title: Factors Related with Adiponectinemia in Obese and Normal-Weight Women and with Its Variation in Weight Loss Programs Dynamics of circulating microparticles in obesity after weight loss Pentraxin 3 and Platelet Activation in Obese Patients After Gastric Banding. A Prospective Study of Dietary Patterns and Mortality in Chinese Women Inhibition of C-Reactive Protein in Morbidly Obese Patients After Laparoscopic Sleeve Gastrectomy Serum C-Reactive Protein and White Blood Cell Count in Morbidly Obese Surgical Patients Reduction in Inflammatory Gene Expression in Skeletal Muscle from Roux-en-Y Gastric Bypass Patients Randomized to Omentectomy Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. Early effects of gastric bypass on endothelial function, inflammation, and cardiovascular risk in obese patients C-Reactive Protein Decrease After Postbariatric Abdominoplasty Gender effect on vascular inflammation following bariatric surgery. Early Regression of Carotid Intima-Media Thickness after Bariatric Surgery and Its Relation to Serum Leptin Reduction Incidence and Predictors of Hypoglycemia 1 Year After Laparoscopic Sleeve Gastrectomy Decreased Levels of Circulating Cancer-Associated Protein Biomarkers Following Bariatric Surgery Decreased serum hepcidin and improved functional iron status 6 months after restrictive bariatric surgery. Lifestyle changes followed by bariatric surgery lower inflammatory markers and the cardiovascular risk factors C3 and C4. A Prospective Randomized Study Comparing Patients with Morbid Obesity Submitted to Sleeve Gastrectomy With or Without Omentectomy Enhanced fasting and post-prandial plasma bile acid responses after Roux-en-Y gastric bypass surgery Effect of bariatric surgery on airway response and lung function in obese subjects with asthma. Independent association between inflammatory markers (C-reactive protein, interleukin-6, and TNF-α) and essential hypertension Endothelial Function in Hypertensive Obese Patients: 1 year After Surgically Induced Weight Loss Periodontal status and pathogenic bacteria after gastric bypass: a cohort study. Omentectomy added to Roux-en-Y gastric bypass surgery: a randomized, controlled trial. Visceral Adipose Tissue Loss and Insulin Resistance 6 Months after Laparoscopic Gastric Banding Surgery: A Preliminary Study Renal cytokines improve early after bariatric surgery Change in Levels of C-Reactive Protein (CRP) and Serum Cortisol in Morbidly Obese Patients After Laparoscopic Sleeve Gastrectomy Increase of Osteopontin Plasma Concentrations After Bariatric Surgery Independent from Inflammation and Insulin Resistance Changes in inflammatory markers after sleeve gastrectomy in patients with impaired glucose homeostasis and type 2 diabetes. Impact of Laparoscopic Sleeve Gastrectomy on Iron Indices: 1 Year Follow-Up Evaluation of the biochemical, inflammatory and oxidative profile of obese patients given clinical treatment and bariatric surgery. Sleep Apnea Determines Soluble TNF-α Receptor 2 Response to Massive Weight Loss Leptin as an Acute Phase Reactant after Non-Adjustable Laparoscopic Gastric Banding Determinants associated with the correction of glomerular hyper-filtration one year after bariatric surgery. Roux-en-Y Bypass Gastroplasty: Markers of Oxidative Stress 6 Months After Surgery Micronutrient intake, from diet and supplements, and association with status markers in pre- and post-RYGB patients. Weight loss induced by very low calorie diet is associated with a more beneficial systemic inflammatory profile than by Roux-en-Y gastric bypass. Roux-en-Y gastric bypass and calorie restriction induce comparable time-dependent effects on thyroid hormone function tests in obese female subjects. Impact of Roux-en-Y gastric bypass on lipid and inflammatory profiles. Bariatric Surgery can Reduce Albuminuria in Patients with Severe Obesity and Normal Kidney Function by Reducing Systemic Inflammation
abstract: Objective : To assess different factors influencing adiponectinemia in obese and normal-weight women ; to identify factors associated with the variation ( Δ ) in adiponectinemia in obese women following a 6-month weight loss program  , according to surgical/non-surgical interventions . Methods : We studied 100 normal-weight women and 112 obese premenopausal women ; none of them was on any medical treatment . Women were characterized for anthropometrics , daily macronutrient intake , smoking status , contraceptives use , adiponectin as well as IL-6 and TNF-α serum concentrations . Results : Adiponectinemia was lower in obese women ( p < 0.001 ) , revealing an inverse association with waist-to-hip ratio ( p < 0.001 ; r = -0.335 ) . Normal-weight women presented lower adiponectinemia among smokers ( p = 0.041 ) ; body fat , waist-to-hip ratio , TNF-α levels , carbohydrate intake , and smoking all influence