In patients with obesity, gastric bypass impacts lipid levels more than low-energy diet
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Key takeaways:
- Gastric bypass surgery plus a very low-energy diet reduced lipid levels more than a very low-energy diet alone at 6 weeks.
- There were no differences in fat mass reduction, blood pressure or glycemic control.
In patients with obesity, gastric bypass surgery plus a very low-energy diet reduced major atherogenic blood lipids to a greater degree than a very low-energy diet alone at 6 weeks, according to the results of the COCKTAIL trial.
For the nonrandomized controlled COCKTAIL trial of 78 patients with severe obesity (mean age, 48 years; 65% women) preparing for Roux-en-Y gastric bypass surgery or a very low-energy diet, the researchers put participants on a low-energy diet for 3 weeks prior to baseline, then on a very low-energy diet for 6 weeks (starting the date of surgery for those who had it). The outcomes of interest were changes in CV risk factors at 6 weeks.
The groups had similar baseline characteristics except for BMI (44.5 kg/m2 in the surgery group; 41.9 kg/m2 in the diet-only group).
At 6 weeks, both groups had similar reductions in fat mass, but the surgery group had greater reductions in atherogenic blood lipids, Cecilia Karlsson, MD, PhD, senior global development medical director at AstraZeneca and associate professor of medicine at Sahlgrenska Academy, University of Gothenburg, Sweden, and colleagues wrote in JAMA Surgery.
Between-group differences at 6 weeks favored the surgery group in the following lipids: LDL (–17.7 mg/dL; 95% CI, –27.9 to –7.5), non-HDL (–17.4 mg/dL; 95% CI, –29.8 to –5) and apolipoprotein B (–9.94 mg/dL; 95% CI, –15.75 to –4.14), and for lipoprotein(a), the geometric mean ratio favored the surgery group (0.55 U/L; 95% CI, 0.42-0.75), according to the researchers.
There were no differences between the groups at 6 weeks in changes in glycemic control or BP.
“The additional LDL cholesterol reduction of approximately 18 mg/dL in the [surgery] group is of a magnitude that may reduce the relative risk of CVD by 8% over 5 years,” Karlsson and colleagues wrote. “Furthermore, the LDL cholesterol reduction after [surgery] is similar with the effect of ezetimibe (10 mg/day), which may improve cardiovascular outcomes in people with preexisting CVD.”
In a related editorial, Leah J. Schoel, MD, general surgery resident at Michigan Medicine, and Dana A. Telem, MD, MPH, section head of general surgery, the associate chair for quality and patient safety and the Lazar J. Greenfield Professor of Surgery at Michigan Medicine, wrote: “While impressive, one is left wondering about the relevance of such a study in the contemporary landscape. With the rise of glucagon-like peptide-1 agonists, medical weight-loss therapy is arguably the comparison group of interest. Additionally, studying whether these benefits are reproduced across more popular weight-loss surgeries, such as sleeve gastrectomy, is imperative.”
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