To determine the change in weight loss, lipid profile, and cardiovascular risk predictor (CVRP) in moderately, morbidly, and super obese patients who underwent laparoscopic sleeve gastrectomy (LSG).
Subjects and Method:
A total of 115 patients who diagnosed as moderately (n = 35), morbidly (n = 60), and super obese (n = 20) underwent LSG, and followed up were evaluated retrospectively. The anthropometric measurements of the patients were evaluated four times: Preoperative, 0–4 months, 5–12 months, and after 1 year. Biochemical findings were evaluated twice as the first and last evaluation.
Results:
In this study the median percentage of excess weight loss (%EWL) was 77.9% (12.4–214.7), and median percentage of excess BMI loss (%EBL) was 83.3% (34.9–130.9) after 1 year. Total cholesterol and triglyceride levels decreased significantly in morbidly obese patients (p = 0.01, p = 0.02, respectively). C-reactive protein was greatly reduced in moderately obese patients (p = 0.01). Alanine aminotransferase levels improved in moderately and morbidly obese patients after 1 year (p = 0.01, p = 0.002). CVRP decreased significantly from 3.2 to 2.4 after 1 year in all patients (p = 0.04). There was a negative correlation between %EBL (r = −0,857, p = 0.01), percentage of total body weight loss (r = −0.786, p = 0.03), and CVRP in moderately obese patients.
Conclusion:
In conclusion, we observed that LSG appears to reduce lipid profile and CVRP in moderately and morbidly obese patients in our study.
Get full access to this article
View all access options for this article.
References
1.
SabuncuT, BayramF, SonmezA, GuldikenS, SahinI, YilmazM, et al.Bariatric Surgery Guide. 1st Edn [in Turkish]. Ankara, Turkey: BAYT Bilimsel Araştırmalar Basın Yayın, 2018:1–95.
PoirierP, GilesTD, BrayGA, HongY, SternJS, Pi-SunyerFX, EckelRH. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association scientific statement on obesity and heart disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation, 2006; 113:898–918.
4.
Ruiz-TovarJ, ZubiagaL, LlaveroC.Mammary Volume-to-Body Mass Index Ratio: preoperative Predictor of Cardiovascular Risk Factor and Indicator of Long-term Postoperative Remission of Comorbidities in Premenopausal Women Undergoing Sleeve Gastrectomy. Obes Surg, 2020 [Epub ahead of print]; DOI: 10.1007/s11695-020-04887-5.
5.
FisherBL, SchauerP. Medical and surgical options in the treatment of Moderate obesity. Am J Surg, 2002; 184:9S–16S.
6.
DixonJB, DixonME, O'BrienPE. Quality of life after lap-band placement: influence of time, weight loss, and comorbidities. Obes Res, 2001; 9:713–721.
7.
SjostromL, NarbroK, SjostromCD, KarasonK. Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med, 2007; 357:741–752.
8.
AdamsTD, GressRE, SmithSC. Long-term mortality after gastric bypass surgery. N Engl J Med, 2007; 357:753–761.
9.
GuidaB, CataldiM, BusettoL, AielloML, MusellaM, CaponeD, et al.Predictors of fat-free mass loss 1 year after laparoscopic sleeve gastrectomy. J Endocrinol Invest, 2018; 41:1307–1315.
10.
ZhangF, StrainGW, LeiW, DakinGF, GagnerM, PompA. Changes in lipid profiles in morbidly obese patients after laparoscopic sleeve gastrectomy (LSG). Obes Surg, 2011; 21:305–309.
11.
BenaigesD, Flores-Le-RouxJA, Pedro-BotetJ, RamonJM, ParriA, VillatoroM, et al.Obemar Group. Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery (Roux-en-Y gastric bypass) on lipid profile. Obes Surg, 2012; 22:1268–1275.
12.
SharaihaRZ, KumtaNA, SaumoyM, DesaiAP, SarkisianAM, BenevenutoA, et al.Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients. Clin Gastroenterol Hepatol, 2017; 15:504–510.
13.
GazianoJM, HennekensCH, O'DonnellCJ, BreslowJL, BuringJE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation, 1997; 96:2520–2525.
14.
CottamDR, MattarSG, Barinas-MitchellE, EidG, KullerL, KelleyDE, et al.The chronic inflammatory hypothesis for the morbidity associated with morbid obesity: implications and effects of weight loss. Obes Surg, 2004; 14:589–600.
