Changes in the Composition and Function of Lipoproteins after Bariatric Surgery in Patients with Severe Obesity

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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Abstract 018: Two-year Changes of Adiponectin after Bariatric Surgery and Their Association with Incident Type 2 Diabetes, Cardiovascular Disease, Cancer and Mortality: Results from the Swedish Obese Subjects Study

Circulation ◽

10.1161/circ.125.suppl_10.a018 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Christian Herder ◽

Markku Peltonen ◽

Per-Arne Svensson ◽

Maren Carstensen ◽

Peter Jacobson ◽

...

Keyword(s):

Myocardial Infarction ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Bariatric Surgery ◽

Weight Loss ◽

Control Group ◽

Incident Type ◽

Surgery Group ◽

Obese Subjects

Introduction: Adiponectin has anti-inflammatory, insulin-sensitising and atheroprotective effects in rodents. Although serum adiponectin is uniformly downregulated in obesity, its clinical relevance in humans seems more complex. It is not known whether changes in circulating adiponectin predict type 2 diabetes, cardiovascular disease, cancer and mortality in an obese population. Hypothesis: We hypothesised that adiponectin levels are upregulated substantially after weight loss following bariatric surgery and that pronounced increases of adiponectin should offer better protection for individuals against type 2 diabetes. In addition, findings for type 2 diabetes should be compared to associations with cardiovascular disease, myocardial infarction, stroke, cancer and mortality. Methods: Serum concentrations of total adiponectin were measured in 3,223 participants of the Swedish Obese Subjects (SOS) Study (1,533 in the bariatric surgery group: 229 with gastric bypass, 1056 with vertical banded gastroplasty, 248 with adjustable gastric banding; 1,690 in the control group without surgery) at study baseline and after 2 years. Hazard ratios (HR) and 95% confidence intervals (CI) per 1 standard deviation (SD) of 2-year changes (concentration at year 2 - concentration at baseline) in adiponectin were calculated for incident type 2 diabetes, cardiovascular disease, myocardial infarction, stroke, cancer and mortality in the combined surgery group. Numbers of cases were 93, 122, 78, 55, 82 and 179, respectively. Median follow-up times ranged from 10 years for diabetes up to 16 years for mortality. Results: Mean (SD) levels of adiponectin at baseline were 7,453 (4,150) ng/ml in the combined surgery group and 8,247 (4,846) ng/ml in the control group. During the first 2 years of follow-up, adiponectin levels increased in the surgery group by 4,850 (5,387) ng/ml (parallel to a loss of 24% of body weight) and decreased slightly by 270 (2,650) ng/ml in the control group (parallel to a slight gain of 0.1% body weight). The degree of correlation between changes in adiponectin and weight loss in kg was more pronounced in the surgery groups compared with the control group (p=0.001 for interaction). Two-year increases in adiponectin in the surgery group were associated with decreased risk of type 2 diabetes (HR [95% CI] 0.61 [0.38-0.98], adjusted for baseline data for age, sex, BMI, lipids, blood pressure, alcohol consumption, smoking, anti-hypertensive drugs, glucose, insulin), but not with cardiovascular disease, myocardial infarction, stroke, cancer and mortality (adjusted HR between 0.89 and 1.05). Conclusions: Weight loss after bariatric surgery is paralleled by a substantial increase in circulating adiponectin. The degree of upregulation of adiponectin is associated with protection against future type 2 diabetes, but not with the incidence of cardiovascular outcomes, cancer or mortality.

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Resistant Starch Supplementation Improves Bifidobacteria Colonization and Lipid Profile in Adult Obese Subjects Residing in Urban Vadodara

The Indian Journal of Nutrition and Dietetics ◽

10.21048/ijnd.2018.55.4.22115 ◽

2018 ◽

Vol 55 (4) ◽

pp. 432

Author(s):

Mini Sheth ◽

Aanchal Johari ◽

Isha Shah

Keyword(s):

Lipid Profile ◽

Resistant Starch ◽

Age Groups ◽

Randomised Control Trial ◽

Control Group ◽

Obese Adults ◽

Obese Subjects ◽

The Mean ◽

The Impact ◽

Experimental Group

Obesity continues to be a growing problem globally among all age groups, further associated with life threatening co-morbidities. Resistant Starch (RS) as a dietary component has been recently recognized as a prebiotic with potential role in improving the bacterial ecology of human gut. The present study was undertaken to evaluate the impact of resistant starch supplementation by the obese adults in urban Vadodara on microbial changes in gut flora with respect to Bifidobacteria and Enterobacteria. Using a non randomised control trial study design, 60 obese adults were enrolled from the free living population of urban Vadodara. Baseline information was collected and subjects were classified into control (n=30) and experimental group (n=30). Experimental group was supplemented with 10 g of RS daily for the period of two months (60 days). The control group were not given anything during this period. Blood and stool samples were analysed for lipid profile and the presence of Bifidobacteria and pathogenic Enterobacteria, respectively both at baseline and after the intervention period. Results revealed a significant increase in the mean log counts of Bifidobacteria by 11.7% with no significant reduction in the mean log counts of enteric pathogens and lipid profile of subjects. Hence study concludes that a daily supplementation of 10 grams of RS for 60 days to the obese subjects improved colonization of beneficial gut microbiota in terms of Bifidobacteria, but had little effect on obesity.

