Exploring the impact of bariatric surgery on high density lipoprotein

Surg Obes Relat Dis. Jan-Feb 2015;11(1):238-47. doi: 10.1016/j.soard.2014.07.017. Epub 2014 Aug 11.


Low HDL cholesterol is an independent cardiac risk factor. A general efficacy gradient exists for the resolution of cardiovascular risk factors after bariatric surgery (i.e., biliopancreatic diversion [BPD]>Roux-en-Y gastric bypass [RYGB]>sleeve gastrectomy [SG]>adjustable gastric banding [AGB]). However, a review of high level of evidence clinical studies shows a different hierarchy for the effect of bariatric surgery on HDL (i.e., RYGB=SG>BPD, AGB). Surgically induced weight loss effectively reverses many steps in HDL metabolism that have been altered with obesity. Furthermore, enterocytes contribute to HDL levels through the synthesis of apolipoproteins A-IV and A-I. RYGB and SG that preserve the small intestine (particularly the jejunum) lead to a significant rise in HDL. However, when the small intestinal contribution does not reinforce the weight loss dependent mechanisms (e.g., after BPD and AGB), only a modest rise in HDL occurs. Further experimental and clinical studies are required to better delineate the issue.

Keywords: Apolipoprotein; Bariatric surgery; Biliopancreatic diversion; Cholesterol; Diabetes; Gastric banding; Gastric bypass; HDL; High density lipoprotein; LDL; RYGB; Sleeve gastrectomy; Triglyceride.

Publication types

  • Review

MeSH terms

  • Apolipoprotein A-I / metabolism
  • Apolipoproteins A / metabolism
  • Bariatric Surgery* / methods
  • Cholesterol, HDL / blood*
  • Humans
  • Obesity / blood*
  • Obesity / surgery
  • Weight Loss


  • Apolipoprotein A-I
  • Apolipoproteins A
  • Cholesterol, HDL
  • apolipoprotein A-IV