Lipids and bariatric procedures part 1 of 2: Scientific statement from the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and Obesity Medicine Association: EXECUTIVE SUMMARY

Abstract

Bariatric procedures often improve lipid levels in patients with obesity. This 2-part scientific statement examines the potential lipid benefits of bariatric procedures and represents contributions from authors representing the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and the Obesity Medicine Association. The foundation for this scientific statement was based on data published through June 2015. Part 1 of this 2-part scientific statement provides an overview of: (1) adipose tissue, cholesterol metabolism, and lipids; (2) bariatric procedures, cholesterol metabolism, and lipids; (3) endocrine factors relevant to lipid influx, synthesis, metabolism, and efflux; (4) immune factors relevant to lipid influx, synthesis, metabolism, and efflux; (5) bariatric procedures, bile acid metabolism, and lipids; and (6) bariatric procedures, intestinal microbiota, and lipids, with specific emphasis on how the alterations in the microbiome by bariatric procedures influence obesity, bile acids, and inflammation, which in turn, may all affect lipid levels. Included in part 2 of this comprehensive scientific statement will be a review of: (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on cardiovascular disease; and finally (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures. This document represents the executive summary of part 1.

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

“…(2019*). Evidence‐based recommendations to manage lipid disorders are provided in recent AACE/ACE and National Lipid Association (NLA) CPGs , with an emphasis on bariatric surgery in another CPG by ASMBS/NLA/OMA . Baseline preoperative abnormalities in the lipid profile can guide procedure selection.…”

“…In a prospective, single‐center cohort study of 65 patients after SG, there was a 6% reduction in lipid‐lowering medication use at 1 month and 24% at 6 months . The pathophysiology of bariatric surgery on lipids is complex, with salutary effects on lipid metabolism postoperatively, but also downstream effects of lipids on micronutrient status and effects of micronutrients on lipid status . These networked effects among obesity, bariatric surgical disruption of GI physiology, lipid status, micronutrient status, and CVD risk will need further elucidation and research.…”

Clinical Practice Guidelines For The Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored By American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

“…. Evidence-based recommendations to manage lipid disorders are provided in recent AACE/ ACE (432) and National Lipid Association (NLA) CPGs (433,434), with an emphasis on bariatric surgery in another CPG by ASMBS/NLA/OMA (435,436). Baseline preoperative abnormalities in the lipid profile can guide procedure selection.…”

Effect of one-anastomosis gastric bypass on cardiovascular risk factors in patients with vitamin D deficiency and morbid obesity: A secondary analysis

“…Obesity is often characterized by low levels of HDL-C, as well as impaired HDL-C function, which in turn can be improved by weight loss [33]. In the case of bariatric surgery, this improvement can be explained by anatomical and metabolically changes as well as reduced systematic inflammation which in turn affects lipid metabolism, gastrointestinal lipid absorption, bile acid metabolism, microbiome, and gut hormones [10,24,34,35]. The levels of HDL-C and apoA1, which is the main protein constituent of HDL-C, are significant determinants of cholesterol efflux capacity (CEC).…”

“…Our findings showed a positive association between the development of Lp(a), TC and LDL-C at T12. It is assumed that bariatric surgery may affect the quantity and quality of gut bile acids, increase circulating bile acids, and modulate nuclear receptors that may alter both lipid and glucose metabolism, as well as bile acid sensing farnesoid X nuclear receptor (FXR) [34]. It is conceivable that FXR agonism by bile acids may also reduce Lp(a) following bariatric procedures, although no data for OAGB is currently available.…”