Skip to main content

Advertisement

SpringerLink
Log in

Detailed Description of Change in Serum Cholesterol Profile with Incremental Weight Loss After Restrictive Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Introduction

Dyslipidemia affects up to 75% of morbidly obese individuals and is a key driver of cardiovascular disease. Weight loss is an established strategy to improve metabolic risk, including dyslipidemia. We aimed to determine weight loss goals for resolution of serum lipid abnormalities, by measuring improvements during progressive weight loss in obese individuals.

Methods

We performed a prospective cohort study of obese individuals with the metabolic syndrome undergoing adjustable gastric banding. Lipid levels were monitored monthly for 9 months, then three monthly until 24 months.

Results

There were 101 participants included, age 47.4 ± 10.9 years with body mass index 42.6 ± 5.9 kg/m2. At 24 months, total body weight loss (TBWL) was 18.3 ± 7.9%. This was associated with significant improvements in high-density lipoprotein (HDL) (1.18 vs 1.47, p < 0.001), triglyceride (2.0 vs 1.4, p < 0.001), and total cholesterol to HDL ratio (TC:HDL) (4.6 vs 3.6, p < 0.001). Over this time, progressive and linear improvements in HDL, triglycerides, and TC:HDL were seen with incremental weight loss (observed at 2.5% TBWL intervals). Significant improvements occurred after a threshold weight loss of 7.5–12.5% TBWL was achieved, with odds ratio (OR) 1.48–2.50 for normalization. These odds improved significantly with increasing weight loss (OR 18.2–30.4 with > 25% TBWL). Despite significant weight loss, there was no significant change in low-density lipoprotein (LDL).

Conclusion

Significant improvements in triglycerides, HDL, and TC:HDL occur after 7.5–12.5% TBWL, with ongoing benefit after greater weight loss. LDL needs to be addressed independently, as this was not observed to respond to weight loss alone.

Trial registration number

Australian Clinical Trials Registry (ACTRN12610000049077)

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ricci C, Gaeta M, Rausa E, et al. Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6,587 patients. Obes Surg. 2014;24(4):522–8. https://doi.org/10.1007/s11695-013-1121-x.

    Article  PubMed  Google Scholar 

  2. Bastien M, Poirier P, Lemieux I, et al. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovas Dis. 2014;56(4):369–81. https://doi.org/10.1016/j.pcad.2013.10.016.

    Article  Google Scholar 

  3. Nicholls S, Lundman P. The emerging role of lipoproteins in atherogenesis: beyond LDL cholesterol. Seminars in Vascular Medine. 2004;4(2):187–95. https://doi.org/10.1055/s-2004-835377.

    Article  Google Scholar 

  4. Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96. https://doi.org/10.1016/S0140-6736(09)60318-4.

    Article  PubMed  Google Scholar 

  5. National Vasulcar Disease Prevention Alliance (NVDPA). Guidelines for the management of absolute cardiovascular disease risk. 2012.

  6. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;63(25 Pt B):2889–934.

  7. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50. https://doi.org/10.1056/NEJM200105033441801.

    Article  PubMed  CAS  Google Scholar 

  8. Knowler W, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. https://doi.org/10.1056/NEJMoa012512.

    Article  PubMed  CAS  Google Scholar 

  9. O’Brien PE, MacDonald L, Anderson M, et al. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg. 2013;257(1):87–94. https://doi.org/10.1097/SLA.0b013e31827b6c02.

    Article  PubMed  Google Scholar 

  10. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial-a prospective controlled intervention study of bariatric surgery. JIntern Med. 2013;273(3):219–34. https://doi.org/10.1111/joim.12012.

    Article  CAS  Google Scholar 

  11. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93. https://doi.org/10.1056/NEJMoa035622.

    Article  PubMed  Google Scholar 

  12. Nguyen NT, Varela JE, Sabio A, et al. Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2006;203(1):24–9. https://doi.org/10.1016/j.jamcollsurg.2006.03.019.

    Article  PubMed  Google Scholar 

  13. Sandoval D. Bariatric surgeries: beyond restriction and malabsorption. Int J Obes. 2011;35:545–9.

    Article  Google Scholar 

  14. Flynn CR, Albaugh VL, Cai S, et al. Bile diversion to the distal small intestine has comparable metabolic benefits to bariatric surgery. Nat Commun. 2015;6:7715. https://doi.org/10.1038/ncomms8715.

  15. Burton PR, Brown WA. The mechanism of weight loss after laparoscopic adjustable gastric banding: induction of satiety not restriction. Int J Obes. 2011;35(S3):S26–30. https://doi.org/10.1038/ijo.2011.144.

    Article  Google Scholar 

  16. Magkos F, Fraterrigo G, Yoshino J, et al. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab. 2016;23:1–11.

    Article  CAS  Google Scholar 

  17. Ooi GJ, Doyle L, Tie T, et al. Weight loss after laparoscopic adjustable gastric band and resolution of the metabolic syndrome and its components. Int J Obes. 2017 21 March 2017;41(6):902–8.

