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Figure 35.8. Two-year incidence of diabetes by decentile of percentage weight change in the SOS intervention study. Pooled data from 1281 obese controls and surgically treated subjects not having diabetes at baseline. Striped bars indicate new cases of diabetes. At bottom, the average percentage weight change within each decentile. At top, the 2-year incidence of diabetes within each weight change decentile. Data based on ref. (4) and figure reproduced from C.D. Sjostrom (18), with permission some risk factors, such as blood pressure, may relapse in spite of maintained weight loss.

A third explanation may be that non-traditional risk factors deteriorate during weight loss. Recently, 10-year data from SOS have demonstrated that homocysteine increases with increasing weight loss, independent of method of weight loss (surgery or conventional), also when adjusting for changes in folate and B12 (23). Homocysteine levels have been shown to be related to cardiovascular mortality (24). Since homocysteine and folate are negatively related and since folate intake is reduced during

Figure 35.9 Two- and 8-year unadjusted incidence of diabetes and hypertension in 232 obese controls (striped bars) and 251 surgically treated patients (filled bars) from the SOS intervention study. Calculations based on completer population. Almost identical odds ratios were obtained with and without adjustments in completer and intention-to-treat populations (now shown). From C.D. Sjostrom et al. (12), with permission

Figure 35.9 Two- and 8-year unadjusted incidence of diabetes and hypertension in 232 obese controls (striped bars) and 251 surgically treated patients (filled bars) from the SOS intervention study. Calculations based on completer population. Almost identical odds ratios were obtained with and without adjustments in completer and intention-to-treat populations (now shown). From C.D. Sjostrom et al. (12), with permission caloric restriction, our observations suggest that all weight-reducing treatments, whether surgical or not, should be accompanied by substitution with multivamin pills, folic acid and possibly B12 in order to counteract an increased incidence of cardiovascular disease due to hyperhomocystein-aemia.

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