In the Journals

Frequent walking can enhance cardiovascular benefits of bariatric surgery

Adolescents who undergo bariatric surgery can decrease their LDL and non-HDL cholesterol levels and potentially eliminate dyslipidemia by increasing physical activity in the 3 years following the procedure, according to findings presented in Obesity.

Paula Holland Price

“Dyslipidemia in adolescence also predicts [cardiovascular disease] risk in adulthood, particularly high LDL cholesterol and non-HDL cholesterol,” Paula Holland Price, MD, PhD, MS, FAAP a postdoctoral fellow in the department of pediatrics at the University of Colorado School of Medicine in Aurora, and colleagues wrote. “Both obesity and dyslipidemia have been identified as important treatment targets in childhood and adolescence for the reduction of lifelong CVD risk, and metabolic/bariatric surgery has been demonstrated to effectively treat severe obesity and improve dyslipidemia in adolescents.”

“Small increases in walking activity, even at slow cadence, improved lipid measures of cardiovascular disease risk and weight loss maintenance post-metabolic bariatric surgery in adolescents with severe obesity,” Price told Endocrine Today.

A total of 108 adolescents who underwent either Roux-en-Y gastric bypass or vertical sleeve gastrectomy (mean age, 17 years; 76.9% girls; mean BMI at baseline, 54.3 kg/m2) were included as part of the Teen-LABS study. The participants used an activity monitor to record their walking cadence and the number of steps taken each day. A measure of more than 80 steps per minute was considered moderate activity.

At baseline, participants who took at least 6,000 steps per day on average were considered “more active,” and those who took fewer than 4,000 steps per day on average were considered “less active.” After 2 years, the average daily step count for those in the more active group rose to more than 9,000 while the less active group remained static in terms of step count.

After adjusting for baseline non-HDL, time and change in waist circumference, the researchers found that non-HDL was decreased by a greater amount in the more active group after 3 years compared with the less active group (–14.62 mg/dL; 95% CI, –28.18 to –1.06). When including the same adjustments, participants who were considered more active also decreased their LDL levels more than those in the less active group (–14.83 mg/dL; 95% CI, –27.88 to –1.78). This finding held when the researchers adjusted for change in BMI from baseline instead of waist circumference (–13.26 mg/dL; 95% CI, –26.14 to –0.38).

In addition to non-HDL and LDL reductions, the researchers noted that more active participants decreased their BMI by 11% more (P = .046) and that their levels of non-HDL, LDL and triglycerides “converted to acceptable values” more frequently compared with their less active participant counterparts. The researchers added that dyslipidemia normalized for more active participants at 3 years after surgery.

“More physical activity further improves lipid measures of cardiovascular disease risk and weight loss maintenance post-metabolic bariatric surgery in adolescents with severe obesity,” Price said. “Physical activity is a valuable adjunctive therapy in the surgical treatment of adolescents with severe obesity.”– by Phil Neuffer

Disclosures: Price reports she is supported by the National Heart, Lung, and Blood Institute. Please see the study for all other authors’ relevant financial disclosures.

Adolescents who undergo bariatric surgery can decrease their LDL and non-HDL cholesterol levels and potentially eliminate dyslipidemia by increasing physical activity in the 3 years following the procedure, according to findings presented in Obesity.

Paula Holland Price

“Dyslipidemia in adolescence also predicts [cardiovascular disease] risk in adulthood, particularly high LDL cholesterol and non-HDL cholesterol,” Paula Holland Price, MD, PhD, MS, FAAP a postdoctoral fellow in the department of pediatrics at the University of Colorado School of Medicine in Aurora, and colleagues wrote. “Both obesity and dyslipidemia have been identified as important treatment targets in childhood and adolescence for the reduction of lifelong CVD risk, and metabolic/bariatric surgery has been demonstrated to effectively treat severe obesity and improve dyslipidemia in adolescents.”

“Small increases in walking activity, even at slow cadence, improved lipid measures of cardiovascular disease risk and weight loss maintenance post-metabolic bariatric surgery in adolescents with severe obesity,” Price told Endocrine Today.

A total of 108 adolescents who underwent either Roux-en-Y gastric bypass or vertical sleeve gastrectomy (mean age, 17 years; 76.9% girls; mean BMI at baseline, 54.3 kg/m2) were included as part of the Teen-LABS study. The participants used an activity monitor to record their walking cadence and the number of steps taken each day. A measure of more than 80 steps per minute was considered moderate activity.

At baseline, participants who took at least 6,000 steps per day on average were considered “more active,” and those who took fewer than 4,000 steps per day on average were considered “less active.” After 2 years, the average daily step count for those in the more active group rose to more than 9,000 while the less active group remained static in terms of step count.

After adjusting for baseline non-HDL, time and change in waist circumference, the researchers found that non-HDL was decreased by a greater amount in the more active group after 3 years compared with the less active group (–14.62 mg/dL; 95% CI, –28.18 to –1.06). When including the same adjustments, participants who were considered more active also decreased their LDL levels more than those in the less active group (–14.83 mg/dL; 95% CI, –27.88 to –1.78). This finding held when the researchers adjusted for change in BMI from baseline instead of waist circumference (–13.26 mg/dL; 95% CI, –26.14 to –0.38).

In addition to non-HDL and LDL reductions, the researchers noted that more active participants decreased their BMI by 11% more (P = .046) and that their levels of non-HDL, LDL and triglycerides “converted to acceptable values” more frequently compared with their less active participant counterparts. The researchers added that dyslipidemia normalized for more active participants at 3 years after surgery.

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“More physical activity further improves lipid measures of cardiovascular disease risk and weight loss maintenance post-metabolic bariatric surgery in adolescents with severe obesity,” Price said. “Physical activity is a valuable adjunctive therapy in the surgical treatment of adolescents with severe obesity.”– by Phil Neuffer

Disclosures: Price reports she is supported by the National Heart, Lung, and Blood Institute. Please see the study for all other authors’ relevant financial disclosures.