Advertisement

Obesity Surgery

, Volume 19, Issue 5, pp 571–576 | Cite as

Parameters of Inflammation in Morbid Obesity: Lack of Effect of Moderate Weight Loss

  • Eva Solá
  • Ana Jover
  • Antonio López-Ruiz
  • María Jarabo
  • Amparo Vayá
  • Carlos Morillas
  • Marcelino Gómez-Balaguer
  • Antonio Hernández-MijaresEmail author
Research Article

Abstract

Background

Obesity has been associated with a chronic activation of the acute-phase response. The aims of our study were to investigate whether levels of inflammatory cytokines are higher in obese patients, to evaluate their relationship with metabolic syndrome, and to analyze the effect of moderate weight loss upon their levels.

Methods

Sixty-seven severe or morbid obese patients were compared with 67 controls. Patients were submitted to a 4-week very low calorie diet followed by a low calorie diet for 2 months. Exclusion criteria were organic disease, ischemic heart disease or stroke, diabetes mellitus, hyperlipidemia, and hypertension. An evaluation was performed before and after the diet, in which fibrinogen, blood count, high-sensitive C-reactive protein (CRP), interleukin 6 (IL-6), and tumoral necrosis factor α (TNF-α) were measured. The Student t test was employed to compare differences between the groups and Pearson correlation coefficients were calculated.

Results

Obese patients showed higher levels of CRP (P < 0.001), IL-6 (P < 0.001), TNF-α (P < 0.001), leukocyte (P = 0.001), and neutrophil count (P < 0.001) than controls. In obese patients, inflammatory parameters were significantly correlated with anthropometric parameters and did not differ between obese subjects with or without metabolic syndrome. Moderate weight loss (excess weight loss 19.6%) was achieved through dieting, but no change was observed in any inflammatory parameter.

Conclusions

Obesity is associated to a chronic inflammatory state that seems to be due to an increased secretion of cytokines, and this state is not related to the presence of metabolic syndrome. Moderate weight loss does not ameliorate this inflammatory state in the short term.

Keywords

Adipokines Interleukin 6 Tumoral necrosis factor α Inflammation Obesity 

Notes

Acknowledgments

This work was supported by research grants from Instituto de Salud Carlos III (CIBER 06/02/0045).

