric banding} OR {laparoscopic adjustable gastric banding} OR {laparoscopic adjustable silicone banding} OR {bariatric surgeries} OR {Gastric bypass} OR {roux-eny gastric bypass} OR {greenville gastric bypass} OR {gastroileal bypass} OR {gastrojejunostomy} OR {gastrojejunostomies} OR {gastroplasty} OR {gastroplasties} OR {collis gastroplasty} OR {vertical-banded gastroplasty} OR {vertical banded gastroplasty} OR {vertical banded gastroplasties} OR {jejunoileal bypass} OR {jejuno ileal bypass} OR {ileojejunal bypass} OR {ileojejunal bypasses} OR {intestinal bypass} OR {intestinal bypasses} OR {lipectomy} OR {lipectomies} OR {aspiration lipectomy} OR {aspiration lipolysis} OR {suction lipectomy} OR {suction lipectomies} OR {suction lipolysis} 8

9 OR {liposuction} OR {liposuctions} OR {lipoplasty} OR {lipoplasties}) AND ({body mass} OR {body mass} OR {Body Mass Index} OR {Quetelet Index} OR {Quetelets Index} OR {BMI} OR {body ban mass})) AND (LIMIT-TO(PUBYEAR, 2010) OR LIMIT-TO(PUBYEAR, 2009) OR LIMIT-TO(PUBYEAR, 2008) OR LIMIT-TO(PUBYEAR, 2007) OR LIMIT- TO(PUBYEAR, 2006) OR LIMIT-TO(PUBYEAR, 2005) OR LIMIT-TO(PUBYEAR, 2004) OR LIMIT-TO(PUBYEAR, 2003)) AND (LIMIT-TO(LANGUAGE, "English")) COCHRANE Bariatric surgery OR bariatric surgery OR bariatric surgeries OR Gastric bypass OR roux-en-y gastric bypass OR greenville gastric bypass OR gastroileal bypass OR gastrojejunostomy OR gastrojejunostomies OR gastroplasty OR gastroplasties OR collis gastroplasty OR vertical-banded gastroplasty OR vertical banded gastroplasty OR vertical-banded gastroplas OR Jejunoileal bypass OR jejunoileal bypass OR jejunoileal bypass OR jejuno-ileal bypasses OR ileojejunal bypass OR ileojejunal bypasses OR intestinal bypass OR intestinal bypasses OR lipectomy [Mesh] OR lipectomies OR aspiration lipectomy OR aspiration lipolysis OR suction lipectomy OR suction lipectomies OR suction lipolysis OR liposuction OR liposuctions OR lipoplasty OR lipoplasties OR biliopancreatic bypass OR biliopancreatic diversion OR duodenal switch OR pancreatobiliary bypass OR gastric banding OR Stomach banding OR swedish gastric banding OR swedish adjustable gastric banding OR laparoscopic adjustable gastric banding OR laparoscopic adjustable silicone banding OR bariatric operation OR bariatric operations OR bariatric procedure OR bariatric procedures OR bariatric surgical procedure OR bariatric surgical procedures OR obesity surgery Or sleeve gastrectomy OR gastric sleeve "Body Mass Index" OR "Body Mass Index" OR Quetelet Index OR Quetelets Index OR BMI OR body ban mass diabetes mellitus type 2 OR Ketosis-Resistant Diabetes Mellitus OR Diabetes Mellitus Maturity-Onset OR Diabetes Mellitus Maturity Onset OR Non-Insulin-Dependent Diabetes Mellitus OR Type 2 Diabetes Mellitus OR Slow-Onset Diabetes Mellitus OR Stable Diabetes Mellitus OR Diabetes Mellitus Type II OR MODY OR NIDDM OR Adult- Onset Diabetes Mellitus OR lipoatrophic diabetes mellitus OR type 2 diabetes OR type II diabetes OR dm 2 OR insulin independent diabetes OR insulin independent diabetes mellitus OR ketosis resistant diabetes mellitus OR non insulin dependent diabetes OR non insulin dependent diabetes mellitus OR type 2 diabetes mellitus cardiovascular diseases OR cardiovascular disease OR cardiovascular abnormalities OR cardiovascular infections OR Heart diseases OR vascular diseases OR coronary artery insufficiency OR coronary artery occlusive disease OR coronary heart disease OR coronary insufficiency OR coronary occlusive disease OR ischemic heart disease OR ischaemic heart disease OR ischemic heart disease OR ischemic cardiac disease OR ischemic cardial disease OR ischemic cardiopathy sleep apnea obstructive OR obstructive sleep apnea OR obesity hypoventilation syndrome OR Upper Airway Resistance Sleep Apnea Syndrome OR obstructive sleep apnea syndrome OR sleep apnea OR nocturnal apnea OR obstructive sleep apnea hypopnea syndrome OR obstructive sleep apnoea hypertension OR high blood pressure OR high blood pressures OR hypertension malignant OR hypertension renal OR hypertensive retinopathy OR masked hypertension OR white coat hypertension OR acute hypertension OR arterial hypertension OR cardiovascular hypertension OR controlled hypertension OR endocrine hypertension OR high renin hypertension OR hypertensive disease OR hypertensive effect OR hypertensive response OR increased blood pressure OR neurogenic hypertension OR preexistent hypertension OR refractory hypertension OR salt high blood pressure OR salt hypertension OR secondary hypertension OR systemic hypertension dyslipidemias OR dyslipidemia OR hyperlipidemias OR Hypolipoproteinemias OR Smith-Lemli-Opitz Syndrome OR dyslipoproteinemias OR dyslipoproteinemia OR dys lipidemia stroke OR strokes OR cerebral stoke OR cerebral strokes OR brain vascular accident OR brain vascular accidents OR cerebrovascular apoplexy OR cerebrovascular stroke OR cerebralvascular strokes OR CVA OR CVAs OR apoplexy OR ceberovascular accident OR cerebrovascular accidents OR acute cerebrovascular 9

