Lipid profile in the severely obese: changes with weight loss after lap-band surgery.

OBJECTIVE: To characterize dyslipidemia before and after weight loss in the severely obese. RESEARCH METHODS AND PROCEDURES: Five hundred fifteen subjects who had Lap-Band surgery were followed with yearly conventional lipid profiles for up to 4 years. Preoperative data were collected from the most recent 381 subjects, and predictors of dyslipidemia were sought. One hundred seventy-one subjects completed a 1-year review, providing data to assess predictors of change in lipids.
RESULTS: Favorable changes in fasting triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and total cholesterol (TC):HDL-C ratio occurred within 1 year. All improvements were maintained up to 4 years. Male gender, central obesity, elevated fasting glucose, and insulin resistance were associated with less favorable lipid levels. Fasting plasma glucose best predicted TG (r = 0.46, p < 0.001), whereas insulin sensitivity using the homeostatic model assessment (HOMA %S) correlated best with the HDL-C (r =0.34, p < 0.001). Higher preoperative fasting glucose best predicted the decrease in TG; improved HOMA %S with weight loss correlated best with HDL-C. The extent of weight loss had limited influence on lipid changes. However, low preoperative HOMA %S was associated with lower weight loss. Greater weight loss was associated with more favorable lipid measures after controlling for preoperative HOMA %S. DISCUSSION: Dyslipidemia of obesity is related to weight distribution, insulin sensitivity, and impaired glucose tolerance. Improvement with weight loss is related to the decrease in fasting glucose, improvement in insulin sensitivity, and the extent of weight lost. Improvement in dyslipidemia is sustained with long-term weight loss.