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Effect of bariatric surgery in morbidly obese patients on the quantitative and qualitative characteristics of plasma lipoproteins

Atherosclerosis ◽

10.1016/j.atherosclerosis.2014.05.744 ◽

2014 ◽

Vol 235 (2) ◽

pp. e249

Author(s):

J. Julve ◽

E. Pardina ◽

M. Pérez-Cuéllar ◽

R. Ferrer ◽

J. Rossell ◽

...

Keyword(s):

Bariatric Surgery ◽

Plasma Lipoproteins ◽

Morbidly Obese ◽

Obese Patients ◽

Qualitative Characteristics

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Longitudinal study on the effect of surgical weight loss on beat-to-beat blood pressure variability in patients undergoing bariatric surgery: a study protocol

BMJ Open ◽

10.1136/bmjopen-2021-050957 ◽

2021 ◽

Vol 11 (10) ◽

pp. e050957

Author(s):

Souha Fares ◽

Nour-Mounira Z Bakkar ◽

Ramzi Alami ◽

Issam Lakkis ◽

Kamal Badr

Keyword(s):

Blood Pressure ◽

Bariatric Surgery ◽

Longitudinal Study ◽

Blood Pressure Variability ◽

Morbidly Obese ◽

Study Results ◽

Non Linear ◽

Obese Subjects ◽

Normotensive Subjects ◽

The Impact

IntroductionAlterations in linear and non-linear parameters of beat-to-beat blood pressure variability (BPV) have been shown to predict disease prognosis and distinguish between risk categories in various pathological conditions, independently of average blood pressure levels. Obesity places subjects at elevated risk of vascular diseases, including hypertension, resulting in serious cardiac, respiratory and cerebral events. However, little is known about the status of vascular dynamics in obese and morbidly obese adults.Methods and analysisIn this present quasi-experimental longitudinal study, changes in beat-to-beat BPV, using continuous, non-invasive blood pressure monitoring, in obese subjects undergoing bariatric surgery are characterised. The capacity of linear and non-linear measures of BPV to detect differences between hypertensive, prehypertensive and normotensive obese subjects prebariatric and postbariatric surgery are tested. Additionally, potential correlations between beat-to-beat BPV and age, body mass index, gender and comorbidities will be investigated. In parallel, the impact of the unsteady fluctuations of beat-to-beat blood pressure on the dynamic stresses imparted by blood flow on blood vessel walls will be explored. We expect to find altered BPV profiles in hypertensive and prehypertensive subjects as compared with normotensive subjects. We also expect to see differential normalisation in BPV profiles between hypertensive, prehypertensive and normotensive subjects over time.Ethics and disseminationThe study has been approved by the Institutional Review Board at the American University of Beirut (IRB ID: BIO-2018-0040). Study results will be made available to the public through publications in peer-reviewed journals and conference papers and/or presentations.

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9p21.3 Coronary Artery Disease Locus Identifies Patients With Treatment Benefit From Bariatric Surgery in the Nonrandomized Prospective Controlled Swedish Obese Subjects Study

Circulation Genomic and Precision Medicine ◽

10.1161/circgen.120.003113 ◽

2020 ◽

Vol 13 (5) ◽

pp. 460-465

Author(s):

Peter Jacobson ◽

Markku Peltonen ◽

Per-Arne Svensson ◽

Magdalena Taube ◽

Johanna C. Andersson-Assarsson ◽

...

Keyword(s):

