Hypoadiponectinemia and its Association with Liver Fibrosis in Morbidly Obese Patients

Background

Reduced serum levels of adiponectin have been associated with insulin resistance and non-alcoholic fatty liver disease (NAFLD). However, the relationship between serum adiponectin levels and hepatic histology in NAFLD is controversial. The aim of this study was to explore associations between plasma adiponectin concentrations and liver histology in morbidly obese patients.

Methods

We conducted a case–control study including obese patients undergoing bariatric surgery and normal controls. Anthropometric, standard biochemical variables as well as plasma adiponectin and leptin levels were determined. Liver biopsy was performed in all patients at the time of surgery.

Results

Seventy morbidly obese patients (mean BMI, 40.6?±?5.6 kg/m²) met the inclusion criteria and were compared with 69 controls (mean BMI, 22.8?±?1.6 kg/m², p?=?0.0001). Thirty patients (43%) had NAFLD and 20 (28%) of them fulfilled the histological criteria for steatohepatitis. Obesity was associated with increased leptin and decreased adiponectin levels. NAFLD patients exhibited decreased levels of serum adiponectin compared with matched controls [median (Q1–Q3), 3.9 (3.2–4.3) vs. 8.6 (6.5–9.2) μg/mL, p?<?0.0001]. In univariate analysis, age, gender, type 2 diabetes mellitus, BMI, HOMA-IR, aspartate aminotransferase (AST), alanine aminotransferase, serum glucose, and adiponectin levels were independently associated with hepatic fibrosis. In multivariate analysis, AST [OR?=?1.082 (1.000–1.170)], age [OR?=?1.119 (1.023–1.225)], and serum adiponectin levels [OR?=?0.529 (0.299–0.936)] were significantly associated with the presence of liver fibrosis.

Conclusions

NAFLD patients have lower plasma adiponectin concentrations than control subjects. Low adiponectin levels are associated with more severe liver histology. Serum adiponectin may be useful to estimate the severity of liver damage in obese patients with NAFLD.     

Changes of Inflammatory Mediators in Obese Patients After Laparoscopic Cholecystectomy

Background

Obesity is associated with the impairment of immunological functions. The aim of this study was to analyze some inflammatory mediators in obese subjects who underwent laparoscopic cholecystectomy.

Methods

Seventeen consecutive female patients with a BMI ranging from 35 to 45 kg/m² (obese) and 17 consecutive female patients with BMI ranging from 20 to 25 kg/m² (nonobese) were included in the study. All patients were affected by symptomatic gallbladder stone disease and underwent laparoscopic cholecystectomy. Changes in levels of leukocytes, neutrophils, IL-6, IL-10, leptin, and adiponectin were evaluated.

Results

We observed a significant increase in leukocyte and neutrophil levels in the obese subjects compared to the nonobese subjects. The serum levels of leptin and IL-6 were higher in the postoperative period (compared to the baseline values in both groups), and always higher in the obese. Both adiponectin and IL-10 increased in the postoperative period in nonobese subjects and was always higher than in the obese.

Conclusions

Obese patients have a stronger acute inflammatory response than do nonobese subjects in reaction to surgical stress.     

Laparoscopic Adjustable Gastric Banding Reduces Subcutaneous Adipose Tissue and Blood Inflammation in Nondiabetic Morbidly Obese Individuals

Background

Significant and sustained excess weight loss (EWL) appears to reduce the risk of obesity-related comorbidities (insulin resistance, hyperlipidemia, and inflammation), but this has been primarily shown in adult diabetic obese patients. We evaluated whether the EWL obtained 3 years after laparoscopic adjustable gastric banding (LAGB) improves the metabolic phenotype in nondiabetic morbidly obese (NDMO) individuals from south Italy.

