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Reduced Cardiovascular Risk Following Bariatric Surgeries is Related to a Partial Recovery from “Adiposopathy”

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Abstract

Background

Altered cytokine secretion from dysfunctional adipose tissue or “adiposopathy” is implicated in obesity related inflammation and may mediate reduced cardiovascular disease (CVD) risk in response to weight loss after bariatric surgery. We hypothesized that bariatric surgery reduces CVD risk by favorably altering the pro-inflammatory profile of adipose tissue as a result of weight loss.

Methods

In this observational study with repeated measures, 142 patients underwent bariatric surgery of which 45 returned for follow-up at ∼6 months. At both time-points, lipid profiles and levels of plasma adiponectin, leptin, and TNF-α were obtained. Ratios of various adipokine parameters were related to pre- and post- surgical (gastric bypass vs. other restrictive bariatric procedures) lipid ratios.

Results

Prior to surgery, circulating adiponectin and the adiponectin/TNF-α ratio was strongly associated with CVD risk characterized by levels of triglycerides, HDL, and the TC/HDL, LDL/HDL, and TG/HDL ratios (all P < 0.05). Following bariatric surgery, BMI was decreased by 22%, adiponectin was increased by 93%, and leptin decreased by 50% as compared to baseline (all P < 0.01). TNF-α levels increased by 120% (P < 0.01) following surgery. Post-surgical changes in adiponectin and the leptin/adiponectin ratio were strongly associated with incremental improvements in triglycerides, HDL, and TC/HDL, LDL/HDL and TG/HDL ratios (all P < 0.05). Roux-en-y gastric bypass surgery (RYGB) as compared to other bariatric procedures was associated with more robust improvements in BMI, HDL, and leptin/adiponectin ratio than other gastric restrictive procedures (P < 0.05).

Conclusions

Thus, bariatric surgery, especially RYGB, ameliorates CVD risk through a partial recovery from “adiposopathy”, distinctively characterized by improved adiponectin and the leptin/adiponectin ratio.

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Abbreviations

TC:

Total cholesterol

HDL:

High-density lipoprotein

LDL:

Low-density lipoprotein

TG:

Triglyceride

RYGB:

Roux-en-y gastric bypass

TNFα:

Tumor necrosis factor alpha

BMI:

Body mass index

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Acknowledgments

We are grateful to the skilled technical assistance of Rose Lounsbury for performing adipokine measurements and Steve Maximuk in the Preventive Cardiology Core Laboratory for processing serum samples. This work was supported by National Institutes of Health, RO1 DK089547-01 NIDDK/NIH (JPK, SRK, PRS).

Conflict of Interest

SRK and PS receive research funding from Ethicon endo-surgery. The other authors (SA, KRK, JPK, SH, MG) have nothing to disclose.

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 44195, USA

    Swathi Appachi

  2. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Karen R. Kelly & John P. Kirwan

  3. Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Philip R. Schauer, Manjula Gupta & Sangeeta R. Kashyap

  4. Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Stanley Hazen

  5. Endocrinology, Diabetes and Metabolism, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Sangeeta R. Kashyap

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  1. Swathi Appachi
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Correspondence to Sangeeta R. Kashyap.

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Appachi, S., Kelly, K.R., Schauer, P.R. et al. Reduced Cardiovascular Risk Following Bariatric Surgeries is Related to a Partial Recovery from “Adiposopathy”. OBES SURG 21, 1928–1936 (2011). https://doi.org/10.1007/s11695-011-0447-5

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