Obesity Surgery

, Volume 19, Issue 7, pp 915–920 | Cite as

Morbid Obesity and Inflammation: A Prospective Study After Adjustable Gastric Banding Surgery

  • Renata RamalhoEmail author
  • Cristina Guimarães
  • Cidália Gil
  • Celestino Neves
  • João Tiago Guimarães
  • Luís Delgado
Clinical Research



Inflammatory status underlying obesity seems to be implicated in several aspects of metabolic syndrome.


This study aimed to investigate the association between weight loss achieved by laparoscopic gastric banding (LAGB) surgery, chronic inflammatory markers, and nutritional state.


Thirty-two morbid obese females were enrolled in the study and evaluated at baseline, 1 and 18 months after LAGB surgery. Serum immunoglobulin G (IgG), IgA, IgM, C-reactive protein (CRP), haptoglobin, alpha-1 antitrypsin, total proteins, albumin, prealbumin, transferrin, ferritin, and transferrin soluble receptor were evaluated. In addition, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and fasting glucose were also evaluated.


In average, patients presented 18.7% and 63.2% excess body weight loss 1 and 18 months after LAGB, respectively (p < 0.01). CRP and total cholesterol mean levels were elevated (1.03 ± 1.11 mg dL−1 and 2.02 ± 0.41 g L−1) at the presurgery study. CRP mean levels were significantly reduced when compared to reference range (p < 0.01) 18 months after the LAGB surgery. Prealbumin as well as serum total protein mean levels decreased 1 month after surgery (p < 0.01) and values returned to normal at 18 months after surgery. Albumin mean levels showed an increase during the postsurgery evaluations. Serum IgA and IgM concentrations were significantly increased at 1 month after surgery compared to baseline (p < 0.01, both cases).


Our results indicate that amelioration of inflammatory markers after LAGB does not seem to negatively impact nutritional status following weight reduction surgery. However, careful attention should be driven to serum IgA. Adequacy of nutritional intake and complete serial laboratory measurements should be always included in the required life-long follow-up of patients surgically treated for morbid obesity.


Morbid obesity Laparoscopic adjustable gastric banding (LAGB) surgery C-reactive protein Acute-phase proteins Immunoglobulins 


