Lipid risk profile and weight stability after gastric restrictive operations for morbid obesity

There are no longitudinal data that address weight loss stability and lipid levels in bariatric surgical patients. The goal of this study was to deter mine whether weight regain adversely affected reduction in lipid levels aft er gastric bariatric operations. Of 651 consecutive patients undergoing gas tric restrictive surgery for morbid obesity, 227 (35%) had increased serum levels of total cholesterol (TC), triglycerides, or hc,th preoperatively. H igh-density lipoprotein cholesterol (HDL-C) levels were subnormal (less tha n or equal to 35 mg/dl) in 45 (20%) of the hyperlipidemic patients. Fasting lipid profiles were determined at 6-month intervals postoperatively. This series included the following three operations: gastroplasty (GP; N = 13), standard Roux-en-Y gastric bypass (RYGB; N = 205), and distal Roux-en-Y gas tric bypass (DRY; N = 9). By 6 months postoperatively, patients had a great er than or equal to 15% mean reduction in TC and a greater than or equal to 50% mean reduction in triglycerides, both of which were significant in com parison with preoperative levels (P less than or equal to0.05). Mean HDL-C levels had increased significantly vs, preoperative levels by 12 months pos toperatively (P <0.05) and continued to increase through 5 years. By 18 mon ths both HDL-C and TC were significantly lower after DRY than after GP or R YGB. In 91 patients who were followed for 2 years or longer (mean 48 +/- 25 months), mean excess weight loss was 55% with mean body mass index reduced from 48 to 33 kg/m(2). This group was divided into patients whose weight r emained stable (N = 54) and patients who regained <greater than or equal to >15% of their lost weight or lost less than 50% of excess weight (N = 37). Although mean excess weight loss and body mass index were significantly dif ferent between the two groups (P < 0.0001) at 2 years, there was no differe nce in the lipid profile (TC/HDL) between the two groups at any interval th rough 5 years. These results show that abnormal lipid profiles can be perma nently improved after gastric bariatric surgery and are not adversely affec ted by mediocre weight loss or regaining <greater than or equal to>15% of l ost weight. DRY appears to be a superior operation for TC reduction in comp arison with GP and RYGB.