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Effect of Massive Weight Loss on Inflammatory Adipocytokines and the Innate Immune System in Morbidly Obese Women

Department of Internal Medicine (M.E.V.M., M.Cal., G.M.), Catholic University, 00168 Rome, Italy; Unit of Hepatology (M.M.), "Bambino Gesù" Hospital and Research Institute, 00165 Rome, Italy; Section of Diabetes, Endocrinology and Nutrition (J.M.F.-R., J.V., W.R.), University Hospital of Girona and Unit of Endocrinology and Nutrition, University Hospital of Tarragona "Joan XXIII," 17007 Tarragona, Spain; Department of Transfusion Medicine (F.E.), "San Filippo Neri" Hospital, 00168 Rome, Italy; and Department of Surgery (G.N., V.T., M.Cas.), Catholic University, 00168 Rome, Italy

Address all correspondence and requests for reprints to: Dr. Melania Manco, Via Pineta Sacchetti 484, 00168 Rome, Italy. E-mail: melaniamanco{at}tiscali.it.

Context: Obesity may be regarded as a low-grade inflammatory state.

Objective: The aim of this study was to evaluate changes in pro-inflammatory adipocytokines and the innate immune system, cardiovascular risk, and insulin sensitivity after massive weight loss.

Design: This was a longitudinal study.

Setting: The study was conducted at Catholic University, Rome.

Subjects and Methods: There were 10 normoglucose-tolerant obese women evaluated before and 36 months after bilio-pancreatic diversion (BPD). Glucose sensitivity (M value) was estimated using the euglycemic-hyperinsulinemic clamp. Mannan-binding lectin (MBL), bactericidal/permeability increasing protein (BPI), -defensins, soluble CD14 receptor (sCD14), C-reactive protein, adiponectin, leptin, visfatin, IL-6, and TNF- were assayed.

Results: After massive weight loss (53% of excess body weight), leptin (P 0.0001), IL-6 (P 0.0001), -defensins (P 0.001), and C-reactive protein (P 0.0001) decreased significantly. Adiponectin increased significantly (P 0.001). Of the nine subjects who lost more than 20% of body mass index, sCD14 (2.87 ± 0.5 to 2.55 ± 0.5; P = 0.016) and visfatin levels (12.20 ± 0.93 to 10.63 ± 1.93 ng/ml; P = 0.045) decreased significantly. No significant changes were observed in TNF-, BPI, or MBL. Insulin sensitivity more than doubled after BPD (P 0.0001). sCD14 changes were significantly associated with body mass index (r₀ = 0.80; P = 0.003) and M changes (r₀ = –0.59; P = 0.03). MBL correlated with insulin sensitivity in obese (r₀ = 0.93; P = 0.0001) and post-BPD women (r₀ = 0.66; P = 0.038). Adiponectin correlated negatively with cardiovascular risk (r₀ = –0.709; P = 0.02) and IL-6 (r₀ = –0.634; P = 0.05). Multiple linear regression analysis showed that changes in sCD14 were also significantly related to changes in insulin sensitivity.

Conclusions: Surgically induced weight loss is capable of reversing low-grade inflammation, at least partially. The relationships between sCD14, MBL, BPI, and glucose sensitivity, and the role of TNF- in obesity warrant further investigation.