Methods

Serum and subcutaneous adipose tissue (SAT) samples from 20 obese individuals (median BMI?=?41.5 kg/m²) before (T0) and after LAGB (T1) and from 10 controls (median BMI?=?22.8 kg/m²) were taken. Serum leptin, adiponectin, C reactive protein (CRP), and main analyte levels were evaluated by routine methods or immunoassay. In SAT, adipocyte size was measured by hematoxylin/eosin staining, cluster of differentiation 68 (CD68) macrophage infiltration marker by immunohistochemistry, and adiponectin, adiponectin receptors 1 and 2, and interleukin 6 (IL6) messenger RNAs by qRT-PCR.

Results

The average EWL was 66.7 %, and CRP, triglycerides, hepatic markers, leptin levels, homeostasis model assessment, and the leptin/adiponectin ratio were lower (p?p?p?R ²?=?0.905) of EWL (dependent variable) was explained by CD68, adiponectinemia, triglyceridemia, CRP, and total protein levels.

Conclusions

The EWL obtained 3 years after LAGB resulted in an improvement of lipid metabolism and a reduction of inflammation in NDMO patients, thereby decreasing the risk of obesity-associated diseases.     

Adipokines correlate with pain in lower limb osteoarthritis: different associations in hip and knee

Purpose

Our aim was to investigate whether serum and synovial-fluid (SF) concentrations of interleukin-6 (IL-6), leptin, adiponectin, resistin or visfatin are associated with joint pain in hip and knee in end-stage osteoarthritis (OA).

Methods

A cross-sectional study assessing patients with hip and knee OA undergoing total joint arthroplasty between January and December 2010 was conducted at a large university hospital. Serum and SF cytokine and adipokine concentrations were determined in samples obtained on the day of surgery. The main outcome was pain severity measured pre-operatively using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) pain scores.

Results

A total of 206 patients were involved (112 with hip and 94 with knee OA). Median age was 72 years [interquartile range (IQR) 66–79], 59 % were women. All adipokine levels were significantly higher in the SF of hip joints than in that of knee joints, except for leptin, which tended to be higher in the knee. In both hip and knee OA, median serum concentrations of leptin, adiponectin, resistin and visfatin exceeded those in SF, whereas for IL-6, median concentrations were much higher in SF than in serum. In hip OA, worse pain was significantly associated with high SF concentrations of IL-6, visfatin and leptin; in knee OA, it was associated with high SF leptin and low SF adiponectin concentrations and a low adiponectin–leptin ratio.

Conclusion

Our findings support a connection between intra-articular concentrations of several adipokines and severity of preoperative OA pain. However, the specific adipokines differed by joints: in hip OA, pain was associated with IL-6 and visfatin and in knee OA with adiponectin; leptin played a role in both hip and knee OA.     

Effect of Prophylactic Dalteparin on Anti-factor Xa Levels in Morbidly Obese Patients After Bariatric Surgery

Background

There are limited data on appropriate dosing of low-molecular-weight heparins (LMWH) for venous thromboembolism (VTE) prophylaxis in bariatric surgery. The objective of this study was to describe the postoperative effects of LMWH dalteparin on anti-factor Xa (AFXa) level in morbidly obese patients undergoing bariatric surgery.

Methods

This was a retrospective study. Morbidly obese patients (BMI?≥?40 kg/m² or BMI?>?35 kg/m² with at least one significant co-morbidity) received subcutaneous dalteparin 7,500 IU daily during the postoperative period after biliopancreatic derivation with duodenal switch. AFXa level was measured 4 h after the fourth dalteparin administration.

Results

One hundred and thirty-five patients with a mean BMI of 53.7 kg/m² were included into this study. Only 60% of patients had targeted AFXa levels (0.2–0.5 UI/ml). There was a statistical difference in body weight between individuals with sub-target AFXa levels and those with values over target (159.4?±?35.8 vs. 134.6?±?24.2, p?=?0.0310). There were three haemorrhages documented. These events were not associated with elevated AFXa values.

Conclusion

These findings indicate that the 7,500 IU dalteparin dosage is appropriate for the majority of morbidly obese patients undergoing bariatric surgery. The present study, however, suggests that this dose might not be sufficient for patient with a very high body weight.     

