Is dermolipectomy effective in improving insulin action and lowering inflammatory markers in obese women?
OBJECTIVE
Obesity is a major risk factor for coronary heart disease, and surgical treatment of obese patients as part of a multidisciplinary approach seems to provide faster results than diet therapy. The aim of this study was to evaluate the effect of dermolipectomy on insulin action and inflammatory markers in 20 obese women.


METHODS
At baseline and 40 days after dermolipectomy, 20 obese women underwent indirect calorimetry and hyperinsulinaemic glucose clamp. Twenty obese nonsmoking females (age range 25--40 years) volunteered for the study. All subjects had a stable body weight for 2 months before the study. No patient was affected by cardiovascular and/or pulmonary disease, type 2 diabetes, thyroid dysfunction, acute or chronic hepatitis, renal insufficiency or cancer. No patients was receiving any drug therapy and all measurements were made during the follicular phase of the menstrual cycle.


RESULTS
At baseline, fat mass (FM) correlated with plasma triglycerides (r=.58, P<0.009), free fatty acids (FFA) (r=0.73, P<0.001), insulin (r=0.70, P<0.002), leptin (r=0.55, P<0.01), adiponectin (r=-0.32, P<0.02) and resistin (r=0.31, P<0.01), insulin sensitivity (IS) (r=-0.59, P<0.005) and respiratory quotient (Rq) (r=0.62, P<0.002). With regard to inflammatory markers, FM was significantly correlated with plasma interleukin (IL)-6 (r=0.71, P<0.001), IL-10 (r=-0.67, P<0.002), tumour necrosis factor-alpha (TNF-alpha) (r=0.78, P<0.001) and soluble IL-6 receptor (sIL-6r) (r=-0.65, P<0.003). Dermolipectomy resulted in a significant decline in total FM of 2.3+/- 0.2 kg. A significant decline in BMI was also observed (30.0+/- 0.08 vs. 31.1+/- 0.7 kg/m(2)). After 40 days a significant decline in plasma resistin (P<0.001) and inflammatory markers and an increase in plasma adiponectin (P<0.03) were observed. Those metabolic changes were accompanied by a significant improvement in insulin-mediated glucose uptake (P<0.001), substrate oxidation and degree of inflammation. Changes in FM following dermolipectomy correlated with the changes in IS (P<0.01), substrate oxidation and FFA (P<0.001).


CONCLUSIONS
In obese patients, dermolipectomy is associated with weight lost, improved glucose handling and lower inflammatory markers.
Rizzo
M R
MR
Department of Geriatric Medicine and Metabolic Diseases, University of Naples, Italy.
Paolisso
G
G
Grella
R
R
Barbieri
M
M
Grella
E
E
Ragno
E
E
Grella
R
R
Nicoletti
G
G
D'Andrea
F
F
D052242:Adiponectin; D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002153:Calorimetry, Indirect; D016207:Cytokines / Q000097:blood*; D062109:Dermatologic Surgical Procedures; D005260:Female; D005951:Glucose Tolerance Test; D006729:Hormones, Ectopic / Q000097:blood; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D020738:Leptin / Q000097:blood; D015187:Lipectomy; D009765:Obesity / Q000178:diet therapy / Q000378:metabolism / Q000601:surgery*; D011184:Postoperative Period; D052243:Resistin; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D052242:Adiponectin; D015415:Biomarkers; D001786:Blood Glucose; D016207:Cytokines; D006729:Hormones, Ectopic; D007328:Insulin; D036341:Intercellular Signaling Peptides and Proteins; D015850:Interleukin-6; D020738:Leptin; C499624:RETN protein, human; D052243:Resistin; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10