15.
CarboneF, Nulli MigliolaE, BonaventuraA, VecchiéA, De VuonoS, RicciMA, et al.High serum levels of C-reactive protein (CRP) predict beneficial decrease of visceral fat in obese females after sleeve gastrectomy. Nutr Metab Cardiovasc Dis, 2018; 28:494–500.
16.
HayesK, EidG. Laparoscopic sleeve gastrectomy: surgical technique and perioperative care. Surg Clin North Am, 2016; 96:763–771.
17.
Ruiz-TovarJ, OllerI, GalindoI, LlaveroC, ArroyoA, CaleroA, et al.Change in levels of C-reactive protein (CRP) and serum cortisol in morbidly obese patients after laparoscopic sleeve gastrectomy. Obes Surg, 2013; 23:764–769.
18.
BuseJB, CaprioS, CefaluWT, CerielloA, Del PratoS, InzucchiSE, et al.How do we define cure of diabetes?. Diabetes Care, 2009, 32:2133–2135.
19.
PratiD, TaioliE, ZanellaA, Della TorreE, ButelliS, Del VecchioE, et al.Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med, 2002; 2:137:1–10.
20.
Gastrointestinal surgery for Moderate obesity: national Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr, 1992; 55:615S–619S.
WhiteS, HanSH, LewisC, PatelK, McEvoyB, KadellB, et al.Selective approach to use of upper gastroesophageal imaging study after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis, 2008; 4:122–125.
23.
MenenakosE, StamouKM, AlbanopoulosK, PapailiouJ, TheodorouD, LeandrosE. Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg, 2010; 20:276–282.
24.
PeterliR, BorbélyY, KernB, GassM, PetersT, ThurnheerM, et al.Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg, 2013; 258:690–694.
25.
KatsanosCS, MaduraJA 2nd, RoustLR. Essential amino acid ingestion as an efficient nutritional strategy for the preservation of muscle mass following gastric bypass surgery. Nutrition, 2016; 32:9–13.
26.
ChastonTB, DixonJB, O'BrienPE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes (Lond), 2007; 31:743–750.
27.
Damms-MachadoA, FriedrichA, KramerKM, StingelK, MeileT, KüperMA, et al.Pre- and postoperative nutritional deficiencies in obese patients under-going laparoscopic sleeve gastrectomy. Obes Surg, 2012; 22:881e9.
ErdemZ, KahramanF.Monitoring the diets of bariatric patients. Basic Nutrition and Dietetics. 1st Edn [in Turkish]. Ankara, Turkey: Güneş Medical Bookstore, 2015. pp. 355–382.
30.
MoizeV, AndreuA, RodriguezL, FloresL, IbarzabalA, LacyA, et al.Protein intake and lean tissue mass retention following bariatric surgery. Clin Nutr, 2013; 32:550–555.
31.
GazianoJM.Triglycerides and coronary risk. Curr Cardiol Rep, 1999; 1:125–130.
32.
HokansonJE, AustinMA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of populationbased prospective studies. J Cardiovasc Risk, 1996; 3:213–219.
33.
IannelliA, AntyR, PicheT, DahmanM, GualP, TranA, et al.Impact of laparoscopic Roux-en-Y gastric bypass on metabolic syndrome, inflammation, and insulin resistance in super versus morbidly obese women. Obes Surg, 2009; 19:577–582.
34.
HadyHR, DadanJ, GołaszewskiP, SafiejkoK. Impact of laparoscopic sleeve gastrectomy on body mass index, ghrelin, insulin and lipid levels in 100 obese patients. Wideochir Inne Tech Maloinwazyjne, 2012; 7:251–259.
35.
PoirierP, GilesTD, BrayGA, HongY, SternJS, Pi-SunyerFX, et al.American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation, 2006, 14; 113:898–918.
36.
RidkerPM, BuringJE, CookNR, RifaiN.C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation, 2003, 28; 107:391–397.
37.
KoppHP, KoppCW, FestaA, KrzyzanowskaK, KriwanekS, MinarE, et al.Impact of weight loss on inflammatory proteins and their association with the insulin resistance syndrome in morbidly obese patients. Arterioscler Thromb Vasc Biol, 2003, 1; 23:1042–1047.
