Key result
Bariatric surgery linked to sustained NT-proBNP increases correlating with improved insulin resistance.
Why the study?
Postoperative weight loss after bariatric surgery is associated with increased NT-proBNP levels without cardiac dysfunction, but longitudinal patterns across procedures and metabolic associations remained to be investigated.
Does bariatric surgery alter NT-proBNP levels, and is this change associated with metabolic improvements in patients with obesity?
Cohort (n=508)
No
Does bariatric surgery alter NT-proBNP levels, and is this change associated with metabolic improvements in patients with obesity?
Bariatric surgery induces a sustained increase in NT-proBNP that correlates with improved insulin resistance, particularly in women, suggesting a metabolic rather than cardiac mechanism for this biomarker shift.
Rising NT-proBNP after bariatric surgery warrants no cardiac workup in stable patients; leaves open metabolic correlations pending prospective validation.
BACKGROUND: Obesity is linked to increased risk of cardiovascular disease, type 2 diabetes, and overall mortality. Bariatric surgery effectively achieves long-term weight loss, especially in clinically severe obesity. Postoperative weight loss is associated with increased N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, without signs of cardiac dysfunction. OBJECTIVES: We investigated longitudinal changes in NT-proBNP levels following different bariatric procedures and examined their associations with metabolic alterations. SETTING: This retrospective study was conducted in a large university hospital in central Europe using data from 2005 to 2016. METHODS: We analyzed preoperative and postoperative laboratory results from 508 patients undergoing three different bariatric procedures. Follow-up records were available for 347 (68.3%) patients at month 3, 260 (51.2%) at month 6, 152 (29.9%) at month 9, 183 (36.0%) at month 12, 166 (32.7%) at month 18, and 127 (25.0%) at month 24 postsurgery. RESULTS: NT-proBNP levels rose shortly after bariatric surgery and remained elevated, with no significant differences between surgical types. Women exhibited significantly higher postoperative NT-proBNP concentrations than men. The increase in NT-proBNP correlated with improved insulin resistance but not with other metabolic parameters. We found no evidence supporting reduced renal clearance as a cause for elevated natriuretic peptides. CONCLUSIONS: Our data suggest a link between the NT-proBNP increase and reduced hyperinsulinemia following bariatric surgery, offering new insights into mechanisms underlying this frequent postoperative finding.
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Kartnig et al. (2025) conducted a cohort in Obesity (n=508). Bariatric surgery vs. Preoperative baseline was evaluated on Longitudinal changes in NT-proBNP levels. In 508 patients, bariatric surgery was associated with a sustained increase in NT-proBNP levels over 24 months, which was more pronounced in women and correlated with improved insulin resistance.
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