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Morbid obesity

Bariatric surgery reduces systemic inflammation

Systemic inflammome of morbid obesity is independent of sex, smoking status and/or comorbidities

The systemic inflammome of morbid obesity - independent of sex, smoking status and/or comorbidities - is significantly reduced by bariatric surgery and mirrored in the lungs, according to a paper published in PLOSone.

“This study describes, for the first time to our knowledge, the systemic inflammome associated with morbid obesity and shows that it is: (1) barely modified by sex, smoking status and/or coexistence of OSAS and/or MS; (2) significantly reduced, albeit not fully normalised, after bariatric surgery; and, (3) related to pulmonary inflammation”, note the authors from Universitat de Barcelona, Hospital Clínic and Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.

The researchers write that obesity is associated with low-grade systemic inflammation, this ‘inflammome’ is a network layout of the inflammatory pattern, they hypothesised that it can be significantly worsened by smoking and other comorbidities frequently associated with obesity, and improved by bariatric surgery. In addition, it is also unknown whether any improvements would also be seen in the lungs, although any improvement would be beneficial to the patient considering that but obesity is often associated with pulmonary inflammation and bronchial hyper responsiveness.

One hundred and twenty nine patients were enrolled in this prospective, observational study (96 females/33 males; age 46±12 years) with a BMI≥40 (or ≥35 in those with comorbidities) without major cardiovascular and chronic obstructive airway diseases, who were candidates for bariatric surgery.

They also recruited 20 healthy, normal weighted, sex- (16 females/4 males) and age-matched (43±7 years) non-smokers with normal spirometry, in the controls group.

The gathered the following measurements from all the obese subjects before and after surgery: forced spirometry, plethysmographic lung volumes, arterial blood gases and the 6-minute walking test (6MWT).

Outcomes

Prior to surgery all obese subjects displayed a strong and coordinated (inflammome) systemic inflammatory response (adiponectin, C-reactive protein, interleukin (IL)-8, IL-10, leptin, soluble tumour necrosis factor-receptor 1(sTNF-R1), and 8-isoprostane), compared with the control group. This inflammome was independent of sex, smoking or coexistence of obstructive sleep apnoea and/or metabolic syndrome.

Sleeve gastrectomy was performed in 68 (53%) and Roux-en-Y gastric bypass in 61 (47%) obese subjects. Ninety-one percent of obese subjects (n=118) had an excess weight loss>50% (75±18%).

However, following surgery the inflammome it was “significantly ameliorated, albeit not completely abolished, after bariatric surgery’ (Figure 1). The researchers also reported that there was evidence that the obese subjects who were believe to have pulmonary inflammation (exhaled condensate), also decreased following surgery.

Figure 1: Systemic inflammome in healthy and obese individuals before and after BS. Each node represents one inflammatory marker and color indicates the type of inflammatory marker considered (acute phase reactants, cytokines, adipokines or oxidative stress). The node diameter is proportional to the prevalence of abnormal values (i.e.,>95th or <5th of controls) of that particular biomarker in the population under consideration (control or obese individuals) and the thickness of the edges linking pairs of nodes is proportional to the prevalence of co-occurrence of abnormal biomarkers of that particular pair of nodes.

“Morbid obesity is associated with a significant systemic inflammome that is not influenced by sex, smoking status, presence of obstructive sleep apnoea and/or metabolic syndrome, is related to pulmonary inflammation, and is significantly ameliorated after bariatric surgery,” the authors conclude.

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