10 accident OR acute cerebrovascular accidents OR brain infarction OR lacunar stroke OR acute cerebrovascular lesion OR acute focal cerebral vasculopathy OR apoplectic stroke OR apoplexia OR brain blood flow disturbance OR brain accident OR brain attack OR brain insult OR brain insults OR brain ischemic attack OR cerebral apoplexia OR cerebral insult OR cerebral vascular accident OR cerebral vascular insufficiency OR cerebro vascular accident OR cerebrovascular arrest OR cerebrovascular failure OR cerebrovascular injury OR cerebrovascular insufficiency OR cerebrovascular insult OR cerebrovascular trauma OR cerebrum vascular accident OR ischaemic seizure OR ischemic cerebral attack OR ischemic seizure Clinicaltrials.gov Search terms Bariatric surgery and body mass index and diabetes Bariatric surgery and body mass index and cardiovascular disease Bariatric surgery and body mass index and hypertension Bariatric surgery and body mass index and dyslipidemia Bariatric surgery and body mass index and stroke Bariatric surgery and body mass index and sleep apnea Bariatric surgery and body mass index and quality of life 10

11 2. Models used to estimate operative mortality and complication rates and remission rate of the obesity-attributable comorbidities 2.1 Meta-analytic approach proposed by Bhaumik et al. (Bhaumik models) Denote as the observed percentage of interest. Let be the number of studies included in the meta-analysis,, 1,,, is the sample size for study. Bhaumik et al. 1 proposed a meta-analytic method that eliminates much of the bias from moment-based estimators of combined treatment effects in rare binary event cases. The estimator is a simple (unweighted) average: 1, For the variance estimate, we slightly modified the variance estimate proposed by Bhaumik et al. to account for the different study s of our study as follows: 1 1 1, where is the estimated heterogeneity parameter and can be obtained from the solution of the following equation: 1 0, where, in which, and 2.2 Bayesian random-effects models and. is denoted as the number of of interest. Assume ~,. Let For the priors, we use exp 1 exp, log 1 ~,, (1) ~ 10, 10,and ~ 0, 2. 2,3