Disclosure/conflict of interest



  1. 1.
    Darvall KA, Sam RC, Silverman SH, et al. Obesity and thrombosis. Eur J Vasc Endovasc Surg. 2007;33(2):223–33.CrossRefGoogle Scholar
  2. 2.
    Matsuzawa Y. The metabolic syndrome and adipocytokines. FEBS Lett. 2006;580(12):2917–21.CrossRefGoogle Scholar
  3. 3.
    Tilg H, Moschen AR. Inflammatory mechanisms in the regulation of insulin resistance. Mol Med. 2008;14(3–4):222–31.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Browning L, Krebs J, Edel M, et al. Circulating markers of inflammation and their link to indices of adiposity. Obesity Facts. 2008;1:259–65.CrossRefGoogle Scholar
  5. 5.
    Ferrante AW. Obesity-induced inflammation: a metabolic dialogue in the language of inflammation. J Int Med. 2007;262(4):408–14.CrossRefGoogle Scholar
  6. 6.
    Sbarbati A, Osculati F, Silvagni D, et al. Obesity and inflammation: evidence for an elementary lesion. Pediatrics. 2006;117:220–3.CrossRefGoogle Scholar
  7. 7.
    Hotamisligil G. Inflammation and metabolic disorders. Nature. 2006;444:860–7.CrossRefGoogle Scholar
  8. 8.
    Guzik TJ, Mangalat D, Korbut R. Adipocytokines—novel link between inflammation and vascular function? J Physiol Pharmacol. 2006;57(4):505–28.PubMedGoogle Scholar
  9. 9.
    Forsythe L, Wallace J, Livingstone MBE. Obesity and inflammation: the effects of weight loss. Nut Res Rev. 2008;21:117–33.CrossRefGoogle Scholar
  10. 10.
    Elder CA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132(6):2253–71.CrossRefGoogle Scholar
  11. 11.
    Kral JG, Näslund E. Surgical treatment of obesity. Nat Clin Pract Endocrinol Metab. 2007;3(8):574–83.CrossRefGoogle Scholar
  12. 12.
    Pontiroli AE, Pizzocri P, Librenti MC, et al. Laparoscopic adjustable gastric banding for the treatment of morbid (grade 3) obesity and its metabolic complications: a three-year study. J Clin Endocrinol Metab. 2002;87(8):3555–61.CrossRefGoogle Scholar
  13. 13.
    Farrell T, Haggerty S, Overby D, et al. Clinical application of laparoscopic banding surgery: an evidence-based review. Surg Endosc. 2009;23:930–49.CrossRefGoogle Scholar
  14. 14.
    Martin LF, Smits GJ, Greenstein RJ. Treating morbid obesity with laparoscopic adjustable gastric banding. Am J Surg. 2007;197:333–43.CrossRefGoogle Scholar
  15. 15.
    Ridker P, Hennekens C, Buring G, et al. C reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. NEJM. 2000;342(12):836–43.CrossRefGoogle Scholar
  16. 16.
    Shenkin A. Serum prealbumin: is it a marker of nutritional status or of risk of malnutrition? Clin Chem. 2006;52(12):2177–9.CrossRefGoogle Scholar
  17. 17.
    Quaye I. Haptoglobin, inflammation and disease. Trans R Soc Trop Med Hyg. 2008;102:735–42.CrossRefGoogle Scholar
  18. 18.
    Minang J, Gyan B, Anchang J, et al. Haptoglobin phenotypes and malaria infection in pregnant women at delivery in western Cameroon. Acta Trop. 2004;90:107–14.CrossRefGoogle Scholar
  19. 19.
    Atkinson SH, Mwangi TW, Uyoga SM, et al. The haptoglobin 2–2 genotype is associated with a reduced incidence of Plasmodium falciparum malaria in children on the coast of Kenya. Clin Infect Dis. 2007;44(6):802–9.CrossRefGoogle Scholar
  20. 20.
    Quaye IK, Ekuban FA, Goka BQ, et al. Haptoglobin 1-1 is associated with susceptibility to severe Plasmodium falciparum malaria. Trans R Soc Trop Med Hyg. 2000;94(2):216–9.CrossRefGoogle Scholar
  21. 21.
    Chiellini C, Santini F, Marsili A, et al. Serum haptoglobin: a novel marker of adiposity in humans. J Clin Endocrinol Metab. 2004;89(6):2678–83.CrossRefGoogle Scholar
  22. 22.
    Zulet MA, Puchau B, Nevarra C, et al. Inflammatory biomarkers: the link between obesity and associated pathologies. Nutr Hosp. 2007;22(5):511–27.PubMedGoogle Scholar
  23. 23.
    Gabay C, Kushner I. Acute phase proteins and other systemic responses to inflammation. NEJM. 1999;340(6):448–54.CrossRefGoogle Scholar
  24. 24.
    Love A, Billett H. Obesity, bariatric surgery and iron deficiency: true, true, true and related. Am J Hematol. 2008;83:403–9.CrossRefGoogle Scholar
  25. 25.
