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Effects of Changes in Body Weight and Insulin Resistance on Inflammation and Endothelial Function in Morbid Obesity after Bariatric Surgery

Endocrine Unit (L.A.V., F.P., M.T.G.-U., J.F., J.A.A.), Cardiology Service (J.R.B.), and Surgery Service (C.F.-E.), University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain

Address all correspondence and requests for reprints to: Dr. Fernando Pazos, Endocrine Unit, P.O. Box 2257, 39080 Santander, Spain. E-mail: endptf{at}humv.es.

Metabolic alterations such as insulin resistance are thought to underlie the endothelial dysfunction and low grade inflammation found in morbid obesity. Twenty-six morbidly obese patients, aged 39.0 ± 10.0 (mean ± SD), were evaluated before and 4.2 ± 0.8 months after bariatric surgery. A marked increment in the insulin sensitivity index (S_I) and the endothelium-dependent vasodilatory response in a dorsal hand vein was observed after weight loss following bariatric surgery. Circulating levels of E-selectin, P-selectin, plasminogen activator inhibitor-1, and von Willebrand factor, which were higher than those in the control group, decreased significantly after surgery. Plasma vascular cell adhesion molecule-1, angiotensin-converting enzyme, intercellular adhesion molecule-1, thrombomodulin, and plasma and intraplatelet cGMP levels did not change after weight loss. All inflammatory markers were higher in morbidly obese patients. After surgery, C- reactive protein and sialic acid diminished, whereas circulating levels of IL-6, TNF-, and its soluble receptors did not. Positive correlations were found between changes in adiposity and S_I and changes in C-reactive protein and between changes in sialic acid and changes in endothelial function. In conclusion, a marked improvement in S_I, endothelial function, and low grade inflammation was observed in the weight-losing, morbidly obese patients after bariatric surgery. S_I and adiposity appear to play roles in obesity-related, low grade inflammation that contribute to the endothelial dysfunction observed in morbid obesity.

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