Abstract
Background. Morbid obesity is believed to be an extreme of the metabolic spectrum. Moreover, diabetes is hypothesized to be associated with a chronic inflammatory state that is not observed in nondiabetic healthy individuals. We investigated the differences in expression of inflammatory cytokines induced by surgical stress between diabetic and nondiabetic individuals. Method. 39 morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (9 with type 2 diabetes mellitus) were compared with 8 nonobese euglycemic patients undergoing laparoscopic antireflux surgery. Cytokine levels for IL-6, IL-10, and IL-18 were measured 15 minutes before surgery and immediately after surgery. Results. IL-6 and IL-10 levels were elevated from baseline following surgery, but morbidly obese patients exhibited a much higher elevation than lean patients. Individuals with type 2 diabetes had the most pronounced IL-6 and IL-10 elevations. Baseline IL-18 levels were significantly higher in diabetic patients compared with nondiabetic or lean patients. However, IL-18 levels were not changed in response to surgery. Conclusions. Diabetes and morbid obesity are associated with augmented cytokine expression in response to surgical trauma that is several folds higher than in nonobese euglycemic patients. Diabetic patients exhibit a chronic elevation in IL-18 that is not changed by surgical stress.
Highlights
Surgical stress induces an appropriate systemic in ammatory response that has been extensively characterized [1]. e initial in ammatory response is inherently designed to eradicate microorganisms, promote healing following injury, and restore homeostasis
Due to the known perioperative risks associated with weight-loss surgery [5], there is intense interest in being able to identify markers of injury as a potential tool to predict perioperative outcomes. is study characterizes the acute alterations in circulating IL-18 levels, a newer proin ammatory cytokine, in a set of consecutive patients undergoing laparoscopic roux-en-Y gastric bypass (RYGB) and in lean patients undergoing laparoscopic antire ux operations (LAR) to determine if this cytokine is a marker of ISRN Obesity systemic in ammatory response in obese patients. e study further attempts to determine if patients with type 2 diabetes mellitus (DM) exhibit different responses. e acute response of IL-18 to surgical stress is compared to the responses of two bettercharacterized cytokines, IL-6 and IL-10
Using a protocol approved by the Institutional Review Board (IRB), consecutive morbidly obese patients undergoing laparoscopic RYGB were enrolled into the study. irty (30) of these patients did not have clinical diabetes as de ned by no use of insulin or oral antihyperglycemic medications and normal fasting blood glucose levels. e other nine (9) patients had type 2 DM
Summary
Morbid obesity is believed to be an extreme of the metabolic spectrum. diabetes is hypothesized to be associated with a chronic in ammatory state that is not observed in nondiabetic healthy individuals. e investigated the di erences in expression of in ammatory cytokines induced by surgical stress between diabetic and nondiabetic individuals. E investigated the di erences in expression of in ammatory cytokines induced by surgical stress between diabetic and nondiabetic individuals. 39 morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (9 with type 2 diabetes mellitus) were compared with 8 nonobese euglycemic patients undergoing laparoscopic antire ux surgery. IL-6 and IL-10 levels were elevated from baseline following surgery, but morbidly obese patients exhibited a much higher elevation than lean patients. Baseline IL-18 levels were signi cantly higher in diabetic patients compared with nondiabetic or lean patients. Diabetes and morbid obesity are associated with augmented cytokine expression in response to surgical trauma that is several folds higher than in nonobese euglycemic patients. Diabetic patients exhibit a chronic elevation in IL-18 that is not changed by surgical stress
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