Impact of Restrictive (Sleeve Gastrectomy) vs Hybrid Bariatric Surgery (Roux-en-Y Gastric Bypass) on Lipid Profile Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. Superior weight loss and lower HbA1c 3 years after duodenal switch compared with Roux-en-Y gastric bypass--a randomized controlled trial. Evolution of Glycolipid Profile After Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass: Results of a Prospective Randomized Clinical Trial Exercise and Weight Loss Improve Muscle Mitochondrial Respiration, Lipid Partitioning, and Insulin Sensitivity After Gastric Bypass Surgery Health benefits of gastric bypass surgery after 6 years. Cholesterol absorption decreases after Roux-en-Y gastric bypass but not after gastric banding. Serum Cholesterol by Morbidly Obese Patients after Laparoscopic Sleeve Gastrectomy and Additional Physical Activity Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m2 Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. Omentectomy added to Roux-en-Y gastric bypass surgery: a randomized, controlled trial. Outcomes of bariatric surgery in patients with body mass index <35 kg/m2. Comparison of Changes in Lipid Profile after Bilio-intestinal Bypass and Gastric Banding in Patients with Morbid Obesity Early Enhancements of Hepatic and Later of Peripheral Insulin Sensitivity Combined With Increased Postprandial Insulin Secretion Contribute to Improved Glycemic Control After Roux-en-Y Gastric Bypass Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-En-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects A Prospective Randomized Study Comparing Patients with Morbid Obesity Submitted to Sleeve Gastrectomy With or Without Omentectomy Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention
Background Few studies have evaluated the impact of hybrid versus purely restrictive bariatric surgery on lipid profile , with the results being contradictory . The effect of laparoscopic sleeve gastrectomy ( LSG ) and laparoscopic Roux-en-Y gastric bypass ( LRYGB ) on lipid profile was compared . Methods A nonr and omized prospect i ve cohort study was conducted on severely obese patients undergoing bariatric surgery .  Indication for the type of surgical procedure was based on clinical criteria . Patients on lipid-lowering drugs and those that could not be matched for age , sex , and body mass index were excluded . Finally , 51 patients who underwent LSG and 51 undergoing LRYGB completed this study . Results During the first year post-surgery , no differences in percentage of excess weight loss and triglyceride reduction were found between groups . After LRYGR , low-density lipoprotein ( LDL ) cholesterol concentrations fell significantly ( 125.9 ± 29.3 to 100.3 ± 26.4 mg/dl , p < 0.001 ) , whereas no significant changes were observed in the LSG group ( 118.6 ± 30.7 to 114.6 ± 33.5 mg/dl , p = 0.220 ) . High-density lipoprotein ( HDL ) cholesterol increase was significantly greater after LSG ( 15.4 ± 13.1 mg/dl ) compared with LRYGB ( 9.4 ± 14.0 mg/dl , p = 0.032 ) . Factors independently associated with LDL cholesterol reduction were higher baseline total cholesterol and undergoing LRYGB . A greater increase in HDL cholesterol was associated with LSG , older age , and baseline HDL cholesterol . Conclusions LRYGB produces an overall improvement in lipid profile , with a clear benefit in all lipid fractions . Although LSG does not alter LDL cholesterol levels , its effect on HDL cholesterol is comparable to or greater than that obtained with malabsorptive techniques IMPORTANCE Emerging data support bariatric surgery as a therapeutic strategy for management of type 2 diabetes mellitus . OBJECTIVE To test the feasibility of methods to conduct a larger multisite trial to determine the long-term effect of Roux-en-Y gastric bypass ( RYGB ) surgery compared with an intensive diabetes medical and weight management ( Weight Achievement and Intensive Treatment [ Why WAIT ] ) program for type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A 1-year pragmatic r and omized clinical trial was conducted in an academic medical institution . Participants included persons aged 21 to 65 years with type 2 diabetes diagnosed more than 1 year before the study ; their body mass index was 30 to 42 ( calculated as weight in kilograms divided by height in meters squared ) and hemoglobin A1c ( HbA1c ) was greater than or equal to 6.5 % . All participants were receiving antihyperglycemic medications . INTERVENTIONS RYGB ( n = 19 ) or Why WAIT ( n = 19 ) including 12 weekly multidisciplinary group lifestyle , medical , and educational sessions with monthly follow-up thereafter . MAIN OUTCOMES AND MEASURES Proportion of patients with fasting plasma glucose levels less than 126  mg/dL  and HbA1c less than 6.5 % , measures of cardiometabolic health , and patient-reported outcomes . RESULTS At 1 year , the proportion of patients achieving HbA1c below 6.5 % and fasting glucose below 126 mg/dL was higher following RYGB than Why WAIT ( 58 % vs 16 % , respectively ; P = .03 ) . Other outcomes , including HbA1c , weight , waist circumference , fat mass , lean mass , blood pressure , and triglyceride levels , decreased and high-density lipoprotein cholesterol increased more after RYGB compared with Why WAIT . Improvement in cardiovascular risk scores was greater in the surgical group . At baseline the participants exhibited moderately low self-reported quality -of-life scores reflected by Short Form-36 total , physical health , and mental health , as well as high Impact of Weight on Quality of Life-Lite and Problem Areas in Diabetes health status scores . At 1 year , improvements in Short Form-36 physical and mental health scores and Problem Areas in Diabetes scores did not differ significantly between groups . The Impact of Weight on Quality of Life-Lite score improved more with RYGB and correlated with greater weight loss compared with Why WAIT . CONCLUSIONS AND RELEVANCE In obese patients with type 2 diabetes , RYGB produces greater weight loss and sustained improvements in HbA1c and cardiometabolic risk factors compared with medical management , with emergent differences over 1 year . Both treatments improve general quality -of-life measures , but RYGB provides greater improvement in the effect of weight on quality of life . These differences may help inform therapeutic decisions for diabetes and weight loss strategies in obese patients with type 2 diabetes until larger r and omized trials are performed . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01073020 BACKGROUND Obesity is a rising threat to public health . The relative increase in the incidence of morbid obesity is most pronounced in the most severely obese .  Roux-en-Y gastric bypass ( RYGB ) results in inferior weight loss in this group . Therefore , we have offered biliopancreatic diversion with duodenal switch ( BPD/DS ) as an alternative for this patient category . Our objective was to compare BPD/DS and RYGB in the surgical treatment of morbid obesity in patients with a body mass index ( BMI ) > 48 kg/m(2 ) . The setting was a university hospital in Sweden . METHODS In a controlled trial ( registration number IS RCT N10940791 ) , 47 patients ( 25 men , BMI 54.5 ± 6.1 kg/m(2 ) ) were r and omized to RYGB ( n = 23 ) or BPD/DS ( n = 24 ) . Biochemical data were collected preoperatively and 1 and 3 years postoperatively . A question naire addressing weight , general satisfaction , and gastrointestinal symptoms was distributed a median of 4 years postoperatively . RESULTS Both procedures were safe . The duration of surgery and postoperative morphine consumption were greater after BPD/DS than after RYGB ( 157 versus 117 min and 140 versus 93 mg , respectively ) . BPD/DS result ed in greater weight loss  than RYGB ( -23.2 ± 4.9 versus -16.2 ± 6.9 BMI units or 80 % ± 15 % versus 51 % ± 23 % excess BMI loss , P < .001 ) . BPD/DS  yielded lower glucose and glycated hemoglobin levels at 3 years . More patients listed troublesome diarrhea and malodorous flatus in the question naire after BPD/DS , but no significant difference was seen ( P = .078 and P = .073 , respectively ) . CONCLUSIONS BPD/DS produced superior weight results and lower glycated hemoglobin levels compared with RYGB in patients with a BMI > 48 kg/m(2 ) . Both operations yield high satisfaction rates . However , diarrhea tended to be more common after BPD/DS Background This study aims to report glycolipid changes after  sleeve gastrectomy ( SG ) or Roux-en-Y gastric bypass ( RYGB )  