Long-term Changes in Leptin, Chemerin and Ghrelin Levels Following Different Bariatric Surgery Procedures: Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

Background

Different studies have evaluated changes in adipo/cytokine levels after bariatric surgery and have given conflicting results. The adipo/cytokines, leptin and chemerin, and the orexigenic hormone, ghrelin, have been shown to play a role in the regulation of metabolism and appetite. The aims of our study were to test the levels of these molecules after bariatric surgery and to compare the results between Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy.

Methods

We analysed circulating levels of chemerin, ghrelin and leptin in 30 morbidly obese women (body mass index of >40 kg/m²). Subjects were studied at three time points: baseline (before the surgery started), and after 6 and 12 months.

Results

After surgery, chemerin (baseline, 95.03?±?23.79; after 12 months, 76.80?±?21.51; p?=?0.034) and leptin levels (baseline, 248.17?±?89.16; after 12 months, 63.85?±?33.48; p?<?0.001) were significantly lower than their baseline levels, whereas ghrelin was higher (baseline, 0.87?±?0.38; after 12 months, 1.08?±?0.31; p?=?0.010). Fasting glucose, insulin and homeostasis model assessment of insulin resistance levels were markedly lower postoperatively. High-density lipoprotein levels moderately increased and triglyceride levels sharply decreased. There were no differences between the types of bariatric surgery in terms of weight reduction, general metabolic state or adipo/cytokine levels after surgery.

Conclusions

Our study demonstrates a marked decrease in fasting leptin and chemerin levels, and an increase in ghrelin levels, after bariatric surgery-induced weight loss, independently of the type of surgery performed. Further studies are needed on the interrelation between the changes in the circulating levels of these molecules and the efficacy of the bariatric surgery procedures to induce the beneficial metabolic changes and to sustain body weight loss.     

Adipokine response in diabetics and nondiabetics following the Roux-en-Y gastric bypass: a preliminary study

INTRODUCTION: The adipocyte influences eating behavior and metabolism via cytokine secretion. We report our findings of adipokine secretion in a cohort of diabetic and nondiabetic morbidly obese patients before and after Roux-en-Y gastric bypass (RYGB). METHODS: Ten morbidly obese subjects who underwent uncomplicated RYGB were studied: five were diabetic and nine were female. Nonfasting plasma levels of adiponectin, resistin, leptin, and tumor necrosis factor-alpha were determined preoperatively and 6 mo postoperatively. C-reactive protein (CRP) was followed as a marker of the metabolic syndrome. RESULTS: The patient age was 42 +/- 11 y, and the preoperative BMI was 50 +/- 6 kg/m(2). The 6 mo BMI fell to 33 +/- 5 kg/m(2) (P < 0.0001), and there were no differences between diabetics and nondiabetics with respect to amount of weight loss. In nondiabetic patients, there were significant increases compared with preoperative levels for adiponectin, resistin, and tumor necrosis factor-alpha; leptin was significantly decreased while CRP was unchanged. CRP and leptin levels were both significantly lower (P < 0.05), while all other protein levels were unchanged in diabetic patients. CONCLUSIONS: At 6 mo postoperation, RYGB significantly altered most adipokine levels for nondiabetic patients. Only CRP and leptin were changed in diabetic patients. All patients lost a significant amount of weight over 6 mo, suggesting a different metabolic effect between nondiabetic and diabetic patients after RYGB.     

Prevalence of Defaecatory Disorders in Morbidly Obese Patients Before and After Bariatric Surgery

Background

The prevalence of obesity is increasing worldwide and has lately reached epidemic proportions in western countries. Several epidemiological studies have consistently shown that both overweight and obesity are important risk factors for the development of various functional defaecatory disorders (DDs), including faecal incontinence and constipation. However, data on their prevalence as well as effectiveness of bariatric surgery on their correction are scant. The primary objective of this study was to estimate the effect of morbid obesity on DDs in a cohort of patients listed for bariatric surgery. We also evaluated preliminary results of the effects of sleeve gastrectomy on these disorders.

