Gastric bypass for obesity lowers major atherogenic blood lipids vs. very low-energy diet
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Key takeaways:
- Roux-en-Y gastric bypass reduced atherogenic blood lipids at 6 weeks, while lipids remained stable with a very low-energy diet.
- There were no differences in glycemic control and blood pressure between groups.
Patients with severe obesity undergoing Roux-en-Y gastric bypass for weight loss demonstrated greater reductions in blood lipids at 6 weeks vs. those on a very low-energy diet, according to study results in JAMA Surgery.
“Bariatric surgery is more effective than nonsurgical treatment in reducing body weight and cardiovascular risk factors such as type 2 diabetes, hypertension and dyslipidemia in patients with severe obesity,” Cecilia Karlsson, MD, PhD, senior global development medical director at AstraZeneca, and colleagues wrote. “It is further associated with lower incidence of cardiovascular events and lower all-cause mortality.”
They continued: “Whether the beneficial effects are specifically explained by the surgical procedure, caloric restriction or weight loss is unclear, as most studies have displayed large weight loss differences between groups.”
In the open, nonrandomized controlled COCKTAIL study in Norway, researchers compared changes in glucose metabolism, blood pressure, blood lipids, metabolic biomarkers and body composition in adult patients with severe obesity undergoing weight loss treatment with Roux-en-Y gastric bypass or a very low-energy diet (< 800 kcal/d).
Seventy-eight patients (mean age, 47.5 years; 65% women) were included in the statistical analysis — 41 undergoing gastric bypass and 37 receiving the diet. The difference in mean BMI between groups at baseline was not significant (44.5 vs. 41.9), and other demographic and clinical characteristics were similar.
All patients participated in 3 weeks of a low energy diet (< 1,200 kcal/d), followed by 6 weeks of the very low-energy diet alone or after bypass surgery.
Following the 3-week low-energy diet, researchers reported reductions of 5% in body weight, 8% in fat mass, 4% in HbA1c, 5% in systolic blood pressure and 19% in LDL cholesterol, although there were no “clinically relevant differences” between groups.
According to results, the gastric bypass group lost more weight between weeks 3 and 9 than the very low-energy diet group, with a mean between-group difference of –2.3 kg (95% CI, –3.4 to –1.2).
Although both groups had similar fat mass loss at 6 weeks, the gastric bypass group experienced reductions in total cholesterol, LDL cholesterol and non-HDL cholesterol, whereas those values remained stable or “tended to increase” in the diet group. The between-group mean differences were –18 mg/dL (95% CI, –31.4 to –4.6), –17.7 mg/dL (95% CI, –27.9 to –7.5) and –17.4 mg/dL (95% CI, –29.8 to –5), respectively.
In addition, apolipoprotein and lipoprotein(a) decreased with surgery and diet but not diet alone, with a mean between-group difference of –9.94 mg/dL (95% CI, –15.75 to –4.14) and geometric mean ratio of 0.55 U/L (95% CI, 0.42-0.72), respectively.
There were no differences between groups glycemic control and blood pressure.
“Key novel findings from our study demonstrate that major atherogenic blood lipids were reduced at 6 weeks after Roux-en-Y gastric bypass but remained stable after very low-energy diet despite a similar fat mass loss,” Karlsson and colleagues wrote. “By contrast, both groups improved in HbA1c, with no differences in changes between groups in HbA1c, insulin sensitivity and blood pressure.”
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