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Petrinović M, Majetić D, Bakula M, Pećin I, Fabris-Vitković D, Deškin M, Tešanović Perković D, Bakula M, Gradišer M, Ćurčić IB, Canecki-Varžić S. Molecular Mechanisms Affecting Statin Pharmacokinetics after Bariatric Surgery. Int J Mol Sci 2024; 25:10375. [PMID: 39408705 PMCID: PMC11476770 DOI: 10.3390/ijms251910375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/20/2024] Open
Abstract
According to recent data, one in eight people in the world struggle with obesity. Obesity management is increasingly dependent on bariatric surgical interventions, as the combination of lifestyle modifications and pharmacotherapy could have a modest long-term effect. Surgery is recommended only for individuals whose body mass index (BMI) ≥ 40 kg/m2 and ≥ 35 kg/m2 in the presence of weight-related comorbidities. The most commonly performed procedures are sleeve gastrectomy and roux-en-Y gastric bypass. Pharmacokinetic and pharmacodynamic alterations occur as a result of the anatomical and physiological changes caused by surgery, which further differ depending on physicochemical drug factors and factors related to the dosage form. The following modifications are distinguished based on the type of bariatric surgery performed. Most bariatric patients have accompanying comorbidities, including dyslipidemia treated with hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors or statins. Significant improvements in the lipid profile are observed early in the postoperative period. The data reported in this review on statin pharmacokinetic alterations have demonstrated substantial inter- and intravariability, making it difficult to adopt clear guidelines. Based on the current literature review, reducing the statin dose to the lowest effective with continuous monitoring is considered an optimal approach in clinical practice.
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Affiliation(s)
- Matea Petrinović
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.P.); (D.M.)
- Polyclinic Slavonija, 31000 Osijek, Croatia
| | - Domagoj Majetić
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.P.); (D.M.)
- The Clinic for Internal Diseases, Department for Gastroenterology and Hepatology, Clinical Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Miro Bakula
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolic Diseases, Sveti Duh University Hospital, 10000 Zagreb, Croatia;
| | - Ivan Pećin
- Department of Internal Medicine, Unit for Metabolic Diseases, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Marin Deškin
- Division of Endocrinology and Diabetes, General Hospital Pula, 52100 Pula, Croatia
| | | | - Maja Bakula
- Vuk Vrhovac University Clinic for Diabetes and Metabolism, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Marina Gradišer
- Internal Medicine Department, County Hospital Čakovec, 40000 Čakovec, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Ines Bilić Ćurčić
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.P.); (D.M.)
- Clinic for Internal Diseases, Department for Endocrinology and Diabetes, Clinical Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Silvija Canecki-Varžić
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.P.); (D.M.)
- Clinic for Internal Diseases, Department for Endocrinology and Diabetes, Clinical Hospital Centre Osijek, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Karlsson C, Johnson LK, Greasley PJ, Retterstøl K, Hedberg J, Hall M, Hawker N, Robertsen I, Havsol J, Hertel JK, Sandbu R, Skovlund E, Olsen T, Christensen H, Jansson-Löfmark R, Andersson S, Åsberg A, Hjelmesæth J. Gastric Bypass vs Diet and Cardiovascular Risk Factors: A Nonrandomized Controlled Trial. JAMA Surg 2024; 159:971-980. [PMID: 38959017 PMCID: PMC11223056 DOI: 10.1001/jamasurg.2024.2162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/13/2024] [Indexed: 07/04/2024]
Abstract
Importance Roux-en-Y gastric bypass (RYGB) is associated with reduced cardiovascular (CV) risk factors, morbidity, and mortality. Whether these effects are specifically induced by the surgical procedure or the weight loss is unclear. Objective To compare 6-week changes in CV risk factors in patients with obesity undergoing matching caloric restriction and weight loss by RYGB or a very low-energy diet (VLED). Design, Setting, and Participants This nonrandomized controlled study (Impact of Body Weight, Low Calorie Diet, and Gastric Bypass on Drug Bioavailability, Cardiovascular Risk Factors, and Metabolic Biomarkers [COCKTAIL]) was conducted at a tertiary care obesity center in Norway. Participants were individuals with severe obesity preparing for RYGB or a VLED. Recruitment began February 26, 2015; the first patient visit was on March 18, 2015, and the last patient visit (9-week follow-up) was on August 9, 2017. Data were analyzed from April 30, 2021, through June 29, 2023. Interventions VLED alone for 6 weeks or VLED for 6 weeks after RYGB; both interventions were preceded by 3-week LED. Main Outcomes and Measures Between-group comparisons of 6-week changes in CV risk factors. Results Among 78 patients included in the analyses, the mean (SD) age was 47.5 (9.7) years; 51 (65%) were women, and 27 (35%) were men. Except for a slightly higher mean (SD) body mass index of 44.5 (6.2) in the RYGB group (n = 41) vs 41.9 (5.4) in the VLED group (n = 37), baseline demographic and clinical characteristics were similar between groups. Major atherogenic blood lipids (low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B, lipoprotein[a]) were reduced after RYGB in comparison with VLED despite a similar fat mass loss. Mean between-group differences were -17.7 mg/dL (95% CI, -27.9 to -7.5), -17.4 mg/dL (95% CI, -29.8 to -5.0) mg/dL, -9.94 mg/dL (95% CI, -15.75 to -4.14), and geometric mean ratio was 0.55 U/L (95% CI, 0.42 to 0.72), respectively. Changes in glycemic control and blood pressure were similar between groups. Conclusions and Relevance This study found that clinically meaningful reductions in major atherogenic blood lipids were demonstrated after RYGB, indicating that RYGB may reduce CV risk independent of weight loss. Trial Registration ClinicalTrials.gov Identifier: NCT02386917.
