Top

Obesity Surgery

Published in:

01-06-2016 | Original Contributions

Effects of Sleeve Gastrectomy and Gastric Bypass on Postprandial Lipid Profile in Obese Type 2 Diabetic Patients: a 2-Year Follow-up

Authors: E. Griffo, M. Cotugno, G. Nosso, G. Saldalamacchia, A. Mangione, L. Angrisani, A. A. Rivellese, B. Capaldo

Published in: Obesity Surgery | Issue 6/2016

Abstract

Background

Bariatric surgery (BS) is known to favorably impact fasting lipid profile. Fasting and postprandial lipids were evaluated before and 2 years after BS in obese type 2 diabetic (T2DM) patients.

Methods

A prospective study was conducted in 19 obese T2DM patients: ten undergoing sleeve gastrectomy (SG) and nine undergoing Roux-en-Y gastric bypass (RYGB). Before and 2 years after BS, clinical parameters and the response of lipid and incretin hormones to a mixed meal (MM) were assessed.

Results

The two groups had similar characteristics at baseline. After BS, weight loss was similar in the two groups (p ≤ 0.01). Fasting glucose, insulin, and triglycerides decreased while HDL cholesterol increased in a similar way (p < 0.05); in contrast, fasting LDL cholesterol decreased only after RYGB (p < 0.05). Post-meal glucose concentrations decreased while early insulin response significantly improved after both procedures (p < 0.001 for both). Postprandial triglycerides decreased after both procedures (p < 0.05) while postprandial LDL cholesterol decreased only after RYGB (p < 0.05). Meal-GLP-1 increased postoperatively in both groups although to a greater extent after RYGB (p < 0.001 vs. SG). GIP decreased after both procedures, especially after RYGB (p = 0.003). At multivariate analysis, GLP-1 peak was the best predictor of LDL reduction (β = −0.552, p = 0.039) while the improvement of HOMA-IR (β = 0.574, p = 0.014) and weight loss (β = 0.418, p = 0.036) predicted triglycerides reduction.

Conclusions

Both surgical procedures markedly reduce fasting and postprandial triglycerides and increase HDL cholesterol levels. LDL cholesterol decreases only after RYGB through a mechanism likely mediated by the restoration of GLP-1.

Yu J, Zhou X, Li L, et al. The long-term effects of bariatric surgery for type 2 diabetes: systematic review and meta-analysis of randomized and non-randomized evidence. Obes Surg. 2015;25(1):143–58.CrossRefPubMed

Moustarah F, Gilbert A, Després JP, et al. Impact of gastrointestinal surgery on cardiometabolic risk. Curr Atheroscler Rep. 2012;4(6):588–96.CrossRef

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;13(14):1724–37.CrossRef

Benetti A, Del Puppo M, Crosignani A, et al. Cholesterol metabolism after bariatric surgery in grade 3 obesity: differences between malabsorptive and restrictive procedures. Diabetes Care. 2013;36(6):1443–7.CrossRefPubMedPubMedCentral

Pihlajamäki J, Grönlund S, Simonen M, et al. Cholesterol absorption decreases after Roux-en-Y gastric bypass but not after gastric banding. Metabolism. 2010;59(6):866–72.CrossRefPubMed

Pirillo A, Norata GD, Catapano AL. Postprandial lipemia as a cardiometabolic risk factor. Curr Med Res Opin. 2014;30(8):1489–503.CrossRefPubMed

Griffo E, Nosso G, Lupoli R, et al. Early improvement of postprandial lipemia after bariatric surgery in obese type 2 diabetic patients. Obes Surg. 2014;24(5):765–70.CrossRefPubMed

Waldmann E, Hüttl TP, Göke B, et al. Effect of sleeve gastrectomy on postprandial lipoprotein metabolism in morbidly obese patients. Lipids Health Dis. 2013;12:82.CrossRefPubMedPubMedCentral

Umeda LM, Pereira AZ, Carneiro G, et al. Postprandial adiponectin levels are associated with improvements in postprandial triglycerides after Roux-en-Y gastric bypass in type 2 diabetic patients. Metab Syndr Relat Disord. 2013;11(5):343.CrossRefPubMed

10.

