Obesity Surgery

, Volume 23, Issue 6, pp 764–769 | Cite as

Change in Levels of C-Reactive Protein (CRP) and Serum Cortisol in Morbidly Obese Patients After Laparoscopic Sleeve Gastrectomy

  • Jaime Ruiz-Tovar
  • Inmaculada Oller
  • Isabel Galindo
  • Carolina Llavero
  • Antonio Arroyo
  • Alicia Calero
  • María Diez
  • Lorea Zubiaga
  • Rafael Calpena
Clinical Research

Abstract

Background

C-Reactive protein (CRP) has been associated with the macro- and microvascular effects of hypertension and diabetes mellitus. Referring to serum cortisol, it has been proposed to contribute to the pathogenesis of metabolic syndrome, and it has been demonstrated that weight loss normalizes cortisol levels and improves insulin resistance. The aims of this study were to analyze CRP and cortisol levels pre- and postoperatively in morbidly obese patients undergoing a laparoscopic sleeve gastrectomy and to correlate them with weight loss and parameters associated with cardiovascular risk.

Methods

A prospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between October 2007 and May 2011 was performed.

Results

A total of 40 patients were included in the study. CRP levels decreased significantly 12 months after surgery (median reduction of 8.9 mg/l; p = 0.001). Serum cortisol levels decreased significantly 6 months after surgery (median reduction of 34.9 μg/dl; p = 0.001). CRP values reached the normal range (<5 mg/l) 1 year after surgery. Referring to cortisol, a significant association was observed with the cardiovascular risk predictor (triglyceride/high-density lipoprotein cholesterol ratio) from the 6th month after surgery onward (Pearson correlation coefficient, 0.559; p = 0.008).

Conclusion

CRP levels are increased preoperatively and in the postoperative course up to 1 year after surgery. Serum cortisol levels remain elevated until the 6th month after surgery. From this moment onward, serum cortisol is associated with the cardiovascular risk predictor reflecting the cardiovascular risk decreasement during the weight loss.

Keywords

Sleeve gastrectomy Cortisol C-Reactive protein 

References

  1. 1.
    Bray GA. Medical consequences of obesity. J Clin Endocrinol Metab. 2004;89:2583–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Sullivan PW, Ghushchyan VH, Ben-Joseph R. The impact of obesity on diabetes, hyperlipidemia and hypertension in the United States. Qual Life Res. 2008;17:1063–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Nguyen NT, Magno CP, Lane KT, et al. Association of hypertension, diabetes, dyslipidemia and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey 1999 to 2004. J Am Coll Surg. 2008;207:928–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Zhang F, Strain GW, Lei W, et al. Changes in lipid profiles in morbidly obese patients after laparoscopic sleeve gastrectomy. Obes Surg. 2011;21:305–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Marantos G, Daskalakis M, Karkavitsas N, et al. Changes in metabolic profile and adipoinsular axis in morbidly obese premenopauseal females treated with restrictive bariatric surgery. World J Surg. 2011;35:2022–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Shah PS, Todkar JS, Shah SS. Effectiveness of laparoscopic sleeve gastrectomy on glycemic control in obese Indians with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6:138–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Gomez-Marcos MA, Recio-Rodriguez JI, Patino-Alonso MC, et al. Relationships between high-sensitive C-reactive protein and markers of arterial stiffness in hypertensive patients. Differences by sex. BMC Cardiovasc Disord. 2012;12:37.PubMedCrossRefGoogle Scholar
  8. 8.
    Klempfner R, Leor J, Tenenbaum A, et al. Effects of a vildagliptin/metformin combination on markers of atherosclerosis, thrombosis and inflammation in diabetic patients with coronary artery disease. Cardiovasc Diabetol. 2012;6:60.CrossRefGoogle Scholar
  9. 9.
    Varghese B, Swamy S, Srilakshmi MA, et al. Visceral adiposity in young patients with coronary artery disease—a case control study. Indian Heart J. 2012;64:284–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Pasquali R, Vicennati V, Cacciari M, et al. The hypothalamic-pituitary-adrenal axis activity in obesity and the metabolic syndrome. Ann NY Acad Sci. 2006;1083:111–28.PubMedCrossRefGoogle Scholar
  11. 11.
    Walker BR. Cortisol—cause and cure for metabolic syndrome? Diabet Med. 2006;23:1281–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Reinher T, Andler W. Cortisol and its relation to insulin resistance before and after weight loss in obese children. Horm Res. 2004;62:107–12.CrossRefGoogle Scholar
  13. 13.
    Gaziano JM, Hennekens CH, O’Donnell CJ, et al. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997;96:2520–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Jiménez A, Casamitjana R, Flores L, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256:1023–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107:363–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Chen JY, Chou CH, Tsai WC, et al. Effects of increased systemic inflammation and central obesity on arterial stiffness in patients with nonalcoholic fatty liver disease. J Am Soc Hypertens. 2012;6:253–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Aguilar Cordero MJ, González Jiménez E, Sánchez Perona J, et al. Obesidad y su relación con marcadores de inflamación y ácidos grasos de eritrocito en un grupo de adolescentes obesos. Nutr Hosp. 2012;27:161–4.PubMedGoogle Scholar
  18. 18.
    Stenholm S, Maggio M, Lauretani F, et al. Anabolic and catabolic biomarkers as predictors of muscle strength decline: the InCHIANT study. Rejuvenation Res. 2010;13:3–11.PubMedCrossRefGoogle Scholar
  19. 19.
    Schaap LA, Pluijm SM, Deeg DJ, et al. Higher inflammatory marker levels in older persons: associations with 5-year change in muscle mass and muscle strength. J Gerontol A Biol Sci Med Sci. 2009;64:118–1189.Google Scholar
  20. 20.
    Rao SR. Inflammatory markers and bariatric surgery. Inflamm Res. 2012;61:789–807.PubMedCrossRefGoogle Scholar
  21. 21.
    Nelson D, Porta R, Blair K, et al. The duodenal switch for morbid obesity: modification of cardiovascular risk markers compared with standard bariatric surgeries. Am J Surg. 2012;203:603–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Anagnostis P, Athyros VG, Tzionalos K, et al. The pathogenetic role of cortisol in the metabolic síndrome: a hypothesis. J Clin Endocrinol Metab. 2009;94:2692–701.PubMedCrossRefGoogle Scholar
  23. 23.
    Third report of the National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation and treatment of high blood cholesterol in adults (adult treatment panel III) final report 2002. Circulation. 2002;106:3143–421.Google Scholar
  24. 24.
    Heneghan HM, Meron-Eldar S, Brethauer SA, et al. Effect of bariatric surgery on cardiovascular risk profile. Am J Cardiol. 2011;108:1499–507.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jaime Ruiz-Tovar
    • 1
    • 2
    • 4
  • Inmaculada Oller
    • 1
  • Isabel Galindo
    • 1
  • Carolina Llavero
    • 3
  • Antonio Arroyo
    • 1
    • 2
  • Alicia Calero
    • 1
    • 2
  • María Diez
    • 1
  • Lorea Zubiaga
    • 1
  • Rafael Calpena
    • 1
    • 2
  1. 1.Bariatric Surgery Unit, Department of SurgeryGeneral University Hospital ElcheAlicanteSpain
  2. 2.University Miguel Hernandez. ElcheAlicanteSpain
  3. 3.Department of Surgical NurseryHospital de SuresteMadridSpain
  4. 4.MadridSpain

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