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Affiliation(s)
- Cecilia Karlsson
- Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Line Kristin Johnson
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - Peter J. Greasley
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Kjetil Retterstøl
- The Lipid Clinic, Oslo University Hospital, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jonatan Hedberg
- Medical Evidence and Observational Research, Global Medical BioPharmaceuticals, AstraZeneca, Gothenburg, Sweden
| | - Martin Hall
- Early Biometrics & Statistical Innovation, Data Science & Artificial Intelligence, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Noele Hawker
- Early Biometrics & Statistical Innovation, Data Science & Artificial Intelligence, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Ida Robertsen
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Jesper Havsol
- Data Science and Artificial Intelligence, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Jens Kristoffer Hertel
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - Rune Sandbu
- Department of Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hege Christensen
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Rasmus Jansson-Löfmark
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Shalini Andersson
- Research and Early Development, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anders Åsberg
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jøran Hjelmesæth
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Albitar O, D'Souza CM, Adeghate EA. Effects of Lipoproteins on Metabolic Health. Nutrients 2024; 16:2156. [PMID: 38999903 PMCID: PMC11243180 DOI: 10.3390/nu16132156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Lipids are primarily transported in the bloodstream by lipoproteins, which are macromolecules of lipids and conjugated proteins also known as apolipoproteins. The processes of lipoprotein assembly, secretion, transportation, modification, and clearance are crucial components of maintaining a healthy lipid metabolism. Disruption in any of these steps results in pathophysiological abnormalities such as dyslipidemia, obesity, insulin resistance, inflammation, atherosclerosis, peripheral artery disease, and cardiovascular diseases. By studying these genetic mutations, researchers can gain valuable insights into the underlying mechanisms that govern the relationship between protein structure and its physiological role. These lipoproteins, including HDL, LDL, lipoprotein(a), and VLDL, mainly serve the purpose of transporting lipids between tissues and organs. However, studies have provided evidence that apo(a) also possesses protective properties against pathogens. In the future, the field of study will be significantly influenced by the integration of recombinant DNA technology and human site-specific mutagenesis for treating hereditary disorders. Several medications are available for the treatment of dyslipoproteinemia. These include statins, fibrates, ezetimibe, niacin, PCSK9 inhibitors, evinacumab, DPP 4 inhibitors, glucagon-like peptide-1 receptor agonists GLP1RAs, GLP-1, and GIP dual receptor agonists, in addition to SGLT2 inhibitors. This current review article exhibits, for the first time, a comprehensive reflection of the available body of publications concerning the impact of lipoproteins on metabolic well-being across various pathological states.
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Affiliation(s)
- Obaida Albitar
- Department of Pharmacology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Crystal M D'Souza
- Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Ernest A Adeghate
- Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
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Jaliliyan A, Madankan A, Mosavari H, Khalili P, Pouraskari B, Lotfi S, Honarfar A, Fakhri E, Eghbali F. The Impact of Metabolic and Bariatric Surgery on Apo B100 Levels in Individuals with high BMI: A Multi-Centric Prospective Cohort Study. Obes Surg 2024; 34:2454-2466. [PMID: 38744799 DOI: 10.1007/s11695-024-07258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Metabolic and Bariatric surgery (MBS) leads to significant weight loss and improvements in obesity-related comorbidities. However, the impact of MBS on Apolipoprotein B100 (Apo-B100) regulation is unclear. Apo-B100 is essential for the assembly and secretion of serum lipoprotein particles. Elevated levels of these factors can accelerate the development of atherosclerotic plaques in blood vessels. This study aimed to evaluate changes in Apo-B100 levels following MBS. METHODS 121 participants from the Iranian National Obesity and Metabolic Surgery Database (INOSD) underwent Laparoscopic Sleeve Gastrectomy (LSG) (n = 43), One-Anastomosis Gastric Bypass (OAGB) (n = 70) or Roux-en-Y Gastric Bypass (RYGB) (n = 8). Serum Apo-B100, lipid profiles, liver enzymes, and fasting glucose were measured preoperatively and six months postoperatively. RESULTS Apo-B100 levels significantly decreased from 94.63 ± 14.35 mg/dL preoperatively to 62.97 ± 19.97 mg/dL after six months (p < 0.01), alongside reductions in total cholesterol, triglycerides, LDL, VLDL, AST, and ALT (p < 0.05). Greater Apo-B100 reductions occurred in non-diabetics versus people with diabetes (p = 0.012) and strongly correlated with baseline Apo-B100 (r = 0.455, p < 0.01) and LDL levels (r = 0.413, p < 0.01). However, surgery type did not impact Apo-B100 changes in multivariate analysis (p > 0.05). CONCLUSION Bariatric surgery leads to a significant reduction in Apo-B100 levels and improvements in lipid profiles and liver enzymes, indicating a positive impact on dyslipidemia and cardiovascular risk in individuals with high BMI.
