Abstract
ABSTRACT Background: In the last decades, numerous studies have confirmed the importance of lactate - by-product to the nutrient signal of the intracellular redox state - to regulatory functions in energy metabolism. Aim: To evaluate changes in blood lactate in patients with severe obesity and its correlation with body composition and metabolic profile. Methods: Twenty-four people with severe obesity (BMI=40 kg/m2) were evaluated in a prospective case-control study before and six months after Roux-in-Y gastric bypass. The blood lactate, total cholesterol, and fractions, C-reactive protein and HOMA-IR were analyzed after 12 h fasting. Body mass composition was evaluated by bioelectrical impedance and respiratory quotient was measured by indirect calorimetry. Results:The initial lactate level was 2.5±1.1 mmol/l and returned to normal level (1.9±3.6 mmol/l, p=0.0018) after surgery. This reduction was positively correlated with a decrease in BMI (p=0.0001), % free fat mass (p=0,001), % fat mass (p=0.001) and HOMA-IR (p=0.01). There was normalization of lactatemia in 70% of patients. There was no correlation between lactatemia and C-reactive protein. Conclusions: There was a significant improvement of metabolic parameters, normalization of blood lactate, fat mass loss, although these individuals remained with a high BMI.
Highlights
The increasing prevalence of obesity and metabolic syndrome (MetS) has become a concern, mainly due to risk of progression to type 2 diabetes and cardiovascular diseases[15,2,29]
A significant improvement in these parameters was found, with normalization of up to 70% of patients with loss of fat mass after Roux-en-Y gastric bypass
It was attempted to demonstrate that tissue hypoxia at the level of white adipose tissue (WAT) would be the cause of increased local production of lactate, to what would happen in the musculature under anaerobic conditions[13]
Summary
The increasing prevalence of obesity and metabolic syndrome (MetS) has become a concern, mainly due to risk of progression to type 2 diabetes and cardiovascular diseases[15,2,29]. MetS and increased resistance to insulin are interrelated[11,26], this variable is difficult to assess in the clinical context. If we consider MetS and severe obesity from the point of view of metabolic flexibility, a compelling perspective is opened to study the role of lactate in this context. Despite the extensive literature on the interrelationships between adipose tissue and lactate, there are virtually no prospective clinical studies evaluating the prevalence of increased basal lactate in patients with severe obesity individuals as well as the impact of weight loss in this context. The aim of this study was to determine changes in blood lactate level at rest in subjects with severe obesity before and one-year after bariatric surgery as well as correlations between blood lactate concentration, body composition (lean and body fat mass) and improvement in metabolic profile
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