Patel VJ, Joharapurkar AA, Shah GB, et al. Effect of GLP-1 based therapies on diabetic dyslipidemia. Curr Diabetes Rev. 2014;10(4):238–50.CrossRefPubMed

11.

Mells JE, Anania FA. The role of gastrointestinal hormones in hepatic lipid metabolism. Semin Liver Dis. 2013;33(4):343–57.CrossRefPubMedPubMedCentral

12.

Ben-Shlomo S, Zvibel I, Shnell M, et al. Glucagon-like peptide-1 reduces hepatic lipogenesis via activation of AMP-activated protein kinase. J Hepatol. 2011;54(6):1214–23.CrossRefPubMed

13.

Svegliati-Baroni G, Saccomanno S, Rychlicki C, et al. Glucagon-like peptide-1 receptor activation stimulates hepatic lipid oxidation and restores hepatic signalling alteration induced by a high-fat diet in nonalcoholic steatohepatitis. Liver Int. 2011;31(9):1285–97.CrossRefPubMed

14.

Nakatani H, Kasama K, Oshiro T, et al. Serum bile acid along with plasma incretins and serum high-molecular weight adiponectin levels are increased after bariatric surgery. Metabolism. 2009;58(10):1400–7.CrossRefPubMed

15.

Kohli R, Bradley D, Setchell KD, et al. Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. J Clin Endocrinol Metab. 2013;98(4):E708–12.CrossRefPubMedPubMedCentral

16.

Patti ME, Houten SM, Bianco AC, et al. Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism. Obesity (Silver Spring). 2009;17(9):1671–7.CrossRef

17.

Moschetta A. Nuclear receptors and cholesterol metabolism in the intestine. Atheroscler Suppl. 2015;17:9–11.CrossRefPubMed

18.

Padilla N, Maraninchi M, Béliard S, et al. Effects of bariatric surgery on hepatic and intestinal lipoprotein particle metabolism in obese, nondiabetic humans. Arterioscler Thromb Vasc Biol. 2014;34(10):2330–7.CrossRefPubMed

19.

Rao RS, Kini S. GIP and bariatric surgery. Obes Surg. 2011;21(2):244–52.CrossRefPubMed

20.

Miyawaki K, Yamada Y, Ban N, et al. Inhibition of gastric inhibitory polypeptide signaling prevents obesity. Nat Med. 2002;8(7):738–42.CrossRefPubMed

21.

Miyawaki K, Yamada Y, Yano H, et al. Glucose intolerance caused by a defect in the enteroinsular axis: a study in gastric inhibitory polypeptide receptor knockout mice. Proc Natl Acad Sci U S A. 1999;96(26):14843–7.CrossRefPubMedPubMedCentral

22.

Brethauer SA, Aminian A, Romero-Talamás H, et al. Can diabetes be surgically cured?: Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–37.PubMedPubMedCentral

Title: Effects of Sleeve Gastrectomy and Gastric Bypass on Postprandial Lipid Profile in Obese Type 2 Diabetic Patients: a 2-Year Follow-up
Authors: E. Griffo
M. Cotugno
G. Nosso
G. Saldalamacchia
A. Mangione
L. Angrisani
A. A. Rivellese
B. Capaldo
Publication date: 01-06-2016
Publisher: Springer US
Published in: Obesity Surgery / Issue 6/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-015-1891-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Effects of Sleeve Gastrectomy and Gastric Bypass on Postprandial Lipid Profile in Obese Type 2 Diabetic Patients: a 2-Year Follow-up

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2016

Nicola Scopinaro, MD, FACS (Hon)

Response to the Letter to the Editor for “Pharmacotherapy for the Treatment of Weight Recidivism or Weight-Loss Plateau Post-Bariatric Surgery”

Behavioural Interventions for Severe Obesity Before and/or After Bariatric Surgery: a Systematic Review and Meta-analysis

Copper Deficiency after Gastric Bypass for Morbid Obesity: a Systematic Review

Early Weight Loss as a Predictor of 2-Year Weight Loss and Resolution of Comorbidities After Sleeve Gastrectomy

Laparoscopic Management of Internal Hernia After Roux-en-Y Gastric Bypass