Patients with severe obesity who underwent one-anastomosis gastric bypass (OAGB) had a better improvement in their lipid plasma values than laparoscopic sleeve gastrectomy (LSG) patients, according to researchers from Italy. The paper, ‘Improvement of Lipid Profile after One-Anastomosis Gastric Bypass Compared to Sleeve Gastrectomy’, published in Nutrients, was written by the authors on behalf of the Veneto Obesity Network who added that the reduction of lipid plasma levels was independent of the significant decrease of BMI after surgery, of age and of sex.
The researchers noted that several of studies (systematic reviews and meta-analyses) have reported the effectiveness of bariatric surgery on weight loss, complications, quality of life and remission of T2DM, hypertension and obstructive sleep apnoea. However, only a few studies have investigated dyslipidaemia. Therefore, they decided to compare weight loss and the impact on improvement of lipid profile 18 months after LSG and OAGB in patients with obesity. The study included 134 patients – 46 who had OAGB and 88 patients treated with LSG – who were matched according to age, sex and BMI values.
All participants were followed-up for almost two years by the respective centres and were recommended to follow a balanced hypocaloric diet (25–30% fat, 50–55% carbohydrates, 20% protein) and physical activity prescriptions (150 min per week of moderate intensity physical activity). All patients also received the same dietary counselling, psychotherapy and physical training, according to an internal therapeutic care plan of the Veneto Obesity Network.
At baseline, there were no significant differences between the two groups (age p=0.473, pre-operative BMI p=0.159, pre-operative dyslipidaemia p=0.443 and metabolic impairment p=0.479). The only significant difference was the OAGB group presenting higher TG values (p=0.007).
After 18 months, weight loss after LSG was 29.6% and it was accompanied by a statistically significant reduction of waist circumference (19.8%, p<0.001), FPG (14.8%, p<0.001), ALT (26.1%, p<0.001), AST (22.7%, p<0.001), HDL (20.4%, p<0.001), NHDLC (11.4%, p<0.001), LDL (7.8%, p<0.001) and TG (24.2%, p<0.001). After OAGB, weight loss was greater (33.2%) with a deeper decrease of lipid profile levels: CT (12.6%, p<0.001), HDL (16.6%, p<0.001), NHDLC (20.6%, p<0.001), LDL (16.8%, p<0.001) and TG (32.6%, p<0.001). Both procedures resulted in a relevant improvement of metabolic profile and a decrease in prevalence of prediabetes and diabetes (LSG p<0.001, OAGB p<0.01).
“We demonstrated that plasma lipid levels decrease more after OAGB compared to LSG, in patients with similar preoperative characteristics, independently of age, sex and the reduction of BMI. In our study we compared comorbidities outcome between LSG and OAGB, focusing on dyslipidaemia,” the authors write. “Both after LSG and OAGB we noticed a relevant improvement of metabolic profile and a decrease in prevalence of prediabetes and diabetes. Furthermore, we demonstrated that prevalence of dyslipidaemia statistically significant decreased only in the OAGB group, even if the lipid profile values decreased in both groups.”
Figure 1: The difference in the prevalence of dyslipidaemia after LSG (before surgery 52%, after surgery 49%, p=0.763) and OAGB, showing a statistically significant slowing only after OAGB (before surgery 61%, after surgery 22%, p<0.001).
“Since OAGB resulted more effective than LSG in the management of dyslipidaemia, we suggest that a surgical procedure that includes a bypass component (such as OAGB) could be tailored to patients with severe obesity and a worst control of plasma lipids,” the authors concluded.
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