title: Reduced cardiovascular risk following bariatric surgeries is related to a partial recovery from "adiposopathy".
abstract: BACKGROUND
  Altered cytokine secretion from dysfunctional adipose tissue or "adiposopathy" is implicated in obesity related inflammation and may mediate reduced cardiovascular disease (CVD) risk in response to weight loss after bariatric surgery. We hypothesized that bariatric surgery reduces CVD risk by favorably altering the pro-inflammatory profile of adipose tissue as a result of weight loss.
  
  
  METHODS
  In this observational study with repeated measures, 142 patients underwent bariatric surgery of which 45 returned for follow-up at ∼6 months. At both time-points, lipid profiles and levels of plasma adiponectin, leptin, and TNF-α were obtained. Ratios of various adipokine parameters were related to pre- and post- surgical (gastric bypass vs. other restrictive bariatric procedures) lipid ratios.
  
  
  RESULTS
  Prior to surgery, circulating adiponectin and the adiponectin/TNF-α ratio was strongly associated with CVD risk characterized by levels of triglycerides, HDL, and the TC/HDL, LDL/HDL, and TG/HDL ratios (all P < 0.05). Following bariatric surgery, BMI was decreased by 22%, adiponectin was increased by 93%, and leptin decreased by 50% as compared to baseline (all P < 0.01). TNF-α levels increased by 120% (P < 0.01) following surgery. Post-surgical changes in adiponectin and the leptin/adiponectin ratio were strongly associated with incremental improvements in triglycerides, HDL, and TC/HDL, LDL/HDL and TG/HDL ratios (all P < 0.05). Roux-en-y gastric bypass surgery (RYGB) as compared to other bariatric procedures was associated with more robust improvements in BMI, HDL, and leptin/adiponectin ratio than other gastric restrictive procedures (P < 0.05).
  
  
  CONCLUSIONS
  Thus, bariatric surgery, especially RYGB, ameliorates CVD risk through a partial recovery from "adiposopathy", distinctively characterized by improved adiponectin and the leptin/adiponectin ratio.
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA.
authors.forename: Swathi
authors.initials: S
authors.lastname: Appachi
authors.forename: Karen R
authors.initials: KR
authors.lastname: Kelly
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.forename: John P
authors.initials: JP
authors.lastname: Kirwan
authors.forename: Stanley
authors.initials: S
authors.lastname: Hazen
authors.forename: Manjula
authors.initials: M
authors.lastname: Gupta
authors.forename: Sangeeta R
authors.initials: SR
authors.lastname: Kashyap
mesh_terms: D054392:Adipokines; D000273:Adipose Tissue / Q000378:metabolism*; D050110:Bariatric Surgery; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D003240:Connective Tissue Diseases / Q000209:etiology* / Q000378:metabolism*; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D054392:Adipokines; D008055:Lipids