Obesity Surgery

, Volume 27, Issue 8, pp 2005–2014 | Cite as

Effects of Weight Reduction After Sleeve Gastrectomy on Metabolic Variables in Saudi Obese Subjects in Aseer Province of Kingdom of Saudi Arabia

  • Mohammed A. Bawahab
  • Abdullah S. Assiri
  • Walid Abdel Maksoud
  • Ayyub Patel
  • Osama Kadoumi
  • Gaffar Sarwar Zaman
  • Riyad Mohammed Khalil Alessih
  • Syed Saleem HaiderEmail author
Original Contributions



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.


Obesity 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

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

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. 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
  2. 2.
    Morrow JD. Is oxidant stressing a connection between obesity and atherosclerosis? Arterioscler Thromb Vasc Biol. 2003;23(3):368–70.CrossRefPubMedGoogle Scholar
  3. 3.
    Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13(3):329–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Arab News. KSA 3rd in world obesity ranking. The Middle East’s Leading English Language Daily, Sunday, the 18 December 2016.Google Scholar
  5. 5.
    Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–45.CrossRefPubMedGoogle Scholar
  6. 6.
    Al Akwaa A, El Zubier A, Al SM. Pattern of liver function tests in morbidly obese Saudi patients undergoing bariatric surgery. Saudi Journal of Gastroenterology. 2011;17(4):252.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Furukawa S, Fujita T, Shimabukuro M, et al. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest. 2004;114(12):1752–61.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sardu C, Marfella R, Santulli G. Impact of diabetes mellitus on the clinical response to cardiac resynchronization therapy in elderly people. J Cardiovasc Transl Res. 2014;7(3):362–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Palmieri VO, Grattagliano, Portincasa P, et al. Systemic oxidative alterations are associated with visceral adioposity and liver steatosis in patients with metabolic syndrome. J Nutr. 2006;136(12):3022–6.PubMedGoogle Scholar
  10. 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. 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. 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
  13. 13.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17(7):962–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Aggarwal S, Kini SU, Herron DM. Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis. 2007;3(2):189–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Al Khaldi YM. Obesity in Saudi Arabia…Gaps in research. Saudi J Obesity. 2014;[2]:47Google Scholar
  17. 17.
    Chiu HK, Tsai EC, Juneja R. Equivalent insulin resistance. Diabetes Res Clin Pract. 2007;77:237–44. doi: 10.1016/j.diabres.2006.12.013. PMID 17234296. Retrieved May 30, 2014CrossRefPubMedGoogle Scholar
  18. 18.
    Dankel SN, Staalesen V, Bjorndal B, et al. Tissue–specific effects of bariatric surgery including mitochondrial function. J Obesity. 2011; doi: 10.1155/2011/435245.PubMedGoogle Scholar
  19. 19.
    Al-Sultan AI. Assessment of the relationship of hepatic enzymes with obesity and insulin resistance in adults in Saudi Arabia. Sultan Qaboos Univ Med J. 2008;8(2):185–92.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Frei B, Stocker R, Ames BN. Antioxidant defences and lipid peroxidation in human blood plasma. Proc NatlAcad Sci. 1988;85(24):9748–52.CrossRefGoogle Scholar
  21. 21.
    Gerchman F. Body mass index is associated with increased creatinine clearance by a mechanism independent of body fat distribution. J Clin Endocrinol Metab. 2009;94(10):3781–8. doi: 10.1210/jc.2008-2508.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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. 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
  24. 24.
    Yakinci G, PAC A, Zehra KF, et al. Serum zinc, copper, and magnesium levels in obese children. Ped Intl. 1997;39(3):339–41.CrossRefGoogle Scholar
  25. 25.
    Del Rio D, Stewart AJ, Pellegrini N. A review of recent studies on malondialdehyde as toxic molecule and biological marker of oxidative stress. Nutr Metab Cardiovasc Dis. 2005;15(4):316–28.CrossRefPubMedGoogle Scholar
  26. 26.
    Dalle-Donne I, Rossi R, Colombo R, et al. Biomarkers of oxidative damage in human disease. Clin Chem. 2006;53(4):601–23.CrossRefGoogle Scholar
  27. 27.
    Prazny M, Skrha J, Hilgertova J. Plasma malondialdehyde and obesity: is there a relationship? Clin Chem Lab Med. 1999;37(11/12):1129–30.PubMedGoogle Scholar
  28. 28.
