Original article

Impact of laparoscopic sleeve gastrectomy on glycolipid metabolism of patients with morbid obesity

Expand
  • The 3rd Department of General Surgery, Puyang Oilfield General Hospital, Henan Puyang 457001, China

Received date: 2019-06-11

  Online published: 2020-04-25

Abstract

Objective: To investigate the impact of laparoscopic sleeve gastrectomy (LSG) on glycolipid metabolism of patients with morbid obesity and the associated mechanisms. Methods: Clinical data of 82 patients with morbid obesity were analyzed retrospectively including 25 cases with type 2 diabetes mellitus (T2DM), 30 cases with impaired glucose to-lerance and 27 cases with both glucose and glucose tolerance normal. Fifty healthy individuals of normal weight in the period from January 2012 to June 2017 were as control. Postoperative weight loss, index of glycolipid metabolism, Uric acid (UA) and tumor necrosis factor α (TNF-α) were compared between pre and post operation. Correlation between homeostasis model assessment of insulin resistance (HOMA-IR) and some index of metabolism was performed. Results: ①Body mass index (BMI) and waist circumference of obese patients 6 months post operation were significantly lower than pre operation (P<0.05). Higher postoperative excess weight loss (EWL) was found in the obese patients with T2DM compared with normal blood glucose and glucose tolerance (P<0.05). ②Fasting blood glucose (FBG), 2 h postprandial blood glucose and insulin of obese patients 6 months post operation were significantly lower than pre operation (P<0.05). HOMA-IR of obese patients 6 months post operation was significantly lower than pre operation (P<0.05). ③Low density lipoprotein cholesterol of obese patients 6 months post operation was significantly higher than control (P<0.05). Body fat ratio of obese patients 6 months post operation was significantly lower than pre operation (P<0.05). UA and TNF-α of obese patients pre operation, which were significantly higher than control (P<0.05), decreased at 6 months post operation significantly (P<0.05). ④The levels of insulin in 120 min and 180 min after meal at 6 months post operation of obese patients were significantly lower than pre operation (P<0.05). Insulin of obese patients 30 min and 60 min postprandial were significantly higher than control (P<0.05). The peak of insulin secretion curve of patients with impaired glucose tolerance and T2DM pre operation moved to 120 min postprandial and returned to 60 min postprandial. Insulin secretion rhythm of the patients was basically normal. ⑤There were three types of positive correlation of HOMA-IR in obese patients 6 months post operation. It was present with BMI, FBG and fasting insulin (P<0.05). It was present with UA in the obese patients of blood glucose and glucose tolerance normal(P<0.05). It was present with triglyceride and TNF-α of obesity patients of impaired glucose tolerance and T2DM(P<0.05). Conclusions: LSG in the treatment of patients with morbid obese could effectively recover abnormal insulin secretion curve, improve hyperinsulinemia, and correct insulin resistance and metabolic disorders. Insulin resistance of obese patients was closely related to BMI, UA, TNF-α and lipid metabolism disorders.

Cite this article

ZHANG Huaibo, MA Ronglong, ZHANG Dejing . Impact of laparoscopic sleeve gastrectomy on glycolipid metabolism of patients with morbid obesity[J]. Journal of Surgery Concepts & Practice, 2020 , 25(02) : 129 -133 . DOI: 10.16139/j.1007-9610.2020.02.009

References

[1] 李子建, 于健春, 康维明, 等. 腹腔镜袖状胃切除术治疗肥胖症及其合并症的疗效分析[J]. 中国医学科学院学报, 2018, 40(5):39-45.
[2] Arapis K, Tammaro P, Parenti LR, et al. Long-term results after laparoscopic adjustable gastric banding for morbid obesity: 18-year follow-up in a single university unit[J]. Obes Surg, 2017, 27(3):630-640.
[3] Tammaro P, Hansel B, Police A, et al. Laparoscopic adjustable gastric banding: predictive factors for weight loss and band removal after more than 10 years' follow-up in a single university unit[J]. World J Surg, 2017, 41(8):2078-2086.
[4] Dicker D, Yahalom R, Comaneshter DS, et al. Long-term outcomes of three types of bariatric surgery on obesity and type 2 diabetes control and remission[J]. Obes Surg, 2016, 26(8):1814-1820.
[5] 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖和2型糖尿病外科治疗指南(2014)[J]. 中国实用外科杂志, 2014, 34(11):1005-1010.
[6] Barrichello S, Minata MK, García Ruiz de Gordejuela A, et al. Laparoscopic greater curvature plication and laparoscopic sleeve gastrectomy treatments for obesity: systematic review and meta-analysis of short- and mid-term results[J]. Obes Surg, 2018, 28(10):3199-3212.
[7] Akash MSH, Rehman K, Liaqat A. Tumor necrosis factor-alpha: role in development of insulin resistance and pathogenesis of type 2 diabetes mellitus[J]. J Cell Biochem, 2018, 119(1):105-110.
[8] Rheinheimer J, de Souza BM, Cardoso NS, et al. Current role of the NLRP3 inflammasome on obesity and insulin resistance: A systematic review[J]. Metabolism, 2017, 74(6):1-9.
[9] Murphy R, Clarke MG, Evennett NJ, et al. Laparoscopic sleeve gastrectomy versus banded Roux-en-Y gastric bypass for diabetes and obesity: a prospective randomised double-blind trial[J]. Obes Surg, 2018, 28(2):293-302.
[10] Gadiot RPM, Biter LU. Response to: letter to the editor: long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results[J]. Obes Surg, 2017, 27(6):1625.
[11] Gastaldelli A, Rubino F, Mingrone G, et al. Short-term effects of laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass[J]. Diabetes Care, 2017, 40(4):e49.
[12] Kowalewski PK, Olszewski R, Kwiatkowski A, et al. Life with a gastric band. long-term outcomes of laparoscopic adjustable gastric banding- a retrospective study[J]. Obes Surg, 2017, 27(5):1250-1253.
[13] Singendonk M, Kritas S, Omari T, et al. Upper gastrointestinal function in morbidly obese adolescents before and 6 months after gastric banding[J]. Obes Surg, 2018, 28(5):1277-1288.
[14] Egan RJ, Morgan JD, Norton SA. The impact of laparoscopic adjustable gastric banding on an NHS cohort of type 2 diabetics: a prospective cohort study[J]. Obes Surg, 2017, 27(3):824-825.
[15] Shih KC, Janckila AJ, Lee WJ, et al. Effects of bariatric weight loss surgery on glucose metabolism, inflammatory cytokines, and serum tartrate-resistant acid phosphatase 5a in obese Chinese adults[J]. Clin Chim Acta, 2016, 453(3):197-202.
[16] Lju C, Feng X, Li Q, et al. Adiponectin, TNF-α and inflammatory cytokines and risk of type 2 diabetes: A systematic review and meta-analysis[J]. Cytokine, 2016, 86(5):100-109.
Outlines

/