Abstract
BackgroundFetuin-A and leukocyte cell-derived chemotaxin-2 (LECT-2) are liver-derived proteins. Fetuin-A is an independent risk factor for type 2 diabetes (T2D) and obese patients with T2D have higher plasma fetuin-A levels than those without T2D. LECT-2 has positive correlation with the severity of both obesity and insulin resistance. The changes in plasma fetuin-A are not consistent after bariatric surgery and no studies have investigated the changes in LECT-2 on the obese patients with T2D after bariatric surgery.MethodsOverall, 18 patients undergoing gastric bypass (GB) and 16 patients undergoing sleeve gastrectomy (SG) were enrolled. The fasting plasma fetuin-A and LECT-2 levels were measured at baseline, one week, three months, and one year after surgery.ResultsBoth the GB and SG groups significantly decreased the body mass index (BMI), waist-to-hip ratio, a body shape index; the triglyceride, fasting blood sugar (FBS), hemoglobin A1c, C-peptide levels; and homeostatic model assessment (HOMA-IR) one year after surgery. The SG group showed a decreasing trend in plasma fetuin-A levels one year after SG surgery. There are no significant changes in LECT-2 one year after either GB or SG. Fetuin-A had a near significant negative relationship with insulin (P = 0.056) and HOMA-IR (P = 0.050) in the SG group. Changes in fetuin-A had a significant positive relationship with changes in BMI (P = 0.031) and waist-to-hip ratio (P = 0.031) in the GB group and had a near significant positive correlation with FBS (P = 0.051) in the SG group.DiscussionNeither GB nor SG modifies plasma levels of plasma fetuin-A or LECT-2 in T2D patients after surgery. The changes in plasma fetuin-A have a positive correlation with those of the BMI and waist-to-hip ratio 12 months after GB.
Highlights
The incidence of obesity has tripled over the past 20 years (Hossain, Kawar & El Nahas, 2007). With this increasing prevalence of obesity, diabetes has increased at the same rate as 90% of diabetes is attributed to excess weight (Hossain, Kawar & El Nahas, 2007)
A recent randomized trial has demonstrated that metabolic surgery, including gastric bypass and sleeve gastrectomy (SG), is as effective as surgical treatment in Asian patients who are non-morbidly obese with poorly-controlled type 2 diabetes (T2D) at one and two years after surgery (Lee et al, 2011a; Chen et al, 2013)
SG was recommended for T2D patients with an ABCD score >4; bariatric surgery with SG was recommended for T2D patients with younger age, high body mass index (BMI), high C-peptide levels and short duration of T2D (Lee et al, 2015)
Summary
The incidence of obesity has tripled over the past 20 years (Hossain, Kawar & El Nahas, 2007). Bariatric surgery (GB and SG) is known as the most effective and consistent method to improve metabolic syndrome, and has helped maintain body weight, glycemic control, and quality of life, when compared to medical therapy alone (Schauer et al, 2014). Both GB and SG had positive effects on metabolic liver disease (Mattar et al, 2005; Klein et al, 2006; Billeter et al, 2016).
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