title: Obesity-related insulin resistance: implications for the surgical patient.
abstract: In healthy surgical patients, preoperative fasting and major surgery induce development of insulin resistance (IR). IR can be present in up to 41% of obese patients without diabetes and this can rise in the postoperative period, leading to an increased risk of postoperative complications. Inflammation is implicated in the aetiology of IR. This review examines obesity-associated IR and its implications for the surgical patient. Searches of the Medline and Science Citation Index databases were performed using various key words in combinations with the Boolean operators AND, OR and NOT. Key journals, nutrition and metabolism textbooks and the reference lists of key articles were also hand searched. Adipose tissue has been identified as an active endocrine organ and the chemokines secreted as a result of macrophage infiltration have a role in the pathogenesis of IR. Visceral adipose tissue appears to be the most metabolically active, although results across studies are not consistent. Results from animal and human studies often provide conflicting results, which has rendered the pursuit of a common mechanistic pathway challenging. Obesity-associated IR appears, in part, to be related to inflammatory changes associated with increased adiposity. Postoperatively, the surgical patient is in a proinflammatory state, so this finding has important implications for the obese surgical patient.
authors.affiliation: Gastrointestinal Surgery, National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK.
authors.forename: N
authors.initials: N
authors.lastname: Tewari
authors.affiliation: The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK.|School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Awad
authors.affiliation: School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
authors.forename: I A
authors.initials: IA
authors.lastname: Macdonald
authors.affiliation: Gastrointestinal Surgery, National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK.|School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
authors.forename: D N
authors.initials: DN
authors.lastname: Lobo
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000276:immunology; D007333:Insulin Resistance / Q000276:immunology; D050152:Intra-Abdominal Fat; D009765:Obesity / Q000150:complications* / Q000276:immunology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000276:immunology; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D014409:Tumor Necrosis Factor-alpha