Patients and methods

A questionnaire-based study was proposed to morbidly obese patients having bariatric surgery. Data included demographics, past medical, surgical and obstetrics histories, as well as obesity related co-morbidities. Wexner Constipation Score (WCS) and the Faecal Incontinence Severity Index (FISI) questionnaires were used to evaluate constipation and incontinence. For the purpose of this study, we considered clinically relevant a WCS ??5 and a FISI score ??10. The same questionnaires were completed at 3 and 6?months follow-up after surgery.

Results

A total of 139 patients accepted the study and 68 underwent sleeve gastrectomy and fully satisfied our inclusion criteria with a minimum follow-up of 6?months. Overall, mean body mass index (BMI) at listing was 47?±?7?kg/m² (range 35?C67?kg/m²). Mean WCS was 4.1?±?4 (range 0?C17), while mean FISI score (expressed as mean±standard deviation) was 9.5?±?9 (range 0?C38). Overall, 58.9% of the patients reported DDs according to the above-mentioned scores. Twenty-eight patients (20%) had WCS ??5. Thirty-five patients (25%) had a FISI ??10 while 19 patients (13.7%) reported combined abnormal scores. Overall, DDs were more evident with the increase of obesity grade: Mean BMI decreased significantly from 47?±?7 to 36?±?6 and to 29?±?4?kg/m² respectively at 3 and 6?months after surgery (p?p?=?0.02). Similarly, the FISI score decreased from 10?±?8 to 3?±?4 and to 1?±?2 respectively at 3 and 6?months (p?=?0.0001).

Conclusions

Defaecatory disorders are common in morbidly obese patients. The risk of DDs increases with BMI. Bariatric surgery reduces DDs, mainly faecal incontinence, and these findings correlated with BMI reduction.     

Efficacy of Laparoscopic Greater Curvature Plication for Weight Loss and Type 2 Diabetes: 1-Year Follow-Up

Background

Laparoscopic greater curvature plication (LGCP) has gained popularity within the last 2?years because it is a restrictive procedure that reduces gastric volume without the need for stomach resection.

Methods

A prospective study was performed in which 55 morbidly obese patients with type 2 diabetes (44 female, 11 male) underwent LGCP. The patients had a mean age of 38.5?years (22?C55?years), mean BMI of 43.5?kg/m² (35?C52?kg/m²), and mean glycosylated hemoglobin (HbA1c) of 7.9?% (6?C10?%).

Results

All procedures were completed laparoscopically. The mean operative time was 55?min (40?C80?min), and the mean hospital stay was 1.8?days (1.5?C5?days). No intraoperative or postoperative complications were reported apart from three cases of resistant nausea and vomiting and one case of intraluminal bleeding. The mean excess weight loss (EWL%) was 35?% (30?C65?%) after 12?months with a mean BMI of 38?kg/m² after 12?months. A total of 23?% of patients stopped losing weight 6?months after the procedure, and 11?% began regaining about 14?% (12?C20?%) of their EWL 9?months after the procedure. The mean HbA1c was 7.5?% (5.5?C8?%) after 12?months.

Conclusions

LGCP is feasible and safe in the short term when applied to morbidly obese patients, but may be unsustainable. It is inferior as a restrictive procedure for resolution of type 2 diabetes. Longer follow-up and prospective comparative trials are needed to clarify whether it can be considered an effective single-stage procedure for treating morbidly obese diabetic patients and their comorbidities.     