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Affiliation(s)
- Ali Jaliliyan
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Madankan
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Mosavari
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Pantea Khalili
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bahador Pouraskari
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Lotfi
- Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Andia Honarfar
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Fakhri
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Foolad Eghbali
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Benaiges D, Goday A, Casajoana A, Flores-Le Roux JA, Fitó M, Pozo OJ, Serra C, Pera M, Llauradó G, Climent E, Villatoro M, Lazaro I, Castañer O, Pedro-Botet J. Short-term effects of gastric bypass versus sleeve gastrectomy on high LDL cholesterol: The BASALTO randomized clinical trial. Cardiovasc Diabetol 2024; 23:205. [PMID: 38879559 PMCID: PMC11180388 DOI: 10.1186/s12933-024-02296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/04/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND There has been a substantial increase in the use of laparoscopic sleeve gastrectomy (SG) to treat morbid obesity despite observational evidence demonstrating the superiority of Roux-en-Y gastric bypass (RYGB) for reducing low-density lipoprotein (LDL) cholesterol. The main aim was to ascertain whether high LDL cholesterol levels should be considered when selecting the most appropriate surgical procedure for each patient (RYGB or SG). METHODS In this single-center, randomized clinical trial using intention-to-treat analysis, 38 patients with severe obesity and elevated levels of LDL cholesterol were randomly assigned to undergo RYGB or SG. The primary outcome was LDL cholesterol remission at 12 months, defined as LDL cholesterol < 3.36 nmol/l without lipid-lowering medications. Secondary outcomes included changes in weight, other comorbidities, qualitative lipoprotein traits, cholesterol esters, glycoproteins, cholesterol absorption and synthesis metabolites and complications. RESULTS Intention-to-treat analysis revealed that LDL cholesterol remission occurred in 66.6% of RYGB patients compared to 27.8% of SG patients (p = 0.019). Among patients completing follow-up, RYGB demonstrated superior remission (80.0% vs. 29.4%, p = 0.005). Exclusive benefits of RYGB included a reduction in large, medium, and small LDL particles. Cholesterol absorption markers showed differential behavior after both techniques: campesterol (Δ -15.2 µg/mg, 95% CI -30.2 to -0.1) decreased after RYGB, and sitosterol (Δ 21.1 µg/mg, 95% CI 0.9 to 41.2), cholestanol (Δ 30.6 µg/mg, 95% CI 14.8 to 57.9) and campesterol (Δ 18.4 µg/mg, 95% CI 4.4 to 32.3) increased after SG. No differences in weight loss, cholesterol esters, glycoproteins, cholesterol synthesis metabolites or postoperative complications were observed between techniques. CONCLUSION In conclusion, RYGB is superior to SG in terms of short-term of high LDL cholesterol remission. Furthermore, RYGB also led to a greater improvement in lipoprotein parameters that confer an atherogenic profile. Therefore, the presence of elevated levels of LDL cholesterol should be considered when determining the optimal bariatric surgery procedure for each patient. TRIAL REGISTRATION Clinicaltrials.gov number, NCT03975478).
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Affiliation(s)
- David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain.
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, Barcelona, 08002, Spain.
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain.
- Consorci Sanitari de l'Alt Penedès i Garraf, Vilafranca del Penedès, Spain.
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain.
| | - Albert Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
- Department of Medicine, Universitat Autònoma de Barcelona. Plaça Cívica, Bellaterra, Barcelona, 08193, Spain
| | - Anna Casajoana
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- Esophago-Gastric and Bariatric Surgery Unit, Department of Surgery, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
| | - Juana A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
| | - Montserrat Fitó
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Oscar J Pozo
- Applied Metabolomics Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Research Institute), Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Carme Serra
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
| | - Manuel Pera
- Esophago-Gastric and Bariatric Surgery Unit, Department of Surgery, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
| | - Gemma Llauradó
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
| | - Elisenda Climent
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
| | - Montserrat Villatoro
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
| | - Iolanda Lazaro
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Olga Castañer
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
- Ciber Epidemiología y Salud Pública (CiberESP), Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- Department of Medicine, Universitat Autònoma de Barcelona. Plaça Cívica, Bellaterra, Barcelona, 08193, Spain
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Bays HE. Obesity, dyslipidemia, and cardiovascular disease: A joint expert review from the Obesity Medicine Association and the National Lipid Association 2024. OBESITY PILLARS 2024; 10:100108. [PMID: 38706496 PMCID: PMC11066689 DOI: 10.1016/j.obpill.2024.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 05/07/2024]
Abstract
Background This joint expert review by the Obesity Medicine Association (OMA) and National Lipid Association (NLA) provides clinicians an overview of the pathophysiologic and clinical considerations regarding obesity, dyslipidemia, and cardiovascular disease (CVD) risk. Methods This joint expert review is based upon scientific evidence, clinical perspectives of the authors, and peer review by the OMA and NLA leadership. Results Among individuals with obesity, adipose tissue may store over 50% of the total body free cholesterol. Triglycerides may represent up to 99% of lipid species in adipose tissue. The potential for adipose tissue expansion accounts for the greatest weight variance among most individuals, with percent body fat ranging from less than 5% to over 60%. While population studies suggest a modest increase in blood low-density lipoprotein cholesterol (LDL-C) levels with excess adiposity, the adiposopathic dyslipidemia pattern most often described with an increase in adiposity includes elevated triglycerides, reduced high density lipoprotein cholesterol (HDL-C), increased non-HDL-C, elevated apolipoprotein B, increased LDL particle concentration, and increased small, dense LDL particles. Conclusions Obesity increases CVD risk, at least partially due to promotion of an adiposopathic, atherogenic lipid profile. Obesity also worsens other cardiometabolic risk factors. Among patients with obesity, interventions that reduce body weight and improve CVD outcomes are generally associated with improved lipid levels. Given the modest improvement in blood LDL-C with weight reduction in patients with overweight or obesity, early interventions to treat both excess adiposity and elevated atherogenic cholesterol (LDL-C and/or non-HDL-C) levels represent priorities in reducing the risk of CVD.
