Abstract
Introduction
Dyslipidemia affects up to 75% of morbidly obese individuals and is a key driver of cardiovascular disease. Weight loss is an established strategy to improve metabolic risk, including dyslipidemia. We aimed to determine weight loss goals for resolution of serum lipid abnormalities, by measuring improvements during progressive weight loss in obese individuals.
Methods
We performed a prospective cohort study of obese individuals with the metabolic syndrome undergoing adjustable gastric banding. Lipid levels were monitored monthly for 9 months, then three monthly until 24 months.
Results
There were 101 participants included, age 47.4 ± 10.9 years with body mass index 42.6 ± 5.9 kg/m2. At 24 months, total body weight loss (TBWL) was 18.3 ± 7.9%. This was associated with significant improvements in high-density lipoprotein (HDL) (1.18 vs 1.47, p < 0.001), triglyceride (2.0 vs 1.4, p < 0.001), and total cholesterol to HDL ratio (TC:HDL) (4.6 vs 3.6, p < 0.001). Over this time, progressive and linear improvements in HDL, triglycerides, and TC:HDL were seen with incremental weight loss (observed at 2.5% TBWL intervals). Significant improvements occurred after a threshold weight loss of 7.5–12.5% TBWL was achieved, with odds ratio (OR) 1.48–2.50 for normalization. These odds improved significantly with increasing weight loss (OR 18.2–30.4 with > 25% TBWL). Despite significant weight loss, there was no significant change in low-density lipoprotein (LDL).
Conclusion
Significant improvements in triglycerides, HDL, and TC:HDL occur after 7.5–12.5% TBWL, with ongoing benefit after greater weight loss. LDL needs to be addressed independently, as this was not observed to respond to weight loss alone.
Trial registration number
Australian Clinical Trials Registry (ACTRN12610000049077)
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Ethics approval was obtained from the Avenue Ethics Committee (reference no. 099)
Conflict of Interest
GJO, PRB, and WAB report being affiliated with the Center for Obesity Research and Education. The center has received funding for research purposes from Allergan and Apollo Endosurgery, the manufacturers of the LapBand™. The grant is not tied to any specific research project, and neither Allergan nor Apollo Endosurgery have control of the protocol, analysis, and reporting of any studies. The center also receives a grant from Applied Medical towards educational programs.
WB reports financial support for a bariatric surgery registry from the Commonwealth of Australia, Apollo Endosurgery, Covidien, Johnson and Johnson, Gore, and Applied Medical. Since the initial submission of this paper, she has also received a speaker’s honorarium from Merck Sharpe and Dohme and a speaker’s honorarium and fees from participation in a scientific advisory board from Novo Nordisk. The Bariatric Registry and the honorariums are outside of the submitted work.
KS is the Director of Clinical Support Services at Sonic Healthcare; this is unrelated to this work.
CWL has received funding from the Science Foundation Ireland (12/YI/B2480). He also serves on the advisory boards of NovoNordisk and Herbalife, and has received speaker’s fees from Ethicon Endosurgery.
PEO has written a patient information book entitled “The Lap-Band Solution: A partnership for weight loss” which is given to patients without charge, but some are sold to surgeons and others, for which he receives a royalty.
GJO and LD reports scholarships from the National Health and Medical Research Council and the Royal Australasian College of Surgeons.
The remaining authors have no other disclosures or conflicts of interest.
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Ooi, G.J., Earnest, A., Doyle, L. et al. Detailed Description of Change in Serum Cholesterol Profile with Incremental Weight Loss After Restrictive Bariatric Surgery. OBES SURG 28, 1351–1362 (2018). https://doi.org/10.1007/s11695-017-3015-9
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DOI: https://doi.org/10.1007/s11695-017-3015-9