Impact of Gastric Banding on Plasma Adiponectin Levels

Background: Several endocrine abnormalities are reported in obesity. In an earlier study, we found that the changes in BMI following laparoscopic adjustable gastric banding (LAGB) were associated with changes in hormone profiles such as insulin and proinsulin. In the current study, we explored the changes in plasma adiponectin levels in morbidly obese subjects who lost abundant weight following LAGB. Methods: 23 adult morbidly obese patients (15 females), aged 21-56 years, were studied. Blood samples were collected before, and 6 and 14 months after LAGB. The plasma adiponectin levels were determined by commercial kit (B-Bridge International, Inc). Statistical analysis was based on one-way repeated measures ANOVA, followed by Student-NewmanKeuls post-hoc test. Regression model was used to look for predictors of adiponectin change after LAGB. Results: Mean BMI before surgery was 46.04±4.44 kg/m², and decreased significantly by 18% 6 months after surgery to 37.67±4.47 kg/m². BMI further decreased by 32% 14 months after surgery to a mean of 31.30±4.65 kg/m² (P =.000). The mean adiponectin level before surgery was 3997±1766 μg/ml, and increased significantly by 16% to 4763±1776 μg/ml 6 months after surgery, and to 6336±3292 μg/ml (37%) 14 months after surgery. Although BMI persistently decreased, while adiponectin persistently increased, BMI did not correlate with adiponectin. Conclusion: In morbidly obese patients who underwent LAGB, adiponectin levels persistently increased, probably due to the reduction of visceral fat mass. Adiponectin plasma increase was correlated with proinsulin levels prior to the surgery. The interaction between adiponectin, proinsulin and BMI change in morbid obesity merits further investigation.     

Fibronectin Gene Expression in Human Adipose Tissue and Its Associations with Obesity-Related Genes and Metabolic Parameters

Background

Limited data are available on the in vivo expression of fibronectin, one of the main extracellular matrix components. We investigated the expression of fibronectin in abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and the associations of leptin, adiponectin, and vaspin gene expression with metabolic parameters in obese women.

Methods

We recruited female subjects undergoing bariatric surgery for obesity (n?=?24) and patients undergoing benign gynecological surgery as the control group (n?=?23). We measured anthropometric variables, abdominal fat distribution, metabolic parameters, serum concentrations of leptin, adiponectin, and vaspin, and depot-specific mRNA expression of fibronectin, leptin, adiponectin, and vaspin.

Results

Fibronectin expression in both VAT and SAT was significantly lower in the obese group than in the control group. Fibronectin expression in both VAT and SAT were negatively correlated with body mass index or waist circumference, with higher prominence in VAT. In multiple regression analysis, fibronectin expression in both VAT and SAT was negatively correlated with serum leptin concentration. Fibronectin expression in VAT was negatively correlated with leptin expression in VAT. Additionally, fibronectin expression in SAT was negatively correlated with leptin expression in SAT and positively correlated with adiponectin expression in VAT and SAT.

Conclusions

We found significant negative associations between depot-specific fibronectin expression in human adipose tissue and obesity indices and obesity-related biomarkers. Our results suggest that fibronectin expression may contribute to obesity and metabolic dysregulation in humans.     

The Relationships Between IGF-1 and CRP, NO, Leptin, and Adiponectin During Weight Loss in the Morbidly Obese

Background

The relationship between C-reactive protein (CRP), nitric oxide (NO), leptin, adiponectin, and insulin growth factor 1 (IGF-1) is poorly defined in morbidly obese patients before and after gastric bypass and, in some cases, is controversial.

Methods

We examined the plasma of 34 morbidly obese patients before and 1, 6, and 12 months after Roux-en-Y gastric bypass surgery.

Results

Obese people had more CRP (21.3?±?1.8 μg/ml) and leptin (36.9?±?4.0 ng/ml) than those in the control group (nonobese people: CRP?= 6.9?±?0.9 μg/ml, p?<?0.0001; leptin?= 7.5?±?0.4 ng/ml, p?<?0.0001). However, they had less NO (30.4?±?2.7 nmol/ml), IGF-1 (77.5?±?6.6 ng/ml), and adiponectin (11.1?±?1.0 μg/ml) than those in the control group (NO?= 45.8?±?3.9 nmol/ml, p?=?0.0059; IGF-1?= 202.0?±?12.0 ng/ml, p?<?0.0001; adiponectin?= 18.0?±?2.0 μg/ml, p?<?0.0001). During weight loss, the amount of CRP and leptin decreased until they reached the nonobese values, but the level of NO remained lower than in nonobese people, even 1 year after surgery. The linear regression slopes were negative and very significant for leptin (p?=?0.0005) and CRP (p?=?0.0018) but were less significant for NO (p?=?0.0221). IGF-1 displayed a very good linear regression (both negative and significant) with some anthropometric parameters, including body mass index (p?=?0.0025), total fat (p?=?0.0177), and the percentage of fat (p?<?0.0001).

