ORIGINAL ARTICLEThe effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up
Introduction
Obesity, a health problem of epidemic proportions in developed and developing countries, increases the risk of many common diseases such as cardiovascular disease, type 2 diabetes mellitus, hyperlipidemia and hypertension. Consequently, the mortality rate, mainly due to atherosclerosis, also increases.1, 2 Furthermore, obesity has been linked to a higher incidence of proteinuria, decreased renal function and glomerulopathy in the general population.2, 3 Two hormones secreted by adipocytes, leptin and adiponectin (ADPN), have been associated with cardiovascular disease. Plasma leptin plays a major regulatory role in the control of body weight homeostasis and has been found to be increased in obesity.4 Plasma ADPN has anti-inflammatory, anti-atherogenic5 and insulin-sensitizing properties6 and, as opposed to leptin, has been found to be decreased in obesity.7, 8
A decrease in cardiovascular risk factors (CVRFs) has been reported in obese and extremely obese patients after diet-induced weight loss; however, bariatric surgery (BS) achieves a greater weight loss leading to a more effective reduction in hypertension, diabetes and lipid disorders.9 Furthermore, the relationship between adipocytokines (leptin and ADPN) and renal parameters (changes in glomerular filtration and microalbuminuria) in non-extremely obese patients, has become an area of interest for investigation in recent years.10, 11
Recent studies and reviews have shown the effect of drastic weight loss after BS on adipocytokines and their relation with other CVRF as plasma glucose, insulin resistance and the adipoinsular axis12, 13, 14, 15, 16 or inflammation.16, 17, 18, 19 However, to our knowledge there are no studies focused on adipocytokines and renal parameters in extreme obesity. Furthermore, no studies have compared these data before and after BS in relation to the severity of obesity prior to surgery. While it has been shown in the literature that a proportion of patients with extreme obesity are metabolically normal (MN), there are no studies on the evolution of anthropometrical and metabolical parameters in these patients.
The aim of this prospective study was to evaluate the effect of weight loss after BS in peripheral adipocytokines, renal function, microalbuminuria and other CVRFs in 70 patients with extreme obesity and to study the relationship of ADPN with renal and other CVRF. Furthermore we analyze if there are differences on the evolution of these parameters in relation to the severity of the obesity or in relation to the presence or absence of metabolically abnormalities previously to surgery.
Section snippets
Subjects and methods
All patients undergoing BS (102 patients) from December 2001 to December 2004 were asked to participate in this study. Seventy patients accepted and were prospectively studied. Patients met the criteria for surgery according to the NHI Consensus and SEEDO Spanish Consensus.20, 21 A gastric bypass operation was performed according to the method described by Fobi et al.22 (30 patients) and by Salmon23 with some modifications (40 patients). Both operations combine a permanent restriction on volume
Patients baseline and 12 months after BS and controls
Clinical, anthropometrical, biochemical and hormonal parameters in all 70 patients (baseline and 12 months after BS) and 24 normal-weight healthy controls are shown in Table 1. Before surgery statistical differences were found between patients and controls in all the parameters studied except for total-ch and plasma albumin, which showed no differences. After surgery, our patients changed to obesity type I and all parameters studied significantly improved compared with baseline (Table 1).
Twelve
Discussion
The present work shows that after BS, our patients showed substantial improvement in adipocytokines, renal parameters (creatinine clearance, proteinuria and microalbuminuria) and all others CVRFs studied. The change produced in ADPN in relation with the weight lost, correlated negatively with the changes in HOMA-IR and plasma albumin, but not with the change of renal function. We also demonstrated that the improvement in all the above-mentioned parameters were similar in severe and very severe
References (45)
- et al.
Obesity-related glomerulopathy: an emerging epidemic
Kidney Int
(2001) - et al.
Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity
Biochem Biophys Res Commun
(1999) - et al.
Increased glomerular filtration rate as a predictor of diabetic nephropathy. An 8-year prospective study
Kidney Int
(1992) - et al.
Microalbuminuria as predictor of vascular disease in non-diabetic subjects
Lancet
(1988) Obesity as a medical problem
Nature
(2000)Obesity as a cardiovascular risk factor
Am J Med
(2003)- et al.
Increased leptin concentrations correlate with increased concentrations of inflammatory markers in morbidly obese individuals
Int J Obes
(2001) - et al.
Novel modulator for endothelial adhesion molecules. Adipocyte-derived plasma protein adiponectin
Circulation
(1999) - et al.
The adipocyte-secreted protein Acrp 30 enhances hepatic insulin action
Nat Med
(2001) - et al.
Plasma adiponectin levels in overweight and obese Asians
Obes Res
(2002)
Reduction in Incidence of diabetes, hypertension and lipid disturbances after intestinal weight loss induced by bariatric surgery: the SOS intervention study
Obes Res
Adiponectin in chronic kidney disease is related more to metabolic disturbances than to decline in renal function
Nephrol Dial Transplant
Adiponectin is markedly increased in patients with nephrotic syndrome and is related to metabolic risk factors
Kidney Int
Plasma acylation-stimulating protein, adiponectin, leptin and ghrelin before and after weight loss induced by gastric bypass surgery in morbidly obese subjects
J Clin Endocrinol Metab
Weight reduction increases plasma levels of an adipose-derived anti-inflammatory protein, adiponectin
J Clin Endocrinol Metab
Ghrelin and adipose tissue regulatory peptides: effect of gastric bypass surgery in obese humans
J Clin Endocrin Metab
Changes in insulin resistance following bariatric surgery and the adipoinsular axis: role of the adipocytokines, leptin, adiponectin and resistin
Obes Surg
Effects of marked weight loss on plasma levels of adiponectin, markers of chronic subclinical inflammation and insulin resistance in morbidly obese women
Int J Obes
Richart Cw resistin, adiponectin, ghrelin, leptin, and proinflammatory cytokines: relationships in obesity
Obes Res
The chronic inflammatory hypothesis for the morbidity associated with morbid obesity: implications and effects of weight loss
Obes Surg
Effects of changes in body weight and insulin resistance on inflammation and endotelial function in morbid obesity alter bariatric surgery
J Clin Endocrinol Metab
Gastrointestinal surgery for severe obesity
Ann Intern Med
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2017, Kidney InternationalCitation Excerpt :These findings suggest that surgical intervention may be an effective treatment to improve early kidney injury and prevent progression of obesity-related kidney disease. Our results are consistent with previous adult studies that have shown improvement in albuminuria after bariatric surgery.14–19 Improvements in serum creatinine and eGFR after bariatric surgery also have been observed in adults with decreased kidney function, although function has remained stable in those without baseline kidney disease.20–22