Changes in Lipid Profile of Obese Patients following Contemporary Bariatric Surgery: A Meta-Analysis

• Published in: The American journal of medicine Vol. 129; no. 9; pp. 952 - 959
• Main Authors: Heffron, Sean P., MD, MS, MSc, Parikh, Amar, MD, Volodarskiy, Alexandar, MD, Ren-Fielding, Christine, MD, Schwartzbard, Arthur, MD, Nicholson, Joseph, MLIS, MPH, Bangalore, Sripal, MD, MHA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016; Elsevier Sequoia S.A
• Subjects: Bariatric Surgery; Cholesterol; Cholesterol - blood; Gastrointestinal surgery; Humans; Internal Medicine; Lipids; Lipids - blood; Lipoproteins, HDL - blood; Lipoproteins, LDL - blood; Meta-analysis; Middle Aged; Obesity; Obesity - blood; Obesity - surgery; Triglycerides - blood; meta-analysis; cholesterol; lipids; bariatric surgery; obesity; Obesity; Lipids; Cholesterol; Bariatric surgery; Meta-analysis
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2016.02.004

Abstract Background Although metabolic surgery was originally performed to treat hypercholesterolemia, the effects of contemporary bariatric surgery on serum lipids have not been systematically characterized. Methods and Results MEDLINE, EMBASE and Cochrane databases were searched for studies with ≥20 obese adults undergoing bariatric surgery [Roux-en-Y Gastric Bypass (RYGBP), Adjustable Gastric Banding, Bilio-Pancreatic Diversion (BPD), or Sleeve Gastrectomy]. The primary outcome was change in lipids from baseline to one-year after surgery. The search yielded 178 studies with 25,189 subjects (pre-operative BMI 45.5±4.8kg/m2 ) and 47,779 patient-years of follow-up. In patients undergoing any bariatric surgery, compared to baseline, there were significant reductions in total cholesterol (TC; -28.5mg/dL), low density lipoprotein cholesterol (LDL-C; -22.0mg/dL), triglycerides (-61.6mg/dL) and a significant increase in high density lipoprotein cholesterol (6.9mg/dL) at one year (P<0.00001 for all). The magnitude of this change was significantly greater than that seen in non-surgical control patients (eg LDL-C; -22.0mg/dL vs -4.3mg/dL). When assessed separately, the magnitude of changes varied greatly by surgical type (Pinteraction <0.00001; eg LDL-C: BPD -42.5mg/dL, RYGBP -24.7mg/dL, Adjustable Gastric Banding -8.8mg/dL, Sleeve Gastrectomy -7.9mg/dL). In the cases of Adjustable Gastric Banding (TC and LDL-C) and Sleeve Gastrectomy (LDL-C), the response at one year following surgery was not significantly different from non-surgical control patients. Conclusions Contemporary bariatric surgical techniques produce significant improvements in serum lipids, but changes vary widely, likely due to anatomic alterations unique to each procedure. These differences may be relevant in deciding the most appropriate technique for a given patient.