  18. Busetto L, Dixon JB, De Luca M, et al. Bariatric surgery in class I obesity: position statement from the International Federation for the Surgery of Obesity and Metabolic Disorders. Obes Surg. 2014;24(4):487–519. https://doi.org/10.1007/s11695-014-1214-1.

    Article  PubMed  Google Scholar 

  19. O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144(9):625–33. https://doi.org/10.7326/0003-4819-144-9-200605020-00005.

  20. World Health Organisation. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation (WHO Technical Report Series 894). In: Obesity WCo, editor. Geneva: World Health Organisation; 2000.

  21. National Cholesterol Education Program (NCEP). Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). In: National Institute of Health, editor. 2002.

  22. Nayor M, Vasan RS. Recent update to the US cholesterol treatment guidelines. A comparison with international guidelines. Circulation. 2016;133(18):1795–806. https://doi.org/10.1161/CIRCULATIONAHA.116.021407.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Poirier P, Cornier M-A, Mazzone T, et al. Bariatric surgery and cardiovascular risk factors. A scientific statement from the American Heart Association. Circulation. 2011;123(15):1683–701. https://doi.org/10.1161/CIR.0b013e3182149099.

  24. Dixon JB, O’Brien PE. Lipid profile in the severely obese: changes with weight loss after lap-band surgery. Obes Res. 2002;2002(10)

  25. To VT, Huttl TP, Lang R, Piotrowski K, Parhofer KG. Changes in body weight, glucose homeostasis, lipid profiles, and metabolic syndrome after restrictive bariatric surgery. Exp Clin Endocrinol Diabetes 2012;120:547–552, 9, DOI: https://doi.org/10.1055/s-0032-1323738.

  26. Franz MJ, Boucher JL, Rutten-Ramos S, et al. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet. 2015;115(9):1447–63. https://doi.org/10.1016/j.jand.2015.02.031.

    Article  PubMed  Google Scholar 

  27. Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. J Am Med Assoc. 2012;307(1):56–65. https://doi.org/10.1001/jama.2011.1914.

    Article  Google Scholar 

  28. Benaiges D, Flores-Le-Roux JA, Pedro-Botet J, et al. Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery (Roux-en-Y gastric bypass) on lipid profile. Obes Surg. 2012;22(8):1268–75. https://doi.org/10.1007/s11695-012-0662-8.

    Article  PubMed  CAS  Google Scholar 

  29. Berneis KK, Krauss RM. Metabolic origins and clinical significance of LDL heterogeneity. J Lipid Res. 2002;43(9):1363–79. https://doi.org/10.1194/jlr.R200004-JLR200.

    Article  PubMed  CAS  Google Scholar 

  30. Parish S, Offer A, Clarke R, et al. Lipids and lipoproteins and risk of differential vascular events in the MRC/BHF Heart Protection Study. Circulation. 2012;125(20):2469–78. https://doi.org/10.1161/CIRCULATIONAHA.111.073684.

  31. Hoogeveen RC, Gaubatz JW, Sun W, et al. Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2014;34(5):1069–77. https://doi.org/10.1161/ATVBAHA.114.303284.

  32. Tsai MY, Steffen BT, Guan W, et al. A new automated assay of small dense LDL cholesterol identifies risk. Arterioscler Thromb Vasc Biol. 2014;34(1):196–201. https://doi.org/10.1161/ATVBAHA.113.302401.

    Article  PubMed  CAS  Google Scholar 

  33. Krauss RM, Blanche PJ, Rawlings RS, et al. Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr. 2006;83(5):1025–31.

    Article  PubMed  CAS  Google Scholar 

  34. Zambon S, Romanato G, Sartore G, et al. Bariatric surgery improves atherogenic LDL profile by triglyceride reduction. Obes Surg. 2009;19(2):190–5. https://doi.org/10.1007/s11695-008-9644-2.

  35. Krauss RM, Lindgren FT, Ray RM. Interrelationships among subgroups of serum lipoproteins in normal human subjects. Clin Chem Acta. 1980;104(3):275–90. https://doi.org/10.1016/0009-8981(80)90385-X.

    Article  CAS  Google Scholar 

  36. Miccoli R, Bianchi C, Penno G, et al. Insulin resistance and lipid disorders. Future Lipidol. 2008;3(6):651–64. https://doi.org/10.2217/17460875.3.6.651.

    Article  CAS  Google Scholar 

  37. Grundy SM. Small LDL, atherogenic dyslipidemia and the metabolic syndrome. Circulation. 1997;95(1):1–4. https://doi.org/10.1161/01.CIR.95.1.1.

    Article  PubMed  CAS  Google Scholar 

  38. Miller MT, Stone NJ, Ballantyne CM, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011;123(20):2292–333. https://doi.org/10.1161/CIR.0b013e3182160726.

    Article  PubMed  Google Scholar 

  39. Ridker PM. LDL cholesterol: controversies and future therapeutic directions. Lancet. 2014;384(9943):607–17. https://doi.org/10.1016/S0140-6736(14)61009-6.