adiponectinemia ( r2 = 0.436 ) . After weight loss interventions , a significant modification in macronutrient intake occurs followed by anthropometrics decrease ( chiefly after bariatric procedures ) and adiponectinemia increase ( similar after surgical and non-surgical interventions ) . After bariatric intervention , Δ adiponectinemia was inversely correlated to Δ waist circumference and Δ carbohydrate intake ( r2 = 0.706 ) . Conclusion : Anthropometrics , diet , smoking , and TNF-α levels all influence adiponectinemia in normal-weight women , although explaining less than 50 % of it . In obese women , anthropometrics modestly explain adiponectinemia . Opposite to non-surgical interventions , after bariatric  surgery adiponectinemia increase is largely explained by diet composition and anthropometric changes Abstract A definitive relationship between adiposity and MP production is yet to be demonstrated . The aim of our study was to prospect ively evaluate the levels of microparticles ( MP ) in a group of 20 III degree obese patients before and after weight loss .  Plasma levels of annexin V-MP , endothelial-derived MP , platelet-derived MP ( CD61 + and P-Selectin+ ) , leukocyte-derived MP , tissue factor-bearing ( TF+ ) and CD36+MP  were prospect ively measured in 20 patients with III degree obesity ( BMI ≥ 40 kg/m2 ) before ( T0 ) and 3 ( T3 ) and 12 ( T12 ) months after sleeve gastrectomy ( SLG ) . Obese patients had lost 18 % of their body weight at T3 and 41 % at T12 . We find that considering all MP , except for endothelial-derived MP , which had significantly decreased at T3 , all MP subtypes had significantly decreased at T12 . At T12 , subjects showed a higher median level of all types of MP , except endothelial-derived MP , compared to T3 , but without a statistically significant difference . The percentages of reduction of all the MP were significantly correlated with the percentage of reduction of BMI . The reductions of leukocyte-derived , TF+ and CD36+MP were significantly correlated with the reduction of leptin . Moreover , the reductions of leukocyte-derived and CD36+MP were significantly correlated with hs-CRP decrease . The decrease of BMI post-SLG in morbid obesity was matched with a decrease of circulating MP of endothelial , platelet , leukocyte origin , TF+ and CD36 + . A trend of slight increase in all MP subtypes , except endothelial-derived , was detected 12 months after gastrectomy , indicating a possible underlying slow low- grade inflammatory/hypercoagulability state from adipose tissue before the potential overt weight gain BACKGROUND Circulating pentraxin 3 ( PTX3 ) , the main regulator of the inflammatory response , rapidly increases following cardiovascular events , and low PTX3 is associated with high body mass index . METHODS AND RESULTS We conducted a 12-month longitudinal study , to test the hypothesis that laparoscopic adjustable gastric b and ing (LAGB)-induced weight loss was associated with changes in platelet activation markers and PTX3 . Twelve obese patients , scheduled to undergo LAGB , were enrolled at the University Obesity Center . Urinary 11-dehydro-thromboxane (Tx)B2excretion rate was measured on radioimmunoassay , and PTX3 and CD40L were determined on immunoassay .  Plasma PTX3  increased by 178.8 and 214.9 % ( P<0.0001 ) , respectively , 6 and 12 months after LAGB . High-sensitivity CRP decreased by 24 and 29.7 % ( P<0.0001 ) , whereas CD40L decreased by 64.3 and 58.6 % ( P=0.002 ) , respectively . Urinary 11-dehydro-TxB2decreased from 1,443 to 715 and 564 pg/mg creatinine , respectively 6 months and 12 months after LAGB ( P<0.0001 ) . PTX3 was inversely related to platelet activation markers , 11-dehydro-TxB2 and CD40L . Moreover , multiple regression analysis on pooled data showed that plasma PTX3 was an independent predictor of urinary 11-dehydro-TxB2 . CONCLUSIONS There is an association between inflammation , platelet activation and metabolic dysfunction in obesity , and PTX3 is a key player within these circuits Background : Many foods and nutrients have been suggested to influence life expectancy . However , previous studies have not examined the relationship between dietary patterns and cause-specific mortality . Our study prospect ively examines the relationship of dietary patterns with total mortality and cause-specific mortality in a population -based cohort study of Chinese women . Methods : The Shanghai Women 's Health Study is a population -based cohort study of 74,942 women age 40 to 70 years at the time of recruitment ( September 1996 to May 2000 ) . Detailed dietary information was collected using a vali date d , quantitative food frequency question naire . The cohort has been followed using a combination of in-person interviews and record linkage with various registries . Dietary patterns , derived