12 3. Mixed treatment comparison meta-analysis 3.1 Network of evidence Using mixed treatment comparison (MTC) meta-analysis, 4 we estimated relative surgical effects on change in body mass index (BMI) from networks of evidence randomized controlled trials (s) comparing different surgical procedures in terms of post-surgery BMI change. efigure 1 demonstrates the network of evidence across 17 studies included in the MTC meta-analysis. Each line presents one or two s as indicated by the thickness of the line. The number at the end of each line corresponds to a type of bariatric surgery, which is detailed in etable 3. Among these procedures, the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) was most commonly compared with, having head-to-head comparisons against 6 other surgical procedures. Therefore, it was placed at the center of the network, and was treated as the reference surgery in the MTC meta-analysis. 3.2 MTC meta-analysis models Let,, denote the observed mean BMI change ( BMI) at timepoint in arm of study, which was assumed to have a normal distribution with mean,, and variance,,. Model 1:,, ~,,,,,,,,, where, is the mean BMI change at timepoint in the baseline arm (arm 1) of study, and, is the difference in mean BMI change between arm and arm 1 for study (, 0). The pooled surgery effects, for surgery, relative to the reference surgery, LRYGB ( 1), are the parameters of interest. The surgery effects in arm of study,,, are assumed to be drawn from a common distribution with mean,, and (between study) standard deviation :, ~,,,, where, denotes the surgical procedure used in arm of study. is assumed to be constant across surgery comparisons (homogeneous). We estimated the model using Bayesian technique., and were given non-informative Gaussian priors, 0, 10,000, while was assigned a wide uniform prior, 0, 20. Model 2: Model 2 is identical to Model 1, except that surgery effects were assumed to be constant within each surgery category., where is the pooled mean surgery effect for surgery category relative to the first category, gastric bypass (GB), and ~ 0, 10,000. We estimated all mean category effects relative to GB. Model 3: Model 3 is similar to Model 2, except that the surgery effects are exchangeable within categories, i.e., the surgery effects for different surgical procedures in the same category are similar. The surgery effects within the same category were

13 assumed to be drawn from a normal distribution with category mean and variance. We assumed were different across categories, but was the same. ~, for categories including more than one surgical procedure for categories including only one type of surgery ~ 0, 10,000 and ~ 0, 20 We estimated mean surgery effects relative to LRYGB. Model 4:,,,,,. In model 4, we incorporated time factors and estimated surgery effects separately for three terms: short (<1 year), mid ( 1 and <3 years), and long term ( 3 years). This allows relative surgery effects to vary over time, while assuming the effects are piecewise constant within each time intervals.,,, are assumed to be drawn from a common distribution with mean,,,,,, and (between study) standard deviation :, ~,,,,,,,, where denotes the time interval, and, ~ 0, 10,000. We estimated mean surgery effects relative to LRYGB for each time interval. 4. Estimation results 4.1 Bayesian and Bhaumik random-effects meta-analyses of surgical risks and benefits (Bayesian and Bhaumik) We present the full set of estimation results in etable 1, in which part of the Bayesian results are presented in Table Random-effects and fixed-effect meta-analyses using the Frequentist technique (FRE and FFE) We present in etable 2 the estimation results and I 2 index, measuring the percentage of variation across studies that is due to heterogeneity rather than random chance. 5,6 Part of the FRE results are presented in Table 3. Publication bias was evaluated using funnel plots and Egger s test. 7,8 efigure 2 shows the funnel plots and Egger s test results for the outcomes of yearly BMI change for which publication bias was able to be evaluated. The Egger s test for small-study effect showed that there was no evidence showing small study effects for all post-surgery yearly BMI change outcomes, except for post-surgery years 1 and 3 BMI change for observational studies. 4.3 Meta-regression analyses of BMI change We conducted meta-regression analyses for post-surgery year 1-2 BMI change. We adjusted for characteristics of (pre-surgery mean BMI, percentage of female, and age at surgery), study design (s or not) and quality, surgery category (GB, AGB, VBG, SG, Control, or Combined), and geographic location where surgery was performed (North America, Europe, Asia, or others). For study quality, we created nine dummy variables (QC1-9). QC1: surgeries are clearly defined; QC2: clear time points were given for outcomes; QC3: adjustment for potential confounders in analysis in observational studies (OBSs); QC4: adequate randomization for s; QC5: a priori sample size calculations were defined; QC6: loss to follow up information was given, but loss to follow up was >20%; QC7: loss to follow up information was given, and loss to follow up <20%; QC8: funding and conflicts of interest were declared, but the study was funded by

