Roux-en-Y gastric bypass decreases pro-inflammatory and thrombotic biomarkers in individuals with extreme obesity.
BACKGROUND
The low-grade inflammatory state in obesity leads to insulin resistance and endothelial dysfunction, which promote cardiovascular diseases in individuals with obesity. The purpose of this study was to evaluate the early effects of weight loss achieved through bariatric surgery on the inflammatory and prothrombotic states. This study also aimed to identify the role of hyperleptinemia on the prothrombotic state.


METHODS
The sample was composed of 41 extremely obese who underwent Roux-en-Y gastric bypass (RYGB). Anthropometric and clinical data, and biochemical markers of inflammation were collected prior to surgery and 6 months post-RYGB.


RESULTS
It was found that plasminogen activator inhibitor-1 (PAI-1) concentrations were higher among extremely obese individuals with hyperleptinemia than in those without hyperleptinemia (p < 0.01).In relation to the baseline, post-surgery body mass index (BMI) was reduced by 12.9 kg/m(2), corresponding to 63.50 % of excess weight loss. Additionally, waist circumference was found to decrease significantly from 126.2 to 101.4 cm. Plasma total cholesterol (p < 0.01), LDL cholesterol (p = 0.02), triglycerides (p < 0.01), and glucose (p = 0.01) were also found to decrease. Pro-inflammatory biomarkers were observed to decrease: PAI-1 by 55.9 ± 6.0 % (p < 0.01), C-reactive protein (CRP) by 18.8 ± 3.4 % (p < 0.01), intercellular adhesion molecule-1 (ICAM-1) by 89.9 ± 5.7 % (p < 0.01), leptin by 27.9 ± 3.2 % (p < 0.01), and resistin by 69.3 ± 5.8 % (p < 0.01). Additionally, significant decreases of tumor necrosis factor alpha (TNF-α) and leptin/adiponectin ratio were observed. Anti-inflammatory cytokines adiponectin and interleukin-10 (IL-10) were significantly increased (170.7 ± 82.5 %, p < 0.01; 122.7 ± 55.1 %, p = 0.02). CRP levels were predictive of ICAM-1 (p = 0.04), and changes in leptin concentrations were associated with decreased PAI-1 levels (p = 0.03).


CONCLUSIONS
We observed that individuals with obesity that have hyperleptinemia have higher circulating PAI-1 levels, which could indicate increased risk for cardiovascular disease. The biomarkers of inflammation and thrombosis measured in this study decreased after RYGB, suggesting that the surgery may be effective in reducing pro-inflammatory and thrombotic risk in individuals with extreme obesity.
Post-Graduate Program of Nutrition, Universidade Federal de São Paulo - UNIFESP, Rua Marselhesa, 630 - Vila Clementino, São Paulo, SP, 04020-060, Brazil, barbaradmnetto@gmail.com.
Bárbara Dal Molin
BD
Netto
Solange Cravo
SC
Bettini
Ana Paula Grotti
AP
Clemente
Joana Pereira de Carvalho
JP
Ferreira
Katia
K
Boritza
Sandy de Fátima
Sde F
Souza
Maria Emilia
ME
Von der Heyde
Carrie P
CP
Earthman
Ana R
AR
Dâmaso
D052242:Adiponectin / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D007249:Inflammation / Q000097:blood; D007333:Insulin Resistance; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D016753:Interleukin-10 / Q000097:blood*; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000601:surgery*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss; D055815:Young Adult
C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers; C508609:IL10 protein, human; D020738:Leptin; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D014280:Triglycerides; D018799:Intercellular Adhesion Molecule-1; D016753:Interleukin-10; D002097:C-Reactive Protein