Changes in Body Weight, Glucose Homeostasis, Lipid Profiles, and Metabolic Syndrome after Restrictive Bariatric Surgery

To, V. T.; Hüttl, T. P.; Lang, R. A.; Piotrowski, Katja; Parhofer, Klaus G.

doi:10.1055/s-0032-1323738

Cited by 39 publications

(24 citation statements)

References 17 publications

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“…Furthermore, after surgery, there was a reduction in plasma leptin levels and, at the sixth month, in plasma insulin and insulin resistance. This suggests that the sympathoinhibition may play a role in the favorable cardiovascular and metabolic effects of this therapeutic procedure reported in previous studies [5][6][7]10 and largely confirmed in the present one. This is not unexpected because the importance of sympathetic hyperactivity in the pathogenesis of hypertension is well documented [32][33][34] and so is, both in experimental animals and in man, its stimulating influence on leptin and insulin secretion, [35][36][37] as well as its ability to cause or worsen insulin resistance.…”

Section: Discussionsupporting

confidence: 91%

“…[2][3][4] It is a widespread belief that the protective effect of bariatric surgery in obese patients may perhaps be related to a reduction of body weight per se but that the concomitant improvement of the array of risk factors commonly associated with obesity, for example, alterations in lipid and glucose metabolism, is likely to play a major role. [5][6][7] In this context, however, little attention has to date been given to whether bariatric surgery is also associated with the improvement of another adverse phenomenon of obesity (ie, sympathetic activation). 8,9 The only information available comes from 3 studies that assessed sympathetic tone by making use of spectral analysis of heart rate signal or 24-hour norepinephrine urinary excretion [10][11][12] (ie, approaches that display major intrinsic limitations not allowing to provide any direct insight on the effects of the intervention on central sympathetic outflow, as the microneurographic technique only allows to achieve 13 .)…”

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confidence: 99%

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Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

Seravalle

Colombo

et al. 2014

Hypertension

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L ong-term prospective studies have recently shown that bariatric surgery significantly reduces the risk of death in severely obese patients.1 This has been confirmed by retrospective analyses of a large cohort of obese individuals in whom surgery-related reductions in body weight were associated with a significant reduction in death rate compared with obese individuals followed under dietary and medical treatment. [2][3][4] It is a widespread belief that the protective effect of bariatric surgery in obese patients may perhaps be related to a reduction of body weight per se but that the concomitant improvement of the array of risk factors commonly associated with obesity, for example, alterations in lipid and glucose metabolism, is likely to play a major role. [5][6][7] In this context, however, little attention has to date been given to whether bariatric surgery is also associated with the improvement of another adverse phenomenon of obesity (ie, sympathetic activation). 8,9 The only information available comes from 3 studies that assessed sympathetic tone by making use of spectral analysis of heart rate signal or 24-hour norepinephrine urinary excretion [10][11][12] (ie, approaches that display major intrinsic limitations not allowing to provide any direct insight on the effects of the intervention on central sympathetic outflow, as the microneurographic technique only allows to achieve 13 .) The issue has pathophysiological and clinical relevance because sympathetic activation has been shown to be an adverse prognostic factor in several clinical conditions.14-17 Furthermore, evidence has been obtained that sympathetic overdrive may cause or worsen insulin resistance, 18,19 thus contributing to a common metabolic alteration in obesity.Abstract-Weight loss improves insulin sensitivity and exerts sympathomodulatory effects. No data, however, are available on the effects of the weight loss induced by vertical sleeve gastrectomy on sympathetic neural drive, insulin sensitivity, and their reciprocal cross talks. In 10 severe obese hypertensives (age, 54.0±2.3 years [mean±SEM]), we measured sphygmomanometric blood pressure, heart rate, body mass index, homeostatic model assessment index, plasma leptin, muscle sympathetic nerve traffic (microneurography), and baroreflex sensitivity (vasoactive drug technique). Measurements were performed 2 to 3 days before surgery and repeated 6 and 12 months after the procedure. Ten matched hypertensive obeses not undergoing gastrectomy served as controls. Six months after bariatric surgery, a significant (P<0.05) reduction in body mass index (−9.1±1.4 kg/m 2 ), sphygmomanometric systolic blood pressure (−10.2±4.5 mm Hg), heart rate (−11.0±2.4 bpm), homeostatic model assessment index (−3-3±1.3 AU), plasma leptin (−53.6±8.8 μg/L), and muscle sympathetic nerve traffic (−15.0±3.4 bursts/100 heart beats) was observed. The weight loss, the plasma leptin reduction, and the sympathetic inhibition were maintained after 12 months, whereas homeostatic model assessment index showed a tendency ...

