Short-term effects of gastric bypass versus sleeve gastrectomy on high LDL cholesterol: The BASALTO randomized clinical trial

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• dc.contributor.author Benaiges Foix, David
• dc.contributor.author Goday Arno, Alberto
• dc.contributor.author Casajoana, Anna
• dc.contributor.author Flores Le Roux, Juana A.
• dc.contributor.author Fitó Colomer, Montserrat
• dc.contributor.author Pozo Mendoza, Óscar J., 1975-
• dc.contributor.author Serra, Carme
• dc.contributor.author Pera Roman, Manuel Ramón
• dc.contributor.author Llauradó Cabot, Gemma
• dc.contributor.author Climent Biescas, Elisenda
• dc.contributor.author Villatoro Moreno, Montserrat
• dc.contributor.author Lázaro, Iolanda
• dc.contributor.author Castañer, Olga
• dc.contributor.author Pedro-Botet, Juan Carlos
• dc.date.accessioned 2025-03-14T07:14:24Z
• dc.date.available 2025-03-14T07:14:24Z
• dc.date.issued 2024
• dc.description.abstract Background: There has been a substantial increase in the use of laparoscopic sleeve gastrectomy (SG) to treat morbid obesity despite observational evidence demonstrating the superiority of Roux-en-Y gastric bypass (RYGB) for reducing low-density lipoprotein (LDL) cholesterol. The main aim was to ascertain whether high LDL cholesterol levels should be considered when selecting the most appropriate surgical procedure for each patient (RYGB or SG). Methods: In this single-center, randomized clinical trial using intention-to-treat analysis, 38 patients with severe obesity and elevated levels of LDL cholesterol were randomly assigned to undergo RYGB or SG. The primary outcome was LDL cholesterol remission at 12 months, defined as LDL cholesterol < 3.36 nmol/l without lipid-lowering medications. Secondary outcomes included changes in weight, other comorbidities, qualitative lipoprotein traits, cholesterol esters, glycoproteins, cholesterol absorption and synthesis metabolites and complications. Results: Intention-to-treat analysis revealed that LDL cholesterol remission occurred in 66.6% of RYGB patients compared to 27.8% of SG patients (p = 0.019). Among patients completing follow-up, RYGB demonstrated superior remission (80.0% vs. 29.4%, p = 0.005). Exclusive benefits of RYGB included a reduction in large, medium, and small LDL particles. Cholesterol absorption markers showed differential behavior after both techniques: campesterol (Δ -15.2 µg/mg, 95% CI -30.2 to -0.1) decreased after RYGB, and sitosterol (Δ 21.1 µg/mg, 95% CI 0.9 to 41.2), cholestanol (Δ 30.6 µg/mg, 95% CI 14.8 to 57.9) and campesterol (Δ 18.4 µg/mg, 95% CI 4.4 to 32.3) increased after SG. No differences in weight loss, cholesterol esters, glycoproteins, cholesterol synthesis metabolites or postoperative complications were observed between techniques. Conclusion: In conclusion, RYGB is superior to SG in terms of short-term of high LDL cholesterol remission. Furthermore, RYGB also led to a greater improvement in lipoprotein parameters that confer an atherogenic profile. Therefore, the presence of elevated levels of LDL cholesterol should be considered when determining the optimal bariatric surgery procedure for each patient. Trial registration: Clinicaltrials.gov number, NCT03975478).
• dc.format.mimetype application/pdf
• dc.identifier.citation Benaiges D, Goday A, Casajoana A, Flores-Le Roux JA, Fitó M, Pozo OJ, et al. Short-term effects of gastric bypass versus sleeve gastrectomy on high LDL cholesterol: The BASALTO randomized clinical trial. Cardiovasc Diabetol. 2024 Jun 15;23(1):205. DOI: 10.1186/s12933-024-02296-x
• dc.identifier.doi http://dx.doi.org/10.1186/s12933-024-02296-x
• dc.identifier.issn 1475-2840
• dc.identifier.uri http://hdl.handle.net/10230/69937
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.relation.ispartof Cardiovasc Diabetol. 2024 Jun 15;23(1):205
• dc.rights © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Bariatric surgery
• dc.subject.keyword Cholesterol esters
• dc.subject.keyword Hypercholesterolemia
• dc.subject.keyword LDL cholesterol
• dc.subject.keyword Lipoprotein
• dc.subject.keyword Roux-en-Y gastric bypass
• dc.subject.keyword Sleeve gastrectomy
• dc.title Short-term effects of gastric bypass versus sleeve gastrectomy on high LDL cholesterol: The BASALTO randomized clinical trial
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion