As many of you know, the ASMBS had their Annual Convention in Las Vegas last week and now the journals are starting to pour out a ton of information from that meeting.  I’ve been slacking of late, but I’m going to start putting in the things that they’ve churned out from the meeting as it directly relates to the WLS community.  Maybe not nutrition-wise, but still.

Another thing to add to the “duh” pile. Nice nod to the DS towards the end.

From Medscape:

Durable Improvement in Lipid Levels After Gastric Bypass Surgery

Nancy A. Melville

June 30, 2010 (Las Vegas, Nevada) — Gastric bypass surgery can significantly reduce cholesterol levels in morbidly obese patients within just 6 months of the surgery, and overall lipid profiles continue to improve for as long as 6 years after surgery, according to a study presented here at the American Society for Metabolic and Bariatric Surgery 27th Annual Meeting.

“Hyperlipidemia is present in nearly 50% of severely obese individuals, and it fails to show clinically significant amelioration with conventional weight management methods,” said coauthor Isaac Samuel, MD, bariatric surgeon with the University of Iowa Hospitals and Clinics, in Iowa City, during his presentation.

To determine if the significant weight loss associated with gastric bypass surgery had an effect on lipid levels, Dr. Samuel and his colleagues conducted a retrospective analysis of 248 patients undergoing Roux-en-Y gastric bypass surgery at their center between 2000 and 2005. Of these, 198 patients were female (mean age, 39 years), 94 were identified as having hyperlipidemia at baseline, and 23 were being clinically treated with lipid-lowering medications prior to surgery.

For the study, hyperlipidemia was defined as a total cholesterol level of 200 mg/dL or greater and elevated triglyceride levels of 150 mg/dL or greater.

The researchers also evaluated changes in the lipid profile of patients with subnormal levels of high-density-lipoprotein (HDL) cholesterol (≤40 mg/dL) and high levels of low-density-lipoprotein (LDL) cholesterol (>130 mg/dL).

Fasting lipid profiles were measured preoperatively and at annual intervals in the 6 years after surgery.

The results showed that within 6 months of surgery, nearly all patients with hypercholesterolemia at baseline had normal blood cholesterol levels, and the majority of patients who were taking statins or other lipid-lowering medications prior to the surgery no longer needed them.

“The percentage of patients on lipid-lowering medications was 24% prior to operation. Within 6 months, only 2% were on medications,” Dr. Samuel said.

Patients showed average declines in total cholesterol levels of 20%, dropping from 220 mg/dL to 179 mg/dL 6 months later. Triglyceride levels dropped more than 40%, from 212 mg/dL at baseline to 128 mg/dL at follow-up. LDL cholesterol levels dropped more than 20%, from 135 mg/dL at baseline to 106 mg/dL at 6-month follow-up.

Even 6 years after the surgery, the levels remained unchanged; however, there was the additional benefit of a greater than 10% increase in HDL cholesterol levels (51 to 57 mg/dL), and the ratio of total to HDL cholesterol dropped from 4.3 to 2.8.

Patients who had an average body mass index (BMI) of 50 kg/m2 before surgery had lost nearly 40% of their BMI, or 80% of their excess body weight, 6 years later.

Dr. Samuel noted that the National Institutes of Health, in 2008, determined gastric bypass surgery to be better than insulin in the treatment of type 2 diabetes, and he said that, likewise, the degree and longevity of improvement in lipid levels from gastric bypass surgery raise the issue of whether the surgery itself could become a primary tool for treating hyperlipidemia.

“The study’s findings raise the question of whether Roux-en-Y gastric bypass surgery is more effective than lipid-lowering medications in the treatment of hyperlipidemia in the morbidly obese,” he said. “It could even be worthwhile to consider whether there could be a place for the Roux-en-Y gastric bypass surgery in the management of hyperlipidemia in patients with a BMI of less than 35 kg/m2.”

Bariatric surgeon Marina Kurian, MD, session moderator and medical director of New York University’s Weight Management Program in New York City, said some improvement in a host of comorbidities can be expected with gastric bypass surgery, and sustained benefits at 6 years is impressive, but as more years pass, problems can arise.

“In general, you tend to see improvement with all medical comorbidities when there is weight loss of 20% of excess body weight or more,” said Dr. Kurian. “But I’ve had patients with bypass surgery actually become hypercholesterolemic in the long term, and there is an incidence over 10 years where patients may see comorbid conditions. I’ve seen hypertension occur in patients who lost a significant amount of weight, I’ve seen them become diabetic with weight gain, and not as much weight gain as you might expect,” she explained. “So you may find some of these comorbid conditions emerging if you follow patients long enough.”

She noted, however, that gastric bypass surgery could indeed have an expanded role in treating hyperlipidemia; however, getting insurance companies to go along with the idea might be a challenge.

“Gastric bypass surgery is definitely a potential treatment, as is the duodenal switch, and we have actually performed a bypass to treat severe hypertriglyceridemia,” she said. “But in general, insurance companies currently don’t consider hyperlipidemia as severe a disease as diabetes because of the sequelae and because diabetes affects more organs than hyperlipidemia.”

The study did not receive any funding. Dr. Samuel and Dr. Kurian have disclosed no relevant financial relationships.

American Society for Metabolic and Bariatric Surgery (ASMBS) 27th Annual Meeting: Abstract PL-210. Presented June 25, 2010.

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