14 surgery-related industry; and QC9: funding and conflicts of interest were declared, and there was no link to industry. Analyses for post-surgery year 3-5 BMI change were not included due to insufficient observations. The results are shown in etable 4. Analyses for the first 2-year post-surgery BMI change included 91 and 48 observations. Older were associated with less BMI loss for both years (p = 0.00 and 0.01). Percentage of females was not statistically significant throughout year 1 to year 2 (p = 0.26 and 0.71). Pre-surgery BMI was a strong predictor for post-surgery BMI for both years (p = 0.00 and 0.01). design was associated with more weight loss, but was not statistically significant in the second year (p = 0.00 for the first year and p = 0.4 for the second year). Whether an had adequate randomization and whether a study provided a priori information on sample size calculation were positively associated with the first year BMI change (p = 0.00 and 0.001). Loss to follow up >20% was significantly associated with more weight loss in the second year (p = 0.02), but not in the first year (p = 0.65). In the first year after surgery, AGB (p = 0.00), SG (p = 0.02), VBG (p = 0.01), and non-surgical interventions (p = 0.00) were less effective on BMI loss than GB. But the difference was not found in the second year. Geographical locations where surgery was performed were not statistically significant in any years. 4.4 MTC meta-analysis of BMI change for s etable 5 shows the MTC estimates of the parameters (, 2,,11) in Model 1 and corresponds to Figure 2 in the text. The estimated pooled surgery effects (Column 2) were compared to the effect of LRYGB (see etable 3). Positive values represent that LRYGB outperformed the target surgical procedure. Therefore, LRYGB with presurgery weight loss, laparoscopic biliopancreatic diversion with duodenal switch, and biliopancreatic diversion with RYGB (procedure #3, 4, and 5) had greater effects on BMI loss than LRYGB. Non-surgical interventions did the worst in terms of BMI loss. On average, the effect of non-surgical interventions on BMI loss was approximately 14 kg/m 2 less than that of LRYGB. Procedures in AGB category (either using LAP-BAND or Swedish band) were outperformed by LRYGB by 9-10 kg/m 2. All other relative effects can be obtained from these basic estimates via the consistency equations based on the exchangeability assumptions. 9,10 For example, the estimated relative effect of surgical procedure #2 to #3 is 3.34 kg/m 2 because 1.62-(-1.72) = 3.34; in other words, LRYGB with pre-surgery weight loss helped lose 3.34 kg/m 2 more on average compared to ORYGB. etable 6 shows the MTC estimates corresponding to the parameters in Model 2. The results are also shown in Figure 2. The estimated pooled mean category effects (Column 2) were compared to the effect of the first category of surgery, GB (see etable 3). The results show that sleeve gastrectomy (SG) was comparable to GB overall, BMI loss was only 0.27 kg/m 2 less than GB. Vertical banded gastroplasty (VBG) was less effective than GB in terms of BMI change (by 3.4 kg/m 2 ), but more effective than AGB (by 5.4 kg/m 2 ). Model 2 makes a strong assumption that surgery effects were constant within categories, but it is informative when comparing different categories of bariatric surgery. etable 7 shows the MTC estimates corresponding to the parameters in Model 3. The estimated pooled surgery and category effects (Column 2) were compared to that of LRYGB (see etable 3). Model 3 makes a strong assumption that the between surgery within category standard deviation,, is the same across all categories. In addition, this model assumes surgical procedures in the same category are drawn from the same distribution (exchangeability of surgery effects within categories). Its results would prone to bias if the common variance assumption and the exchangeability assumption were not valid for all categories. MTC estimates corresponding to the parameters in Model 4 are presented in etable 8. The estimated pooled surgery effects within the designated time interval were compared to the effect of the first type of surgery, LRYGB (see etable 3). Surgery #3-5 and 9 had better BMI loss effect than LRYGB the first year after surgery; surgery #4, 5, and 10 had better performance in terms of BMI loss than LRYGB between 1 and 3 years after surgery. Surgery #9 and 10 performed better than LRYGB >3 years after surgery.

15 MTC estimates corresponding to the parameters in Model 4 are presented in etable 8. The estimated pooled surgery effects within the designated time interval were compared to the effect of the first type of surgery, LRYGB (see etable 3). Surgery #3-5 and 9 had better BMI loss effect than LRYGB the first year after surgery; surgery #4, 5, and 10 had better performance in terms of BMI loss than LRYGB between 1 and 3 years after surgery. Surgery #9 and 10 performed better than LRYGB >3 years after surgery. 15