from principal component analysis , were examined for their relation to total mortality and cause-specific mortality using Cox regression models . Results : After an average of 5.7 years of follow-up ( 423,717 person-years of observation ) , there were 1565 deaths . We derived 3 major dietary patterns ( vegetable-rich , fruit-rich , and meat-rich ) . The adjusted hazard ratios for the fruit-rich diet were 0.94 ( 95 % CI = 0.89–0.98 ) for all causes of death and 0.89 ( 0.81–0.99 ) , 0.79 ( 0.69–0.91 ) , and 0.51 ( 0.39–0.65 ) for death caused by cardiovascular disease , stroke , and diabetes , respectively . The meat-rich diet was associated with increased risk of diabetes ( HR = 1.18 ; 95 % CI = 0.98–1.42 ) and a slightly elevated risk of total mortality . Conclusion : In general , a fruit-rich diet was related to lower mortality , whereas a meat-rich diet appeared to increase the probability of death Background Obesity is considered a low- grade chronic inflammatory condition as reflected by increased C-reactive protein ( CRP ) levels . Inflammation is emerging as a predictor of cardiovascular disease and it may be a precursor of the metabolic syndrome . Bariatric surgery is commonly performed as a treatment for morbid obesity offering significant reductions in premature myocardial infa rct ion . Laparoscopic sleeve gastrectomy ( LSG ) is a relatively new bariatric procedure that is currently used as a definitive procedure for weight loss . The aim of this study is to assess the impact of sleeve gastrectomy on CRP levels . Methods This study is part of an ongoing , prospect i ve , cohort study to evaluate LSG impact on iron indices . CRP levels were compared preoperatively and 6 months after surgery . Similarly , demographics including body mass index and excess weight were also compared at these same study points . Data were analyzed using Student paired t test and Pearson product moment correlation analysis . Results Twenty-nine morbidly obese patients were included . There was significant decrease in body mass index ( BMI ) between the preoperative and 6-month period ( 50.9 ± 13.2 and 35.1 ± 6.85 , respectively ; P < 0.001 ) . Also CRP levels were statistically significantly lower at 6 months after surgery ( preoperative 12.3 ± 7.53 mg/L and postoperative 5.6 ± 4.2 mg/L. P < 0.0001 ) . The significant weight loss as reflected by change in BMI was correlated with the difference between preoperative and postoperative CRP levels . Conclusions Massive weight loss in morbidly obese patients induced by LSG causes a significant decrease in CRP levels , which could reduce the risk of cardiovascular diseases in these patients Background Obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators including C-reactive protein ( CRP ) and white blood cell count ( WBC ) . Recent studies have shown elevated CRP or WBC is a significant risk factor for cardiac events and stroke but the clinical significance of CRP and WBC has not been clearly studied in morbidly obese patients . This study is aim ed at the clinical significance of WBC and CRP in morbidly obese patients and the change after bariatric surgery . Methods The study was a prospect ively controlled clinical study . From December 1 , 2001 to January 31 , 2006 , of 640 ( 442 females and 198 males ) consecutive morbid obese patients enrolled in a surgically supervised weight loss program with at least 1 year ’s follow-up were examined . Results Of the patients , 476 ( 74.4 % ) had elevated CRP and 100 ( 15.6 % ) had elevated WBC at preoperative study .  CRP and WBC were significantly related and both increased with increasing body mass index ( BMI ) . CRP is also increased with increasing waist , glucose level , hemoglobin , albumin , Ca , insulin , C-peptide , and metabolic syndrome while WBC is increased with metabolic syndrome but decreased with increasing age . Multivariate analysis confirmed fasting glucose level and hemoglobin are independent predictors of the elevation of CRP while age is the only independent predictor for elevated WBC . Both WBC and CRP levels decreased rapidly after obesity surgery . These improvements result ed in a 69.8 % reduction of CRP and 26.4 % reduction of WBC 1 year after surgery . Although individuals who underwent laparoscopic gastric bypass lost significantly more weight ( 36.8 ± 11.7 kg vs. 17.3 ± 10.8 kg ; p = 0.000 ) and achieved a lower BMI ( 27.8 ± 4.6 vs. 35.0 ± 5.5 ; p = 0.000 ) than individuals who underwent laparoscopic gastric b and ing , there was no difference in the resolution of elevated CRP 1 year after surgery ( 95.9 % vs. 84.5 % ; p = 0.169 ) and WBC ( 99.4 % vs. 98.3 % ; p = 0.323 ) . Conclusions Both baseline WBC and CRP are elevated in morbid obese patients but CRP has a better clinical significance . Significant weight reduction 1 year after surgery markedly reduced CRP and WBC with a resolution rate of 93.9 % and 98.2 % separately . Obesity surgery performed by laparoscopic surgery is recommended for obese patients with elevated CRP or WBC Objectives To examine the effects of  Roux-en-Y gastric bypass ( RYGB ) surgery with and without laparoscopic removal of omental fat ( omentectomy )  on the temporal gene expression profiles of skeletal muscle . Design Previously reported were the whole-body metabolic effects of a r and omized , single-blinded study in patients receiving RYGB surgery stratified to receive or not receive omentectomy .  