Elsevier

Clinical Nutrition

Volume 25, Issue 3, June 2006, Pages 400-408
Clinical Nutrition

ORIGINAL ARTICLE
The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up

https://doi.org/10.1016/j.clnu.2005.11.014Get rights and content

Summary

Aims

To evaluate the effect of weight loss after bariatric surgery (BS) on peripheral adipocytokines, renal parameters and other cardiovascular risk factors (CVRFs).

Methods

A total of 70 (41 women) extremely obese adults were prospectively studied before and 12 months after surgery. Controls: 24 (15 women) normal-weight adults. Anthropometric, biochemical and renal parameters were recorded.

Results

Presurgery, adiponectin (ADPN) was lower, whereas leptin, insulin resistance, C-reactive protein, creatinine clearance and albuminuria were higher in patients than controls (P<0.001). All parameters improved postsurgery. Changes in ADPN correlated negatively with leptin, insulin resistance, albumin, C-reactive protein, and creatinine clearance. Multiple regression analysis: using changes in ADPN as the dependent variable, only changes in insulin resistance (P=0.005) and albumin (P=0.019) were significant independent determinants for changes in ADPN. No statistical differences were found in relation to the degree of obesity.

Conclusion

Patients changed to obesity type I after surgery. This implies a substantial improvement of CVRFs including ADPN, creatinine clearance and albuminuria. Changes in plasma ADPN correlated negatively with insulin resistance and with albuminemia but not with renal parameters. The lack of differences between different degrees of obesity suggests that the relationship between weight and CVRFs no longer exists when obesity becomes very extreme.

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

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