Obesity is associated with chronic low-grade inflammation, which has been linked to increased morbidity. However, inflammation variably and unpredictably improves after bariatric surgery. This study aimed at (1) evaluating the relationship between amplitude of weight loss and variation of inflammatory parameters after bariatric surgery, and (2) identifying, among clinical and biological baseline parameters, predictive factors of variation in inflammatory parameters.
In a prospective cohort of patients who underwent bariatric surgery, serum concentrations of interleukin (IL)-6, IL-10, resistin, leptin, adiponectin chemerin, and C-reactive protein (CRP) were measured preoperatively and 1 year after surgery, and routine clinical and biochemical parameters were retrieved. Univariate and multivariate analyses (partial least square method) were performed to assess how parameters were associated with weight loss and to predict improvement of inflammatory parameters.
Eighty-seven patients were included (mean weight ± SD 136.3 ± 3.2 kg, 35 gastric bypasses, 52 sleeve gastrectomies). In parallel with weight loss (39.5 ± 13.8 kg), pro-inflammatory markers (IL-6, CRP, leptin, resistin) significantly decreased, and anti-inflammatory markers (IL-10, adiponectin) increased. Multivariate analysis revealed a significant association between weight loss and improvement in inflammatory parameters. Among all the clinical and biological preoperative parameters, baseline chemerin level was the only parameter that was significantly associated with global improvement of the inflammatory status after surgery.
The amplitude of weight loss 1 year after bariatric surgery was strongly correlated with improvement of inflammatory profile, which could be predicted by baseline plasma level of chemerin. This suggests a key role of chemerin in obesity-driven inflammation, and a potential use as a biomarker.
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We would like to thank Véronique Théret, Carole Sauvestre, Patricia Cosson, Marie-Céline Bourgoin, and Dr. David Jacobi. Some of the figures were created using the vector image bank of Servier Medical Art (http://smart.servier.com/). Servier Medical Art by Servier is licensed under a Creative Commons Attribution 3.0 Unported License (https://creativecommons.org/licenses/ by/3.0/).
Conflict of Interest
The authors declare that they have no conflict interest.
All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards All patients included in the study gave written consent for scientific and anonymous use of their data, and the study was approved by the institutional ethic committee.
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Electronic Supplementary Material
Volcano plot representation of association between weight loss and variation of inflammatory and metabolic parameters, before and after bariatric surgery. Univariate analysis was performed to highlight the most discriminant parameters associated with weight loss. Results are represented as a volcano plot built on fold-change values and the threshold of significance using the non-parametric Wilcoxon test after adjustment for multiple test. (Reviewer #3, Q#3) The most relevant parameters were characterized by FC> 1.2 or <0.8 and adjusted p<0.2. (difference between baseline and one-year levels, noted Δ). Parameters with adjusted p=0.2 and fold change (FC) >1.2 or < 0.8 were considered as significant and are showed on the graph: variation of insulinemia, QUICKI and LDLc. QUICKI: quantitative insulin sensitivity check index; LDLc: low density lipoprotein cholesterol. (PDF 220 kb)
Predicting improvement of inflammatory parameters after surgery using baseline clinical and biological parameters. (A): In univariate analysis, among the selected inflammatory cytokines and adipokines, only IL-6 and adiponectin variations revealed significant association with baseline parameters. Parameters with adjusted p=0.2 and fold change (FC) >1.2 or < 0,8 were considered as significant. Thus, IL-6 variation before and after surgery was significantly associated with baseline IL-6 level (adjusted p =0.002, FC=3.3), and baseline resistin level (p=0.007, FC=1.9). Adiponectin variation before and after surgery was significantly associated with baseline adiponectin level (p=0.036 and FC=0.81) and baseline lean mass (adjusted p=0.026, FC=0.78). Volcano plots were next built for representations of association between fold change of variation of IL-6 and adiponectin before and after surgery (difference between baseline and one-year levels, noted “Δ”) and baseline parameters. Significant associations are mentioned on the graphs. (B): Results of multivariate analysis using non-optimized partial least square technic to explore association between baseline clinical and biological parameters and variation of selected inflammatory parameters (Resistin, CRP, Adiponectin and IL-6) before and after surgery (noted Δ), defined as < or > to the median. The two important measures in PLS-DA are represented: the variable importance in projection (VIP) and the weighted sum of absolute regression coefficients (the colored boxes on the right indicate the relative concentrations of the corresponding variable in each group under study). CRP: C-reactive protein; HDLc: high density lipoprotein cholesterol; LDLc: low density lipoprotein cholesterol; TG: Triglyceride. (PDF 1192 kb)
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Jouan, Y., Blasco, H., Bongrani, A. et al. Preoperative Chemerin Level Is Predictive of Inflammatory Status 1 Year After Bariatric Surgery. OBES SURG 30, 3852–3861 (2020). https://doi.org/10.1007/s11695-020-04584-3
- Low-grade inflammation