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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

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)

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.

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.