Effects of Weight Reduction After Sleeve Gastrectomy on Metabolic Variables in Saudi Obese Subjects in Aseer Province of Kingdom of Saudi Arabia
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The objectives of this study were to investigate the occurrence of oxidative stress, status of protective antioxidants enzymes, inflammatory biomarkers, and some metabolic health variables in the blood and to compare the results between those of the normal controls and obese patients submitted to sleeve gastrectomy-induced weight loss over a 1-year follow-up period.
Materials and methods
A prospective study was conducted in Aseer Central Hospital and Abha Private Hospital in the Kingdom of Saudi Arabia from January 2012 to January 2013 on 50 normal (BMI = 22–25 kg/m2) control subjects and 50 obese (BMI = 45–50 kg/m2) patients. A subset of 20 men and 80 women patients, aged 20–45 years, was included. The systemic blood cell counts were determined by Beckman Coulter UniCel analyzer. The occurrence of oxidative stress, the status of antioxidant enzyme system in the blood, levels of serum hepatic enzymes, cardiovascular risk factors, and serum sodium, potassium, copper, and zinc levels were determined by spectrophotometric procedures. The concentration of TSH and T4 were analyzed by Siemens Immunoassay System.
Group 1 (Obese: preoperative) This group compared with the normal controls exhibited significant (p < 0.05) increase in inflammatory biomarkers, a significant (p < 0.05) rise in hepatic enzymes, a significant (p < 0.05) decrease in serum total bilirubin. Concentration of serum total cholesterol (TC), triacylglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose(FBG) were significantly (p < 0.05) increased, but HDL cholesterol (HDL-C) was significantly depleted (p < 0.05). Serum urea and creatinine contents were significantly (p < 0.05) decreased. Serum copper and zinc levels were significantly (p < 0.05) increased. Group 2: Sleeve Gastrectomy Surgery (Obese: postoperative) This group compared with the obese group, preoperatively, demonstrated a profound reduction in body weight (−32%) as well as in BMI (−29%). Serum malondialdehyde, a stress index, was significantly (p < 0.001) inhibited and conversely, activities of antioxidant enzymes: superoxide dismutase(Cu-Zn SOD), glutathione peroxidase (GPx), glutathione-S-transferase (GST), glucose-6-phosphate dehydrogenase (G6PDH), and vitamin C, were remarkably (p < 0.001) increased. Furthermore, remarkable improvements in deranged metabolic variables approaching normality were discernible. Inflammatory biomarkers in the blood and hepatic enzymes in serum were significantly (p < 0.001) decreased. Levels of TC, TG, LDL-C, FBG, and HDL-C in serum exhibited significant (p < 0.05) reductions, a reversal toward normality. Serum albumin and total bilirubin concentrations were significantly increased (p < 0.001). Serum sodium, potassium, copper, zinc, and TSH levels were significantly (p < 0.001) decreased.
Obesity is a chronic disease of multifactorial origin and resulted in perturbations of whole body metabolism in this study. It is thus likely that this imbalance was associated with an inhibition in protective antioxidants and occurrence of oxidative stress. The staging concept of sleeve gastrectomy is a safe and effective approach with remarkable efficacy in sustaining weight loss and bringing back normal metabolism of variables in tissues over a 1-year follow-up period.
KeywordsObesity Weight loss Sleeve gastrectomy Biochemical markers Oxidant stress-antioxidant enzymes
We extend our sincerest thanks to the Directors of the Asser Central Hospital and Abha Private Hospital in Abha province of the Kingdom of Saudi Arabia and all the male and female study subjects who served as samples of this study for their cooperation.
Compliance with Ethical Standards
This work was supported by a grant from the Deanship of Scientific Research in King Khalid University (Grant no. KKU-MED-11-0090), Abha, Kingdom of Saudi Arabia.
Conflict of Interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
This research protocol was approved by the Ethics Committee on Human Research of King Khalid University, Abha, Kingdom of Saudi Arabia (Opinion REC# 2012-10-02/Project number KKU-MED-11-0090).
