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Effectiveness of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Lipid Levels in Type 2 Diabetes: a Meta-analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Obesity and its co-morbidities, including type 2 diabetes (T2DM) and dyslipidemia, are accompanied by excess cardiovascular morbi-mortality. Aside from excess low density lipoprotein-cholesterol (LDL-C), atherogenic dyslipidemia (AD), mainly characterized by elevated triglycerides and decreased high density lipoprotein-cholesterol (HDL-C) levels, is often present in T2DM obese patients. Bariatric surgery, such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), has become a reference treatment in that population. However, the respective effects of RYGB vs SG on lipid metabolism in T2DM patients have been rarely studied.

Methods

A meta-analysis of randomized controlled trials, comparing the effects of RGYBG vs SG on lipid metabolism 12 months after surgery in T2DM patients, was performed.

Results

Four studies including a total of 298 patients (151 patients in the RYGB and 147 patients in the SG group) were examined. Despite a greater decrease in body mass index and greater improvement in glycemic control in RYGB compared to SG. RYGB vs SG was more effective in reducing total cholesterol, LDL-C, and non-HDL-C levels (mean difference [MD] −26.10 mg/dL, 95 % CI −38.88 to −13.50, p<0.00001; [MD] −20.10 mg/dL, 95 % CI −27.90 to −12.20, p<0.00001 and MD 31.90 mg/dl, 95 % CI −46.90 to −16.80, p<0.00001, respectively).

Conclusions

The superiority of RYGB vs SG in reducing LDL-C, with an effect comparable to a moderate-intensity statin, suggests RYBG should be favored in hypercholesterolemic T2DM patients in order to further reduce cardiovascular risk.

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Acknowledgments

We are grateful to Lagranja Elena at the Researcher at the CIENM center being part of the faculty of health sciences for performing the systematic search, and we thank for proofreading the manuscript.

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Authors and Affiliations

  1. Centro Medico Melian, Av. 9 de Julio 243, CP: 3600, Formosa, Argentina

    Cecilia Closs

  2. Centro CIEN, Corrientes, Salta 1524, CP: 3400, Corrientes, Argentina

    Marianela Ackerman

  3. Hospital Italiano de Buenos Aires, Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CP:1199, Buenos Aires, Argentina

    Walter Masson

  4. Consejo de Epidemiologia y Prevención, Sociedad Argentina de Cardiología, Azcuénaga 980, CP: 1115, Buenos Aires, Argentina

    Martin Lobo, Graciela Molinero & Augusto Lavalle-Cobo

  5. Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, University Hospital La Conception, Department of Nutrition, Metabolic Diseases and Endocrinology, 147 Bd Baille, 13005, Marseille, France

    Sophie Béliard, Florian Mourre & René Valéro

  6. Centro de Investigación en Endocrinología, Nutrición y Metabolismo (CIENM), Facultad de Ciencias de la Salud, Universidad Nacional de Formosa, Av. Gutnisky 3200, 3600, Formosa, Argentina

    Juan Patricio Nogueira

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Contributions

Nogueira Juan Patricio was the main coordinator of the project and was responsible for the study design. Closs Cecilia, Ackerman Marianela, and René Valéro drafted the manuscript of the present paper. Sophie Beliard, Mourre Florian, and Molinero Graciela were involved in the supervising of data collection and stratification. Lobo Martin and Nogueira Juan Patricio contributed to data assembly and analysis. Lavalle-Covos Augusto contributed with manuscript revision. All authors contributed intellectually to this manuscript and have approved this final version.

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Correspondence to Juan Patricio Nogueira.

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Closs, C., Ackerman, M., Masson, W. et al. Effectiveness of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Lipid Levels in Type 2 Diabetes: a Meta-analysis. J Gastrointest Surg 26, 1575–1584 (2022). https://doi.org/10.1007/s11605-022-05338-5

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