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Submitted on November 30, 2003
Accepted on September 28, 2004
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
* To whom correspondence should be addressed.
Fernando Pazos, 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 morbid obese patients, aged 39.0 ± 10.0 (SD), were evaluated before and 4.2 ± 0.8 months after bariatric surgery. A marked increment in insulin sensitivity index (SI) and endothelium-dependent vasodilatory response in a dorsal hand vein were 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 morbid obese patients. After surgery, C-reactive protein (CRP) and sialic acid (SA) diminished whereas circulating levels of IL-6, TNF-
and its soluble receptors did not. A positive correlations were found between changes in adiposity and SI with changes in CRP, and between changes in SA and changes in endothelial function. In conclusion, a marked improvement in SI, endothelial function and low-grade inflammation were observed in the weight-losing morbid obese patients following bariatric surgery. SI and adiposity appear to play a role in obesity-related low-grade inflammation which contribute to the endothelial dysfunction observed in morbid obesity.
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