Obesity Surgery

, Volume 17, Issue 3, pp 341–347 | Cite as

Systemic Inflammation in Morbidly Obese Subjects: Response to Oral Supplementation with Alpha-Linolenic Acid

  • Joel FaintuchEmail author
  • Lilian M. Horie
  • Hermes V. Barbeiro
  • Denise F. Barbeiro
  • Francisco G. Soriano
  • Robson K. Ishida
  • Ivan Cecconello


Morbidly obese patients frequently display asymptomatic chronic activation of acute phase response, with potentially adverse metabolic and cardiovascular consequences. Nutritional preparations to improve this phenomenon have rarely been administered. Aiming to investigate the supplementation of flaxseed flour, a source of omega-3 fatty acids, a prospective randomized double-blind cross-over study was designed.


Outpatient obese subjects (n = 41) were clinically and biochemically screened, and results for 24 randomized subjects are shown. Age was 40.8 ± 11.6 years (83.3% females) and body mass index (BMI) was 47.1 ± 7.2 kg/m2. Flaxseed flour (Farinha de Linhaca Dourada LinoLive, Cisbra, Brazil) in the amount of 30 g/day (5 g of alpha-linolenic acid – omega-3) and an equal mass of placebo (manioc flour) were administered for 2 weeks each. Variables included general biochemical investigation, white blood cell count (WBC), C-reactive protein (CRP), serum amyloid A (SAA) and fibronectin.


No intolerance was registered. Body weight and general biochemical indices remained stable. Initial CRP and SAA were elevated (13.7 ± 9.9 and 17.4 ± 8.0). WBC (8100 ± 2100/mm3) and fibronectin (463.2 ± 61.3 mg/dL) were acceptable but in the upper normal range. Corresponding findings after supplementation of flaxseed were 10.6 ± 6.2 mg/L, 14.3 ± 9.2 mg/L, 7300 ± 1800/mm3 and 412.8 ± 38.6 respectively (P < 0.05 ). No change during the control period regarding baseline occurred when placebo was randomized to be given first; however, when it followed omega-3 supplementation, CRP and SAA recovered, whereas WBC and fibronection remained depressed during those 2 weeks (7500 ± 2100/mm3 and 393.2 ± 75.8 mg/dL, P < 0.05).


1) Various inflammatory markers were elevated in the studied population, although not necessarily exceeding the normal range; 2) Significant reduction could be demonstrated; 3) Some persistent effects of flaxseed supplement 2 weeks after discontinuation were observed.

Key words

Morbid obesity bariatric surgery inflammation omega-3 fatty acids alpha-linolenic acid ALA Creactive protein leukocytosis flaxseed flour serum amyloid A acute-phase proteins dietary supplement 