in the setting of a prospect i ve r and omized clinical trial . Methods One hundred patients were r and omly assigned to RYGB ( n = 45 ) and SG ( n = 55 )  . Fasting glucose , insulin , glycated hemoglobin ( HbA1c% ) , triglycerides , and serum cholesterol ( total , HDL , and LDL ) were evaluated at inclusion and after 1 , 3 , 6 , and 12 months . The index for homeostasis model assessment of insulin resistance ( HOMA-IR ) and β cell function ( HOMA-B ) were assessed . Results Mean postoperative 1- , 3- , 6- , and 12-month excess weight loss was 25.39 , 43.47 , 63.75 , and 80.38 % after RYGB and 25.25 , 51.32 , 64.67 , and 82.97 % after SG , respectively . Mean fasting glucose and fasting serum insulin were similarly and statistically significantly reduced in both RYGB and SG . Mean HOMA-IR improved in both groups , particularly in case of high preoperative values , and mean HOMA-B improved at 1 year after RYGB . HbA1c% dropped from 5.66 % ( SD = 0.61 ) to 5.57 % ( SD = 0.32 ) after RYGB and from 5.64 % ( SD = 0.43 ) to 5.44 % ( SD = 0.43 ) after SG . Total cholesterol was significantly higher at 1 month ( p = 0.04 ) , 3 months ( p = 0.03 ) , and 1 year ( p = 0.005 ) after SG as compared to RYGB . LDL cholesterol decreased significantly after RYGB at 1 month ( p = 0.03 ) , 3 months ( p = 0.0001 ) , and 1 year ( p = 0.0004 ) as compared to SG . HDL cholesterol was increased at 1 year in the RYGB group but not in the SG group . Triglycerides decreased similarly in both groups . Conclusions Short-term glycemic control was comparable after SG and RYGB . An improved lipid profile was noted after RYGB in patients with abnormal preoperative values Both Roux-en-Y gastric bypass ( RYGB ) surgery and exercise can improve insulin sensitivity in individuals with severe obesity . However , the impact of RYGB with or without exercise on skeletal muscle mitochondria , intramyocellular lipids , and insulin sensitivity index ( SI ) is unknown . We conducted a r and omized exercise trial in patients ( n = 101 ) who underwent RYGB surgery  and completed either a 6-month moderate exercise ( EX ) or a health education control ( CON ) intervention . SI was determined by intravenous glucose tolerance test . Mitochondrial respiration and intramyocellular triglyceride , sphingolipid , and diacylglycerol content were measured in vastus lateralis biopsy specimens . We found that EX provided additional improvements in SI and that only EX improved cardiorespiratory fitness , mitochondrial respiration and enzyme activities , and cardiolipin profile with no change in mitochondrial content . Muscle triglycerides were reduced in type I fibers in CON , and sphingolipids decreased in both groups , with EX showing a further reduction in a number of ceramide species . In conclusion , exercise superimposed on bariatric surgery – induced weight loss enhances mitochondrial respiration , induces cardiolipin remodeling , reduces specific sphingolipids , and provides additional improvements in insulin sensitivity CONTEXT Extreme obesity is associated with health and cardiovascular disease risks . Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term , long-term outcomes are uncertain . OBJECTIVE To examine the association of  Roux-en-Y gastric bypass ( RYGB ) surgery  with weight loss , diabetes mellitus , and other health risks 6 years after surgery . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve Utah-based study conducted between July 2000 and June 2011 of 1156 severely obese ( body mass index [ BMI ] ≥ 35 ) participants aged 18 to 72 years ( 82 % women ; mean BMI , 45.9 ; 95 % CI , 31.2 - 60.6 ) who sought and received RYGB surgery ( n = 418 ) , sought but did not have surgery ( n = 417 ; control group 1 ) , or who were r and omly selected from a population -based sample not seeking weight loss surgery ( n = 321 ; control group 2 ) . MAIN OUTCOME MEASURES Weight loss , diabetes , hypertension , dyslipidemia , and health-related quality of life were compared between participants having RYGB surgery and control participants using propensity score adjustment . RESULTS Six years after surgery , patients who received RYGB surgery ( with 92.6 % follow-up ) lost 27.7 % ( 95 % CI , 26.6%-28.9 % ) of their initial body weight compared with 