Evaluation of metabolic and inflammatory markers in patients undergoing obesity surgery

Abstract

Purpose: Obesity is known to improve chronic inflammatory status. It is known that chronic diseases and inflammation regress with weight loss after bariatric surgery. The aim of this study is to evaluate early metabolic and inflammatory changes after laparoscopic sleeve gastrectomy.

Materials and methods: The demographic features of the patients who were operated for morbid obesity were evaluated before and after the operation, body mass index, waist circumference, blood leukocyte count, CRP, AST, ALT, GGT levels.

Results: Eighty-two patients were included in this study. 21 (25.6%) patients were male and 61 (74.4%) were female. Mean age was 33.7±9.6 (18-64), mean BMI was 42.9±6.1 kg/m² (32.3-59.4), waist circumference was 126.6±17.7 cm (103-153). Although no significant difference was found between preop and postop mean values, leukocyte, ALT, AST and GGT mean values ​​were found to be lower in the early postop postoperative period.

Conclusion: Chronic inflammation caused by obesity is associated with diabetes, insulin resistance and cancer. Bariatric surgery induced weight loss and anatomical changes can play an important role in healing chronic inflammation.

Keywords

• Obesity
• inflammation
• sleeve gastrectomy

Obezite cerrahisi sonrası metabolik ve inflamatuar belirteçlerin değerlendirilmesi

Öz

Amaç: Obezite kronik inflamasyona neden olmaktadır. Bariatrik cerrahi sonrası kilo kaybı ile kronik hastalıklar ve inflamasyonun gerilediği bilinmektedir.  Bu çalışmanın amacı laparoskopik sleeve gastrektomi sonrası erken dönem metabolik ve inflamatuar değişimlerin değerlendirilmesi amaçlanmıştır.

Gereç ve yöntem: Morbid obezite nedeniyle opere edilen hastaların demografik özellikleri ile birlikte operasyon öncesi ve sonrası vücut kitle indeksi, bel çevresi, kan lökosit sayısı, CRP, AST, ALT, GGT, düzeyleri değerlendirilmiştir.

Bulgular: Çalışmaya dahil edilen 82 morbid obez hastanın 21 (%25,6) erkek, 61 (%74,4) kadındı. Ortalama yaşı 33,7±9,6 (18-64), ortalama BMI 42,9±6,1 kg/m² (32,3-59,4), bel çevresi 126,6±17,7 cm (103-153) idi. Preop ve postop ortalama değerler arasında anlamlı fark saptanmamakla birlikte lökosit, ALT, AST ve GGT ortalama değerlerinin postoperatif erken dönemde daha düşük olduğu saptanmıştır.

Sonuç: Obezitenin sebep olduğu kronik inflamasyon durumu diyabet, insülin direnci ve kanser ile ilişkilidir. Cerrahi olarak indüklenen kilo kaybı ve anatomik değişiklikler kronik inflamasyonda iyileşme için önemli bir rol oynayabilir.

Anahtar Kelimeler

• obezite
• inflamasyon
• Sleeve gastrektomi

References

1. 1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: actual causes of death in the United States, 2000. JAMA. 2005 Jan 19;293[3]:293–4.
2. 2. Solomon CG, Dluhy RG. Bariatric surgery--quick fix or long-term solution? N Engl J Med. 2004 Dec 23;351[26]:2751–3.
3. 3. Sjöström L, Lindroos A-K, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004 Dec 23;351[26]:2683–93.
4. 4. Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006 Dec 14;444[7121]:860–7.
5. 5. Wellen KE, Hotamisligil GS. Inflammation, stress, and diabetes. J Clin Invest. 2005 May;115[5]:1111–9.
6. 6. Hotamisligil GS. Inflammation, metaflammation and immunometabolic disorders. Nature. 2017 08;542[7640]:177–85.
7. 7. Dahlman I, Elsen M, Tennagels N, Korn M, Brockmann B, Sell H, et al. Functional annotation of the human fat cell secretome. Arch Physiol Biochem. 2012 Jul;118[3]:84–91.
8. 8. Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 1993 Jan 1;259[5091]:87–91.

