Bariatric Surgery Significantly Improves Lipid Profile in Obese Patients

In-depth, multi-study analysis characterizes role of contemporary bariatric surgery procedures in benefiting serum lipids, reports The American Journal of Medicine

Philadelphia, PA, June 14, 2016

Fifty years after the first reported partial-ileal bypass, metabolic surgery has an established role in achieving weight loss and reducing cardiovascular death in obese patients. Scientists have now demonstrated that it can significantly benefit the lipid profiles of these patients a year and more after surgery, according to a new report published in The American Journal of Medicine.

Bariatric (weight reduction) surgery has evolved into four dominant procedures ranging from largely malabsorptive to completely restrictive: Bilio-pancreatic Diversion (BPD), Roux-en-Y Gastric Bypass (RYGBP), Adjustable Gastric Banding, and Sleeve Gastrectomy. These are regarded as the most effective therapies for treating obesity.

Investigators undertook a meta-analysis of studies on contemporary bariatric surgery outcomes to describe the effects of these 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 Sean Heffron, MD, of the Division of Cardiology at NYU Langone Medical Center.

Investigators identified 178 studies that fit the criteria for inclusion in this analysis. Each study needed to involve 20 or more obese adults undergoing RYGBP, Adjustable Gastric Banding, Sleeve Gastrectomy, or BPD, report lipid profile at baseline, and provide follow-up data for at least one year. More than 25,000 patients with nearly 48,000 patient-years of follow-up were included. At the time of surgery, patients were generally between 35 and 45 years old with body mass index (BMI) of between 40 and 50. The mean follow-up across all studies was 27.9 months.

In patients undergoing any form of bariatric surgery, compared to baseline, there were significant reductions in total cholesterol, low density lipoprotein cholesterol, and triglycerides, and a significant increase in high density lipoprotein cholesterol. The magnitude of this change was significantly greater than that observed in non-surgical control patients.

When assessed separately, the magnitude of changes varied greatly by surgical type. Only RYGBP showed improvements in each lipid parameter relative to controls at both one year and last follow-up beyond one year. In the cases of Adjustable Gastric Banding and Sleeve Gastrectomy 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,” observed Dr. 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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Notes for editors
“Changes in Lipid Profile of Obese Patients following Contemporary Bariatric Surgery: A Meta-Analysis,” by Sean P. Heffron, MD, MS, MSc, Amar Parikh, MD, Alexandar Volodarskiy, MD, Christine Ren-Fielding, MD, Arthur Schwartzbard, MD, Joseph Nicholson, MLIS, MPH, and Sripal Bangalore, MD, MHA (doi: 10.1016/j.amjmed.2016.02.004). This article appears online in advance of The American Journal of Medicine, Volume 129, Issue 7 (July 2016),published by Elsevier.

Full text of this article is available to credentialed journalists upon request. Contact Jane Grochowski at +1 215 239 3712 or ajmmedia@elsevier.com to obtain copies. Journalists who would like to interview the authors should contact Allison Clair at +1 212 404 3753 or Allison.clair@nyumc.org.

About The American Journal of Medicine
The American Journal of Medicine, known as the “Green Journal,” is one of the oldest and most prestigious general internal medicine journals published in the United States. It has an Impact Factor of 5.61 and is ranked #13 out of 151 General and Internal Medicine titles based on number of total citations, according to the 2015 Journal Citation Reports® published by Thomson Reuters.

AJM, the official journal of The Association of Professors of Medicine, a group comprised of chairs of departments of internal medicine at 125-plus US medical schools, publishes peer-reviewed, original scientific studies that have direct clinical significance. The information contained in this article in The American Journal of Medicine is not a substitute for medical advice or treatment, and the Journal recommends consultation with your physician or healthcare professional. AJM is published by Elsevier.

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