Bariatric Surgery ◽

Risk Allele ◽

Hazard Ratio ◽

Control Group ◽

Fasting Insulin ◽

Unique Identifier ◽

Treatment Benefit ◽

Obese Subjects ◽

Traditional Risk Factors

Background: Sequence variation at chromosome 9p21.3 accounts for 20% of myocardial infarctions (MIs) in several populations. Whereas the risk conferred by the 9p21.3 locus appears to act independently of traditional risk factors, studies suggest that the association between 9p21.3 and MI is modified by glucose homeostasis and lifestyle. We examined if the 9p21.3 variant rs1333049, along with the previously identified predictor fasting insulin, modifies the preventive effect of bariatric surgery on MI incidence. Methods: rs1333049 was genotyped in 1852 patients treated by bariatric surgery and 1803 controls given usual care in the SOS study (Swedish Obese Subjects). MI incidence was determined using national registers. Median follow-up was 21 years (interquartile range 18–24 years). Results: Overall, 366 MIs occurred during follow-up. Among rs1333049 risk-allele carriers (CC+GC), the incidence of MI was reduced in the surgery group compared with the control group (hazard ratio=0.72 [95% CI, 0.57–0.92], P =0.008). By contrast, noncarriers (GG) showed no significant differences in MI incidence between the treatment groups (hazard ratio=1.28 [0.86–1.90], P =0.227; interaction between treatment and the risk-allele P =0.016). In addition, carriers with higher fasting insulin (above the median [17 mmol/L]) experienced significantly higher MI incidence than carriers with lower fasting insulin (hazard ratio=0.58 [0.42–0.78], P <0.001, interaction P =0.031). Conclusions: In the SOS cohort, patients with the chromosome 9p21.3 rs1333049 risk allele together with high fasting insulin levels benefitted from bariatric surgery in terms of reduced incidence of MI. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01479452.

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Central Resistance to Thyroid Hormones in Morbidly Obese Subjects Is Reversed after Bariatric Surgery-Induced Weight Loss

Journal of Clinical Medicine ◽

10.3390/jcm9020359 ◽

2020 ◽

Vol 9 (2) ◽

pp. 359

Author(s):

Paula Juiz-Valiña ◽

María Cordido ◽

Elena Outeiriño-Blanco ◽

Sonia Pértega ◽

Bárbara María Varela-Rodríguez ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Thyroid Hormones ◽

Thyroid Function ◽

Control Group ◽

Morbidly Obese ◽

Extreme Obesity ◽

Resistance To Thyroid Hormones ◽

Altered Thyroid ◽

Over Time

Endocrine abnormalities are common in obesity, including altered thyroid function. The altered thyroid function of obesity may be due to a mild acquired resistance to the thyroid hormone. The aim of this study was to investigate the effect of weight loss after bariatric surgery (BS) on resistance to thyroid hormones in patients with extreme obesity compared with a control group. We performed an observational study evaluating patients with extreme obesity who underwent BS. We included 106 patients (83 women) and 38 controls (24 women). The primary endpoint was the thyrotroph thyroxine resistance index (TT4RI) and thyroid stimulating hormone (TSH) index (TSHRI). The parameters were studied before and after surgery. TSHRI and TT4RI were higher in the obese patients than in the control group. TT4RI and TSHI decreased significantly over time after surgery, with this decrease being associated with the excessive body mass index (BMI) loss and C-reactive protein (CRP). In extreme obesity, BS promotes a significant decrease in the increased TT4RI and TSHI. This decrease of TT4RI and TSHI is progressive over time after BS and significantly associated with excess BMI lost and CRP. Extreme obesity is characterized by a mild reversible central resistance to thyroid hormones.

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The relationship between specialized pro-resolving lipid mediators, morbid obesity and weight loss after bariatric surgery

Scientific Reports ◽

10.1038/s41598-020-75353-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Fabian Schulte ◽

Abdul Aziz Asbeutah ◽

Peter N. Benotti ◽

G. Craig Wood ◽

Christopher Still ◽

...

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Weight Loss ◽

White Blood Cells ◽

Diabetes Remission ◽

Lipid Mediators ◽

Morbidly Obese ◽

Post Surgery ◽

Obesity And Diabetes ◽

Obese Subjects

AbstractObesity and diabetes are associated with chronic inflammation. Specialized pro-resolving lipid mediators (SPMs)—resolvins (Rv), protectins (PD) and maresins (MaR)—actively resolve inflammation. Bariatric surgery achieves remission of diabetes, but mechanisms are unclear. We measured SPMs and proinflammatory eicosanoid levels using liquid chromatography-tandem mass spectrometry in 29 morbidly obese subjects (13 with diabetes) and 15 nondiabetic, mildly obese subjects. Compared to the mildly obese, the morbidly obese had higher levels of SPMs—RvD3, RvD4 and PD1—and white blood cells (WBC) and platelets. Post-surgery, SPM and platelet levels decreased in morbidly obese nondiabetic subjects but not in diabetic subjects, suggesting continued inflammation. Despite similar weight reductions 1 year after surgery (44.6% vs. 46.6%), 8 diabetes remitters had significant reductions in WBC and platelet counts whereas five non-remitters did not. Remitters had a 58.2% decrease (p = 0.03) in 14-HDHA, a maresin pathway marker; non-remitters had an 875.7% increase in 14-HDHA but a 36.9% decrease in MaR1 to a median of 0. In conclusion, higher levels of RvD3, PD1 and their pathway marker, 17-HDHA, are markers of leukocyte activation and inflammation in morbid obesity and diabetes and diminish with weight loss in nondiabetic but not diabetic subjects, possibly representing sustained inflammation in the latter. Lack of diabetes remission after surgically-induced weight loss may be associated with reduced ability to produce MaR1 and sustained inflammation.

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