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Affiliation(s)
- Harold Edward Bays
- Corresponding author. Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, 40213, USA.
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7
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Genua I, Miñambres I, Puig R, Sardà H, Fernández-Ananin S, Sánchez-Quesada JL, Pérez A. Weight loss benefits on HDL cholesterol persist even after weight regaining. Surg Endosc 2024; 38:3320-3328. [PMID: 38684527 DOI: 10.1007/s00464-024-10826-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Obesity-related comorbidities may relapse in patients with weight regain after bariatric surgery. However, HDL cholesterol (HDLc) levels increase after surgery and seem to remain stable despite a gradual increase in BMI. The aim of this study is to analyze the effects of weight regain after bariatric surgery on HDL cholesterol. MATERIALS AND METHODS This is a retrospective, observational, cohort study in patients who underwent bariatric surgery in the Hospital de la Santa Creu i Sant Pau (Barcelona) between 2007 and 2015. Patients without at least 5 years of follow-up after surgery, under fibrate treatment, and those who required revisional surgery were excluded from the analysis. Data were collected at baseline, 3 and 6 months after surgery, and then annually until 5 years post-surgery. RESULTS One hundred fifty patients were analyzed. 93.3% of patients reached > 20% of total weight loss after surgery. At 5th year, 37% of patients had regained > 15% of nadir weight, 60% had regained > 10%, and 22% had regained < 5% of nadir weight. No differences were found in HDLc levels between the different groups of weight regain, nor in the % of change in HDLc levels between nadir weight and 5 years, or in the proportion of patients with normal HDLc concentrations either. CONCLUSION HDLc remains stable regardless of weight regain after bariatric surgery.
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Affiliation(s)
- Idoia Genua
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Inka Miñambres
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain.
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Rocío Puig
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain
| | - Helena Sardà
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sonia Fernández-Ananin
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
- Unit of Esophagogastric and Bariatric and Metabolic Surgery, Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Luis Sánchez-Quesada
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Cardiovascular Biochemistry Group, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Antonio Pérez
- Department of Endocrinology and Nutrition, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí 89, 08025, Barcelona, Spain.
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
- CIBER of Diabetes and Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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8
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Bays HE, Kirkpatrick CF, Maki KC, Toth PP, Morgan RT, Tondt J, Christensen SM, Dixon DL, Jacobson TA. Obesity, dyslipidemia, and cardiovascular disease: A joint expert review from the Obesity Medicine Association and the National Lipid Association 2024. J Clin Lipidol 2024; 18:e320-e350. [PMID: 38664184 DOI: 10.1016/j.jacl.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND This joint expert review by the Obesity Medicine Association (OMA) and National Lipid Association (NLA) provides clinicians an overview of the pathophysiologic and clinical considerations regarding obesity, dyslipidemia, and cardiovascular disease (CVD) risk. METHODS This joint expert review is based upon scientific evidence, clinical perspectives of the authors, and peer review by the OMA and NLA leadership. RESULTS Among individuals with obesity, adipose tissue may store over 50% of the total body free cholesterol. Triglycerides may represent up to 99% of lipid species in adipose tissue. The potential for adipose tissue expansion accounts for the greatest weight variance among most individuals, with percent body fat ranging from less than 5% to over 60%. While population studies suggest a modest increase in blood low-density lipoprotein cholesterol (LDL-C) levels with excess adiposity, the adiposopathic dyslipidemia pattern most often described with an increase in adiposity includes elevated triglycerides, reduced high-density lipoprotein cholesterol (HDL-C), increased non-HDL-C, elevated apolipoprotein B, increased LDL particle concentration, and increased small, dense LDL particles. CONCLUSIONS Obesity increases CVD risk, at least partially due to promotion of an adiposopathic, atherogenic lipid profile. Obesity also worsens other cardiometabolic risk factors. Among patients with obesity, interventions that reduce body weight and improve CVD outcomes are generally associated with improved lipid levels. Given the modest improvement in blood LDL-C with weight reduction in patients with overweight or obesity, early interventions to treat both excess adiposity and elevated atherogenic cholesterol (LDL-C and/or non-HDL-C) levels represent priorities in reducing the risk of CVD.
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Affiliation(s)
- Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville KY 40213 (Dr Bays).
| | - Carol F Kirkpatrick
- Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID (Dr Kirkpatrick).
| | - Kevin C Maki
- Indiana University School of Public Health, Bloomington, IN (Dr Maki).
| | - Peter P Toth
- CGH Medical Center, Department of Clinical Family and Community Medicine, University of Illinois School of Medicine, Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine (Dr Toth).
| | - Ryan T Morgan
- Oklahoma State University Center for Health Sciences, Principal Investigator at Lynn Health Science Institute, 3555 NW 58th St., STE 910-W, Oklahoma City, OK 73112 (Dr Morgan).
| | - Justin Tondt
- Department of Family and Community Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center (Dr Tondt)
| | | | - Dave L Dixon
- Deptartment of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy 410 N 12th Street, Box 980533, Richmond, VA 23298-0533 (Dr Dixon).
| | - Terry A Jacobson
- Lipid Clinic and Cardiovascular Risk Reduction Program, Emory University Department of Medicine, Atlanta, GA (Dr Jacobson).