Conclusion

For the first time, we report the relationship between IGF-1 and CRP, NO, leptin, and adiponectin. For all these parameters, the best and most widely demonstrated improvements in comorbidities before and during weight loss in morbid obesity were associated with CRP and leptin.     

Combined paraesophageal hernia repair and partial longitudinal gastrectomy in obese patients with symptomatic paraesophageal hernias

Background

Obesity is a risk factor for gastroesophageal reflux disease and hiatal hernia. Studies have demonstrated poor symptom control in obese patients undergoing fundoplication. The ideal operation remains elusive. However, addressing both obesity and the anatomic abnormality should be the goal.

Methods

This study retrospectively identified 19 obese (body mass index [BMI], >30?kg/m²) and morbidly obese (BMI, >40?kg/m²) patients who presented between December 2007 and November 2011 for management of large or recurrent paraesophageal hernia. All the patients underwent a combined primary paraesophageal hernia repair and longitudinal gastrectomy. Charts were retrospectively reviewed to collect preoperative, operative, and short-term postoperative results. Quantitative data were analyzed using Student??s t test and qualitative data with ??² testing.

Results

Laparoscopy was successful for all 19 patients. The mean preoperative BMI was 37.8?±?4.1?kg/m², and the mean operative time was 236?±?80?min. Preoperative endoscopy showed that 5 patients who had undergone prior fundoplication experienced anatomic failures, whereas the remaining 14 patients had type 3 and one type 4 paraesophageal Hernia. Mesh was used to reinforce the hiatus in 15 of the 19 cases. The postoperative complications included pulmonary embolism (n?=?1) and pulmonary decompensation (n?=?2) due to underlying chronic obstructive pulmonary disease. The mean hospital stay was 5.3?±?3?days. Upper gastrointestinal esophagography was performed for all the patients, with no short-term recurrence of paraesophageal hernia. Weight loss was seen for all the patients during the first month, with a mean BMI drop of 2.7?±?1?kg/m². All the patients experienced near to total resolution of their preoperative symptoms within the first month.

Conclusion

Combined laparoscopic paraesophageal hernia repair and longitudinal gastrectomy offer a safe and feasible approach for the management of large or recurrent paraesophageal hernias in well-selected obese and morbidly obese patients. In a short-term follow-up period, this approach demonstrated effective symptom control and weight loss.     

Effects of RS9939609 Gene Variant in FTO Gene on Weight Loss and Cardiovascular Risk Factors After Biliopancreatic Diversion Surgery

Background

The high variation in responses to bariatric surgery might be partially explained by genetic effects. Recently, common polymorphisms of the fat mass and obesity-associated gene (FTO) have been linked to obesity in some populations. Only two studies have investigated the effect of FTO variants on weight loss of morbid obese patients undergoing bariatric surgery with contradictory results.

Objective

We decided to investigate the role of the rs9939609 FTO gene polymorphism on outcomes after a biliopancreatic diversion surgery (BPD) in morbidly obese patients.

Design

A sample of 119 morbidly obese patients' body mass index (BMI)?>?40?kg/m² were operated. Weight, fat mass, blood pressure, basal glucose, triacylglycerols, total cholesterol, low density lipoprotein cholesterol and high density lipoprotein cholesterol were measured at basal visit and at each visit (basal, 3, 9 and 12?months). The frequency of metabolic comorbidities was recorded at each visit.

