Obesity is a worldwide disease related to genetic, environmental, and behavioral factors, and it is associated with high rates of morbidity and mortality. Recently, obesity has been characterized by a low-grade inflammatory state known as inflammome indicated by chronic increases in circulating concentrations of inflammatory markers. The purpose of this study was to evaluate the effect of weight loss induced by surgery for obesity and weight-related diseases on pro-inflammatory cytokine (TNF-α) and anti-inflammatory adipokine (adiponectin) levels, and on an adipose-derived hormone (leptin) in severely obese subjects.
This randomized, controlled trial involved 55 severe obese patients (50 women, age 18–63 years, and body mass index of 35.7–63 kg/m2) who underwent bariatric surgery (BS). Patients with a BMI > 65 kg/m2 and clinical and mental instability, or significant and unrealistic expectations of surgery were excluded. Blood samples were collected during the fasting period to analyze tumor necrosis factor alpha (TNF-α), adiponectin, and leptin levels by enzyme-linked immunosorbent assay.
At baseline, no significant difference was observed in the anthropometric, demographic, clinical characteristics and biochemistry and inflammatory markers between the control group (CG) and bariatric surgery group (BSG). The same finding was also observed when we compared the baseline variables to those at the 6-month follow-up in the CG. However, the same variables in the BSG group were significantly different between baseline and the 6-month follow-up after BS.
Weight loss induced by surgery for obesity and weight-related diseases reduced the inflammome state in severely obese patients.
World Health Organization: Obesity and overweight fact sheet. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 04 Nov 2016.
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894:i-xii, 1–253.
Pesquisa Nacional de Saúde 2013. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística–IBGE. 2014. Rio de Janeiro, RJ–Brasil. ISBN 978-85-240-4334-5.
Campos JM, Ramos AC, Cohen R. The importance of Brazilian Society of Metabolic and Bariatric Surgery and its interaction with the XXI World Congress of IFSO in Brazil. ABCD Arq Bras Cir Dig. 2016;29(Supl.1):1–2. https://doi.org/10.1590/0102-6720201600S10001. CrossRef
De Luca M, Angrisani L, Himpens J, 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 Aug;26(8):1659–96. https://doi.org/10.1007/s11695-016-2271-4. CrossRefPubMedPubMedCentral
Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005;115(5):911–9. https://doi.org/10.1016/j.jaci.2005.02.023. CrossRefPubMed
Yudkin JS, Stehouwer CD, Emeis JJ, et al. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol. 1999;19(4):972–8. https://doi.org/10.1161/01.ATV.19.4.972. CrossRefPubMed
Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association scientific statement on obesity and heart disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006 14;113(6):898–918. https://doi.org/10.1161/CIRCULATIONAHA.106.171016. CrossRefPubMed
Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641. https://doi.org/10.1002/14651858.CD003641.pub4. CrossRef
Jimenez A, Casamitjana R, Flores L, et al. Longterm effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256(6):1023–9. https://doi.org/10.1097/SLA.0b013e318262ee6b. CrossRefPubMed
Moy J, Pomp A, Dakin G, et al. Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg. 2008;196(5):e56–9. https://doi.org/10.1016/j.amjsurg.2008.04.008. CrossRefPubMed
Arismendi E, Rivas E, Agustí A, et al. The systemic inflammome of severe obesity before and after bariatric surgery. PLoS One. 2014;9(9):e107859. https://doi.org/10.1371/journal.pone.0107859. CrossRefPubMedPubMedCentral
Chan AW; Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krlezˇa-Jeric´ K et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013;158:200–207, 3, DOI: https://doi.org/10.7326/0003-4819-158-3-201302050-00583.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report: National Institutes of Health. Obes Res. 1998; Suppl 2:51S–209S.
Freitas Junior WR, Ilias EJ, Kassab P, et al. Assessment of the body composition and the loss of fat-free mass through bioelectric impedance analysis in patients who underwent open gastric bypass. Sci World J. 2014;2014:843253. CrossRef
Park HS, Park JY, Yu R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF- and IL-6. Diabetes Res Clin Pract. 2005;69(1):29–35. https://doi.org/10.1016/j.diabres.2004.11.007. CrossRefPubMed
Ouchi N, Kihara S, Funahashi T, et al. Reciprocal association of C-reactive protein with adiponectin in blood stream and adipose tissue. Circulation. 2003;107(5):671–4. https://doi.org/10.1161/01.CIR.0000055188.83694.B3. CrossRefPubMed
Finck BN, Johnson RW. Tumor necrosis factor (TNF)-alpha induces leptin production through the p55 TNF receptor. Am J Physiol Regul Integr Comp Physiol. 2000;278(2):R537–43. https://doi.org/10.1152/ajpregu.2000.278.2.R537. CrossRefPubMed
Zhao T, Hou M, Xia M, et al. Globular adiponectin decreases leptin-induced tumor necrosis factor-alpha expression by murine macrophages: involvement of cAMP-PKA and MAPK pathways. Cell Immunol. 2005;238(1):19–30. https://doi.org/10.1016/j.cellimm.2005.12.002. CrossRefPubMed
Mallipedhi A, Prior SL, Barry JD, et al. Changes in inflammatory markers after sleeve gastrectomy in patients with impaired glucose homeostasis and type 2 diabetes. Surg Obes Relat Dis. 2014;10(6):1123–8. https://doi.org/10.1016/j.soard.2014.04.019. CrossRefPubMed
Rość D, Adamczyk P, Boinska J, et al. CRP, but not TNF-α or IL-6, decreases after weight loss in patients with morbid obesity exposed to intensive weight reduction and balneological treatment. J Zhejiang Univ Sci B. 2015;16(5):404–11. https://doi.org/10.1631/jzus.B1400219. PubMedPubMedCentralCrossRef
Ibrahim NE, Januzzi Jr JL, Magaret CA, et al. A clinical and biomarker scoring system to predict the presence of obstructive coronary artery disease. J Am Coll Cardiol. 2017;69(9):1147–56. https://doi.org/10.1016/j.jacc.2016.12.021. CrossRefPubMed
Berstein LM, Poroshina TE, Turkevich EA, et al. Features of endometrial cancer in patients with 'metabolically healthy' versus 'standard' obesity: the decreasing frequency of metabolically healthy obesity. Future Sci OA. 2015;1(4):FSO68. https://doi.org/10.4155/fso.15.68. CrossRefPubMedPubMedCentral
Thomsen SB, Rathcke CN, Jørgensen NB, et al. Effects of Roux-en-Y gastric bypass on fasting and postprandial levels of the inflammatory markers YKL-40 and MCP-1 in patients with type 2 diabetes and glucose tolerant subjects. J Obes. 2013;2013:361781–10. https://doi.org/10.1155/2013/361781. CrossRefPubMedPubMedCentral
Ray I, Mahata SK, De RK. Obesity: an Immunometabolic perspective. Front Endocrinol. 2016;7:157. CrossRef
- Systemic Inflammation in Severe Obese Patients Undergoing Surgery for Obesity and Weight-Related Diseases
Wilson R. Freitas Jr.
Luis Vicente Franco Oliveira
Eduardo A. Perez
Elias J. Ilias
Carina P. Lottenberg
Anderson S. Silva
Jessica J. Urbano
Manoel C. Oliveira Jr.
Rodolfo P. Vieira
Vera L. S. Alves
Fabio R. Thuler
Carlos A. Malheiros
- Springer US
Neu im Fachgebiet Chirurgie
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