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9
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Kokkinos A, Tsilingiris D, Simati S, Stefanakis K, Angelidi AM, Tentolouris N, Anastasiou IA, Connelly MA, Alexandrou A, Mantzoros CS. Bariatric surgery, through beneficial effects on underlying mechanisms, improves cardiorenal and liver metabolic risk over an average of ten years of observation: A longitudinal and a case-control study. Metabolism 2024; 152:155773. [PMID: 38181882 PMCID: PMC10872266 DOI: 10.1016/j.metabol.2023.155773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/13/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Bariatric surgery has long-term beneficial effects on body weight and metabolic status, but there is an apparent lack of comprehensive cardiometabolic, renal, liver, and metabolomic/lipidomic panels, whereas the underlying mechanisms driving the observed postoperative ameliorations are still poorly investigated. We aimed to study the long-term effects of bariatric surgery on metabolic profile, cardiorenal and liver outcomes in association with underlying postoperative gut hormone adaptations. METHODS 28 individuals who underwent bariatric surgery [17 sleeve gastrectomy (SG), 11 Roux-en-Y gastric bypass (RYGB)] were followed up 3, 6 and 12 and at 10 years following surgery. Participants at 10 years were cross-sectionally compared with an age-, sex- and adiposity-matched group of non-operated individuals (n = 9) and an age-matched pilot group of normal-weight individuals (n = 4). RESULTS There were durable effects of surgery on body weight and composition, with an increase of lean mass percentage persisting despite some weight regain 10 years postoperatively. The improvements in metabolic and lipoprotein profiles, cardiometabolic risk markers, echocardiographic and cardiorenal outcomes persisted over the ten-year observation period. The robust improvements in insulin resistance, adipokines, activin/follistatin components and postprandial gastrointestinal peptide levels persisted 10 years postoperatively. These effects were largely independent of surgery type, except for a lasting reduction of ghrelin in the SG subgroup, and more pronounced increases in proglucagon products, mainly glicentin and oxyntomodulin, and in the cardiovascular risk marker Trimethylamine-N-oxide (TMAO) within the RYGB subgroup. Despite similar demographic and clinical features, participants 10 years after surgery showed a more favorable metabolic profile compared with the control group, in conjunction with a dramatic increase of postprandial proglucagon product secretion. CONCLUSIONS We demonstrate that cardiorenal and metabolic benefits of bariatric surgery remain robust and largely unchanged ten years postoperatively and are associated with durable effects on gastrointestinal- muscle- and adipose tissue-secreted hormones. TRIAL REGISTRATION ClinicalTrials.gov: NCT04170010.
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Affiliation(s)
- Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Dimitrios Tsilingiris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Stamatia Simati
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Konstantinos Stefanakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece; Department of Internal Medicine, Boston VA Healthcare System, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Angeliki M Angelidi
- Department of Internal Medicine, Boston VA Healthcare System, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna A Anastasiou
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | | | - Andreas Alexandrou
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Christos S Mantzoros
- Department of Internal Medicine, Boston VA Healthcare System, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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10
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San-Cristobal R, de Toro-Martín J, Guénard F, Pérusse L, Biron S, Marceau S, Lafortune Payette A, Vohl MC. Impact of maternal cardiometabolic status after bariatric surgery on the association between telomere length and adiposity in offspring. Sci Rep 2023; 13:20771. [PMID: 38008763 PMCID: PMC10679094 DOI: 10.1038/s41598-023-47813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023] Open
Abstract
The impact of bariatric surgery on metabolic and inflammatory status are reflected in the epigenetic profile and telomere length mediated by the changes in the metabolic status of the patients. This study compared the telomere length of children born before versus after maternal bariatric surgery as a surrogate to test the influence of the mother's metabolic status on children's telomere length. DNA methylation telomere length (DNAmTL) was estimated from Methylation-EPIC BeadChip array data from a total of 24 children born before and after maternal bariatric surgery in the greater Quebec City area. DNAmTL was inversely associated with chronological age in children (r = - 0.80, p < 0.001) and significant differences were observed on age-adjusted DNAmTL between children born before versus after the maternal bariatric surgery. The associations found between body mass index and body fat percentage with DNAmTL in children born after the surgery were influenced by maternal triglycerides, TG/HDL-C ratio and TyG index. This study reports the impact of maternal bariatric surgery on offspring telomere length. The influence of maternal metabolic status on the association between telomere length and markers of adiposity in children suggests a putative modulating effect of bariatric surgery on the cardiometabolic risk in offspring.
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Affiliation(s)
- Rodrigo San-Cristobal
- Centre Nutrition, santé et société (NUTRISS), Université Laval, Quebec, QC, G1V 0A6, Canada
- Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec, QC, Canada
- School of Nutrition, Université Laval, Quebec, QC, Canada
| | - Juan de Toro-Martín
- Centre Nutrition, santé et société (NUTRISS), Université Laval, Quebec, QC, G1V 0A6, Canada
- Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec, QC, Canada
- School of Nutrition, Université Laval, Quebec, QC, Canada
| | - Frédéric Guénard
- Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec, QC, Canada
| | - Louis Pérusse
- Centre Nutrition, santé et société (NUTRISS), Université Laval, Quebec, QC, G1V 0A6, Canada
- Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec, QC, Canada
- Department of Kinesiology, Université Laval, Quebec, QC, Canada
| | - Simon Biron
- Department of Surgery, Université Laval, Quebec, QC, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada
| | - Simon Marceau
- Department of Surgery, Université Laval, Quebec, QC, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada
| | - Annie Lafortune Payette
- Department of Surgery, Université Laval, Quebec, QC, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada
| | - Marie-Claude Vohl
- Centre Nutrition, santé et société (NUTRISS), Université Laval, Quebec, QC, G1V 0A6, Canada.
- Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec, QC, Canada.
- School of Nutrition, Université Laval, Quebec, QC, Canada.
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11
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Crispim Carvalho NN, Martins VJB, Filho JM, de Arruda Neta ADCP, Pimenta FCF, de Brito Alves JL. Effects of preoperative sarcopenia-related parameters on the musculoskeletal and metabolic outcomes after bariatric surgery: a one-year longitudinal study in females. Sci Rep 2023; 13:13373. [PMID: 37591922 PMCID: PMC10435473 DOI: 10.1038/s41598-023-40681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/16/2023] [Indexed: 08/19/2023] Open
Abstract
Reduced muscle mass and/or strength are risk factors for metabolic and musculoskeletal impairment. The present study evaluated anthropometric, metabolic, and musculoskeletal outcomes in females with and without sarcopenic-obesity parameters who underwent bariatric surgery during a 1-year follow-up. A prospective, single-center cohort study was conducted in females with obesity undergoing preoperative evaluation for surgery. In the preoperative period, females were allocated into obesity with sarcopenic-obesity parameters (SOP group, n = 15) and without sarcopenic-obesity parameters (obesity group, n = 21). Sarcopenic obesity parameters were defined as lower appendicular skeletal mass adjusted for weight (ASM/wt) and/or low handgrip strength (HGS). Anthropometric, metabolic, and musculoskeletal parameters were assessed before surgery and at 3 months, 6 months, and a 1-year after bariatric surgery. Weight loss was similar between groups (p > 0.05). Weight, body mass index, fat mass, body fat percentage, skeletal muscle mass, fat-free mass, fat-free mass index, HGS were reduced in both groups during the 1-year follow-up (p < 0.05). However, when muscle mass and strength were analyzed relative to body size, an improvement after bariatric surgery was found in both groups (p < 0.05). Total cholesterol, LDL-c, triglycerides, fasting glucose, glycated hemoglobin, insulin, and insulin resistance were reduced in both groups during the 1-year follow-up (p < 0.05). In addition, HDL-c serum concentration increased in females with and without sarcopenic-obesity parameters over the 1-year follow-up (p < 0.05). Both groups had decreased bone mineral density (BMD) at all sites (lumbar spine, femoral neck, and total femur) over the 1-year follow-up (p < 0.05). The highest quartile of ASM/wt was positively associated with BMD variables in a longitudinal analysis, suggesting that preserved ASM/wt in pre-surgery may be beneficial for BMD after 1 year of bariatric surgery. The results showed that bariatric surgery promotes similar musculoskeletal and metabolic changes in females with preserved muscle mass and strength or in females with sarcopenia-related parameters.
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Affiliation(s)
- Nara Nóbrega Crispim Carvalho
- Department of Nutrition, Health Sciences Center, Federal University of Paraiba, Campus I - Jd. Cidade Universitária, Joao Pessoa, PB, 58051-900, Brazil
- Department of Endocrinology, Lauro Wanderley University Hospital, Federal University of Paraiba, Joao Pessoa, Brazil
| | - Vinícius José Baccin Martins
- Department of Nutrition, Health Sciences Center, Federal University of Paraiba, Campus I - Jd. Cidade Universitária, Joao Pessoa, PB, 58051-900, Brazil
| | - João Modesto Filho
- Department of Endocrinology, Lauro Wanderley University Hospital, Federal University of Paraiba, Joao Pessoa, Brazil
| | | | | | - José Luiz de Brito Alves
- Department of Nutrition, Health Sciences Center, Federal University of Paraiba, Campus I - Jd. Cidade Universitária, Joao Pessoa, PB, 58051-900, Brazil.
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12
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Gao X, Li P, Dai S, Wang G, Li W, Song Z, Zhu L, Zhu S. Is prior bariatric surgery associated with poor COVID-19 outcomes? A systematic review and meta-analysis of case-control studies. J Glob Health 2023; 13:06012. [PMID: 37058575 PMCID: PMC10104427 DOI: 10.7189/jogh.13.06012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
Background Obesity is an independent risk factor for severe coronavirus disease 2019 (COVID-19), but there is little evidence on whether prior bariatric surgery benefits the outcomes of patients with COVID-19. We aimed to summarize this relationship by conducting a systematic review and meta-analysis of current case-control studies. Methods We searched several electronic databases for case-control studies conducted between January 2020 and March 2022. We compared the rates of mortality, mechanical ventilation, intensive care unit (ICU) admission, dialysis, hospitalization, and length of hospital stay between COVID-19 patients with and without a history of bariatric surgery. Results We included six studies with 137 903 patients; 5270 (3.8%) had prior bariatric surgery, while 132 633 (96.2%) did not. COVID-19 patients with a history of bariatric surgery had significantly lower mortality (odds ratio (OR) = 0.42; 95% confidence interval (CI) = 0.23-0.74), ICU admission (OR = 0.48; 95% CI = 0.36-0.65), and mechanical ventilation rates than those with a history of non-bariatric surgery (OR = 0.51; 95% CI = 0.35-0.75). Conclusions Prior bariatric surgery was associated with a reduced risk of mortality and reduced severity of COVID-19 in patients with obesity compared to those with no prior bariatric surgery. Further large-sample prospective studies are needed to support these results. Registration CRD42022323745.