References

  1. 1.
    Yudkin JS. Adipose tissue, insulin action and vascular disease: inflammatory signals. Int J Obes Relat Metab Disord 2003;27:S25–8.CrossRefGoogle Scholar
  2. 2.
    Faintuch J, Marques PC, Bortolotto LA, et al. Systemic inflammation and cardiovascular risk factors: are morbidly obese subjects different. Obes Surg 2008;18:854–62.CrossRefGoogle Scholar
  3. 3.
    Cottam DR, Mattar SG, Barinas-Mitchell E, et al. The chronic inflammatory hypothesis for the morbidity associated with morbid obesity: implications and effects of weight loss. Obes Surg 2004;14:589–600.CrossRefGoogle Scholar
  4. 4.
    Fruhbeck G. Overview of adipose tissue and its role in obesity and metabolic disorders. Methods Mol Biol 2008;456:1–22.CrossRefGoogle Scholar
  5. 5.
    Apovian CM, Bigornia S, Mott M, et al. Adipose macrophage infiltration is associated with insulin resistance and vascular endothelial dysfunction in obese subjects. Arterioscler Thromb Vasc Biol 2008;28:1654–9.CrossRefGoogle Scholar
  6. 6.
    Emery CF, Fondow MD, Schneider CM, et al. Gastric bypass surgery is associated with reduced inflammation and less depression: a preliminary investigation. Obes Surg 2007;17:759–63.CrossRefGoogle Scholar
  7. 7.
    Manco M, Fernandez-Real JM, Equitani F, et al. Effect of massive weight loss on inflammatory adipocytokines and the innate immune system in morbidly obese women. J Clin Endocrinol Metab 2007;92:483–90.CrossRefGoogle Scholar
  8. 8.
    Schernthaner GH, Kopp HP, Kriwanek S, et al. Effect of massive weight loss induced by bariatric surgery on serum levels of interleukin-18 and monocyte-chemoattractant-protein-1 in morbid obesity. Obes Surg 2006;16:709–15.CrossRefGoogle Scholar
  9. 9.
    Lambert CP, Wright NR, Finck BN, et al. Exercise but not diet-induced weight loss decreases skeletal muscle inflammatory gene expression in frail obese elderly persons. J Appl Physiol 2008;105:473–8.CrossRefGoogle Scholar
  10. 10.
    American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2005;28:S37–42.CrossRefGoogle Scholar
  11. 11.
    Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg 2007;17:565–8.CrossRefGoogle Scholar
  12. 12.
    Holt RI. International Diabetes Federation re-defines the metabolic syndrome. Diabetes Obes Metab 2005;7:618–20.CrossRefGoogle Scholar
  13. 13.
    Fontana L, Eagon JC, Trujillo ME, et al. Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes 2007;56:1010–3.CrossRefGoogle Scholar
  14. 14.
    Bastard JP, Jardel C, Bruckert E, et al. Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. J Clin Endocrinol Metab 2000;85:3338–42.PubMedGoogle Scholar
  15. 15.
    Ziccardi P, Nappo F, Giugliano G, et al. Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation 2002;105:804–9.CrossRefGoogle Scholar
  16. 16.
    Klover PJ, Clementi AH, Mooney RA. Interleukin-6 depletion selectively improves hepatic insulin action in obesity. Endocrinology 2005;146:3417–27.CrossRefGoogle Scholar
  17. 17.
    Tilg H, Moschen AR. Inflammatory mechanisms in the regulation of insulin resistance. Mol Med 2008;14:222–31.CrossRefGoogle Scholar
  18. 18.
    Skalicky J, Muzakova V, Kandar R, et al. Evaluation of oxidative stress and inflammation in obese adults with metabolic syndrome. Clin Chem Lab Med 2008;46:499–505.CrossRefGoogle Scholar
  19. 19.
    Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J 1990;265:621–36.CrossRefGoogle Scholar
  20. 20.
    Yudkin JS, Kumari M, Humphries SE, et al. Inflammation, obesity, stress and coronary heart disease: is interleukin-6 the link. Atherosclerosis 2000;148:209–14.CrossRefGoogle Scholar
  21. 21.
    Maeda N, Takahashi M, Funahashi T, et al. PPARgamma ligands increase expression and plasma concentrations of adiponectin, an adipose-derived protein. Diabetes 2001;50:2094–9.CrossRefGoogle Scholar
  22. 22.
    Laimer M, Ebenbichler CF, Kaser S, et al. Markers of chronic inflammation and obesity: a prospective study on the reversibility of this association in middle-aged women undergoing weight loss by surgical intervention. Int J Obes Relat Metab Disord 2002;26:659–62.CrossRefGoogle Scholar
  23. 23.
    Vazquez LA, Pazos F, Berrazueta JR, et al. Effects of changes in body weight and insulin resistance on inflammation and endothelial function in morbid obesity after bariatric surgery. J Clin Endocrinol Metab 2005;90:316–22.CrossRefGoogle Scholar
  24. 24.
    Olszanecka-Glinianowicz M, Zahorska-Markiewicz B, Janowska J, et al. Serum concentrations of nitric oxide, tumor necrosis factor (TNF)-alpha and TNF soluble receptors in women with overweight and obesity. Metabolism 2004;53:1268–73.CrossRefGoogle Scholar
  25. 25.
    Dandona P, Weinstock R, Thusu K, et al. Tumor necrosis factor-alpha in sera of obese patients: fall with weight loss. J Clin Endocrinol Metab 1998;83:2907–10.PubMedGoogle Scholar
  26. 26.
    Romano M, Guagnano MT, Pacini G, et al. Association of inflammation markers with impaired insulin sensitivity and coagulative activation in obese healthy women. J Clin Endocrinol Metab 2003;88:5321–6.CrossRefGoogle Scholar
  27. 27.