    Yesilbursa D, Serdar Z, Serdar A, et al. Lipid peroxides in obese patients and effects of weight loss with orlistat on lipid peroxides levels. Int J Obes. 2005;29:142–5.CrossRefGoogle Scholar
  29. 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
  30. 30.
    Jayakumari N, Ambikakumari V, Balakrishnan KG, et al. Antioxidant status in relation to free radical production during stable and unstable anginal syndromes. Atherosclerosis. 1992;94(2–3):183–90. CrossRefPubMedGoogle Scholar
  31. 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
  32. 32.
    Atkinson RL, Dahms WT, Bray GA, et al. Plasma zinc and copper in obesity and after intestinal bypass. Ann Inter Med. 1978;89(4):491–3.CrossRefGoogle Scholar
  33. 33.
    Chikunguwo S, Brethauer S, Nirujogi V, et al. Influence of obesity and surgical weight loss on thyroid hormone levels. Surg Obes Relat Dis. 2007;3(6):631–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Ramsey MD, Leighton J, Trang A. Analysis of leukopenia and anemia after gastric bypass surgery. Surg Obes Related Dis. 2012;8(2):164–8.CrossRefGoogle Scholar
  35. 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
  36. 36.
    Silvestre V, Ruano M, Domonguez Y, et al. Morbid obesity and gastric bypass surgery: biochemical profile. Obes Surg. 2004;14:1227–32.CrossRefPubMedGoogle Scholar
  37. 37.
    Wolf AM, Beisiegel U. The effect of loss of extra weight on the metabolic risk factors after bariatric surgery in morbidly and super obese patients. Obes Surg. 2007;17:910–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Andersson C, Weeke P, Fosbol EL, et al. Acute effect of weight loss on levels of total bilirubin in obese cardiovascular high-risk patients: an analysis from the lead-in period of the sibutramine cardiovascular trial. Metabolism. 2009;58(8):1109–15.CrossRefPubMedGoogle Scholar
  39. 39.
    Pellegrini CA, Thomas WJ, Way LW. Bilirubin and ALP values before and after surgery for biliary obstruction. Am J Surg. 1982;143:67–73.CrossRefPubMedGoogle Scholar
  40. 40.
    Nguyen NT, Varela E, Sabio A, et al. Resolution of hyperlipidemia after laproscopic Rou-en-Y gastric bypass. J Am Coll Surg. 2006;203(1):24–9.CrossRefPubMedGoogle Scholar
  41. 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. 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
  43. 43.
    Comminetti C, Garrido A, Franciscato ZMF. Zinc nutritional status of morbidly obese patients before and after roux-en-Y gastric bypass: a preliminary report. Obes Surg. 2006;16:448–53.CrossRefGoogle Scholar
  44. 44.
    Balsa J, Botella J, Gomez Martin J, et al. Copper and zinc serum levels after derivative bariatric surgery: differences between roux en y castric bypass and biliopancreatic diversion. Obes Surg. 2011;21:744–50.CrossRefPubMedGoogle Scholar
  45. 45.
    Luis DA, Pacheco D, Izaola O, et al. Zinc and copper serum levels of morbidly obese patients before and after biliopancreatic diversion: 4 years of follow-up. J GatrointestSurg. 2011;15:2178–81.CrossRefGoogle Scholar
  46. 46.
    Dandona P, Mohanty P, Ghanim H, et al. The suppressive effect of dietary restriction and weight loss in the obese on the generation of reactive oxygen species by leukocytes, lipid peroxidation, and protein carbonylation. J Clin Endocrinol Metab. 2001;86:355–62.PubMedGoogle Scholar
  47. 47.
    Yesilbursa D, Serdar Z, Serdar A, et al. Lipid peroxides in obese patients and effecs of weight loss with orlistat on lipid peroxide levels. Int J Obes. 2005;29(1):142–5.CrossRefGoogle Scholar
  48. 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
  49. 49.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;13;292(14):1724–37.CrossRefGoogle Scholar
  50. 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. 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. 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. 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

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Mohammed A. Bawahab
    • 1
  • Abdullah S. Assiri
    • 2
  • Walid Abdel Maksoud
    • 1
  • Ayyub Patel
    • 3
  • Osama Kadoumi
    • 3
  • Gaffar Sarwar Zaman
    • 4
  • Riyad Mohammed Khalil Alessih
    • 3
  • Syed Saleem Haider
    • 3
    Email author
  1. 1.Department of SurgeryCollege of Medicine, King Khalid UniversityAbhaKingdom of Saudi Arabia
  2. 2.Department of MedicineCollege of Medicine, King Khalid UniversityAbhaKingdom of Saudi Arabia
  3. 3.Department of Clinical Biochemistry, College of MedicineKing Khalid UniversityAbhaKingdom of Saudi Arabia
  4. 4.Department of Clinical Laboratory Sciences, College of Applied Medical SciencesKing Khalid UniversityAbhaKingdom of Saudi Arabia

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