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Affiliation(s)
| | | | - Song Dai
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Guohui Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Song
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
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13
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Samson R, Ennezat PV, Le Jemtel TH, Oparil S. Cardiovascular Disease Risk Reduction and Body Mass Index. Curr Hypertens Rep 2022; 24:535-546. [PMID: 35788967 DOI: 10.1007/s11906-022-01213-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Anti-hypertensive and lipid lowering therapy addresses only half of the cardiovascular disease risk in patients with body mass index > 30 kg/m2, i.e., obesity. We examine newer aspects of obesity pathobiology that underlie the partial effectiveness of anti-hypertensive lipid lowering therapy for the reduction of cardiovascular disease risk in obesity. RECENT FINDINGS Obesity-related insulin resistance, vascular endothelium dysfunction, increased sympathetic nervous system/renin-angiotensin-aldosterone system activity, and glomerulopathy lead to type 2 diabetes, coronary atherosclerosis, and chronic disease kidney disease that besides hypertension and dyslipidemia increase cardiovascular disease risk. Obesity increases cardiovascular disease risk through multiple pathways. Optimal reduction of cardiovascular disease risk in patients with obesity is likely to require therapy targeted at both obesity and obesity-associated conditions.
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Affiliation(s)
- Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | | | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Özdemir A, Yozgat A, Işgın-Atıcı K, Avcı E, Yıldız BD, Gündoğdu A, Nalbantoğlu U, Turhan T, Doğruman-Al F, Büyüktuncer Z. Potential associations between alterations in gut microbiome and obesity-related traits after the bariatric surgery. J Hum Nutr Diet 2022; 36:981-996. [PMID: 36082501 DOI: 10.1111/jhn.13087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to examine the effects of both obesity and bariatric surgery on gut microbiome, dietary intake, as well as metabolic and inflammatory parameters. METHODS All participants (15 with morbid obesity who had bariatric surgery, 8 with morbid obesity and 11 non-obese) were followed-up for a 6-month period with the interviews at baseline (M0), at the end of 3 (M3) and 6 months (M6). Dietary assessment was done, and blood and faecal samples were collected. RESULTS Dietary energy and nutrient intakes as well as serum levels glucose, total cholesterol, LDL-cholesterol, and hs-CRP levels decreased by surgery (p<0.05, for each). Participants with morbid obesity had higher levels of Firmicutes and lower levels of Bacteroidetes at M0 compared to non-obese participants. The abundances of Bacteroidetes increased (p=0.02) while Firmicutes decreased (p>0.05) by the surgery, leading a significant decrease in Firmicutes/Bacteroidetes ratio (p=0.01). At sub-phylum level, the abundances of Lactobacillus and Bifidobacterium decreased while Akkermansia increased by the surgery (p<0.01, for each). Although participants who are morbidly obese had a distinct profile according to ß-diversity indices at M0, it became similar with the profile of non-obese participants (p>0.05) at M3 and M6. Similarly, α-diversity indices were lower in subjects with morbid obesity at M0, but became similar to levels in non-obese controls at M6. CONCLUSION This study confirmed that bariatric surgery has substantial impacts on gut microbiome composition and diversity, as well as anthropometrical measurements and biochemical parameters, which were associated with the alterations in dietary intake patterns. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Aslıhan Özdemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ahmet Yozgat
- Department of Gastroenterology, Ankara Numune Research and Education Hospital, Ankara, Turkey
| | - Kübra Işgın-Atıcı
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Enver Avcı
- Department of Gastroenterology, Ankara Numune Research and Education Hospital, Ankara, Turkey
| | - Barış D Yıldız
- Department of General Surgery, Ankara Numune Research and Education Hospital, Ankara, Turkey
| | - Aycan Gündoğdu
- Department of Microbiology and Clinical Microbiology, School of Medicine, Erciyes University, Kayseri, Turkey.,Genome and Stem Cell, Center, Erciyes University, Kayseri, Turkey.,ENBIOSIS Biotechnology, Istanbul, Turkey
| | - Ufuk Nalbantoğlu
- Genome and Stem Cell, Center, Erciyes University, Kayseri, Turkey.,ENBIOSIS Biotechnology, Istanbul, Turkey.,Department of Computer Engineering, School of Engineering, Erciyes University, Kayseri, Turkey
| | - Turan Turhan
- Department of Biochemistry, Ankara Numune Research and Education Hospital, Ankara, Turkey
| | - Funda Doğruman-Al
- Department of Medical Microbiology, School of Medicine, Gazi University, Ankara, Turkey
| | - Zehra Büyüktuncer
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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15
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Wang Y, Duan L, Han X, Wang J, Yan G. Changes in Nutritional Outcomes After Sleeve Gastrectomy: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:103-114. [PMID: 34677757 DOI: 10.1007/s11695-021-05740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this meta-analysis is to evaluate the changes in nutritional indicators in individuals with obesity before and after SG. MATERIALS AND METHODS A systematic retrieval of the available literature was performed using PubMed, Embase, Web of Science, and Chinese National Knowledge Infrastructure databases. The following indicators were evaluated: serum 25-hydroxyvitamin D [25(OH)D], calcium, phosphorus, iron, vitamin B12, folate, magnesium, and zinc from pre-operation to post-operation. RESULTS A total of 38 studies met inclusion criteria. A significant increase was observed in serum 25(OH)D (SMD = 0.70, 95%CI 0.38 to 1.02, P < 0.001), phosphorus (SMD = 0.40, 95%CI 0.14 to 0.67, P = 0.003), iron (SMD = 0.50, 95%CI 0.38 to 0.62, P < 0.001), and folate (SMD = 0.37, 95%CI 0.09 to 0.65, P = 0.01) after SG. Nevertheless, the increasing trend of serum phosphorus (P = 0.143) and folate (P = 0.774) disappeared in the unprescribed subgroup. A significant decrease in serum zinc (SMD = - 0.41, 95%CI - 0.81 to - 0.01, P = 0.044) was found after SG. No significant changes in serum calcium (SMD = 0.08, 95%CI - 0.09 to 0.25, P = 0.372), vitamin B12 (SMD = 0.10, 95%CI - 0.13 to 0.33, P = 0.398), and magnesium (SMD = 0.24, 95%CI - 0.10 to 0.58, P = 0.169) were observed. However, a significant decrease in serum calcium (P = 0.042) and vitamin B12 (P = 0.037) was found in the unprescribed subgroup. CONCLUSIONS Serum 25(OH)D, phosphorus, iron, and folate levels improved after a careful monitoring and due to a rigorous supplementation. The optimal dose of calcium, magnesium, and zinc supplementation has yet to be established; therefore, a broader supplementation of trace elements and minerals has to be suggested.
