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Improvement of Low-Grade Inflammation in Patients with Metabolically Healthy Severe Obesity After Primary Bariatric Surgery

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Abstract

Introduction

The inflammatory state that accompanies adiposity and the metabolic syndrome (MetS) is called “low-grade” inflammation. White blood cell count (WBC) has been proposed as an emerging biomarker for predicting future cardiovascular events, MetS and mortality. Bariatric surgery (BS) improves comorbidities associated with obesity and the MetS and the surgically induced weight loss is known to improve inflammatory status.

Objectives

To analyze the improvement of low-grade inflammation associated to obesity in patients with metabolically healthy severe obesity (MHSO) and patients with metabolically unhealthy obesity (MUSO) (severe obesity with MetS) after primary bariatric surgery as well as the protective effect of BS against the development of MetS in patients with MHSO by reducing the WBC.

Materials and methods

Retrospective analysis of prospectively collected data of patients undergoing laparoscopic primary BS (gastric by-pass or sleeve gastrectomy) from January 2004-December 2015. Outcomes included changing of low-grade inflammation in terms of leukocytes, neutrophils, lymphocytes, and platelets.

Results

Twenty-one patients with MHSO and 167 patients with MUSO underwent laparoscopic primary BS. The preoperative values of leukocyte and platelet were statistically higher in the group of patients with MHSO. In both groups, there was significant postoperative decrease of inflammatory markers. The greatest drop in WBC occurred in the second postoperative year. No patient of the group of patients with MHSO developed MetS within five postoperative years.

Conclusions

Surgically induced weight loss plays an important role for improvement in chronic inflammation associated to obesity because of reduction of visceral fat mass. MHSO associates a low-grade chronic inflammatory status comparable to MUSO. The improvement or decrease of low-grade inflammation in patients with metabolically healthy severe obesity after bariatric surgery could have a protective effect against the development of MetS and medical conditions associated with severe obesity.

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Abbreviations

IR:

insulin resistance

MetS:

metabolic syndrome

WAT:

white adipose tissue

TNF-a:

tumor necrosis alpha

IL-6:

interleukin-6

WBC:

white blood cell count

CRP:

C reactive protein

BS:

bariatric and metabolic surgery

MHSO:

metabolically healthy severe obesity

MUSO:

metabolically unhealthy obesity

LGBP:

laparoscopic gastric by-pass

LSG:

laparoscopic sleeve gastrectomy

BMI:

body mass index

T2D:

type 2 diabetes

AHT:

arterial hypertension

DL:

dyslipidemia

OSAS:

obstructive sleep apnea syndrome

% EBMIL:

% Excess BMI Loss

% TWL:

% Total Weight Loss

FU:

follow-up

PO:

postoperative

T0:

preoperative time

T1:

first postoperative year

T2:

second postoperative year

T5:

fifth postoperative year

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Acknowledgements

Gregorio Vesperinas participated in collecting data.

Author information

Authors and Affiliations

  1. Bariatric and Metabolic Surgery Unit, Department of General Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain

    María Recarte & Ramón Corripio

  2. Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain

    Samara Palma & Ana I. de-Cos

  3. Department of General Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain

    Alberto Mata

Authors
  1. María Recarte
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Correspondence to María Recarte.

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Key Points

• Low-grade inflammation associated to obesity

•Metabolically healthy severe obesity

• Metabolically unhealthy severe obesity

• Primary bariatric and metabolic surgery.

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Recarte, M., Corripio, R., Palma, S. et al. Improvement of Low-Grade Inflammation in Patients with Metabolically Healthy Severe Obesity After Primary Bariatric Surgery. OBES SURG 33, 38–46 (2023). https://doi.org/10.1007/s11695-022-06345-w

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