Obesity Surgery

, Volume 19, Issue 2, pp 190–195 | Cite as

Bariatric Surgery Improves Atherogenic LDL Profile by Triglyceride Reduction

  • Sabina Zambon
  • Giovanna Romanato
  • Giovanni Sartore
  • Raffaella Marin
  • Luca Busetto
  • Silvia Zanoni
  • Franco Favretti
  • Giuseppe Sergi
  • Paola Fioretto
  • Enzo Manzato
Research Article

Abstract

Background

Small dense low-density lipoprotein (LDL) are atherogenic particles frequently observed in obese patients. Fatty acids modulate LDL. Objective of this study was to determine the relations between plasma phospholipid fatty acid composition and the presence of small dense LDL particles in morbidly obese patients treated with laparoscopic gastric banding (LAGB).

Methods

Small dense LDL, plasma lipids, lipoproteins, apoproteins, and phospholipid fatty acid composition (a marker of dietary fatty acid intake) were quantified before and 12 months after surgery in four men and 11 women who were morbidly obese and (BMI > 40 kg/m2) eligible for surgery, consecutively treated with LAGB at the Department of Medical and Surgical Sciences of the University of Padova.

Results

BMI was 48.3 ± 4.8 kg/m2 before and 36.1 ± 5.5 kg/m2 after LAGB. Plasma triglycerides and apoprotein E levels significantly decreased, while HDL cholesterol significantly increased after LAGB. A reduction of small dense LDL with an increase of LDL relative flotation (0.34 ± 0.04 before vs 0.38 ± 0.03 after LAGB, p < 0.001) was also observed. These modifications were neither related to weight reduction nor to changes in phospholipid fatty acid composition, but they were associated to triglyceride reduction, which explained 76.7% of the LDL relative flotation variation.

Conclusion

Weight loss obtained by LAGB in morbidly obese subjects was accompanied by triglyceride reduction, high-density lipoprotein increase, and an improvement of the atherogenic LDL profile. Triglyceride reduction, but not the extent of weight loss or dietary fatty acid modifications, is the determinant of modifications of LDL physical properties in these patients.