In this follow up study we report on changes in skeletal muscle gene expression in a subset of 21 patients , for whom biopsies were collected preoperatively and at either 6 months or 12 months postoperatively . Methodology /Principal Findings RNA isolated from skeletal muscle biopsies of 21 subjects ( 8 without omentectomy and 13 with omentectomy )  taken before RYGB or at 6 and 12 months postoperatively were subjected to gene expression profiling via Exon 1.0 S/T Array and Taqman Low Density Array . Robust Multichip Analysis and gene enrichment data analysis revealed 84 genes with at least a 4-fold expression difference after surgery . At 6 and 12 months the RYGB with omentectomy group displayed a greater reduction in the expression of genes associated with skeletal muscle inflammation ( ANKRD1 , CDR1 , CH25H , CXCL2 , CX3CR1 , IL8 , LBP , NFIL3 , SELE , SOCS3 , TNFAIP3 , and ZFP36 ) relative to the RYGB non-omentectomy group . Expressions of IL6 and CCL2 were decreased at all postoperative time points . There was differential expression of genes driving protein turnover ( IGFN1 , FBXW10 ) in both groups over time and increased expression of PAAF1 in the non-omentectomy group at 12 months . Evidence for the activation of skeletal muscle satellite cells was inferred from the up-regulation of HOXC10 . The elevated post-operative expression of 22 small nucleolar RNAs and the decreased expression of the transcription factors JUNB , FOS , FOSB , ATF3 MYC , EGR1 as well as the orphan nuclear receptors NR4A1 , NR4A2 , NR4A3 suggest dramatic reorganizations at both the cellular and genetic levels . Conclusions / Significance These data indicate that RYGB reduces skeletal muscle inflammation , and removal of omental fat further amplifies this response . Trial Registration Clinical Trials.gov The aim of this study was to investigate the potential role of adipose cytokines in the obesity-associated insulin resistance . To that end , we compared : 1 ) serum concentrations of interleukin 6 ( IL-6 ) , tumor necrosis factor alpha ( TNFalpha ) , and leptin in eight healthy lean control females and in and roid obese female without ( n = 14 ) and with ( n = 7 ) type 2 diabetes ; and 2 ) the levels of these cytokines both in serum and in sc adipose tissue in the 14 obese nondiabetic women before and after 3 weeks of a very low-calorie diet ( VLCD ) .  As compared with lean controls , obese nondiabetic and diabetic patients were more insulin resistant and presented increased values for leptin , IL-6 , TNFalpha , and C-reactive protein . In the whole group , IL-6 values were more closely related to the parameters evaluating insulin resistance than leptin or TNFalpha values .  VLCD result ed in weight loss and decreased body fat mass ( approximately 3 kg ) . Insulin sensitivity was improved with no significant change in both serum and adipose tissue TNFalpha levels . In contrast , VLCD induced significant decreases in IL-6 and leptin levels in both adipose tissue and serum . These results suggest that , as for leptin , circulating IL-6 concentrations reflect , at least in part , adipose tissue production . The reduced production and serum concentrations after weight loss could play a role in the improved sensitivity to insulin observed in these patients Background Obesity is associated with a chronic low- grade inflammatory state , insulin resistance , and endothelial dysfunction , all of which contribute to increased risk of cardiovascular disease . We hypothesized that gastric bypass would produce rapid improvements in endothelial function , reduce inflammation , and lead to a decrease in cardiovascular risk . Methods We performed a prospect i ve study of morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass ( RYGB ) .  