    Bruun JM, Verdich C, Toubro S, et al. Association between measures of insulin sensitivity and circulating levels of interleukin-8, interleukin-6 and tumor necrosis factor-alpha. Effect of weight loss in obese men. Eur J Endocrinol 2003;148:535–42.CrossRefGoogle Scholar
  28. 28.
    Anty R, Dahman M, Iannelli A, et al. Bariatric surgery can correct iron depletion in morbidly obese women: a link with chronic inflammation. Obes Surg 2008;18:709–14.CrossRefGoogle Scholar
  29. 29.
    Kopp HP, Kopp CW, Festa A, et al. Impact of weight loss on inflammatory proteins and their association with the insulin resistance syndrome in morbidly obese patients. Arterioscler Thromb Vasc Biol 2003;23:1042–7.CrossRefGoogle Scholar
  30. 30.
    Tchernof A, Nolan A, Sites CK, et al. Weight loss reduces C-reactive protein levels in obese postmenopausal women. Circulation 2002;105:564–9.CrossRefGoogle Scholar
  31. 31.
    Heilbronn LK, Noakes M, Clifton PM. Energy restriction and weight loss on very-low-fat diets reduce C-reactive protein concentrations in obese, healthy women. Arterioscler Thromb Vasc Biol 2001;21:968–70.CrossRefGoogle Scholar
  32. 32.
    Jellema A, Plat J, Mensink RP. Weight reduction, but not a moderate intake of fish oil, lowers concentrations of inflammatory markers and PAI-1 antigen in obese men during the fasting and postprandial state. Eur J Clin Invest 2004;34:766–73.CrossRefGoogle Scholar
  33. 33.
    Bastard JP, Maachi M, Van Nhieu JT, et al. Adipose tissue IL-6 content correlates with resistance to insulin activation of glucose uptake both in vivo and in vitro. J Clin Endocrinol Metab 2002;87:2084–9.CrossRefGoogle Scholar
  34. 34.
    Esposito K, Pontillo A, Di Palo C, et al. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA 2003;289:1799–804.CrossRefGoogle Scholar
  35. 35.
    Arvidsson E, Viguerie N, Andersson I, et al. Effects of different hypocaloric diets on protein secretion from adipose tissue of obese women. Diabetes 2004;53:1966–71.CrossRefGoogle Scholar
  36. 36.
    Ryan AS, Nicklas BJ. Reductions in plasma cytokine levels with weight loss improve insulin sensitivity in overweight and obese postmenopausal women. Diabetes Care 2004;27:1699–705.CrossRefGoogle Scholar
  37. 37.
    Nicoletti G, Giugliano G, Pontillo A, et al. Effect of a multidisciplinary program of weight reduction on endothelial functions in obese women. J Endocrinol Invest 2003;26:RC5–8.CrossRefGoogle Scholar
  38. 38.
    Xydakis AM, Case CC, Jones PH, et al. Adiponectin, inflammation, and the expression of the metabolic syndrome in obese individuals: the impact of rapid weight loss through caloric restriction. J Clin Endocrinol Metab 2004;89:2697–703.CrossRefGoogle Scholar
  39. 39.
    van Dielen FM, Buurman WA, Hadfoune M, et al. Macrophage inhibitory factor, plasminogen activator inhibitor-1, other acute phase proteins, and inflammatory mediators normalize as a result of weight loss in morbidly obese subjects treated with gastric restrictive surgery. J Clin Endocrinol Metab 2004;89:4062–8.CrossRefGoogle Scholar
  40. 40.
    Peyreigne C, Bouix D, Aissa Benhaddad A, et al. Hemorheologic effects of a short-term ketogenetic diet. Clin Hemorheol Microcirc 1999;21:147–53.PubMedGoogle Scholar
  41. 41.
    Svendsen OL, Hassager C, Christiansen C, et al. Plasminogen activator inhibitor-1, tissue-type plasminogen activator, and fibrinogen: Effect of dieting with or without exercise in overweight postmenopausal women. Arterioscler Thromb Vasc Biol 1996;16:381–5.CrossRefGoogle Scholar
  42. 42.
    Fanari P, Somazzi R, Nasrawi F, et al. Haemorheological changes in obese adolescents after short-term diet. Int J Obes Relat Metab Disord 1993;17:487–94.PubMedGoogle Scholar
  43. 43.
    Marckmann P, Toubro S, Astrup A. Sustained improvement in blood lipids, coagulation, and fibrinolysis after major weight loss in obese subjects. Eur J Clin Nutr 1998;52:329–33.CrossRefGoogle Scholar
  44. 44.
    Primrose JN, Davies JA, Prentice CR, et al. Reduction in factor VII, fibrinogen and plasminogen activator inhibitor-1 activity after surgical treatment of morbid obesity. Thromb Haemost 1992;68:396–9.CrossRefGoogle Scholar
  45. 45.
    Ditschuneit HH, Flechtner-Mors M, Adler G. Fibrinogen in obesity before and after weight reduction. Obes Res 1995;3:43–8.CrossRefGoogle Scholar
  46. 46.
    Olszanecka-Glinianowicz M, Zahorska-Markiewicz B, Kocelak P, et al. The effect of weight loss on inflammation in obese women with polycystic ovary syndrome. Endokrynol Pol 2008;59:13–7.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Eva Solá
    • 1
    • 2
  • Ana Jover
    • 1
  • Antonio López-Ruiz
    • 1
  • María Jarabo
    • 1
  • Amparo Vayá
    • 3
  • Carlos Morillas
    • 1
    • 2
  • Marcelino Gómez-Balaguer
    • 1
  • Antonio Hernández-Mijares
    • 1
    • 2
    Email author
  1. 1.Endocrinology ServiceDoctor Peset University HospitalValenciaSpain
  2. 2.Medicine Department, School of MedicineValencia UniversityValenciaSpain
  3. 3.Hemorheology and Thrombosis Unit, Department of Clinical PathologyLa Fe University HospitalValenciaSpain

Personalised recommendations