Effect of sleeve gastrectomy on lipid parameters and cardiometabolic risk in young women

Objective: to analyze the effect of vertical gastrectomy on lipid profile and cardiometabolic risk in young women, preoperatively and 6 months after the operation. Methods: retrospective study, encompassing medical record reviews of women’s charts, preoperatively and in six months after the operation. Data collection was performed in the second half of 2015, using a review protocol with questions on the clinical-laboratory profile, anthropometric and laboratory classification of dyslipidemias. Descriptive and inferential analysis were used to treat the variables, using measures of variance, association and linear regression. Results: we analyzed medical records of 114 women undergoing vertical gastrectomy, with a mean age of 33.82±10.92, and with complete high school education. There was a significant reduction of anthropometric data, as well as serum lipid values, six months after the surgical procedure. The coefficients of determination and the results of linear regression, showed that the reduction in serum triglyceride values and increase in high-density lipoprotein have a direct impact on the reduction of the cardiometabolic risk. Regarding the laboratory classification of dyslipidemias, it was observed that the majority presented a significant reduction at the six-month follow-up. Mixed hyperlipidemia showed no significant reduction. The categorized cardiometabolic risk showed a significant reduction in women at risk before vertical gastrectomy. Conclusion: at the six-month follow-up, vertical gastrectomy was effective in reducing the serum lipid profile and the cardiometabolic risk of young women when compared to the preoperative data. There was also a different improvement in the laboratory classification of dyslipidemias at the six-month follow-up after the surgical procedure.

Survey" (VIGITEL), carried out in 2018, showed that the majority of respondents claimed to be overweight (55.7%), with higher rates in the male population (57.8%) than in the female (53.9%). For women, weight gain correlated with age and with a lower level of education 2 .
The obesity associated with abnormalities in lipids' metabolism, glucose, and blood pressure, increases the probability of risk for cardiovascular diseases such as cerebrovascular events and Acute Myocardial Infarction 3-4 .
Reduction of excess weight, dietary restriction of sugars and fat, as well as the practice of regular physical activity, are essential to reduce the risks of comorbidities. However, being obese entangles much complexity. A methanalysis encompassing six interventional studies did not indicate food and energy restriction as effective in weight loss 5 .
Primary interventions worldwide are still incipient when it comes to effective policies to reduce obesity, control biochemical and metabolic profiles, and provide remission of associated morbidities, such as arterial hypertension, diabetes Mellitus, hepatic steatosis, dyslipidemia, and metabolic syndrome 3-4, 6  Faced with this question, the individualized care, focusing on weight loss, has led people to seek more incisive interventions and results in the short term, such as bariatric surgery [7][8] .
Bariatric surgery is a therapeutic method for significant weight loss in a short period, resuming normal metabolic rates and reducing and/or correcting chronic diseases associated with obesity. The indication of the procedure follows a rigorous inter professional process, according to the patient's state of health and medical and professional recommendations. The indication to perform the surgical procedure is based on the prognosis in view of the health problems that can be reversed with the sleeve gastrectomy [8][9] .
The metabolic parameters altered with the surgical procedure need to be carefully evaluated by the health team professionals to control the reference levels.
Cardiometabolic events must be monitored after sleeve gastrectomy to verify the reduction in the inflammatory and atherogenic impacts, worsened by primary dyslipidemias 10 .
Studies have shown that sleeve gastrectomy has influence in the reduction of low density lipoproteins (LDL-c), total cholesterol (TC ), triglycerides (TG), and in the increase in high density lipoprotein (HDL-c) [11][12][13]

Design, study location and period
This is a retrospective study, carried out in a clinical institution specialized in bariatric surgery. The

Population and sample
The target population for this study was women with obesity who underwent sleeve gastrectomy in the period prior to data collection, with the convenience sample, according to the inclusion and exclusion criteria.
The inclusion criteria were the existence of appropriate records of clinical, anthropometric, biochemical, and metabolic data, and pharmacological profile of the population.
We excluded medical records that did not contain data from consultations performed in the preoperative period or at six months after the operation. The decision to evaluate the clinical records in this period is based on the patients' lack of attendance in consultations beyond six months after surgery, which would reduce the sample.
We excluded the male population due to the reduced rate of such individuals in the clinic, which predominantly attends the female population, but also in line with the theoretical aspects that supported the statistical analysis of this study.

Study protocol
For data collection, we used an instrument developed by the authors, based on a literature review on the variables used to assess the effectiveness of sleeve gastrectomy. We collected data on all variables for the preoperative and the six-month follow-up periods. The instrument contained the following variables:

Analysis of results and statistics
We checked the data to identify and correct possible flaws and doubly transcribed them to a Microsoft objective of the study included the lipid profile and cardiometabolic risk, we described the anthropometric values, but did not include them in the tables. We used the chi square test to verify whether there was a significant difference in the laboratory classification of dyslipidemia.
We considered a significance level of p < 0.05 for all tests performed.
To assess the correlation between the

RESULTS
We analyzed medical records of 114 women who underwent sleeve gastrectomy, with a mean age of 33.82 ± 10.92 and complete high school. There was a reduction in anthropometric parameters, in which the weight in the preoperative period and six months of      There has been evidence that weight loss is associated with important reduction in biochemical and metabolic parameters, such as the lipid profile, in the short term 21  LDL-c had a reduction after surgical procedures.

Effect of sleeve gastrectomy on lipid parameters and cardiometabolic risk in young women
Nonetheless, there is need to delineate the variation of LDL c particles, which can present significant oxidative markers, resulting from the reduction of such lipoprotein.
These subfractions can display an atherogenic profile, wherein reduced-size LDL c particles have a greater effect on tissue inflammation and oxidation, which should be measured by C-reactive protein (CRP) 25 .
TC decreased significantly and these data reinforce the results from a meta-analysis 26  Regarding cardiometabolic risk, studies 27,28 show that sleeve gastrectomy is effective in weight loss