Clinical data , biochemical markers of inflammation , and parameters indicative of cardiovascular risk were collected preoperatively and at 3 and 6 months postoperatively . Metabolic and inflammatory mediators that were quantified included C-reactive protein , fibrinogen , PAI-1 , IL-6 , IL-10 , IL-1Ra , adiponectin , leptin , triglycerides , total cholesterol , HDL , LDL , glucose , insulin , and HbA1c . Brachial artery reactivity testing ( BART ) was performed to assess peripheral arterial endothelial function , and Framingham cardiovascular risk score ( FRS ) was calculated on all study participants pre- and postoperatively . Results Fifteen patients ( 11 female ) were enrolled ( age = 49.2 ± 10.4 years ; BMI = 48.1 ± 5.3 kg/m2 ) . Six months post RYGB , mean BMI decreased to 35.4 ± 4.5 , corresponding to 51.7 % excess weight loss ( P < 0.001 ) . Mean waist circumference decreased significantly from 132 cm at baseline to 110 cm at 3 months ( P = 0.003 ) and 107 cm at 6 months ( P < 0.001 ) . Six months after RYGB , weight loss led to significant improvements in clinical parameters indicative of cardiovascular disease or risk , including brachial artery diameter , endothelial independent vasodilation , and FRS . Favorable improvements in the proinflammatory markers CRP ( P = 0.01 ) and leptin ( P = 0.005 ) , the anti-inflammatory mediator adiponectin ( P = 0.002 ) , and insulin sensitivity ( HOMA-IR , P = 0.007 ) were evident at 3 months . At 6 months , improvements in CRP , leptin , and fasting insulin were maintained and fibrinogen levels also decreased ( P = 0.047 ) . Adiponectin continued to increase at 6 months ( P = 0.004 ) . Conclusion Gastric bypass is associated with early reversal of endothelial dysfunction , a more favorable inflammatory milieu , and , most importantly , a reduction in cardiovascular risk In a prospect i ve study , indices of glucose homeostasis , lipid profile , and systemic inflammation were monitored after an  aesthetic abdominoplasty  , aim ing to scrutinize the possible metabolic benefits for abdominal fat removal . Premenopausal females with substantial weight loss ( N = 40 ) undergoing circumferential abdominoplasty ( index group , n = 20 ) or augmentation mammoplasty with mastopexy ( controls , n = 20 ) were recruited . All of them originally underwent Roux-en-Y gastric bypass .  Variables included BMI , white blood cell count , C-reactive protein , hemoglobin , total cholesterol and fractions , triglycerides , glucose , and HbA1c . Follow-up reached 20.3 ± 13.6 months for index cases and 29.5 ± 17.4 months for controls . The metabolic and inflammatory indices improved after the bariatric surgery . Subsequent monitoring indicated a stable body weight and biochemical profile in both groups . The exceptions were HDL cholesterol and C-reactive protein , which respectively increased and diminished after the abdominoplasty , consistent with an inflammatory and metabolic advantage for this operation . This is the first long-term study in a weight-stable population to point out such a pattern after abdominoplasty Studies have shown that mortality was reduced by 31.6 % in patients that underwent bariatric surgery  compared with the non-operative control group . However , in most surgical series the majority of patients were women , and men had higher post-operative mortality rates and a higher postoperative morbidity , regardless of weight . Our primary end point was to study gender effects on vascular inflammation following bariatric surgery for weight loss . Methods . A prospect i ve study evaluated vascular inflammation in obese patients before and three months after bariatric surgery .  Markers of vascular inflammation were measured - before surgery and three months afterwards . Results . One hundred and two patients ( 73 women and 29 men , 40.5 ± 12.3 years old ) underwent bariatric surgery .  Correlation was found between BMI change and waist circumference change ( r = 0.658 , P<0.001 ) . Three months post-surgery , BMI was significantly decreased ( p<0.001 ) ( a decrease of 8.82 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 17.33 cm ) . ICAM-1 levels and hs-CRP levels were decreased ( both P = 0.0001 ) . Gender differences seem to be borderline significant with respect to the prevalence of type II diabetes mellitus ( men > women ; P = 0.05 ) and hypertension ( men > women ; P = 0.06 ) . In women , following bariatric surgery  , BMI was decreased ( p<0.001 ) ( a decrease of 9.25 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 18.8 cm ) . ICAM-1 levels were decreased ( p = 0.002 ) and hs-CRP levels were also decreased ( P = 0.0001 ) . In men , following bariatric surgery  , BMI was decreased ( p = 0.001 ) ( a decrease of 8.1 ) , waist circumference was reduced ( p<0.005 ) ( a decrease of 14.6 cm ) ; however , although ICAM-1 levels and hs-CRP levels were decreased the decreases were non-significant ( both P = 0.09 ) . Discussion . Our study examined gender effects of bariatric surgery  on vascular inflammation  . Bariatric surgery had no significant effect on biochemical inflammatory markers in male patients , while females undergoing the same kind of bariatric surgery for weight loss showed a significant decrease in these markers of inflammation . These results may explain the epidemiological data that described higher morbidity and mortality among obese men undergoing  bariatric operation for  weight loss .  