title: Effect of a 3-Week Low-Calorie Diet and Balneological Treatment on Selected Coagulation Parameters in Morbidly Obese Patients.
abstract: BACKGROUND
  The most common cause of death among people with obesity are cardiovascular complications as a result of a hypercoagulability state.
  
  
  OBJECTIVE
  The purpose of the study was to assess the potential of coagulation system activation depending on the tissue factor and to analyze of the influence of a 3-week low-calorie diet and balneological treatment on selected coagulation parameters in morbidly obese patients.
  
  
  METHODS
  The study included 36 patients (28 females and 8 males; mean age 46) with the value of BMI > 40 kg/m2. The study was designed in two stages: baseline and after 21-days. The evaluation of tissue factor (TF), tissue factor pathway inhibitor (TFPI), von Willebrand factor (vWF), fibrinogen, D-dimer, thrombin-antithrombin complexes (TAT), and the activity of antithrombin (AT) was performed in patients before and after the treatment. The control group consisted of 24 healthy volunteers (16 females and 8 males) at a mean age of 39 with BMI . 24.9 kg/m2.
  
  
  RESULTS
  There were significantly higher levels of TF, TFPI, fibrinogen, TAT complexes and D-dimer in the study group as compared to the controls. Moreover, there were no significant changes in the parameters studied before and after the treatment. In the group of obese patients, there were significant positive correlations between the concentrations of vWF and BMI and BMI changes and a significant negative correlation between the WHR changes and TFPI concentration.
  
  
  CONCLUSIONS
  The study confirmed that morbidly obese patients represent a high risk of hypercoagulability state, despite no clinical evidence, which could be due to the great inhibitory potential of TFPI in suppressing the extrinsic pathway of the coagulation system. However, the lack of effect of the 3-week exposure to the LCD and balneological treatment in morbidly obese subjects indicates that substantial fat mass must be reduced before adequate hemostasis is re-established.
authors.affiliation: Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Firszt-Adamczyk
authors.affiliation: Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ruszkowska-Ciastek
authors.affiliation: Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Przemysław
authors.initials: P
authors.lastname: Adamczyk
authors.affiliation: Clinic of Balneology and Physical Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Szafkowski
authors.affiliation: Faculty of Mathematics and Computer Science, Nicolaus Copernicus University in Toruń, Poland.
authors.forename: Mirosława
authors.initials: M
authors.lastname: Firszt
authors.affiliation: Clinic of Balneology and Physical Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Irena
authors.initials: I
authors.lastname: Ponikowska
authors.affiliation: Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Moe
authors.affiliation: Department of Dermatology and Venerology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Iza
authors.initials: I
authors.lastname: Iwan-Ziętek
authors.affiliation: Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Góralczyk
authors.affiliation: Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Góralczyk
authors.affiliation: Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Rość
mesh_terms: D000328:Adult; D001452:Balneology; D001777:Blood Coagulation / Q000502:physiology; D001779:Blood Coagulation Factors / Q000032:analysis*; D031204:Caloric Restriction; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000628:therapy*
chemical_list: D001779:Blood Coagulation Factors
keywords: balneotherapy; low-calorie diet; morbid obesity; tissue factor; tissue factor pathway inhibitor