Effect of massive weight loss on inflammatory adipocytokines and the innate immune system in morbidly obese women.
BACKGROUND
Obesity may be regarded as a low-grade inflammatory state.


OBJECTIVE
The aim of this study was to evaluate changes in pro-inflammatory adipocytokines and the innate immune system, cardiovascular risk, and insulin sensitivity after massive weight loss.


METHODS
This was a longitudinal study.


METHODS
The study was conducted at Catholic University, Rome.


METHODS
There were 10 normoglucose-tolerant obese women evaluated before and 36 months after bilio-pancreatic diversion (BPD). Glucose sensitivity (M value) was estimated using the euglycemic-hyperinsulinemic clamp. Mannan-binding lectin (MBL), bactericidal/permeability increasing protein (BPI), alpha-defensins, soluble CD14 receptor (sCD14), C-reactive protein, adiponectin, leptin, visfatin, IL-6, and TNF-alpha were assayed.


RESULTS
After massive weight loss (53% of excess body weight), leptin (P <or= 0.0001), IL-6 (P <or= 0.0001), alpha-defensins (P <or= 0.001), and C-reactive protein (P <or= 0.0001) decreased significantly. Adiponectin increased significantly (P <or= 0.001). Of the nine subjects who lost more than 20% of body mass index, sCD14 (2.87 +/- 0.5 to 2.55 +/- 0.5; P = 0.016) and visfatin levels (12.20 +/- 0.93 to 10.63 +/- 1.93 ng/ml; P = 0.045) decreased significantly. No significant changes were observed in TNF-alpha, BPI, or MBL. Insulin sensitivity more than doubled after BPD (P <or= 0.0001). sCD14 changes were significantly associated with body mass index (r0 = 0.80; P = 0.003) and M changes (r0 = -0.59; P = 0.03). MBL correlated with insulin sensitivity in obese (r0 = 0.93; P = 0.0001) and post-BPD women (r(0) = 0.66; P = 0.038). Adiponectin correlated negatively with cardiovascular risk (r0 = -0.709; P = 0.02) and IL-6 (r0 = -0.634; P = 0.05). Multiple linear regression analysis showed that changes in sCD14 were also significantly related to changes in insulin sensitivity.


CONCLUSIONS
Surgically induced weight loss is capable of reversing low-grade inflammation, at least partially. The relationships between sCD14, MBL, BPI, and glucose sensitivity, and the role of TNF-alpha in obesity warrant further investigation.
Manco
Melania
M
Department of Internal Medicine, Catholic University, Rome, Italy. melaniamanco@tiscali.it
Fernandez-Real
J Manuel
JM
Equitani
Francesco
F
Vendrell
Joan
J
Valera Mora
Maria Elena
ME
Nanni
Giuseppe
G
Tondolo
Vincenzo
V
Calvani
Menotti
M
Ricart
Wilfredo
W
Castagneto
Marco
M
Mingrone
Geltrude
G
D000210:Acute-Phase Reaction / Q000276:immunology; D017667:Adipocytes / Q000276:immunology*; D052242:Adiponectin / Q000097:blood; D000328:Adult; D023181:Antimicrobial Cationic Peptides / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001798:Blood Proteins; D001823:Body Composition / Q000276:immunology; D002097:C-Reactive Protein / Q000378:metabolism; D016207:Cytokines / Q000097:blood / Q000276:immunology*; D005260:Female; D006801:Humans; D007107:Immune System / Q000502:physiology; D007333:Insulin Resistance / Q000276:immunology; D015850:Interleukin-6 / Q000097:blood; D020738:Leptin / Q000097:blood; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008137:Longitudinal Studies; D037601:Mannose-Binding Lectin / Q000097:blood; D008565:Membrane Proteins / Q000097:blood; D008875:Middle Aged; D054409:Nicotinamide Phosphoribosyltransferase; D009767:Obesity, Morbid / Q000276:immunology* / Q000601:surgery*; D012995:Solubility; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D015431:Weight Loss / Q000276:immunology*; D023084:alpha-Defensins / Q000097:blood
D052242:Adiponectin; D023181:Antimicrobial Cationic Peptides; D001786:Blood Glucose; D001798:Blood Proteins; D016207:Cytokines; D015850:Interleukin-6; D020738:Leptin; D018950:Lipopolysaccharide Receptors; D037601:Mannose-Binding Lectin; D008565:Membrane Proteins; D014409:Tumor Necrosis Factor-alpha; D023084:alpha-Defensins; C021623:bactericidal permeability increasing protein; D002097:C-Reactive Protein; D054409:Nicotinamide Phosphoribosyltransferase; C085455:nicotinamide phosphoribosyltransferase, human