This is the first study that has demonstrated a gender difference in the inflammatory responses that may affect clinical outcome , and cardiovascular morbidity and mortality Purpose Bariatric surgery ( BS ) promotes carotid intima-media thickness ( C-IMT ) regression as early as 6 months post-surgery . To verify whether C-IMT regression occurs even earlier , we aim ed at the effect of Roux-en-Y gastric bypass ( RYGBP ) and biliopancreatic diversion ( BPD ) on C-IMT 1–2 months and 12 months post-surgery . Subjects/ Methods Prospect i ve trial . BS was performed on 109 patients either with ( RYGBP = 42 ; BDP = 40 ) or without type 2 diabetes ( RYGBP = 27 ) . Healthy volunteers served as control group . Follow-up : baseline , 1–2 months , 12 months post-surgery . Endpoints : changes ( ∆ ) in C-IMT , weight , body mass index , fat mass , waist and neck circumferences , blood pressure , HbA1c , glucose , insulin , insulin sensitivity [ HOMA-IR ; OGIS , from meal tolerance test ] , lipids , C-reactive protein , leptin , adiponectin , MCP-1 . Results All surgery subgroups had similar levels of ∆-C-IMT . C-IMT in the pooled surgery group reduced from [ mean ( 95 % confidence interval ) ] 0.81 ( 0.77–0.84 ) mm to 0.66 ( 0.63–0.69 ) mm , p < 0.001 [ −17.1 ( −20.4 to −13.8)% ] at 1–2 months , and to 0.63 ( 0.59–0.66 ) mm , p < 0.001 [ −21.8 ( −25.3 to −18.4)% ] at 12 months post-surgery . ∆-C-IMT 1–2 months and 12 months post-surgery correlated to baseline C-IMT , and with ∆-leptin at 1–2 months , but not at 12 months post-surgery . In linear regression analysis , ∆-leptin and baseline C-IMT were predictors of ∆-C-IMT 1–2 months post-surgery . Conclusions A remarkable C-IMT regression occurred as early as 1–2 months after BS in obese patients either with or without type 2 diabetes , which was associated to the early reduction in leptin , ( at least partially ) independent of weight loss . Whether this is a causative or correlative association needs further investigation Introduction Hypoglycemia is a known adverse event following gastric bypass . The incidence of hypoglycemia after  laparoscopic sleeve gastrectomy ( LSG )  is still under investigation . The aim of our study was to verify the presence of oral glucose tolerance test (OGTT)-related hypoglycemia after LSG and to identify any baseline predictors of its occurrence . Methods We analyzed 197 consecutive non-diabetic morbid obese patients that underwent LSG .  All patients were studied before and 12 months after LSG . Evaluation included anthropometric parameters , 3-h OGTT for blood glucose ( BG ) , insulin and c-peptide , lipid profile , interleukin-6 ( IL-6 ) , tumor necrosis factor alpha ( TNF-α ) , highly sensitive C-reactive protein ( hsCRP ) , and leptin . Hypoglycemia was defined as BG ≤ 2.7 mmol/l . Results After surgery , 180 patients completed the OGTT . Eleven patients did not complete the test for gastric intolerance , and in six patients , the test was stopped earlier for the onset of severe symptomatic hypoglycemia . Of the patients , 61/186 ( 32.8 % ) had at least one OGTT-related hypoglycemia . The highest frequency of hypoglycemic events occurred 150′ after glucose load ( 20.2 % ) . At baseline , patients with hypoglycemic events after surgery ( Hypo ) were younger ( 40 ± 11 vs 46 ± 10 years ; p < 0.001 ) , less obese ( BMI 46 ± 5.7 vs 48.4 ± 7.9 kg/m2 ; p < 0.05 ) , and had a worse lipid profile as compared to patients without hypoglycemic events ( N-Hypo ) . Moreover , after LSG , Hypo patients compared with N-Hypo presented a higher weight loss ( % E BMI L 80 ± 20 vs 62 ± 21 % ; p < 0.001 ) . Low age , low fasting glucose , and high triglyceride levels before LSG were independent predictors of hypoglycemia development after surgery ( r2 = 0.131 ) . Conclusion These findings confirm the high incidence of post-pr and ial hypoglycemia 1 year after LSG . Hypoglycemia is more frequent in younger patients with lower fasting glucose and higher triglyceride levels before surgery Background Epidemiological studies have identified obesity as a major risk factor for cancer in humans , and trials have demonstrated a significant reduction in the incidence of cancer after bariatric surgery . The rapidity of weight loss after bariatric surgery provides an opportunity to identify the molecular changes associated with effective obesity treatment . Indirectly , this may provide some insights into the mechanisms that drive the association between obesity and cancer . We sought to measure circulating cancer-associated proteins before and after laparoscopic sleeve gastrectomy ( LSG ) . Methods We prospect ively enrolled 15 patients undergoing LSG .  