In Obesity Patients, Is the Goal to Lose Weight or to Fight Metabolic Syndrome Components? How Did Leptin and Perilipin 1 Guide US in the Choice of Surgical Procedure?

BACKGROUND

Severe obesity is a growing global health issue and a significant risk factor for cardiovascular diseases. Bariatric and metabolic surgeries, such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are effective interventions for managing cardiometabolic comorbidities associated with obesity. This study investigates early changes in leptin and perilipin-1 levels following SG and RYGB and their impact on cardiometabolic comorbidities.

METHODS

A total of 60 individuals with severe obesity (body mass index [BMI] >35 kg/m2 with cardiometabolic comorbidities or BMI >40 kg/m2) underwent bariatric and metabolic surgery at a single center. Demographic data, preoperative and postoperative (1st-month) laboratory values (leptin, perilipin-1, hemoglobin A1c [HbA1c], low-density lipoprotein [LDL] cholesterol, triglycerides), and weight loss were recorded. Statistical analyses compared changes between the groups.

RESULTS

Forty individuals underwent SG, and 20 underwent RYGB. Both SG and RYGB resulted in significant weight loss and improvements in metabolic parameters within the first 30 postoperative days. Perilipin-1, a lipid droplet-coating protein that regulates lipolysis and is implicated in atherosclerotic plaque formation, showed significantly different postoperative trajectories between the two groups. RYGB demonstrated greater reductions in leptin and perilipin-1 levels compared with SG (P = .007 for perilipin-1). LDL cholesterol and HbA1c levels also decreased more significantly in the RYGB group. While SG showed no significant changes in perilipin-1 levels postoperatively, RYGB significantly reduced this marker, suggesting superior efficacy in addressing obesity-related cardiometabolic comorbidities.

CONCLUSION

Within the first 30 postoperative days, RYGB produces earlier and more pronounced reductions in key metabolic markers, including leptin, perilipin-1, LDL cholesterol, and HbA1c, compared with SG. These early hormonal differences may help explain the long-term cardiometabolic advantages of RYGB reported in the literature and support prioritizing RYGB in patients with severe obesity with associated metabolic comorbidity components. Further prospective studies with long-term follow-up are warranted.