    Gonzalez-Quintela A, Alende R, Gude F, et al. Serum levels of immunoglobulins (IgG, IgA, IgM) in a general adult population and their relationship with alcohol consumption, smoking and common metabolic abnormalities. Clin Exp Immunol. 2008;151(1):42–50.CrossRefGoogle Scholar
  26. 26.
    Ramalho R, Guimarães C. The role of adipose tissue and macrophages in chronic inflammation associated with obesity: clinical implications. Acta Med Port. 2008;21:489–96.PubMedGoogle Scholar
  27. 27.
    Compher C, Badellino K. Obesity and inflammation: lessons from bariatric surgery. J Parenter Enter Nutr. 2008;23:645–7.CrossRefGoogle Scholar
  28. 28.
    Aroson D, Bartha P, Zinder O, et al. Obesity is the major determinant of elevated C-reactive protein in subjects with the metabolic syndrome. Int J Obes. 2004;28:674–9.CrossRefGoogle Scholar
  29. 29.
    Visser M, Bouter LM, McQuillan GM, et al. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282:2131–5.CrossRefGoogle Scholar
  30. 30.
    Chiellini C, Santini F, Marsili A, et al. Serum haptoglobin: a novel marker of adiposity in humans. J Clin Endocrinol Metab. 2004;89:2678–83.CrossRefGoogle Scholar
  31. 31.
    De Pergola G, Di Roma P, Paoli G, et al. J Endocrinol Invest. 2007;30(5):399–403.CrossRefGoogle Scholar
  32. 32.
    Hak AE, Stehouwer CDA, Bots ML, et al. Associations of C-reactive protein with measures of obesity, insulin resistance, and subclinical atherosclerosis in health, middle-aged women. Arterioscler Tromb Vasc Biol. 1999;19:1986–91.CrossRefGoogle Scholar
  33. 33.
    Mehta S, Farmer J. Obesity and Inflammation: a new look at an old problem. Curr Atheroscler Rep. 2007;9(2):134–8.CrossRefGoogle Scholar
  34. 34.
    Faintuch J, Horian L, Barbeiro H, et al. Systemic inflammation in morbidly obese subjects: response to oral supplementation with alpha linoleic acid. Obes Surg. 2007;17(3):341–7.CrossRefGoogle Scholar
  35. 35.
    Zengin K, Taskin M, Sakoglu N, et al. Systemic inflammatory response after laparoscopic and open application of adjustable banding for morbidly obese patients. Obes Surg. 2002;12(2):276–9.CrossRefGoogle Scholar
  36. 36.
    Hanusch-Enserer U, Cauza E, Spak M, et al. Acute-phase response and immunological markers in morbid obese patients and patients following adjustable gastric banding. Int J Obes Relat Metab Disord. 2003;27(3):355–61.CrossRefGoogle Scholar
  37. 37.
    Zagorski SM, Papa NN, Chung MH. The effect of weight loss after gastric bypass on C-reactive protein levels. Surg Obes Relat Dis. 2005;1(2):81–5.CrossRefGoogle Scholar
  38. 38.
    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(2):483–90.CrossRefGoogle Scholar
  39. 39.
    Shah M, Simba V, Garg A. Long-term impact of bariatric surgery on body weight, co-morbidities, and nutritional status: a review. J Clin Endocrinol Metab. 2006;91(11):4223–31.CrossRefGoogle Scholar
  40. 40.
    Elias-Smale SE, Kardys I, Oudkerk M, et al. C-reactive protein is related to extent and progression of coronary and extra-coronary atherosclerosis; results from the Rotterdam study. Atherosclerosis. 2007;195:e195–202. doi: 10.1016/jatherosclerosis.2007.07.006.CrossRefGoogle Scholar
  41. 41.
    Ferri C, Croce G, Cofini V, et al. C-reactive protein: interaction with vascular endothelium and possible role in human atherosclerosis. Curr Pharm Des. 2007;13(6):1631–45.CrossRefGoogle Scholar
  42. 42.
    Rorive M, De Flines J, Paquot N, et al. Recent advances in the management of obesity. Rev Med Liege. 2007;62(5–6):329–34.PubMedGoogle Scholar
  43. 43.
    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. 2002;26:659–62.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Renata Ramalho
    • 1
  • Cristina Guimarães
    • 1
  • Cidália Gil
    • 2
  • Celestino Neves
    • 3
    • 4
  • João Tiago Guimarães
    • 5
    • 6
  • Luís Delgado
    • 1
  1. 1.Immunology, Faculty of MedicineUniversity of PortoPortoPortugal
  2. 2.SurgeryHospital S. João E.P.E.PortoPortugal
  3. 3.EndocrinologyHospital S. João E.P.E.PortoPortugal
  4. 4.Faculty of MedicineUniversity of PortoPortoPortugal
  5. 5.Biochemistry, Faculty of MedicineUniversity of Porto and Clinical PathologyPortoPortugal
  6. 6.Clinical PathologyHospital S. João E.P.E.PortoPortugal

Personalised recommendations