0.2 % ( 95 % CI , -1.1 % to 1.4 % ) gain in control group 1 and 0 % ( 95 % CI , -1.2 % to 1.2 % ) in control group 2 . Weight loss maintenance was superior in patients who received RYGB surgery , with 94 % ( 95 % CI , 92%-96 % ) and 76 % ( 95 % CI , 72%-81 % ) of patients receiving RYGB surgery maintaining at least 20 % weight loss 2 and 6 years after surgery , respectively . Diabetes remission rates 6 years after surgery were 62 % ( 95 % CI , 49%-75 % ) in the RYGB surgery group , 8 % ( 95 % CI , 0%-16 % ) in control group 1 , and 6 % ( 95 % CI , 0%-13 % ) in control group 2 , with remission odds ratios ( ORs ) of 16.5 ( 95 % CI , 4.7 - 57.6 ; P < .001 ) vs control group 1 and 21.5 ( 95 % CI , 5.4 - 85.6 ; P < .001 ) vs control group 2 . The incidence of diabetes throughout the course of the study was reduced after RYGB surgery ( 2 % ; 95 % CI , 0%-4 % ; vs 17 % ; 95 % CI , 10%-24 % ; OR , 0.11 ; 95 % CI , 0.04 - 0.34 compared with control group 1 and 15 % ; 95 % CI , 9%-21 % ; OR , 0.21 ; 95 % CI , 0.06 - 0.67 compared with control group 2 ; both P < .001 ) . The numbers of participants with bariatric surgery-related hospitalizations were 33 ( 7.9 % ) , 13 ( 3.9 % ) , and 6 ( 2.0 % ) for the RYGB surgery group and 2 control groups , respectively . CONCLUSION Among severely obese patients , compared with nonsurgical control patients , the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years The differences in cholesterol metabolism after the 2 most common forms of obesity surgery , Roux-en-Y gastric bypass ( RYGB ) and gastric b and ing ( GB ) , have not been well characterized . In this study , effects of RYGB and GB on cholesterol absorption and synthesis were investigated . To this aim , 1-year follow-up of cholesterol metabolism in 2 nonr and omized cohorts undergoing either RYGB ( n = 29 ; age , 45.2 + /- 7.7 years ; body mass index [ BMI ] , 46.0 + /- 6.1 kg/m(2 ) ) or GB ( n = 26 ; age , 45.9 + /- 8.6 years ; BMI , 50.1 + /- 7.7 kg/m(2 ) ) was performed in a university hospital center specializing in the treatment of morbid obesity .  Serum markers of cholesterol synthesis ( cholestenol , desmosterol , and lathosterol ) and cholesterol absorption ( campesterol , sitosterol , avenasterol , and cholestanol ) were measured preoperatively and at follow-up and expressed as ratios to cholesterol . As expected based on observed weight loss ( 25 % after RYGB and 17 % after GB , P < .001 between groups ) , both operations decreased serum levels of cholesterol synthesis markers by 12 % to 28 % ( all Ps < .001 ) . A decrease in cholesterol absorption markers was only observed after RYGB ( -26 % for sitosterol ) and not after GB ( + 16 % , P = 2 x 10(-6 ) for difference between the groups ) . The difference in sitosterol ratio between the groups remained significant after adjustment for age , BMI , fasting insulin levels , and nutritional status ( P = 2 x 10(-4 ) ) , indicating a specific effect related to RYGB . We conclude that decrease in cholesterol absorption is a novel beneficial effect of RYGB . Together with an improved control of blood glucose , this may contribute to a better cardiovascular risk profile after RYGB Background  Laparoscopic sleeve gastrectomy ( LSG )  has shown to be effective in serum triglycerides reduction and HDL cholesterol increase , but with little effect on total cholesterol and LDL cholesterol .  Physical activity is recognized as an effective non-pharmacological intervention to reduce body fat mass and hypercholesterolemia . Methods A prospect i ve observational study of all the patients undergoing LSG as bariatric technique between 2007 and 2012 was performed . All patients completed the Spanish Version of the Modifiable Physical Activity Question naire at two time points : baseline ( pre-intervention ) and 1 year after surgery , both in face-to-face interviews . Lipid profiles were monitored at the same time points . Results A total of 50 patients were included in the study , 44 females ( 88 % ) and six males ( 12 % ) with a mean age of 42.7 ± 10.3 years . Comorbidities included dyslipidemia in 50 % ( 40 % hypercholesterolemia and 10 % hypertriglyceridemia ) . Preoperatively , four patients ( 8 % ) reported moderately active physical activity and one patient ( 2 % ) active physical exercise . The rest of the patients were sedentary . One year after surgery , 30 patients ( 60 % ) performed any kind of active physical activity , while the rest were sedentary . Lipid profile 12 months after surgery showed significantly lower total cholesterol levels in the active group ( 182.8 mg/dl vs 220 mg/dl in the sedentary group ; p = 0.003 ) . LDL cholesterol levels were also lower in the active group ( 103.2 vs 133 mg/dl in the sedentary group ; p = 0.015 ) . Conclusion The performance of routine moderate physical activity in addition to LSG achieves a significant improvement in all parameters of the lipid profile Background To compare long term effects of two bariatric procedures for Chinese type 2 diabetes mellitus ( T2DM ) patients with a body mass index ( BMI ) of 28 - 35 kg/m2 . Methods Sixty four T2DM patients with Glycated hemoglobin A1c ( HbA1c ) ≧ 7.0 % were r and omly assigned to receive laparoscopic sleeve gastrectomy ( SG ) or Roux-en-Y gastric bypass ( RYGB ) procedure . Weight , percentage of excess weight loss ( % EWL ) , BMI , waist circumference , HbA1c , fasting blood glucose ( FBG ) , and C-peptide were measured . Serum lipid levels were also measured during three-year postoperative follow-up visits . Results Fifty five patients completed the 36-month follow-up . Both groups had similar baseline anthropometric and biochemical measures . At the end point , 22 patients ( 78.6 % ) in SG group and 23 patients ( 85.2 % ) in RYGB group achieved complete remission of diabetes mellitus with HbA1c < 6.0 % ( P = 0.525 ) and without taking diabetic medications , and 25 patients in each group ( 89.3 % vs. 92.6 % ) gained successful treatment of diabetes with HbA1c≦6.5 % ( P = 0.100 ) . Change in HbA1c , FBG and C peptide were comparable in the two groups . The RYGB group had significantly greater weight loss than the SG group [ percentage of total weight loss ( % TWL ) of 31.0 % vs. 27.1 % ( P = 0.049 ) , % EWL of 92.3 % vs. 81.9 % ( P = 0.003 ) , and change in BMI of 11.0 vs. 9.1 kg/m2(P = 0.017 ) , respectively ] . Serum lipids in each group were also greatly improved . Conclusion In this three-year study , SG had similar positive effects on diabetes and dyslipidemia compared to RYGB in Chinese T2DM patients with BMI of 28 - 35 kg/m2 . Longer term follow-ups and larger sample studies are needed to confirm these outcomes , however AIMS The aim of this study was to evaluate the effect of laparoscopic Roux-en-Y gastric bypass ( RYGB ) surgery compared with usual care with and without Exenatide therapy in obese people with type 2 diabetes mellitus ( T2DM ) and hypertension . METHODS 108 obese T2DM with hypertension were enrolled and r and omly allocated to usual care ( group A ) , usual care plus Exenatide ( group B ) , and RYGB surgery ( group C ) . Demographic characteristics , metabolic parameters and cardiac structure/function along with inflammatory cytokines were measured and compared before and after 12 months . RESULTS At 12 months , diabetes remission had occurred in no patients in groups A and B versus 90 % in group C , and there was a significant decrease in requirement of antihypertensive drugs in group C compared with groups A and B ( P<0.05 ) . Other parameters ( body mass index , hemoglobin A1c , homeostasis model assessment of insulin resistance , lipids ) , inflammation index ( high sensitivity C-reactive protein , tumor necrosis factor-α , high molecular weight adiponectin ) and cardiac structure ( left ventricular mass index ) were significantly improved in groups B and C , but patients in group C had the greatest degree of improvement ( P<0.05 ) . CONCLUSION RYGB surgery improves a number of parameters including cardiovascular function in obese hypertensive people with T2DM . This is likely to be due to , at least in part , an improvement in the abnormal metabolic panel and to reduced inflammation BACKGROUND Excess visceral adipose tissue predicts for incipient diabetes mellitus and cardiovascular disease . Human data are mixed regarding the benefits of selective visceral adipose tissue reduction . We investigated the effects of omentectomy added to laparoscopic Roux-en-Y gastric bypass on glucose homeostasis and lipids , inflammatory markers , and