Results

Thirty-seven patients (31.1%) had genotype TT (wild type group), 58 (48.7%) patients had genotype TA and 24 patients (20.2%) had genotype AA. In the wild and mutant type groups, BMI, weight, waist circumference, systolic blood pressure and diastolic blood pressure decreased in a significant way. In the wild type groups, glucose, total cholesterol, low density lipoprotein (LDL) cholesterol and triacylglycerol concentrations decreased at 3, 9 and 12?months after surgery. In the mutant type groups, glucose, total cholesterol and triacylglycerol concentrations decreased at 3, 9 and 12?months after surgery. LDL cholesterol decreased at 9 and 12?months after surgery. Initial weight percent loss at 3?months of follow-up was higher in the wild type group (26.1% vs. 18.6%: p?Conclusion Our study showed a higher initial weight loss at 3?months after the TT variant of FTO gene (rs9939609). However, the weight loss at 9 and 12?months of BPD was similar in both genotypes with a significant improvement in biochemical parameters and cardiovascular comorbidities.     

Ghrelin and Apolipoprotein AIV Levels Show Opposite Trends to Leptin Levels During Weight Loss in Morbidly Obese Patients

Background

Although bariatric surgery is the most common procedure used to induce weight loss in morbidly obese patients, its effect on plasma satiety factors (leptin, ghrelin, and apolipoprotein (apo)-AIV) is controversial. The aim of this work was to analyze these parameters before and at different times after surgery.

Methods

Plasma was obtained from 34 patients before undergoing Roux-en-Y gastric bypass and during weight loss in the 12 months following surgery.

Results

Morbidly obese patients had significantly higher values (147%) of leptin than normal-weight (NW) persons, while their ghrelin levels were 46% less than NW. Apo-AIV levels had approximately the same value in both groups (obese and NW). During weight loss, leptin decreased by 75% and ghrelin increased by 78%. Both parameters reached values less than or near NW, respectively, at 1 year after surgery. During the first month after surgery, apo-AIV plasma levels decreased (47%) but later increased and finally returned to preoperative values. Apo-AIV levels were correlated negatively with leptin and positively with ghrelin. High-density lipoprotein (HDL) levels were positively correlated with those of ghrelin and apo-AIV.

Conclusions

During weight loss, plasma leptin and ghrelin could be good markers of total fat decrease. Ghrelin could also indicate gastric mucous improvement, whereas apo-AIV could indicate the recovery of intestinal function. Changes produced in the HDL levels of morbidly obese patients during weight loss suggest a decreased risk of coronary disease.     

Dietary Iodine Absorption is not Influenced by Malabsorptive Bariatric Surgery

Background

Bariatric surgery is accompanied by malabsorption of protein, carbohydrates, fats, vitamins, and trace elements. Iodine is essential to the synthesis of thyroid hormones. The aim of this study was to estimate the daily iodine intake in severely obese patients before and after bariatric surgery.

Methods

Thirty-five severely obese patients (obese group) with a BMI of 51.3?±?8.3 kg/m² were studied before, 3 months, and 6 months after bariatric surgery. Eleven out of 35 patients were subjected to gastric bypass operation Roux-en-Y and 24 were subjected to a variant of biliopancreatic diversion with long limb procedure. The patients did not use any iodine supplements and no iodine antiseptics were administered during the operation. The messmates of the patients, following a similar diet (control group) with a BMI of 31.2?±?10.7 kg/m², were also studied. Serum T₃, T₄, TSH, thyroid peroxidase antibodies, urinary iodine excretion (UIE) in a spot urine, and thyroid volume were measured in all subjects, at baseline and at 3- and 6-month follow-up in the obese group.

Results

UIE at baseline was similar in obese and control group (median (min-max), 129.5 (24.9–462) vs. 138.9 (30.8–381) μg/L, ns). In the obese group, a transient increase of UIE was observed 3 months after the operation and returned to baseline levels 6-months postsurgery.

Conclusions

The UIE is not reduced after malabsorptive bariatric surgery, although all stomach, duodenum, and a substantial part of jejunum were bypassed. It appears that iodine is absorbed sufficiently along the remaining gastrointestinal tract.     

