Abstract
Bariatric surgery is known to reduce leptin and increase adiponectin levels, but the influence of sleeve gastrectomy on the leptin: adiponectin ratio (LAR), a measure of insulin sensitivity and cardiovascular risk, has not previously been described. We sought to determine the influence of sleeve gastrectomy on LAR in adults with severe obesity.In a single centre prospective cohort study of adults undergoing laparoscopic sleeve gastrectomy over a four-month period in our unit, we measured LAR preoperatively and 12 months after surgery. Of 22 patients undergoing sleeve gastrectomy, 17 (12 females, 12 with type 2 diabetes) had follow-up LAR measured at 12.1 ± 1 months. Mean body weight decreased from 130.6 ± 30.8 kg to 97.6 ± 21.6 kg, body mass index (BMI) from 46.9 ± 7.8 to 35.3 ± 7.2 kg m−2 and excess body weight from 87.5 ± 31.3 to 41.3 ± 28.8% (all p < 0.001). The reduction in leptin from 40.7 ± 24.9 to 30.9 ± 30.5 ng/ml was not significant (p = 0.11), but adiponectin increased from 4.49 ± 1.6 to 8.93 ± 6.36 µg/ml (p = 0.005) and LAR decreased from 8.89 ± 4.8 to 5.26 ± 6.52 ng/µg (p = 0.001), equivalent to a 70.9% increase in insulin sensitivity. The correlation with the amount of weight lost was stronger for LAR than it was for leptin or adiponectin alone. In this single-centre, interventional prospective cohort, patients undergoing laparoscopic sleeve gastrectomy had a substantial reduction in their LAR after 12 months which was proportional to the amount of weight lost. This may indicate an improvement in insulin sensitivity and a reduction in cardiovascular risk.
Highlights
Obesity is a major determinant of type 2 diabetes risk, primarily through its adverse effects on insulin s ensitivity[1]
We sought to quantify the effects of sleeve gastrectomy on leptin, adiponectin and leptin: adiponectin ratio (LAR) in adults with severe obesity, and to assess whether the magnitude of weight loss after surgery influenced the change in LAR
Of 148 patients with severe obesity who were on the waiting list for sleeve gastrectomy at the time the study started, 22 were put forward for surgery
Summary
Obesity is a major determinant of type 2 diabetes risk, primarily through its adverse effects on insulin s ensitivity[1]. The leptin: adiponectin ratio (LAR) is a measure of whole body insulin sensitivity that has been validated in large population-based studies[10,11]. Both of these hormones are adipokines, produced by adipocytes and they influence metabolic homeostasis. Several studies have described reductions in leptin and increases in adiponectin in adults with severe obesity undergoing bariatric surgery[3,6,7,8,15]. We sought to quantify the effects of sleeve gastrectomy on leptin, adiponectin and LAR in adults with severe obesity, and to assess whether the magnitude of weight loss after surgery influenced the change in LAR
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