Abstract
Obesity is a major modifiable risk factor for cardiovascular disease. Bariatric surgery is considered to be the most effective treatment option for weight reduction in obese patients with and without type 2 diabetes (T2DM). To evaluate changes in lipoproteins, insulin resistance, mediators of systemic and vascular inflammation, and endothelial dysfunction following Roux-en-Y bariatric surgery in obese patients with and without diabetes. Lipoproteins, insulin resistance, mediators of systemic and vascular inflammation, and endothelial dysfunction were measured in 37 obese patients with (n = 17) and without (n = 20) T2DM, before and 6 and 12 months after Roux-en-Y bariatric surgery. Two way between subject ANOVA was carried out to study the interaction between independent variables (time since surgery and presence of diabetes) and all dependent variables. There was a significant effect of time since surgery on (large effect size) weight, body mass index (BMI), waist circumference, triglycerides (TG), small-dense LDL apolipoprotein B (sdLDL ApoB), HOMA-IR, CRP, MCP-1, ICAM-1, E-selectin, P-selectin, leptin, and adiponectin. BMI and waist circumference had the largest impact of time since surgery. The effect of time since surgery was noticed mostly in the first 6 months. Absence of diabetes led to a significantly greater reduction in total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol although the effect size was small to medium. There was a greater reduction in TG and HOMA-IR in patients with diabetes with a small effect size. No patients were lost to follow up. Lipoproteins, insulin resistance, mediators of systemic and vascular inflammation, and endothelial dysfunction improve mostly 6 months after bariatric surgery in obese patients with and without diabetes. www.ClinicalTrials.gov, identifier: NCT02169518. https://clinicaltrials.gov/ct2/show/NCT02169518?term=paraoxonase&cntry1=EU%3AGB&rank=1.
Highlights
Mean body mass index (BMI) has increased progressively since 1980 [1]
There was a significant effect of time since surgery on weight, body mass index (BMI), waist circumference, triglycerides (TG), small-dense LDL apolipoprotein B, HOMA-IR, CRP, monocyte chemoattractant protein 1 (MCP-1), intercellular adhesion molecule 1 (ICAM-1), E-selectin, P-selectin, leptin, and adiponectin
BMI and waist circumference had the largest impact of time since surgery
Summary
Mean body mass index (BMI) has increased progressively since 1980 [1]. a 33% increase in obesity prevalence and a 130% increase in severe obesity prevalence have been projected over the 2 decades [2]. The outcome of the Swedish obese subjects (SOS) trial indicated that bariatric surgery, when compared with usual care, was associated with a long-term reduction in overall mortality and reduced incidence of type 2 diabetes (T2DM), myocardial infarction, stroke, and cancer [4]. There is evidence that high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNFα), monocyte chemoattractant protein 1 (MCP-1), intercellular adhesion molecule 1 (ICAM-1), E-selectin, P-selectin, resistin, and leptin may be mediators of insulin resistance, vascular inflammation, and endothelial dysfunction in those with obesity [5,6,7,8,9]. It has been suggested that adiponectin increases insulin sensitivity and reduces the risk of atherosclerosis [10]. Leptin and adiponectin are primarily released from the adipocytes whereas hsCRP, TNFα, MCP-1, and ICAM-1 are released from non-fat cells in adipose tissue [11]
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