adipokines 90 days postoperatively in nondiabetic patients at the Legacy Good Samaritan Hospital and Oregon Health and Science University ( Portl and , OR ) . METHODS A single-blind , r and omized study of laparoscopic Roux-en-Y gastric bypass plus omentectomy versus laparoscopic Roux-en-Y gastric bypass alone in 28 subjects ( 7 men and 21 women ) . The groups were matched at baseline for gender , age , and body mass index ( BMI ) . The eligibility criteria included age ≥18 years , BMI ≥40 and < 50 kg/m(2 ) without co-morbid conditions or BMI ≥35 and < 50 kg/m(2 ) with co-morbid conditions . The primary outcome measures were changes in the fasting plasma glucose , insulin , and homostatic model assessment of insulin resistance . The secondary measures were BMI and the high-sensitivity C-reactive protein , tumor necrosis factor-α , interleukin , total and high-molecular-weight adiponectin , fibrinogen , and plasminogen activator inhibitor-1 levels . RESULTS After surgery , the BMI decreased significantly in both groups and was not different at the follow-up point . Although many outcome parameters improved with weight loss in both groups postoperatively , only the omentectomy group experienced statistically significant decreases in fasting glucose ( P < .05 ) , total ( P = .004 ) and very-low-density lipoprotein ( P = .001 ) cholesterol , and an increase in the high-molecular-weight/total adiponectin ratio ( P = .013 ) . CONCLUSIONS Omentectomy added to laparoscopic Roux-en-Y gastric bypass results in favorable changes in glucose homeostasis , lipid levels , and adipokine profile at 90 days postoperatively . These data support the hypothesis that selective ablation of visceral adipose tissue conveys metabolic benefits in nondiabetic humans BACKGROUND Patients who are categorized with class I obesity have a body mass index ( BMI ) of 30 - 34.99 kg/m(2 ) . This population of patients has a predisposition to diabetes , hypertension , and dyslipidemia . The aim of the present study was to investigate the improvements of these co-morbidities in a class I obese population that had undergone a bariatric procedure . METHODS After internal review board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines , a retrospective review was performed of a prospect ively maintained data base of 42 class I obese patients who underwent a bariatric procedure at our institution during a 10-year period , from February 2000 to May 2010 . The fasting glucose level , glycosylated hemoglobin level , lipid profile , initial weight , and BMI were measured in the preoperative and postoperative periods . RESULTS Our patient population consisted of 30 women and 12 men , with a preoperative mean BMI of 33.9 kg/m(2 ) .  Laparoscopic sleeve gastrectomy was performed in 24 patients ( 57 % ) , laparoscopic Roux-en-Y gastric bypass in 8 ( 19 % ) , and laparoscopic adjustable gastric b and ing in 10 ( 24 % ) . Of these 42 patients , 25 ( 60 % ) had type 2 diabetes , 1 patient was glucose intolerant , 27 ( 64 % ) had arterial hypertension , 25 ( 60 % ) had dyslipidemia , 17 ( 40 % ) had sleep apnea , and 8 ( 19 % ) had osteoarthritis . The postoperative findings included a mean BMI of 26.5 kg/m(2 ) and a mean weight loss of 41.4 lb . Of the 25 diabetic patients , 5 ( 20 % ) gained remission and 12 ( 48 % ) improvement of their diabetic status . The single patient with glucose intolerance showed improvement . Of the 27 patients with arterial hypertension , 9 ( 33 % ) showed remission and 13 ( 52 % ) improvement . Dyslipidemia resolved in 5 patients ( 20 % ) and improved in 13 ( 52 % ) . Obstructive sleep apnea resolved in 10 ( 59 % ) and improvement was seen in 1 patient ( 6 % ) . Finally , osteoarthritis resolved in 1 patient ( 12 % ) and improved in 5 ( 63 % ) . CONCLUSION Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity Background : The presence of hypercholesterolemia is currently not considered a selection criteria for performing gastric restrictive or diversionary bariatric surgery . Methods : We prospect ively investigated the effects of the bilio-intestinal bypass ( BI-bypass ) with a wide cholecysto-jejunal anastomosis and of adjustable gastric b and ing ( AGB ) on blood lipid concentrations in obese patients . To clarify the