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  1. 1.
    Nanji AA, Freeman JB. Relationship between body weight and total leukocyte count in morbid obesity. Am J Clin Pathol 1985; 84: 346–7.PubMedGoogle Scholar
  2. 2.
    Ford ES. Body mass index, diabetes, and C-reactive protein among U.S. adults. Diabetes Care 1999; 22: 1971–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Poitou C, Coussieu C, Rouault C et al. Serum amyloid A: a marker of adiposity-induced low-grade inflammation but not of metabolic status. Obesity (Silver Spring). 2006; 14: 309–18.CrossRefGoogle Scholar
  4. 4.
    Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science 1993; 259: 87–91.PubMedCrossRefGoogle Scholar
  5. 5.
    McCarthy MF. Interleukin-6 as a central mediator of cardiovascular risk associated with chronic inflammation, smoking, diabetes, and visceral obesity: downregulation with essential fatty acids, ethanol and pentoxifylline. Med Hypothesis 1999; 52: 465–477.CrossRefGoogle Scholar
  6. 6.
    Esposito K, Giugliano G, Scuderi N et al. Role of adipokines in the obesity-inflammation relationship: the effect of fat removal Plast Reconstr Surg 2006; 118: 1048–57.PubMedCrossRefGoogle Scholar
  7. 7.
    Vachharanjani V, Russell JM, Scott KL et al. Obesity exacerbates sepsis-induced inflammation and microvascular dysfunction in mouse brain. Microcirculation 2005; 12: 183–94.Google Scholar
  8. 8.
    Gletsu N, Lin E, Zhu JL et al. Increased plasma interleukin 6 concentrations and exaggerated adipose tissue interleukin 6 content in severely obese patients after operative trauma. Surgery 2006; 140: 50–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Paschos GK, Yiannakouris N, Rallidis LS et al. Apolipoprotein E genotype in dyslipidemic patients and response of blood lipids and inflammatory markers to alpha-linolenic acid. Angiology 2005; 56: 49–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Herishanu Y, Rogowski O, Polliack A et al. Leukocytosis in obese individuals: possible link in patients with unexplained persistent neutrophilia. Eur J Haematol 2006; 76: 516–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Fain JN. Release of interleukins and other inflammatory cytokines by human adipose tissue is enhanced in obesity and primarily due to the nonfat cells. Vitam Horm 2006; 74: 443–77.PubMedCrossRefGoogle Scholar
  12. 12.
    Manigrasso MR, Feroni P, Santilli F et al. Association between circulating adiponectin and interleukin-10 levels in android obesity: effects of weight loss. J Clin Endocrinol Metab 2005; 90: 5876–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Rizzo MR, Paolisso G, Grella R et al. Is dermolipectomy effective in improving insulin action and lowering inflammatory markers in obese women? Clin Endocrinol (Oxf) 2005; 63: 253–8.CrossRefGoogle Scholar
  14. 14.
    Foitzik T, Eibl G, Schneider P et al. Omega-3 fatty acid supplementation increases anti-inflammatory cytokines and attenuates systemic disease sequelae in experimental pancreatitis. JPEN 2002; 26: 351–6.Google Scholar
  15. 15.
    Breslow JL. n-3 fatty acids and cardiovascular disease. Am J Clin Nutr 2006; 83 (Suppl 6): 1477S–1482S.PubMedGoogle Scholar
  16. 16.
    Kris-Etherton PM, Harris WS, Appel LJ. AHA scientific statement: fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002; 106: 2747–57.PubMedCrossRefGoogle Scholar
  17. 17.
    Serhan CN. Novel chemical mediators in the resolution of inflammation: resolvins and protectins. Anesthesiol Clin 2006; 24: 341–64.PubMedCrossRefGoogle Scholar
  18. 18.
    Nannicini F, Sofi F, Avanzi G et al. Alpha-linolenic acid and cardiovascular diseases Omega-3 fatty acids beyond eicosapentaenoic acid and docosahexaenoic acid. Minerva Cardioangiol 2006; 54: 431–42.PubMedGoogle Scholar
  19. 19.
    Kew S, Banerjee T, Minihane AM et al. Lack of effect of foods enriched with plant- or marine-derived n-3 fatty acids on human immune function. Am J Clin Nutr 2003; 77: 1287–95.PubMedGoogle Scholar
  20. 20.
    Harper CR, Edwards MJ, DeFilipis AP et al. Flaxseed oil increases the plasma concentrations of cardioprotective (n-3) fatty acids in humans. J Nutr 2006; 136: 83–7.PubMedGoogle Scholar
  21. 21.
    Delarue J, LeFoll C, Corporeau C, Lucas D. N-3 long chain polyunsaturated fatty acids: a nutritional tool to prevent insulin resistance associated to type 2 diabetes and obesity? Reprod Nutr Dev 2004; 44: 289–99.PubMedCrossRefGoogle Scholar
  22. 22.
    Flachs P, Mohamed-Ali V, Horakova O et al. Polyunsaturated fatty acids of marine origin induce adiponectin in mice fed a high-fat diet. Diabetologia 2006; 49: 394–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Morínigo R, Musri M, Vidal J et al. Intra-abdominal fat adiponectin receptors expression and cardiovascular metabolic risk factors in obesity and diabetes. Obes Surg 2006; 16: 745–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Haugen F, Zahid N, Dalen KT et al. Resistin expression in 3T3-L1 adipocytes is reduced by arachidonic acid. J Lipid Res 2005; 46: 143–53.PubMedCrossRefGoogle Scholar
  25. 25.
    Fontani G, Corradeschi F, Felici A et al. Blood profiles, body fat and mood state in healthy subjects on different diets supplemented with omega-3 polyunsaturated fatty acids. Eur J Clin Invest 2005; 35: 499–507.PubMedCrossRefGoogle Scholar
  26. 26.
    Ruzickova J, Rossmeisl M, Prazak T et al. Omega-3 PUFA of marine origin limit diet-induced obesity in mice by reducing cellularity of adipose tissue. Lipids 2004; 39: 1177–85.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Joel Faintuch
    • 1
    • 2
    Email author
  • Lilian M. Horie
    • 1
  • Hermes V. Barbeiro
    • 1
  • Denise F. Barbeiro
    • 1
  • Francisco G. Soriano
    • 1
  • Robson K. Ishida
    • 1
  • Ivan Cecconello
    • 1
  1. 1.Department of Gastroenterology, Hospital das Clinicas and LIM 51São Paulo University Medical SchoolSão PauloBrazil
  2. 2.Hospital das ClinicasSão PauloBrazil

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