Keywords

Obesity Bariatric surgery Lipids Fatty acids Small dense LDL 

References

  1. 1.
    Manzato E, Zambon S, Zambon A, et al. Lipoprotein sub-fraction levels and composition in obese subjects before and after gastroplasty. Int J Obes Relat Metab Disord 1992;16:573–8.PubMedGoogle Scholar
  2. 2.
    Zambon A, Sartore G, Passera D, et al. Effects of hypocaloric dietary treatment enriched in oleic acid on LDL and HDL subclass distribution in mildly obese women. J Intern Med 1999;246:191–201.CrossRefPubMedGoogle Scholar
  3. 3.
    Kwiterovich PO Jr. Clinical relevance of the biochemical, metabolic, and genetic factors that influence low-density lipoprotein heterogeneity. Am J Cardiol 2002;90(Suppl):30i–47i.CrossRefPubMedGoogle Scholar
  4. 4.
    Carmena R, Duriez P, Fruchart J-C. Atherogenic lipoprotein particles in atherosclerosis. Circulation 2004;109(Suppl I):III–2–7.Google Scholar
  5. 5.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.CrossRefPubMedGoogle Scholar
  6. 6.
    Sjöström L, Lindroos A-L, Peltonen M, for the Swedish Obese Subjects Study Scientific Group, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Rudel LL, Parks JS, Hedrick CC, et al. Lipoprotein and cholesterol metabolism in diet-induced coronary artery atherosclerosis in primates. Role of cholesterol and fatty acids. Prog Lipid Res 1998;37:353–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Dreon DM, Fernstrom HA, Campos H, et al. Change in dietary saturated fat intake is correlated with change in mass of large low-density lipoprotein particles in men. Am J Clin Nutr 1998;67:828–36.PubMedGoogle Scholar
  9. 9.
    Vessby B. Dietary fat, fatty acid composition in plasma and the metabolic syndrome. Curr Opin Lipidol 2003;14:15–9.CrossRefPubMedGoogle Scholar
  10. 10.
    National Institute of Health Consensus Development Conference Statement. Gastrointestinal surgery for severe obesity. Bethesda: National institutes of Health; 1991.Google Scholar
  11. 11.
    Favretti F, Cadiere GB, Segato G, et al. Laparoscopic banding: selection and technique in 830 patients. Obes Surg 2002;12:385–90.CrossRefPubMedGoogle Scholar
  12. 12.
    Busetto L, Segato G, De Marchi F, et al. Outcome predictors in morbidly obese recipients of an adjustable gastric band. Obes Surg 2002;12:83–92.CrossRefPubMedGoogle Scholar
  13. 13.
    Favretti F, Cadiere GB, Segato G, et al. Laparoscopic adjustable silicone gastric banding (Lap-Band): how to avoid complications. Obes Surg 1997;7:352–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Busetto L, Valente P, Pisent C, et al. Eating pattern in the first year following adjustable silicone gastric banding (ASGB) for morbid obesity. Int J Obes Relat Metab Disord 1996;20:539–46.PubMedGoogle Scholar
  15. 15.
    Roschlau P, Bernt E, Gruber W. Enzymatische bestimmung des gesamtcholesterins im serum. Klin Chem Klin Biochem 1974;12:403–7.Google Scholar
  16. 16.
    Wahlefeld AW. Triglycerides determination after enzymatic hydrolysis. In: Bergmeyer HU, editor. Methods of enzymatic analysis. New York: Academic; 1976. p. 1831–5.Google Scholar
  17. 17.
    Hainline A, Karon J, Lippell K, editors. In: Lipid research clinics program. Lipid and lipoprotein analysis. Manual of laboratory operations. 2nd ed. Washington DC: US Department of Health and Human Service; 1982. p. 63–77.Google Scholar
  18. 18.
    Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499–502.PubMedGoogle Scholar
  19. 19.
    Chung BH, Segrest JP, Marjory JR, et al. Single vertical spin density gradient ultracentrifugation. In: Segrest JP, Albers JJ, editors. Methods in enzymology. Orlando: Academic; 1986. p. 181–209.Google Scholar
  20. 20.
    Folch J, Lees M, Stanley GHS. A single method for the isolation and purification of total lipids from animal tissue. J Biol Chem 1957;226:497–507.PubMedGoogle Scholar
  21. 21.
    Morrison WR, Smith LM. Preparation of fatty acid methyl esters and dimethylacetals from lipids with boron fluoride-methanol. J Lipid Res 1964;5:600–8.PubMedGoogle Scholar
  22. 22.
    Busetto L, Pisent C, Rinaldi D, et al. Variation in lipid levels in morbidly obese patients operated with the LAP-BAND adjustable gastric banding system: effects of different levels of weight loss. Obes Surg 2000;10:569–77.CrossRefPubMedGoogle Scholar
  23. 23.
    Busetto L, Sergi G, Enzi G, et al. Short-term effects of weight loss on the cardiovascular risk factors in morbidly obese patients. Obes Res 2004;12:1256–63.CrossRefPubMedGoogle Scholar
  24. 24.
    Yusuf S, Hawken S, Ounpuu S, on behalf of the INTERHEART Study Investigators, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case control study. Lancet 2004;364:937–52.CrossRefPubMedGoogle Scholar
  25. 25.
    Lind L, Vessby B, Sundstrom J. The apolipoprotein B/AI ratio and the metabolic syndrome independently predict risk for myocardial infarction in middle-aged men. Arterioscler Thromb Vasc Biol 2006;26:406–10.CrossRefPubMedGoogle Scholar
  26. 26.
    Executive Summary of The 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). JAMA 2001;285:2486–97.CrossRefGoogle Scholar
  27. 27.
    Manzato E, Zambon S, Zambon A, et al. Levels and physicochemical properties of lipoprotein subclasses in moderate hypertriglyceridemia. Clin Chim Acta 1993;219:57–65.CrossRefPubMedGoogle Scholar
  28. 28.
    Lapolla A, Sartore G, Della Rovere GR, et al. Plasma fatty acids and lipoproteins in type 2 diabetic patients. Diabetes Metab Res 2006;22:226–31.CrossRefGoogle Scholar
  29. 29.
    Kathiresan S, Otvos JD, Sullivan LM, et al. Increased small low-density lipoprotein particle number: a prominent feature of the metabolic syndrome in the Framingham heart study. Circulation 2006;113:20–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Zambon A, Austin MA, Brown BG, et al. Effect of hepatic lipase on LDL in normal men and those with coronary artery disease. Arterioscler Thromb Vasc Biol 1993;13:147–53.Google Scholar
  31. 31.
    Ebenbichler CF, Laimer M, Kaser S, et al. Relationship between cholesteryl ester transfer protein and atherogenic lipoprotein profile in morbidly obese women. Arterioscler Thromb Vasc Biol 2002;22:1465–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Kaser S, Laimer M, Sandhofer A, et al. Effects of weight loss on PLTP activity and HDL particle size. Int J Obes Relat Metab Disord 2004;28:1280–2.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Sabina Zambon
    • 1
  • Giovanna Romanato
    • 1
  • Giovanni Sartore
    • 1
  • Raffaella Marin
    • 1
  • Luca Busetto
    • 1
  • Silvia Zanoni
    • 1
  • Franco Favretti
    • 2
  • Giuseppe Sergi
    • 1
  • Paola Fioretto
    • 1
  • Enzo Manzato
    • 3
  1. 1.Department of Medical and Surgical SciencesUniversity of PadovaPadovaItaly
  2. 2.Department of SurgeryRegional Hospital of VicenzaVicenzaItaly
  3. 3.Department of Medical and Surgical SciencesUniversity of Padova, and CNR Institute of Neurosciences, Center on AgingPadovaItaly

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