Changes in plasma lipids after jejunoileal bypass

KAREN WHITLOW, PH D. IAN CLEATOR, MD, FRCS[C]; JIRI FROHLICH, MD, FRCT4c]Severe obesity is often accompaniedby conditions that pose an en-hanced risk to health, such as dia-betes mellitus, hypertension, athe-rosclerosis and gallbladder disease.'For patients whose severe obesitycannot be treated successfully bydietary management, surgical treat-ment may be recommended. Oneof these procedures, the formationof a jejunoileal bypass, was intro-duced by Sherman and associatesin 19652 and has been performedon several thousand patients. Manyside effects of this procedure havebeen reported, including alterationsin lipid metabolism.' Scott and col-leagues3 observed a decrease in theplasma concentration of cholesteroland triglycerides. Rtissner and Hall-berg4 found a change in the tri-glyceride and cholesterol contentof very-low-density lipoprotein(VLDL) and high-density lipropro-tein (HDL). Moreover, Kral andcoworkers5 found the cholesterolcontent of mesentery and temporalarterial tissue to be increased by45% to 103% in four patientstested 22 months after surgery.This same group of researchers alsofound a decrease in HDL-choles-terol concentrations in seven pa-tients tested 2 weeks to 2 years fol-lowing surgery.6Our study was designed to followthe changes in plasma lipids imme-diately after surgery and at variousintervals for up to 3 years.MethodsA jejunoileal bypass (25 cm ofjejunum anastamosed to 50 cm ofileum) was performed on 23 mor-bidly obese patients -that is, in-dividuals who weighed more than120 kg, or more than twice theideal weight -at St. Paul's Hos-