16 5. References 1. Bhaumik DK, Amatya A, Normand SL, et al. Meta Analysis of Rare Binary Adverse Event Data. Journal of the American Statistical Association. 2012;107(498): Smith TC, Spiegelhalter DJ, Thomas A. Bayesian approaches to random effects meta analysis: a comparative study. Stat Med. Dec ;14(24): Warn DE, Thompson SG, Spiegelhalter DJ. Bayesian random effects meta analysis of trials with binary outcomes: methods for the absolute risk difference and relative risk scales. Stat Med. Jun ;21(11): Dakin HA, Welton NJ, Ades AE, Collins S, Orme M, Kelly S. Mixed treatment comparison of repeated measurements of a continuous endpoint: an example using topical treatments for primary open angle glaucoma and ocular hypertension. Stat Med. Jul Higgins JP, Thompson SG. Quantifying heterogeneity in a meta analysis. Stat Med. Jun ;21(11): Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta analyses. Bmj. Sep ;327(7414): Light RJ, Pillemer DB. Summing up : the science of reviewing research. Cambridge, Mass.: Harvard University Press; Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta analysis detected by a simple, graphical test. Bmj. Sep ;315(7109): Lu G, Ades A. Modeling between trial variance structure in mixed treatment comparisons. Biostatistics. Oct 2009;10(4): Lu G, Ades AE. Assessing Evidence Inconsistency in Mixed Treatment Comparisons. Journal of the American Statistical Association. June 2006; : efigure 1 Network diagram 16

17 Egger's test for small-study effects: p = Egger's test for small-study effects: p = Egger's test for small-study effects: p = Egger's test for small-study effects: p = Egger's test for small-study effects: p = Egger's test for small-study effects: p =

18 Egger's test for small-study effects: p = Publication bias was evaluated for yearly BMI change outcomes of all surgical procedures for which at least two study arms were included. : randomized controlled trials; OBS: observational studies; s.e.: standard error. efigure 2 Funnel plots with pseudo 95% confidence limits and Egger s test results 18

19 etable 1 Definitions of comorbid s and comorbidity improvement Study No. Diabetes Authors Herrera MF, Pantoja JP, Velazquez- Fernandez D, Cabiedes J, Aguilar- Salinas C, Garcia- Garcia E, et al Lee WJ, Ser KH, Chong K, Lee YC, Chen SC, Tsou JJ, et al. Procedure with the comorbid with improvement GB Y 4 4 GB Y 6 5 SG N Definition of the comorbid "An oral glucose tolerance test using a dose of 75 g of glucose after an overnight fasting (12 h) period was performed in all...diabetes was diagnosed when glucose was 200 mg/dl 2 h postload." Diabetes was diagnosed in " aged years who had a history of T2DM for 6 months [and] poorly controlled (HbA1C 7.5%).The had to have their C-peptide above 1 ng/ml without irreversible major organ damage related to diabetes." Definition of improvement Chao SH. AGB N Toouli J, Kow L, Ramos AC, Aigner F, Pattyn P, Galvao- Neto MP, et al. AGB N Remission of T2DM was defined as fasting glucose levels less than 126 mg/dl in addition to a HbA1c value less than 6.5% without the use of oral hypoglycemics or insulin. "Changes in co-morbidities were assessed by each investigator by comparing the following categorical and noncategorical parameters to their preoperative status: (1) changes in therapy/medication (i.e., increased, decreased, discontinued, no change, could not assess); and/or (2) changes in diagnostic parameters (laboratory or test results) recorded in the medical records during follow-up and at the onetime prospective study visit. Using this combination of parameters, the investigators 19

20 Study No Authors Sultan S, Parikh M, Youn H, Kurian M, Fielding G, Ren C. Iannelli A, Anty R, Piche T, Dahman M, Gual P, Tran A, et al. Pinheiro JS, Schiavon CA, Pereira PB, Correa JL, Noujaim P, Cohen R. Busetto L, Angrisani L, Basso N, Favretti F, Furbetta F, Lorenzo M, et al. Procedure with the comorbid with improvement AGB N Definition of the comorbid "The presence of comorbidities was defined by either the requirement for physicianprescribed medications or such a diagnosis by the patient s primary care physician." Definition of improvement GB N GB N 6 6 GB GB Y Y "T2DM was diagnosed if the patient presented with 2 fasting serum glucose results of 120 mg/dl and hemoglobin A1c (HbA1c) 7.5%." GB N GB N "At baseline, being diabetic was defined as having a fasting plasma glucose level 7.0 mmol/l or being under the use of any antidiabetic drug..." provided their assessment of changes in disease severity (e.g., no change, improved, worsened or could not assess); and current disease status (e.g., controlled, not controlled, resolved, or could not assess)." "For the purposes of this study, resolution of a comorbidity was defined as the discontinuation of physician-prescribed medications postoperatively, and improvement was defined as a decreased dosage of physicianprescribed medications." "The co-morbidities were considered controlled if the required no medication and had normal blood test results during follow-up. The comorbidities were considered improved if required less medication or had improved blood test results compared with before surgery." "...An improvement in the diabetic during followup was based upon a normalization of glucose levels or a reduction of antidiabetic medications." 20