Safwaan Adam1,2, Yifen Liu, Tarza Siahmansur1, Jan H Ho1,2, Shaishav S Dhage1,2, Rahul Yadav3, John P New1,4, Rachelle Donn1, Basil J Ammori1,5, Akheel A Syed1,4, Rayaz A Malik1,6, Handrean Soran1,2, Paul N Durrington1. 1. 1 Cardiovascular Research Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. 2. 2 Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, UK. 3. 3 Department of Diabetes and Endocrinology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK. 4. 4 Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal NHS Foundation Trust, Salford, UK. 5. 5 Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK. 6. 6 Weill-Cornell Medicine-Qatar, Doha, Qatar.
Abstract
BACKGROUND: Reaven originally described the clustering of insulin resistance/hyperinsulinaemia, obesity (particularly visceral), altered cytokine levels, glucose intolerance, hypertriglyceridaemia and low high-density lipoprotein cholesterol. Subsequently, a potentially highly atherogenic small, dense low-density lipoprotein was also reported. We have studied the effect of bariatric surgery on this and other risk factors for atherosclerosis. METHODS: Forty patients (20 with type 2 diabetes mellitus) undergoing bariatric surgery were studied before and 1 year after bariatric surgery. RESULTS: Twelve months after bariatric surgery, median body mass index had decreased from 49.5 to 36.5 kg/m2, fasting insulin from 21.3 to 7.8 mU/L and insulin resistance (homeostatic model assessment of insulin resistance) from 5.9 to 1.8 (all p < 0.001). Thirteen out of 20 patients had remission from type 2 diabetes mellitus. Highly sensitive C-reactive protein, interleukin-6, fasting triglycerides ( p < 0.001) and small, dense low-density lipoprotein ( p < 0.001) decreased, while high-density lipoprotein cholesterol increased ( p < 0.001) significantly, irrespective of having type 2 diabetes mellitus and/or being treated with statin therapy before surgery. CONCLUSION: The association between marked weight loss and change in insulin resistance and hyperinsulinaemia with the change in small, dense low-density lipoprotein and interleukin-6 warrants further investigation. Bariatric surgery provides a model for investigating the mechanisms linking insulin resistance/hyperinsulinaemia to atherosclerosis.
BACKGROUND: Reaven originally described the clustering of insulin resistance/hyperinsulinaemia, obesity (particularly visceral), altered cytokine levels, glucose intolerance, hypertriglyceridaemia and low high-density lipoprotein cholesterol. Subsequently, a potentially highly atherogenic small, dense low-density lipoprotein was also reported. We have studied the effect of bariatric surgery on this and other risk factors for atherosclerosis. METHODS: Forty patients (20 with type 2 diabetes mellitus) undergoing bariatric surgery were studied before and 1 year after bariatric surgery. RESULTS: Twelve months after bariatric surgery, median body mass index had decreased from 49.5 to 36.5 kg/m2, fasting insulin from 21.3 to 7.8 mU/L and insulin resistance (homeostatic model assessment of insulin resistance) from 5.9 to 1.8 (all p < 0.001). Thirteen out of 20 patients had remission from type 2 diabetes mellitus. Highly sensitive C-reactive protein, interleukin-6, fasting triglycerides ( p < 0.001) and small, dense low-density lipoprotein ( p < 0.001) decreased, while high-density lipoprotein cholesterol increased ( p < 0.001) significantly, irrespective of having type 2 diabetes mellitus and/or being treated with statin therapy before surgery. CONCLUSION: The association between marked weight loss and change in insulin resistance and hyperinsulinaemia with the change in small, dense low-density lipoprotein and interleukin-6 warrants further investigation. Bariatric surgery provides a model for investigating the mechanisms linking insulin resistance/hyperinsulinaemia to atherosclerosis.
Authors: See Kwok; Safwaan Adam; Jan Hoong Ho; Zohaib Iqbal; Peter Turkington; Salman Razvi; Carel W Le Roux; Handrean Soran; Akheel A Syed Journal: Clin Obes Date: 2020-08-28