Reply to: Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women

Abstract

Sir, Giugliano et al.,1Giugliano G. Nicoletti G. Grella E. Giugliano F. Esposito K. Scuderi N. et al.Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women.Br J Plast Surg. 2004; 57: 190-194Google Scholar report the effects of liposuction on insulin resistance and vascular inflammatory markers in obese women. We studied the metabolic consequences of ultrasound-assisted megalipoplasty (UAM) in 15 premenopausal overweight women (BMI 40.23±5.91 kg/m2). Megalipoplasty was defined as removal of more than 10 l of lipoaspirate in the same surgical time. Aspirate volumes ranged from 10.0 to 26.3 l, with an infiltrate to aspirate ratio of 0.67 (wet technique). The metabolic impact of the operation was assessed by the variation of different parameters including basal metabolic rate (BMR measured by indirect calorimetry), insulin resistance (HOMA method), C reactive protein (CRP, Immunonefelometric assay; N CRP, Behring GmbH), Interleukin-6 (IL-6, Immunometric assay, Immulite 1000 IL-6, DPC Ltd) adiponectin (Human Adiponectine ELISA; B-Bridge International Inc) measured before and 1, 3, 28 and 180 days after UAM. Tumor necrosis factor-α (TNF-α, Immunometric Assay, Immulite 1000 TNF-α, DPC Ltd) was measured preoperatively and at the end of surgery. In our series, an acute deterioration of the insulin resistance occurred immediately after the operation (Fig. 1). The inflammatory markers CRP and IL-6 picked, respectively, in the first and third day after surgery, but rapidly decreased returning to baseline values within 1 month (Fig. 2) while TNF-α did not register any variation (below 4 pg/ml). The acute changes of the inflammation markers were associated with simultaneous increase of BMR on the third day after surgery. BMR returned to baseline values after 28 days, declining under preoperative values after 6 months. During the recovery phase a stable improvement of the insulin resistance was registered and maintained in the following months. Adiponectin levels decreased in the first postoperative days, returning to near baseline values at 6 months (Fig. 1).Figure 2C-reactive protein's levels registered an acute increase (p<0.001) and rapid decrease in the postoperative period. Interleukin-6 values acutely increased after UAM (p<0.05) and then returned to baseline values.View Large Image Figure ViewerDownload (PPT) The rapid increase and ready normalisation of the inflammatory markers along with BMR variations were most probably caused by the surgical maneurs and stress. The only parameter that is positively influenced by the subcutaneous fat mass reduction seems to be the insulin resistance. However, studies conducted on more numerous series should validate our results and resolve the controversies that still are present in literature.2Klein S. Fontana L. Young V.L. et al.Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease.N Engl J Med. 2004; 350: 2549-2557Google Scholar, 3Giese S.Y. Bulan E.J. Commons G.W. Spear S.L. Yanovski J.A. Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study.Plast Reconstr Surg. 2001; 108 ([discussion 520–521]): 510-519Google Scholar