Thirty-four plasma protein biomarkers thought to be associated with cancer processes were analyzed at baseline and following successful weight loss at 12 weeks using a multiplex bead-based assay .  Results Mean excess body weight loss was 44 % at 12-week follow-up . After LSG , a significant reduction in circulating plasma levels was observed for half ( 17/34 ) of the proteins assessed : VEGF-A , VEGF-C , VEGF-D , endoglin , PLGF , sFASL , IGFBP-1 , IL-18 , prolactin , EGF , TGFα , sCD40L , IL-18 , TNFα , IL-6 , HB-EGF , and PAI-1 . Nonsignificant decreases were found for the remaining proteins . Conclusions Circulating cancer-related biomarker levels were reduced by surgical weight loss , and this benefit was achieved as early as 3 months after operation . The observed reduction in cancer biomarkers may be related to the reported decrease in cancer incidence following bariatric surgery Excess adiposity is associated with low- grade inflammation and decreased iron status . Iron depletion in obesity is thought to be mediated by an inflammation-induced increase in the body 's main regulator of iron homeostasis , hepcidin . Elevated hepcidin can result in iron depletion as it prevents the release of dietary iron absorbed into the enterocytes , limiting replenishment of body iron losses . Weight reduction is associated with decreased inflammation ; however , the impact of reduced inflammation on iron status and systemic hepcidin in obese individuals remains unknown . We determined prospect ively the impact of weight loss on iron status parameters , serum hepcidin , inflammation , and dietary iron  in 20 obese premenopausal females 6 months after restrictive bariatric surgery .  At baseline , the presence of iron depletion was high with 45 % of the women having serum transferrin receptor ( sTfR ) > 28.1 nmol/l . Differences between baseline and 6 months after surgery for BMI ( 47.56 vs. 39.55 kg/m(2 ) ; P < 0.0001 ) , C-reactive protein ( CRP ) ( 10.83 vs. 5.71 mg/l ; P < 0.0001 ) , sTfR ( 29.97 vs. 23.08 nmol/l ; P = 0.001 ) , and serum hepcidin ( 111.25 vs. 31.35 ng/ml ; P < 0.0001 ) were significantly lower , whereas hemoglobin ( Hb ) ( 12.10 vs. 13.30 g/dl ; P < 0.0001 ) and hematocrit ( Hct ) ( 36.58 vs. 38.78 % ; P = 0.001 ) were significantly higher . Ferritin and transferrin saturation ( Tsat ) showed minimal improvement at follow-up . At baseline , hepcidin was not correlated with sTfR ( r = 0.02 ) ; however , at follow-up , significant correlations were found ( r = -0.58 ) . Change in interleukin-6 ( IL-6 ) from baseline was marginally associated with decreased log serum hepcidin ( Δ IL-6 : β = -0.22 ; P = 0.15 ) , whereas change in BMI or weight was not . No significant difference in dietary iron was noted after surgery . Weight loss in obese premenopausal women is associated with reduced serum hepcidin and inflammation . Reduction in inflammation and hepcidin likely allow for enhanced dietary iron absorption result ing in an improved functional iron profile BACKGROUND Morbidly obese patients are at risk of developing insulin resistance and cardiovascular disease . Low- grade systemic inflammation is an important factor for this development . We evaluated the effect of bariatric surgery on markers of inflammation , coagulation and glucose metabolism . METHODS Ninety-seven morbidly obese patients and 17 lean subjects ( control group ) participated .  Anthropometric measurements  as well as  fasting blood sample s  were obtained at first admission , prior to surgery , and 1 year after surgery . RESULTS At admission , the morbidly obese group had significantly elevated levels of the complement components C3 and C4 compared to the lean control group ( P<0.0001 ) . Levels of C3 and C4 dropped significantly in the morbidly obese group over time ( P<0.0001 ) , and , 1 year after the operation , levels were comparable to those of the control group . The same changes were seen for markers of inflammation ( high-sensitivity C-reactive protein , tumor necrosis factor-α , interferon-γ , interleukin-1 receptor antagonist , IL-6 , and IL-13 ) , coagulation ( fibrinogen and plasminogen activator inhibitor-1 ) , and glucose metabolism ( leptin and insulin ) . There was a positive correlation between changes in C3 and body mass index , weight , coagulation parameters , inflammatory parameters , and leptin , respectively . CONCLUSIONS Bariatric surgery in morbidly obese patients  reduced weight effectively . Even more importantly , the increased levels of several risk factors associated with diabetes and cardiovascular co-morbidity normalized 1 year after surgery Background Increased visceral adipose tissue is a risk factor for the metabolic complications associated with obesity and promotes a low- grade chronic inflammatory process . Resection of the great omentum in patients su bmi tted to a bariatric procedure has been proposed for the amelioration of