mechanism of the hypocholesterolemic effect of the BI-bypass , daily fecal sterol excretion was measured by gas-liquid chromatography ( GLC ) . Results : At 1 year after BI-bypass compared to baseline , the hypercholesterolemic ( n=18 ) and the normocholesterolemic ( n=19 ) patients significantly reduced total ( −38 % and −27 % , respectively ) , LDL ( −47 % and −24 % , respectively ) and HDL ( −11 % and −13 % , respectively ) cholesterol and total / HDL cholesterol ratio ( −25 % and −13 % , respectively ) . At 1 year after AGB , the total / HDL cholesterol ratio was significantly decreased ( −11 % ) compared to baseline in hypercholesterolemic ( n=12 ) but not in normocholesterolemic ( n=6 ) patients , while total and LDL cholesterol were not affected in both groups . At 3 years after BI-bypass compared to baseline , the hypercholesterolemic ( n=9 ) and the normocholesterolemic ( n=11 ) patients significantly reduced total ( −43 % and −28 % , respectively ) and LDL ( −53 % and −29 % , respectively ) cholesterol and total / HDL cholesterol ratio ( −38 % and −21 % , respectively ) . The BI-bypass induced a significant ( P < 0.005 ; n=7 ) 6-fold increase in mean fecal cholesterol output . Conclusions : The BI-bypass but not the AGB leads to a persistent and marked beneficial effect on blood LDL cholesterol associated with an increased cholesterol fecal output . BI-bypass but not AGB is indicated in morbidly obese patients with hypercholesterolemia Roux-en-Y gastric bypass ( RYGB ) improves glycemic control within days after surgery , and changes in insulin sensitivity and β-cell function are likely to be involved . We studied 10 obese patients with type 2 diabetes ( T2D ) and 10 obese glucose-tolerant subjects before and 1 week , 3 months , and 1 year after RYGB . Participants were included after a preoperative diet-induced total weight loss of −9.2 ± 1.2 % . Hepatic and peripheral insulin sensitivity were assessed using the hyperinsulinemic- euglycemic clamp combined with the glucose tracer technique , and β-cell function was evaluated in response to an intravenous glucose-glucagon challenge as well as an oral glucose load . Within 1 week , RYGB  reduced basal glucose production , improved basal hepatic insulin sensitivity , and increased insulin clearance , highlighting the liver as an important organ responsible for early effects on glucose metabolism after surgery . Insulin-mediated glucose disposal and suppression of fatty acids did not improve immediately after surgery but increased at 3 months and 1 year ; this increase likely was related to the reduction in body weight . Insulin secretion increased after RYGB only in patients with T2D and only in response to oral glucose , underscoring the importance of the changed gut anatomy Background Sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass ( RYGBP ) are associated with similar type 2 diabetes mellitus ( T2DM ) resolution rates for morbidly obese subjects . However , the mechanisms underlying the resolution of T2DM after SG have not been clarified to date . This study aim ed to compare the early changes in gastrointestinal hormones involved in insulin and glucagon secretion in morbidly obese T2DM subjects undergoing SG or RYGBP . Methods This prospect i ve study investigated 12 subjects with T2DM who had undergone SG ( n = 6 ) or RYGBP ( n = 6 ) . Five body mass index ( BMI ) -matched obese non-diabetic subjects and five BMI -matched obese diabetic subjects served as control subjects .  Glucose , insulin , glucagon , glucagon-like peptide 1 ( GLP-1 ) , glucose-dependent insulinotropic polypeptide ( GIP ) , and GLP-2 were determined after a st and ardized mixed liquid meal before surgery and 6 weeks afterward . Results After 6 weeks , five of the six subjects in each surgical group presented with T2DM remission , although the area under the curve (AUC)0–120 of glucose was greater than that of the non-diabetic control subjects ( P < 0.01 ) . Postsurgically , the indices of insulin and glucagon secretion were comparable between the two surgical groups . The AUC0–120 of GLP-1 ( P < 0.05 ) and GLP-2 ( P < 0.05 ) was significantly and comparably enlarged after SG and RYGB . The postsurgical GIP response was significantly associated with the glucagon