9. 9. Krinninger P, Ensenauer R, Ehlers K, Rauh K, Stoll J, Krauss-Etschmann S, et al. Peripheral monocytes of obese women display increased chemokine receptor expression and migration capacity. J Clin Endocrinol Metab. 2014 Jul;99[7]:2500–9.
10. 10. Bochud M, Marquant F, Marques-Vidal P-M, Vollenweider P, Beckmann JS, Mooser V, et al. Association between C-reactive protein and adiposity in women. J Clin Endocrinol Metab. 2009 Oct;94[10]:3969–77.
11. 11. Shemesh T, Rowley KG, Jenkins A, Brimblecombe J, Best JD, O’Dea K. Differential association of C-reactive protein with adiposity in men and women in an Aboriginal community in northeast Arnhem Land of Australia. Int J Obes 2005. 2007 Jan;31[1]:103–8.
12. 12. Mortensen OH, Nielsen AR, Erikstrup C, Plomgaard P, Fischer CP, Krogh-Madsen R, et al. Calprotectin--a novel marker of obesity. PloS One. 2009 Oct 12;4[10]:e7419.
13. 13. Hanusch-Enserer U, Cauza E, Spak M, Dunky A, Rosen HR, Wolf H, et al. Acute-phase response and immunological markers in morbid obese patients and patients following adjustable gastric banding. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2003 Mar;27[3]:355–61.
14. 14. Chiappetta S, Schaack HM, Wölnerhannsen B, Stier C, Squillante S, Weiner RA. The Impact of Obesity and Metabolic Surgery on Chronic Inflammation. Obes Surg [Internet]. 2018 Oct [cited 2018 Sep 21];28[10]:3028–40. Available from: http://link.springer.com/10.1007/s11695-018-3320-y
15. 15. Schmidt MI, Duncan BB, Sharrett AR, Lindberg G, Savage PJ, Offenbacher S, et al. Markers of inflammation and prediction of diabetes mellitus in adults [Atherosclerosis Risk in Communities study]: a cohort study. Lancet Lond Engl. 1999 May 15;353[9165]:1649–52.
16. 16. De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, et al. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders [IFSO]. Obes Surg. 2016;26[8]:1659–96.
17. 17. van Dielen FMH, Buurman WA, Hadfoune M, Nijhuis J, Greve JW. Macrophage inhibitory factor, plasminogen activator inhibitor-1, other acute phase proteins, and inflammatory mediators normalize as a result of weight loss in morbidly obese subjects treated with gastric restrictive surgery. J Clin Endocrinol Metab. 2004 Aug;89[8]:4062–8.
18. 18. Santos J, Salgado P, Santos C, Mendes P, Saavedra J, Baldaque P, et al. Effect of bariatric surgery on weight loss, inflammation, iron metabolism, and lipid profile. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc. 2014 Mar;103[1]:21–5 . 19. Park S, Kim YJ, Choi C-Y, Cho N-J, Gil H-W, Lee EY. Bariatric Surgery can Reduce Albuminuria in Patients with Severe Obesity and Normal Kidney Function by Reducing Systemic Inflammation. Obes Surg. 2018 Mar;28[3]:831–7.
19. 20. Patterson RE, Sears DD. Metabolic Effects of Intermittent Fasting. Annu Rev Nutr. 2017 21;37:371–93.
20. 21. Yudkin JS. Adipose tissue, insulin action and vascular disease: inflammatory signals. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2003 Dec;27 Suppl 3:S25-28.
21. 22. Grant RW, Dixit VD. Adipose tissue as an immunological organ. Obes Silver Spring Md. 2015 Mar;23[3]:512–8.
22. 23. Randell, Edward W., et al. "Pre-operative and post-operative changes in CRP and other biomarkers sensitive to inflammatory status in patients with severe obesity undergoing laparoscopic sleeve gastrectomy." Clinical biochemistry 52 [2018]: 13-19.