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Lipid profile

Bariatric surgery improves lipid profile in obese patients

Differences in triglyceride reduction among procedures were most evident at more than one year after surgery, when reductions in subjects undergoing RYGBP and BPD were nearly 50% greater than in Adjustable Gastric Banding and Sleeve Gastrectomy

Bariatric and metabolic surgery can significantly benefit the lipid profiles of patients a year and more after surgery, according to a report published in The American Journal of Medicine. Researchers from the NYU Langone Medical Center, New York, US, made their conclusions after undertaking a meta-analysis of studies on contemporary bariatric surgery outcomes to describe the effects of Bilio-pancreatic Diversion (BPD), Roux-en-Y Gastric Bypass (RYGBP), Adjustable Gastric Banding, and Sleeve Gastrectomy procedures on serum lipids of obese patients at one year and more after surgery.

"These procedures have shown significant benefits beyond weight reduction, including improvements in serum lipids. However, changes in serum lipids beyond the period of early, rapid weight loss are not well characterized," explained lead investigator, Dr Sean Heffron of the Division of Cardiology at NYU Langone Medical Center.

Sean Heffron

In the study, ‘Changes in Lipid Profile of Obese Patients following Contemporary Bariatric Surgery: A Meta-Analysis’, the investigators searched MEDLINE, EMBASE and Cochrane databases were for studies with ≥20 obese adults undergoing one of the four type of bariatric surgery procedures. The primary outcome was change in lipids from baseline to one-year after surgery.

They identified 178 studies that fit the criteria for inclusion in this analysis. Some 25,189 patients with 47,779 patient-years of follow-up were included. At the time of surgery, patients were generally between 35 and 45 years old with a BMI 40-50. The mean follow-up across all studies was 27.9 months.

In patients undergoing any bariatric surgery, compared to baseline, there were significant reductions in total cholesterol (TC; -28.5mg/dL), low density lipoprotein cholesterol (LDL-C; -22.0mg/dL), triglycerides (-61.6mg/dL) and a significant increase in high density lipoprotein cholesterol (6.9mg/dL) at one year (p<0.00001 for all).

When assessed separately, the magnitude of changes varied greatly by surgical type (p<0.00001; eg LDL-C: BPD -42.5mg/dL, RYGBP -24.7mg/dL, Adjustable Gastric Banding -8.8mg/dL, Sleeve Gastrectomy -7.9mg/dL). In the cases of Adjustable Gastric Banding (TC and LDL-C) and Sleeve Gastrectomy (LDL-C), the response at one year following surgery was not significantly different from non-surgical control patients.

"Differences in triglyceride reduction among procedures were most evident at more than one year after surgery, when reductions in subjects undergoing RYGBP and BPD were nearly 50% greater than in Adjustable Gastric Banding and Sleeve Gastrectomy, despite similar baseline BMI in RYGBP and Adjustable Gastric Banding cohorts," said Heffron. "Part of this difference may be secondary to greater weight loss and improvements in insulin sensitivity achieved following RYGBP and BPD versus restrictive procedures. However, the anatomic alterations of RYGBP and BPD may also play important roles. These differences may be relevant in deciding the most appropriate technique for a given patient." 

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