During the above-mentioned period 55 Caucasian patients were considered eligible for this study. We had 33 patients with morbid obesity (5 males, 15.1%), mean age of 41.76±10.78 and mean BMI of 43.34± 7.51 kg/m2; in this „obesity group” we had 7 patients with super-obesity, with a BMI exceding 50 kg/m2. In the control group we included 22 lean patients (9 males, 40.9%), mean age of 55.5±14.23 and mean BMI of 24.02 ± 1.71 kg/m2. In the obesity group we had 31 patients who underwent a LSG and 2 patients who were submitted to a OAGB. The main demographic, anthropometric and laboratory data of our cohort is comparatively shown in Table I, before and one year after surgery for the bariatric group (BG 0 and BG 1) and for the control group, respectively (CG) (Table I insertion). We had statistically significant changes in anthropometric parameters before and one year after the operation i.e. weight, waist circumference, and BMI. Even if it did not reach statistical significance the lipid profile showed decreased LDL and TG and higher HDL values one year after bariatric surgery compared with BG 0 and CG.
Table 1 Demographic, anthropometric and laboratory data in the study groups: BG 0 - before the bariatric procedure, BG 1 - one year after the bariatric procedure, CG - control group.
Variable
|
BG 0 (n=33)
|
BG 1(n=33)
|
CG(n=22)
|
Age (years)
|
41.76 ± 10.78**
|
41.76 ± 10.78
|
55.55 ± 14.23££
|
WC (cm)
|
133.73 ± 22.30**
|
96.30 ± 12.17##
|
84.09 ± 9.04£
|
Height (cm)
|
166.21 ± 6.37
|
166.42 ± 6.27
|
169.77 ± 7.43
|
Weight (kg)
|
128.27 ± 23.04**
|
82.85 ± 12.87##
|
69.50 ± 8.93£
|
BMI
|
43.34 ± 7.51**
|
29.91 ± 4.41##
|
24.02 ± 1.71££
|
Cholesterol (mg/dl)
|
181.63 ± 49.48
|
194.00 ± 55.98
|
175.84 ± 30.59
|
LDL-C (mg/dl)
|
121.53 ± 38.21
|
115.73 ± 40.67
|
113.27 ± 25.87
|
HDL-C (mg/dl)
|
47.79 ± 13.15
|
53.82 ± 12.16
|
52.94 ± 6.35
|
TG (mg/dl)
|
150.13 ± 67.80**
|
124.54 ± 45.26
|
106.07 ± 26.75
|
WC waist circumference, BMI body mass index, LDL-C low density lipoprotein cholesterol, HDL-C high density lipoprotein cholesterol, TG total triglycerides
Data were expressed by mean±SD (Standard deviation)Differences between groups were analyzed by ANOVA test ( and Bonferroni Test for multiple comparison)
CG compared to BG 0: *p < 0.05; **p < 0.01
BG 0 compared to BG 1: #p < 0.05; ##p < 0.01
BG 1 compared to CG: £p < 0.05; ££p < 0.01
As concerned inflammatory cytokines we noted that after surgery adiponectin values increased considerably (almost doubled), while values for IL-6 and TNF-α decreased (Figure 1). After applying the Kruskal Wallis Test and Dunn’s Test of multiple comparisons for the whole study group, significant differences for IL-6 (p=0.010, p<0.05) and adiponectin (p=0.024, p<0.05) were obtained; for IL 6 the median value in BG 0 group was 9369 ng/mL, significantly higher compared with BG 1 and CG (p=0.024).
Figure 1 Adiponectin, TNF-α and IL-6 levels in the studied groups: BG 0 - before the bariatric procedure, BG 1 - one year after the bariatric procedure, CG - control group.
Figure 2 shows the correlations between anthropometric indices and lipid profile before surgery. There was a positive correlation between cholesterol values and both waist circumference (r=0.389, p=0.025) and body mass index (r=0.378, p=0.030). Additionally, a correlation between triglycerides and height (r=0.357, p=0.042) was also found. In case of LDL-C and HDL-C values before surgery, no correlation was found.
Figure 2 Correlations between cholesterol and triglyceride and anthropometric indices (BMI, height, WC) before bariatric surgery
One year later (BG 1 group), changes in cholesterol levels are positively correlated with age (r=0.409, p=0.018) and waist circumference (r=0.351, p=0.045). LDL-C levels are also positively correlated with age (r=0.369, p=0.035) and waist circumference (r=0.375, p=0.031). However, HDL-C and TG show no correlation after surgery with any of these anthropometric measurements (Figure 3).
Figure 3 Correlations of cholesterol and triglyceride levels with age and WC one year after bariatric surgery
Table 2 shows the correlations between anthropometric indices and inflammatory cytokines both before and after surgery. We note that preoperative levels of IL-6 have a positive correlation with WC (r=0.354, p=0.043), weight (r=0.549, p=0.001) and BMI (r=0.520, p=0.002). No correlation was found between adiponectin, IL-6, TNF- α and anthropometric indices after surgery.
Table 2 Correlation between adiponectin, IL-6, TNF-α and anthropometric markers before (BG 0) and after (BG 1) surgery (determined by Spearman`s correlation coefficient)
|
Adiponectin
|
IL-6
|
TNF-α
|
|
BG0
|
BG1
|
BG0
|
BG1
|
BG0
|
BG1
|
AGE (YEARS)
Spearman’s rho
|
0.221
0.219
|
0.465
0.132
|
0.013*
0.943
|
0.913
0.020*
|
0.987
0.005*
|
0.524
0.020*
|
WC (CM)
spearman’s rho
|
0.076
0.313
|
0.193
0.233
|
0.354
0.043*
|
0.229
0.215
|
0.168
0.246
|
0.909
0.021*
|
HEIGHT (CM)
Spearman’s rho
|
0.211
0.224
|
0.205
0.227
|
0.224
0.372
|
0.540
0.110
|
0.265
0.200
|
0.832
0.039*
|
WEIGHT (KG)
Spearman’s rho
|
0.112
0.282
|
0.584
0.099
|
0.001**
0.549
|
0.231
0.215
|
0.348
0.348
|
0.811
0.043*
|
BMI
spearman’s rho
|
0.112
0.258
|
0.899
0.023*
|
0.002**
0.520
|
0.273
0.197
|
0.140
0.262
|
0.722
0.064
|
WC waist circumference, BMI body mass index, IL-6 interleukin 6, TNF-α tumour necrosis factor alpha
*p < 0.05, **p < 0.001
A value of p < 0.05 was considered to be statistically significant