    Article  PubMed  CAS  Google Scholar 

  40. Assmann G, Gotto AM. HDL cholesterol and protective factors in atherosclerosis. Circulation. 2004;109(Suppl III):III8–III14, 23_suppl_1, III-8, III-14, DOI: https://doi.org/10.1161/01.CIR.0000131512.50667.46.

  41. McQueen MJ, Hawken S, Wang X, et al. Lipids, lipoproteins, and apolipoproteins as risk markers for myocardial infarction in 52 countries (the INTERHEART study): a case-control study. Lancet. 2008;372(9634):224–33. https://doi.org/10.1016/S0140-6736(08)61076-4.

    Article  PubMed  CAS  Google Scholar 

  42. Mathews SC, Mallidi J, Kulkarni KR, et al. Achieving secondary prevention low-density lipoprotein particle concentration goals using lipoprotein cholesterol-based data. PLoS One. 2012;7(3):e33692. https://doi.org/10.1371/journal.pone.0033692.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Shai I, Rimm EB, Hankinson SE, et al. Multivariate assessment of lipid parameters as predictors of coronary heart disease among post-menopausal women: potential implications for clinical guidelines. Circulation. 2004;110(18):2824–30. https://doi.org/10.1161/01.CIR.0000146339.57154.9B.

  44. Grundy SM, Cleeman JI, Merz CNB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;2004(110)

  45. Mells JE, Anania FA. The role of gastrointestinal hormones in hepatic lipid metabolism. Semin Liver Dis. 2013;33(4):343–57. https://doi.org/10.1055/s-0033-1358527.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. US Preventative Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: US Preventative Services Task Force recommendation statement. JAMA. 2016;316(19):1997–2007. https://doi.org/10.1001/jama.2016.15450.

    Article  Google Scholar 

  47. Carroll S, Dudfield M. What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Med. 2004;34(6):371–418. https://doi.org/10.2165/00007256-200434060-00004.

    Article  PubMed  Google Scholar 

  48. Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors with overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481–6. https://doi.org/10.2337/dc10-2415.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia

    Geraldine J. Ooi, Lisa Doyle, Cheryl Laurie, Paul R. Burton, Paul E. O’Brien & Wendy A. Brown

  2. Department of Surgery, Alfred Hospital, Melbourne, Australia

    Geraldine J. Ooi, Paul R. Burton & Wendy A. Brown

  3. Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia

    Arul Earnest

  4. Walter and Eliza Hall Institute, Melbourne University, Melbourne, Australia

    John M. Wentworth

  5. Melbourne Pathology, East Melbourne, Australia

    Ken Sikaris

  6. Diabetes Complications Research Centre, University College, Dublin, Ireland

    Carel W. le Roux

Authors
  1. Geraldine J. Ooi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arul Earnest
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa Doyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheryl Laurie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John M. Wentworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ken Sikaris
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carel W. le Roux
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Paul R. Burton
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paul E. O’Brien
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wendy A. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geraldine J. Ooi.

Ethics declarations

Ethics approval was obtained from the Avenue Ethics Committee (reference no. 099)

Conflict of Interest

GJO, PRB, and WAB report being affiliated with the Center for Obesity Research and Education. The center has received funding for research purposes from Allergan and Apollo Endosurgery, the manufacturers of the LapBand™. The grant is not tied to any specific research project, and neither Allergan nor Apollo Endosurgery have control of the protocol, analysis, and reporting of any studies. The center also receives a grant from Applied Medical towards educational programs.

WB reports financial support for a bariatric surgery registry from the Commonwealth of Australia, Apollo Endosurgery, Covidien, Johnson and Johnson, Gore, and Applied Medical. Since the initial submission of this paper, she has also received a speaker’s honorarium from Merck Sharpe and Dohme and a speaker’s honorarium and fees from participation in a scientific advisory board from Novo Nordisk. The Bariatric Registry and the honorariums are outside of the submitted work.

KS is the Director of Clinical Support Services at Sonic Healthcare; this is unrelated to this work.

CWL has received funding from the Science Foundation Ireland (12/YI/B2480). He also serves on the advisory boards of NovoNordisk and Herbalife, and has received speaker’s fees from Ethicon Endosurgery.

PEO has written a patient information book entitled “The Lap-Band Solution: A partnership for weight loss” which is given to patients without charge, but some are sold to surgeons and others, for which he receives a royalty.

GJO and LD reports scholarships from the National Health and Medical Research Council and the Royal Australasian College of Surgeons.

The remaining authors have no other disclosures or conflicts of interest.

Electronic supplementary material

ESM 1

(DOCX 39 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ooi, G.J., Earnest, A., Doyle, L. et al. Detailed Description of Change in Serum Cholesterol Profile with Incremental Weight Loss After Restrictive Bariatric Surgery. OBES SURG 28, 1351–1362 (2018). https://doi.org/10.1007/s11695-017-3015-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-3015-9

Keywords

Search

Navigation