Improvement of Nonalcoholic Fatty Liver Disease After Bariatric Surgery in Morbidly Obese Chinese Patients

Background

Obesity is a risk factor for nonalcoholic fatty liver disease (NAFLD), which appears to improve after weight loss induced by bariatric surgery in Western countries. The present study aims to determine the alterations of clinical measurements and liver histology of NAFLD after bariatric surgery in morbidly obese Chinese patients.

Methods

Between November 2006 and December 2007, 21 morbidly obese patients receiving intra-operative liver biopsy and follow-up liver biopsy 1?year after laparoscopic Roux-en-Y gastric bypass were enrolled. NAFLD activity score (NAS) and fibrosis stage were histologically evaluated.

Results

The mean body mass index fell from 43.8?±?7.5 to 28.3?±?4.6?kg/m² (P?P?P?<?0.01), but not aspartate aminotransferase (P?=?0.66). Histological improvement was noted in NAS (P?P?P?P?=?0.02). Pre-operatively, 4 (19.0%), 11 (52.4%), and 6 (28.6%) patients were found to have NAS ?R5, 3 or 4, and ?Q2, respectively. All patients had NAS ?Q2 after surgery. Fibrosis stage also showed significant improvement (P?Conclusions Bariatric surgery can achieve a dramatic improvement of NAFLD both biochemically and histologically in morbidly obese Chinese patients.     

The Effects on Obesity Related Peptides of Laparoscopic Gastric Band Applications in Morbidly Obese Patients

Background: The aim of this study was to examine the relationship between weight loss and resistin, apelin, chemerin, and visfatin after laparoscopic adjustable gastric banding (LAGB). Methods: The study group consisted of 19 patients who were operated on for morbid obesity (BMI: 48.7 ± 6.6 kg/m²), and 22 healthy, normal-weight (BMI: 22.9 ± 2.5 kg/m²) subjects formed the control group. We obtained blood samples from the study subjects at three different times: before undergoing surgery and at one month and 6 months after surgery. Blood was obtained once from the control group. Results: Significant weight loss was achieved at one and 6 months after surgery. Plasma levels of apelin, resistin, chemerin, and visfatin were higher in morbidly obese patients compared with the control group. Obesity-related peptides decreased one month and 6 months after surgery. Conclusions: Elevated plasma resistin, apelin, chemerin, and visfatin levels in morbidly obese patients are gradually reduced after weight loss. According to these findings, LAGB surgery is found to be an important and efficient means for morbidly obese patients both to lose weight and to develop a better metabolic risk profile in a short time period.     

The Effect of Weight Loss on the Cardiac Structure and Function After Laparoscopic Adjustable Gastric Banding Surgery in Morbidly Obese Individuals

Background

Herein, we investigate the anthropometric, biochemical and left ventricle (LV) geometry changes following the laparoscopic adjustable gastric banding (LAGB) operation in morbidly obese individuals.

Methods

Eighty-three morbidly obese participants (mean age, 46.1?±?11.5 years; 30.1 % men), scheduled for elective LAGB were examined before and 12 months after the surgery. LV geometry and diastolic function were investigated by 2-dimensional echocardiography, whereas laboratory tests assessed the glycaemic, serum lipid and inflammatory marker profiles.

Results

Twelve months after the operation, body mass index (BMI) decreased from 46.9?±?7.2 kg/m² to 40.1?±?8.2 kg/m² (p?p?p?2.7 vs. 52.0?±?12.3 g/m^2.7, p?p?=?0.0001) and BMI (ß?=?0.26, p?=?0.015) were both associated with diminished LV mass. Additionally, a statistically significant correlation between LV mass and changes in BMI (R?=?0.29, p?=?0.007), waist circumference (R?=?0.32, p?=?0.004), LV end-diastolic diameter (R?=?0.63, p?=?0.0001) and E-wave deceleration time (R?=??0.24, p?=?0.03) were observed within our study population.

Conclusions

LV mass decreases 12 months after LAGB surgery, but no improvements in LV geometry and function occur. The regression of LV mass is better predicted by weight loss than by reduction in blood pressure or changes in metabolic parameters.