Key result
Bariatric surgery significantly reduced circulating ANGPTL4 levels, whereas ANGPTL3 levels increased after biliopancreatic diversion but remained unchanged after Roux-en-Y gastric bypass.
Why the study?
ANGPTL3 and ANGPTL4 regulate triglyceride storage and utilization, and bariatric surgery profoundly alters adipose tissue and energy metabolism, but its impact on these proteins was unclear.
Does bariatric surgery alter plasma levels of ANGPTL3 and ANGPTL4 in obese patients with or without type 2 diabetes?
Cohort (n=45)
Yes
Does bariatric surgery alter plasma levels of ANGPTL3 and ANGPTL4 in obese patients with or without type 2 diabetes?
Absolute Event Rate: 24.4% vs 26.6%
p-value: p=0.001
Bariatric surgery reduces ANGPTL4 levels regardless of the procedure, while ANGPTL3 levels increase specifically after biliopancreatic diversion, highlighting differential regulation of these lipid metabolism proteins by metabolic and malabsorptive changes.
Bariatric surgery-associated ANGPTL changes are hypothesis-generating; leaves open effects on lipids or CV risk.
Introduction: Angiopoietin-like protein 3 (ANGPTL3) and 4 (ANGPTL4) are regulators of triglycerides storage and utilization. Bariatric surgery (BS) determines profound changes in adipose tissue composition and energy metabolism. We evaluated the impact of BS on plasma levels of ANGPTL3 and ANGPTL4.Method: Twenty-seven morbidly obese subjects with or without type 2 diabetes (T2D) underwent Roux-en-Y gastric bypass (RYGB) and 18 patients with advanced T2D received Biliopancreatic Diversion (BPD). Fasting ANGPTLs levels, insulin sensitivity (evaluated by euglycemic hyperinsulinemic clamp), total bile acids (TBA) and free fatty acids (FFA) were measured at baseline and 1year after surgery.Results: Both surgical procedures resulted in fat mass loss, improved glucose control, and a ~2-fold increase of insulin sensitivity. ANGPTL4 levels decreased significantly with both RYGB (26.6 ± 0.6 to 24.4 ± 0.3 ng/mL, p=0.001) and BPD (27.9 ± 1.5 to 24.0 ± 0.5 ng/mL, p=0.003). In contrast, ANGPTL3 concentrations did not change after RYGB but rose following BPD (225 ± 20 to 300 ± 15 ng/mL, p=0.003). By multiple regression analysis, changes in ANGPTL4 were independently associated with those of blood glucose, p=0.0169) whereas changes in ANGPTL3 after BPD were associated with variations in FFA (p=0.008) and insulin sensitivity (p=0.0427). Discussion: Circulating ANGPTL4 is reduced by BS probably due to the loss of fat mass and improved insulin sensitivity. Conversely, ANGPTL3 levels increased after BPD, presumably because of the metabolic changes induced by the malabsorptive effect of this surgical procedure.
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Bini et al. (2021) conducted a cohort in Morbid obesity and/or Type 2 Diabetes (n=45). Bariatric surgery (Roux-en-Y gastric bypass or Biliopancreatic Diversion) vs. Baseline (pre-surgery) was evaluated on Plasma ANGPTL4 levels after Roux-en-Y gastric bypass (ng/mL) (p=0.001). Bariatric surgery significantly reduced circulating ANGPTL4 levels, whereas ANGPTL3 levels increased after biliopancreatic diversion but remained unchanged after Roux-en-Y gastric bypass.
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