response throughout the meal test ( ρ = 0.747 ; P < 0.01 ) . Conclusions The data show that in a cohort of morbidly obese T2DM subjects , SG and RYGBP are associated with an early improvement in glucose tolerance , similar changes in insulin and glucagon secretion , and a similar GLP-1 , GIP , and GLP-2 response to a st and ardized mixed liquid meal Background Increased visceral adipose tissue is a risk factor for the metabolic complications associated with obesity and promotes a low- grade chronic inflammatory process . Resection of the great omentum in patients su bmi tted to a bariatric procedure has been proposed for the amelioration of metabolic alterations and the maximization of weight loss . The aim of the present study was to investigate the impact of omentectomy performed in patients with morbid obesity undergoing sleeve gastrectomy ( SG ) on metabolic profile , adipokine secretion , inflammatory status , and weight loss . Methods Thirty-one obese patients were r and omized into two groups : SG alone or with omentectomy . Adiponectin , omentin , interleukin-6 ( IL-6 ) , tumor necrosis factor-α ( TNF-α ) , high-sensitivity C-reactive protein ( hs-CRP ) , blood lipids , fasting glucose , insulin , and insulin resistance were measured before surgery and at 7 days , and 1 , 3 and 12 months after surgery . Results During the 1-year follow-up , body mass index ( BMI ) decreased markedly and comparably in both groups ( p < 0.001 ) . Insulin , IL-6 , and hs-CRP levels decreased significantly compared to baseline ( p < 0.05 ) in both groups with no significant difference between groups . Adiponectin and high-density lipoprotein cholesterol levels were significantly and similarly increased compared to baseline ( p < 0.001 ) in both groups . Omentin levels increased significantly ( p < 0.05 ) in the control group and decreased in the omentectomy group 1 year postoperatively . There was no significant change in TNF-α levels in either group . Conclusions The theoretical advantages of omentectomy in regard to weight loss and obesity-related abnormalities are not confirmed in this prospect i ve study . Furthermore , omentectomy does not induce important changes in the inflammatory status in patients undergoing SG Objective Weight reduction improves several obesity-related health conditions . We aim ed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors . Design One-year controlled clinical trial ( Clinical Trials.gov identifier NCT00273104 ) . Methods Morbidly obese subjects ( 19–66 years , mean ( s.d . ) body mass index 45.1 kg/m2 ( 5.6 ) , 103 women ) were treated with either Roux-en-Y gastric bypass surgery ( n=80 ) or intensive lifestyle intervention at a rehabilitation centre ( n=66 ) . The dropout rate within both groups was 5 % . Results Among the 76 completers in the surgery group and the 63 completers in the lifestyle group , mean ( s.d . ) 1-year weight loss was 30 % ( 8) and 8 % ( 9 ) respectively . Beneficial effects on glucose metabolism , blood pressure , lipids and low- grade inflammation were observed in both groups . Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group ; 70 vs 33 % , P=0.027 , and 49 vs 23 % , P=0.016 . The improvements in glycaemic control and blood pressure were mediated by weight reduction . The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome , albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group . Gastrointestinal symptoms and symptomatic postpr and ial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention . There were no deaths . Conclusions Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies . However , the improvements were greatest in those patients treated with gastric bypass surgery
Conclusions RYGB surgery reverses the dyslipidaemia of obesity .
These findings support the use of RYGB in the management of high cardiovascular risk lipid profiles in morbid obesity
Background Obesity-related dyslipidaemia comprises hypercholesterolaemia , hypertriglyceridaemia , low HDL-cholesterol and normal to raised LDL-cholesterol levels .
40 % of morbidly obese surgical patients have dyslipidaemia .
Roux-en-Y gastric bypass ( RYGB ) surgery has many beneficial metabolic effects , but the full impact on plasma lipids has not been clearly defined .