Laparoscopic gastric banding resolves the metabolic syndrome and improves lipid profile over five years in obese patients with body mass index 30-40 kg/m(2.)

• Published in: Atherosclerosis 2014-11, Vol.237 (1), p.183-190
• Main Authors: Heffron, Sean P, Singh, Amita, Zagzag, Jonathan, Youn, Heekoung A, Underberg, James A, Fielding, George A, Ren-Fielding, Christine J
• Format: Article
• Language: English
• Subjects: Adult; Body Mass Index; Body Weight; Cholesterol, HDL - blood; Female; Gastric Bypass; Humans; Laparoscopy; Lipoproteins, LDL - blood; Male; Metabolic Syndrome - blood; Metabolic Syndrome - complications; Metabolic Syndrome - surgery; Middle Aged; Obesity - surgery; Particle Size; Prospective Studies; Quality of Life; Risk Factors; Waist Circumference; Weight Loss
• ISSN: 1879-1484
• DOI: 10.1016/j.atherosclerosis.2014.08.030

Obesity, metabolic syndrome (MS) and dyslipidemia are independent risk factors for cardiovascular disease. Bariatric surgery is increasingly recognized as an effective intervention for improving each of these risk factors. There are sparse data on the long-term durability of metabolic changes associated with bariatric surgery, in particular with laparoscopic gastric banding (LGB). Our objective was to evaluate the durability of metabolic changes associated with LGB in nonmorbid obesity. Fifty obese patients (BMI 30-40) with ≥1 obesity-related comorbidity were prospectively followed for five years. At follow-up, subjects underwent fasting blood measures, including lipid NMR spectroscopy and standard lipid profile. Forty-seven patients (45 female, mean age 43.8 years) completed four years follow-up (46 completed five years). Baseline BMI was 35.1 ± 2.6. Subjects exhibited mean weight loss of 22.3 ± 7.9 kg (22.9 ± 7.4%) at year one and maintained this (19.8 ± 10.2%) over five years. At baseline, 43% (20/47) of subjects met criteria for MS. This was reduced to 15% (7/47) at year one and remained reduced over five years (13%, 6/46) (p < 0.001). There were reductions in triglycerides (p < 0.001) and increases in HDL cholesterol (HDL-C, p < 0.001) and HDL particle concentration (p = 0.02), with a trend toward increased HDL particle size (p = 0.06) at year five. Changes in triglycerides and HDL-C were more prominent in patients with MS at baseline, but unassociated with weight loss or waist circumference. Changes in HDL particle size and concentration were not associated with MS status, weight loss, waist circumference, or statin use. LGB produces significant weight loss, resolution of MS and changes in lipid profile suggestive of beneficial HDL remodeling. These changes persist five years following LGB.