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Affiliation(s)
- Yan Wang
- Public Health and Preventive Medicine Teaching and Research Center, Henan University of Chinese Medicine, Jinshui East Road 156, Zhengzhou, 450046, Henan, China
| | - Leizhen Duan
- Department of Medical Services, Zhengzhou Central Hospital Affiliated To Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Xue Han
- Public Health and Preventive Medicine Teaching and Research Center, Henan University of Chinese Medicine, Jinshui East Road 156, Zhengzhou, 450046, Henan, China
| | - Jinjin Wang
- Public Health and Preventive Medicine Teaching and Research Center, Henan University of Chinese Medicine, Jinshui East Road 156, Zhengzhou, 450046, Henan, China
| | - Guoli Yan
- Public Health and Preventive Medicine Teaching and Research Center, Henan University of Chinese Medicine, Jinshui East Road 156, Zhengzhou, 450046, Henan, China.
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16
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Bonizzi A, Piuri G, Corsi F, Cazzola R, Mazzucchelli S. HDL Dysfunctionality: Clinical Relevance of Quality Rather Than Quantity. Biomedicines 2021; 9:729. [PMID: 34202201 PMCID: PMC8301425 DOI: 10.3390/biomedicines9070729] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
High-density lipoproteins (HDLs) represent a class of lipoproteins very heterogeneous in structure, composition, and biological functions, which carry out reverse cholesterol transport, antioxidant, anti-inflammatory, antithrombotic, and vasodilator actions. Despite the evidence suggesting a clear inverse relationship between HDL cholesterol (HDL-c) concentration and the risk for cardiovascular disease, plasma HDL cholesterol levels do not predict the functionality and composition of HDLs. The importance of defining both the amount of cholesterol transported and lipoprotein functionality has recently been highlighted. Indeed, different clinical conditions such as obesity, diabetes mellitus type 2 (T2DM), and cardiovascular disease (CVD) can alter the HDL functionality, converting normal HDLs into dysfunctional ones, undergoing structural changes, and exhibiting proinflammatory, pro-oxidant, prothrombotic, and proapoptotic properties. The aim of the current review is to summarize the actual knowledge concerning the physical-chemical alteration of HDLs related to their functions, which have been found to be relevant in several pathological conditions associated with systemic inflammation and oxidative stress.
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Affiliation(s)
- Arianna Bonizzi
- Department of Biomedical and Clinical Sciences "L. Sacco", Università di Milano, 20157 Milan, Italy
| | - Gabriele Piuri
- Department of Biomedical and Clinical Sciences "L. Sacco", Università di Milano, 20157 Milan, Italy
| | - Fabio Corsi
- Department of Biomedical and Clinical Sciences "L. Sacco", Università di Milano, 20157 Milan, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Roberta Cazzola
- Department of Biomedical and Clinical Sciences "L. Sacco", Università di Milano, 20157 Milan, Italy
| | - Serena Mazzucchelli
- Department of Biomedical and Clinical Sciences "L. Sacco", Università di Milano, 20157 Milan, Italy
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Changes in the Composition and Function of Lipoproteins after Bariatric Surgery in Patients with Severe Obesity. J Clin Med 2021; 10:jcm10081716. [PMID: 33923393 PMCID: PMC8071565 DOI: 10.3390/jcm10081716] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
The effect of bariatric surgery on lipid profile and the qualitative characteristics of lipoproteins was analyzed in morbidly obese subjects. Thirteen obese patients underwent bariatric surgery. Plasma samples were obtained before surgery and at 6 and 12 months after the intervention. Thirteen healthy subjects comprised the control group. Lipid profile, hsCRP, and the composition and functional characteristics of VLDL, LDL, and HDL were assessed. At baseline, plasma from subjects with obesity had more triglycerides, VLDLc, and hsCRP, and less HDLc than the control group. These levels progressively normalized after surgery, although triglyceride and hsCRP levels remained higher than those in the controls. The main differences in lipoprotein composition between the obese subjects and the controls were increased apoE in VLDL, and decreased cholesterol and apoJ and increased apoC-III content in HDL. The pro-/anti-atherogenic properties of LDL and HDL were altered in the subjects with obesity at baseline compared with the controls, presenting smaller LDL particles that are more susceptible to modification and smaller HDL particles with decreased antioxidant capacity. Bariatric surgery normalized the composition of lipoproteins and improved the qualitative characteristics of LDL and HDL. In summary, patients with obesity present multiple alterations in the qualitative properties of lipoproteins compared with healthy subjects. Bariatric surgery reverted most of these alterations.
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