You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Effect of Gastric Bypass Versus Diet on Cardiovascular Risk Factors

Raffaelli, Marco MD*; Guidone, Caterina MD; Callari, Cosimo MD*; Iaconelli, Amerigo MD; Bellantone, Rocco MD*; Mingrone, Geltrude MD

Annals of Surgery:
doi: 10.1097/SLA.0b013e31829d6989
Original Articles

Objective: To assess the effect of Roux-en-Y gastric bypass (RYGB) on high-density lipoprotein cholesterol (HDL-C) concentration and its apolipoprotein A4 (ApoA4) content at 1 year after bariatric surgery in comparison with a hypocaloric diet. Secondary aim was to measure total cholesterol and triglycerides levels and insulin sensitivity after interventions.

Background: Very few prospective uncontrolled studies have investigated the effects of RYGB on cardiovascular risk factors. No controlled studies had as primary goal the changes in HDL-C after gastric bypass.

Methods: Forty subjects with a body mass index more than 40 or 35 kg/m2 or more in the presence of diabetes were enrolled. Twenty of them underwent RYGB, whereas 20 received lifestyle modification suggestions and medical therapy for obesity complications (diabetes, hypertension, and hyperlipidemia).

Results: A significant (P < 0.0001) increase in HDL-C concentrations was observed only in the surgical arm (from 41.95 ± 7.24 to 56.55 ± 9.01 mg/dL). Mean systolic and diastolic blood pressures were significantly reduced (P < 0.0001) in both groups with no between-group differences, probably in relation to the optimization of the antihypertensive treatment. Plasma concentration of ApoA4, a major HDL-C protein fraction, significantly increased 1 year after RYGB (from 496.61 ± 400.41 to 987.88 ± 637.41μg/L, P < 0.01). Circulating triglycerides concentration significantly decreased after surgery, whereas both peripheral and hepatic insulin resistance increased significantly.

Conclusions: Our study shows that HDL-C and ApoA4 significantly increase after gastric bypass and that this increase is associated with a net improvement in hepatic insulin sensitivity. Furthermore, we speculate that ApoA4, which induces satiety in animals, can eventually play a role on the appetite reduction after RYGB because there is a strict and inverse relationship between weight and ApoA4 changes. (NCT01707771)

In Brief

This is a prospective, controlled study aiming at investigating the effects of gastric bypass on high-density lipoprotein cholesterol plasma concentration and apolipoprotein A4 content at 1 year after gastric bypass in comparison with a hypocaloric diet. Changes in total cholesterol and triglyceride levels and insulin sensitivity after interventions have been also studied.

Author Information

Departments of *Surgery and

Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.

Reprints: Marco Raffaelli, MD, Istituto di Semeiotica Chirurgica, U.O. di Chirurgia Endocrina e Metabolica, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go A. Gemelli 8-00168, Rome, Italy. E-mail:

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.