- 1.Sinhababu A. Body mass index status and some obesity promoting dietary factors among students of nursing training school, Bankura. Indian J Community Med. 2006;31(2):78.Google Scholar
- 4.Arab News. KSA 3rd in world obesity ranking. The Middle East’s Leading English Language Daily, Sunday, the 18 December 2016.Google Scholar
- 10.Ribeiro SMR, Queiroz JH, Peluzio MCG, et al. A formacao e osefeitos das species reativas de oxigenio no meio. Biologic Biosci J. 2005;21(3):133–49.Google Scholar
- 11.Suliburska J, Bogdański P, Pupek-Musialik D, et al. Dietary intake and serum and hair concentrations of minerals and their relationship with serum lipids and glucose levels in hypertensive and obese patients with insulin resistance. Biol Trace Elem Res. 2011;139(2):137–50.CrossRefPubMedGoogle Scholar
- 12.MacCuish A, Razvi S, Syed AA. Effect of weight loss after gastric bypass surgery on thyroid function in euthyroid people with morbid obesity. Clinical Obesity. 2002;1-2(2):25–8.Google Scholar
- 16.Al Khaldi YM. Obesity in Saudi Arabia…Gaps in research. Saudi J Obesity. 2014;:47Google Scholar
- 22.Maksvytis A, Stakisaitis D. Impact of obesity on lipid profiles in middle-aged women. Medicina (Kaunas). 2004;40(6):553–7.Google Scholar
- 23.Tungtrongchitr R, Pongpaew P, Phonrat B, et al. Serum copper, zinc, ceruloplasmin and superoxide dismutase in Thai overweight and obese. J Med Assoc Thai June. 2003;86(6):543–51.Google Scholar
- 29.Vincent HK, Innes KE, Vincent KR. Oxidative stress and potential interventions to reduce oxidative stress in overweight and obesity. Diabetes ObesMetabol. 2007;9:813–39.Google Scholar
- 31.Landmesser U, Spiekermann S, Dikalov S, et al. Vascular oxidative stress and endothelial dysfunction in patients with chronic heart failure: role of xanthine oxidase and extracellular superoxide dismutase. Circulation. 2002;106:3073–8. doi: 10.1161/01.CIR.0000041431.57222.AF.CrossRefPubMedGoogle Scholar
- 35.Del Genio F, Del Genio G, De Sio I, et al. Noninvasive evaluation of abdominal fat and liver changes following progressive weight loss in severely obese patients treated with laparoscopic gastric bypass. ObesSurg. 2009;19:1664–71.Google Scholar
- 41.Garcia-Marirrodriga I, Amaya-Romero C, Ruiz-Diaz GP, et al. Evolution of lipid profiles after bariatric surgery. ObesSurg. 2012;22:609–16.Google Scholar
- 42.Afshinnia F, Wilt TJ, Duval S, et al. Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrol Dialysis. 2009;23(4):1173–18.Google Scholar
- 48.Ferrier RD, Harvey RA, editors. Lippincotts illustrated reviews: bioenergetics and oxidative phosphorylation. 6th ed. Philadelphia: Wolters Kluwers/Lippincotts Williams and Wilkins; 2012.Google Scholar
- 50.Ak H, Nevbahar T, Habyf S, et al. Plasma lipid peroxides, vitamin E, superoxide dismutase and glutathione alterations in coronary atherosclerosis. Turk Med Sci. 1996;26:11–5.Google Scholar
- 51.Lu D, Maulik N, Moraru II, et al. Molecular adaptation of vascular endothelial cells to oxidative stress. Am J Phys. 1993;264:C715–22.Google Scholar
- 52.Verma VK, Ramesh V, Tiwari S, et al. Role of bilirubin, vitamin C and ceruloplasmin as antioxidants in coronary heart disease. Ind J ClinBiochem. 2005;20(2):68–74.Google Scholar
- 53.Ferrier RD, Harvey RA, editors. Lippincotts illustrated reviews: pentose phosphate pathway and nicotinamide adenine dinucleotide phosphate. 6th ed. Philadelphia: Wolters/Kluwers/Lippincotts Williams and Wilkins; 2012.Google Scholar