A Systematic Review and Meta-analysis of the Effect of Gastric Bypass Surgery on Plasma Lipid Levels
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Obesity-related dyslipidaemia comprises hypercholesterolaemia, hypertriglyceridaemia, low HDL-cholesterol and normal to raised LDL-cholesterol levels. 40 % of morbidly obese surgical patients have dyslipidaemia. Roux-en-Y gastric bypass (RYGB) surgery has many beneficial metabolic effects, but the full impact on plasma lipids has not been clearly defined.
A systematic review of electronic databases (Ovid; Medline; PubMed; Embase) between 1960 and March 2012 was performed using search terms including the following: obesity surgery, bariatric surgery, gastric bypass, cholesterol, lipids, triglycerides and non-esterified fatty acids. A total of 2442 manuscripts were screened. Papers with paired plasma lipid levels around RYGB surgery were included. Exclusions included the following: editorials, dual publications, n < 10, resulting in 75 papers of relevance. A meta-analysis was performed of the effect of RYGB surgery upon plasma lipids at different time points up to 4 years following surgery, using a random effects model.
Paired data were available for 7815 subjects around RYGB surgery for morbid obesity with a baseline BMI 48 kg/m2 (n = 2331). There was a reduction in plasma total cholesterol and LDL-C from 1 month up to 4 years post-RYGB (p < 0.00001, p < 0.00001). Following RYGB, HDL-C increased from 1 year onwards (p < 0.00001), and triglyceride levels were reduced postoperatively from 3 months up to 4 years (p < 0.00001). NEFA levels were increased at 1 month postoperatively (p = 0.003), but from 3 months onwards did not differ from preoperative levels (p = 0.07).
RYGB surgery reverses the dyslipidaemia of obesity. These findings support the use of RYGB in the management of high cardiovascular risk lipid profiles in morbid obesity.
KeywordsGastric bypass surgery Gastric bypass Lipidaemia Cholesterol Triglycerides NEFA
Body mass index
Gastric inhibitory polypeptide
Glucagon-like peptide 1
High-density lipoprotein cholesterol
Low-density lipoprotein cholesterol
Non-esterified fatty acids
Roux-en-Y gastric bypass
Standard mean difference
Type 2 diabetes mellitus
Conflict of Interest
The authors declare that they have no conflict of interest.
Compliance with Ethical Standards
This article does not contain any studies with human participants or animals performed by any of the authors.
This study does not apply informed consent.
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