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

Seravalle

Colombo

et al. 2014

Hypertension

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“…While studies of restrictive procedures have demonstrated correlations of triglyceride change with reductions in body weight, adiposity or insulin resistance, 17-19 the associations are much weaker in hybrid procedures. 20-23 The impacts on incretin hormones, in particular the exaggerated post-prandial GLP-1 response characteristic of RYGBP and BPD, yield improvements in insulin sensitivity beyond those expected due to weight loss alone, and beyond that seen with restrictive procedures. 24 Improved insulin sensitivity results in lower VLDL levels and, in turn, triglycerides, in patients undergoing RYGBP and BPD.…”

Section: Discussionmentioning

confidence: 99%

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

Heffron

Parikh

Volodarskiy

et al. 2016

The American Journal of Medicine

103

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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.

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“…These findings are in keeping with the results of several studies and meta-analysis showing an improvement of dyslipidemia, mainly a decrease in fasting plasma triglyceride, plasma TC, and an increase in HDL-C, in the shortterm (6-12 months) or long-term (≥12 months) after bariatric surgery. 21,23,24 A few studies have investigated the effect of bariatric surgery on postprandial lipoprotein concentrations. In patients with obesity and type 2 diabetes mellitus, the plasma concentrations of triglyceride, TC, and the incremental area under the curve of triglyceride decreased and HDL-C increased after a test meal performed 2 weeks after bariatric surgery, with a similar effect after SG and BP procedures.…”

Section: Discussionmentioning

confidence: 99%

Effects of Bariatric Surgery on Hepatic and Intestinal Lipoprotein Particle Metabolism in Obese, Nondiabetic Humans

Padilla

Maraninchi

Béliard

et al. 2014

ATVB

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T he prevalence of obesity is steadily increasing so much, so that obesity has become a pandemic in developed and developing nations. 1 The increased risk of morbidity and mortality and more particularly of atherosclerotic cardiovascular disease associated with obesity and insulin-resistant states is of great public health concern.2,3 Each 5 kg/m 2 increase above a body mass index (BMI) of 25 kg/m 2 results in a 40% increase in cardiovascular mortality.3 Dyslipidemia is a prominent feature of obesity and insulin-resistant states. 4 The typical dyslipidemia associated with these conditions is mainly characterized by elevated plasma triglyceride concentration, low high-density lipoprotein-cholesterol (HDL-C) level, increased proportion of small and dense low-density lipoprotein (LDL), and postprandial hyperlipidemia.4,5 These abnormalities contribute to the high residual cardiovascular risk observed in obesity and insulin-resistant states, even if low LDL-C levels are achieved by statin treatment.6,7 The pathophysiology of this dyslipidemia is widely explained by the blood accumulation of triglyceride-rich lipoproteins (TRL) from the liver (apolipoprotein [apo]B-100-containing very low-density lipoprotein [VLDL]) and the intestine (apoB-48-containing chylomicrons). This accumulation has been attributed to the © 2014 American Heart Association, Inc. Objective-The dyslipidemia of obesity and other insulin-resistant states is characterized by the elevation of plasma triglyceride-rich lipoproteins (TRL) of both hepatic (apoB-100-containing very low-density lipoprotein) and intestinal (apoB-48-containing chylomicrons) origin. Bariatric surgery is a well-established and effective modality for the treatment of obesity and is associated with improvements in several metabolic abnormalities associated with obesity, including a reduction in plasma triglycerides. Here, we have investigated the effect of bariatric surgery on TRL metabolism. Approach and Results-Twenty-two nondiabetic, obese subjects undergoing bariatric surgery: sleeve gastrectomy (n=12) or gastric bypass (n=10) were studied. Each subject underwent 1 lipoprotein turnover study 1 month before surgery followed by a second study, 6 months after surgery, using established stable isotope enrichment methodology, in constant fed state. TRL-apoB-100 concentration was significantly reduced after sleeve gastrectomy, explained by a decrease (P<0.05) in TRL-apoB-100 production rate and an increase (P<0.05) in TRL-apoB-100 fractional catabolic rate. TRLapoB-48 concentration was also significantly reduced after sleeve gastrectomy, explained by reduction in TRL-apoB-48 production rate (P<0.05). For gastric bypass, although TRL-apoB-100 concentration declined after surgery (P<0.01), without a significant decline in TRL-apoB-48, there was no significant change in either TRL-apoB-100 or TRL-apoB-48 production rate or fractional catabolic rate. The reduction in TRL-apoB-100 concentration was significantly associated with a reduction in plasma apoC-III in the pooled group of pati...

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Changes in Body Weight, Glucose Homeostasis, Lipid Profiles, and Metabolic Syndrome after Restrictive Bariatric Surgery

Cited by 39 publications

References 17 publications

Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients

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

Effects of Bariatric Surgery on Hepatic and Intestinal Lipoprotein Particle Metabolism in Obese, Nondiabetic Humans

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