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Effects of Sleeve Gastrectomy and Gastric Bypass on Postprandial Lipid Profile in Obese Type 2 Diabetic Patients: a 2-Year Follow-up

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Abstract

Background

Bariatric surgery (BS) is known to favorably impact fasting lipid profile. Fasting and postprandial lipids were evaluated before and 2 years after BS in obese type 2 diabetic (T2DM) patients.

Methods

A prospective study was conducted in 19 obese T2DM patients: ten undergoing sleeve gastrectomy (SG) and nine undergoing Roux-en-Y gastric bypass (RYGB). Before and 2 years after BS, clinical parameters and the response of lipid and incretin hormones to a mixed meal (MM) were assessed.

Results

The two groups had similar characteristics at baseline. After BS, weight loss was similar in the two groups (p ≤ 0.01). Fasting glucose, insulin, and triglycerides decreased while HDL cholesterol increased in a similar way (p < 0.05); in contrast, fasting LDL cholesterol decreased only after RYGB (p < 0.05). Post-meal glucose concentrations decreased while early insulin response significantly improved after both procedures (p < 0.001 for both). Postprandial triglycerides decreased after both procedures (p < 0.05) while postprandial LDL cholesterol decreased only after RYGB (p < 0.05). Meal-GLP-1 increased postoperatively in both groups although to a greater extent after RYGB (p < 0.001 vs. SG). GIP decreased after both procedures, especially after RYGB (p = 0.003). At multivariate analysis, GLP-1 peak was the best predictor of LDL reduction (β = −0.552, p = 0.039) while the improvement of HOMA-IR (β = 0.574, p = 0.014) and weight loss (β = 0.418, p = 0.036) predicted triglycerides reduction.

Conclusions

Both surgical procedures markedly reduce fasting and postprandial triglycerides and increase HDL cholesterol levels. LDL cholesterol decreases only after RYGB through a mechanism likely mediated by the restoration of GLP-1.

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Abbreviations

T2DM:

Type 2 diabetes

BS:

Bariatric surgery

GLP-1:

Glucagon-like peptide-1

SG:

Sleeve gastrectomy

RYGB:

Roux-en-Y gastric bypass

HDL:

High-density lipoprotein

LDL:

Low-density lipoprotein

IAUC:

Incremental area under curve

BMI:

Body mass index

HOMA-IR:

Homeostasis model assessment-estimated insulin resistance

GIP:

Glucose dependent insulinotropic peptide

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Acknowledgments

The authors thank Giuliana Vitolo for the dietary counseling.

Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy

    E. Griffo, M. Cotugno, G. Nosso, G. Saldalamacchia, A. Mangione, A. A. Rivellese & B. Capaldo

  2. General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy

    L. Angrisani

Authors
  1. E. Griffo
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  2. M. Cotugno
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  3. G. Nosso
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  4. G. Saldalamacchia
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  5. A. Mangione
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  6. L. Angrisani
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  7. A. A. Rivellese
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  8. B. Capaldo
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Corresponding author

Correspondence to E. Griffo.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no competing interests.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Griffo, E., Cotugno, M., Nosso, G. et al. Effects of Sleeve Gastrectomy and Gastric Bypass on Postprandial Lipid Profile in Obese Type 2 Diabetic Patients: a 2-Year Follow-up. OBES SURG 26, 1247–1253 (2016). https://doi.org/10.1007/s11695-015-1891-4

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  • DOI: https://doi.org/10.1007/s11695-015-1891-4

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