metabolic alterations and the maximization of weight loss . The aim of the present study was to investigate the impact of omentectomy performed in patients with morbid obesity undergoing sleeve gastrectomy ( SG ) on metabolic profile , adipokine secretion , inflammatory status , and weight loss . Methods Thirty-one obese patients were r and omized into two groups : SG alone or with omentectomy . Adiponectin , omentin , interleukin-6 ( IL-6 ) , tumor necrosis factor-α ( TNF-α ) , high-sensitivity C-reactive protein ( hs-CRP ) , blood lipids , fasting glucose , insulin , and insulin resistance were measured before surgery and at 7 days , and 1 , 3 and 12 months after surgery . Results During the 1-year follow-up , body mass index ( BMI ) decreased markedly and comparably in both groups ( p < 0.001 ) . Insulin , IL-6 , and hs-CRP levels decreased significantly compared to baseline ( p < 0.05 ) in both groups with no significant difference between groups . Adiponectin and high-density lipoprotein cholesterol levels were significantly and similarly increased compared to baseline ( p < 0.001 ) in both groups . Omentin levels increased significantly ( p < 0.05 ) in the control group and decreased in the omentectomy group 1 year postoperatively . There was no significant change in TNF-α levels in either group . Conclusions The theoretical advantages of omentectomy in regard to weight loss and obesity-related abnormalities are not confirmed in this prospect i ve study . Furthermore , omentectomy does not induce important changes in the inflammatory status in patients undergoing SG Abstract Objective . Exogenous bile acid ( BA ) administration is associated with beneficial metabolic effects very similar to those seen after Roux-en-Y gastric bypass ( RYGB ) surgery . Re-routing of bile into a biliopancreatic limb with simultaneous exclusion of food occurs after RYGB , with subsequent increased fasting plasma BAs . The study assessed fasting and post-pr and ial plasma BA response before and 15 months after RYGB . Material and methods . The prospect i ve study recruited 63 obese individuals ( 43 females ) , aged 43 ( 36–56 ) [ median ( IQR ) ] years .  Blood sample s were collected before and every 30 min for 120 min after a st and ard 400 kcal meal .  Fasting and post-pr and ial plasma BAs , glucagons like peptide-1 ( GLP-1 ) , –tyrosine ( PYY ) , fasting C-reactive protein ( CRP ) , glucose and insulin were measured and homeostasis model assessment -insulin resistance ( HOMA-IR ) was calculated . Results . Following RYGB , body mass index , CRP , fasting glucose and HOMA-IR decreased ; 43.7 ( 39.3–49.2 ) kg/m2 to 29.2 ( 25.1–35.0 ) kg/m2 , 7.9 ( 4.1–11.9 ) mg/L to 0.4 ( 0.2–1.0 ) mg/L , 5.5 ( 5.0–6.0 ) mmol/L to 4.6 ( 4.3–4.9 ) mmol/L and 5.9 ( 3.5–9.2 ) to 1.7 ( 1.1–2.2 ) , respectively , all P < 0.001 . Fasting total BAs , GLP-1 and PYY increased after RYGB ; 1.69 ( 0.70–2.56 ) µmol/L to 2.43 ( 1.23–3.82 ) µmol/L ( P = 0.02 ) , 6.8 ( 1.5–15.3 ) pmol/L to 17.1 ( 12.6–23.9 ) pmol/L ( P < 0.001 ) and 4.0 ( 1.0–7.1 ) pmol/L to 15.2 ( 10.0–28.3 ) pmol/L ( P < 0.001 ) , respectively . The area under the curve for post-pr and ial total BAs , total glycine-conjugated BAs , GLP-1 and PYY were greater after RYGB ; 486 ( 312–732 ) µmol/L/min versus 1012 ( 684–1921 ) µmol/L/min , 315 ( 221–466 ) µmol/L/min versus 686 ( 424–877 ) µmol/L/min , 3679 ( 3162–4537 ) pmol/L/min versus 5347 ( 4727–5781 ) pmol/L/min and 1887 ( 1423–2092 ) pmol/L/min versus 3296 ( 2534–3834 ) pmol/L/min , respectively , all P < 0.0001 . Conclusion . Weight loss following RYGB is associated with an increase in post-pr and ial plasma BA response due to larger amounts of glycine-conjugated BAs . This suggests up regulation of BA production and conjugation after RYGB BACKGROUND Obesity is a risk factor for self-reported asthma and makes asthma management more difficult . The effects of bariatric surgery on asthma in severely obese subjects remain to be documented . METHODS In this prospect i ve study , 12 asthmatic patients with severe obesity were evaluated before , 6 and 12 months after bariatric surgery .  Each had methacholine inhalation tests , measures of expiratory flows and lung volumes , measurements of C-reactive protein and question naires on asthma medication , asthma symptoms and co-morbid conditions . Eleven severely obese patients with asthma ( considered as controls ) underwent the same evaluations . Primary endpoint was airway responsiveness to methacholine and secondary endpoints were lung volumes and markers of systemic inflammation . RESULTS Mean body mass index decreased from 51.2 to 34.4 kg/m(2 ) twelve months post-surgery . Mean PC(20 ) methacholine improved from 0.84 to 6.2 mg/ml ( P < 0.001 ) ; FEV(1 ) , FVC , FRC , FRC/TLC and ERV all improved ( P ≤ 0.006 ) . C-reactive protein decreased from 8.6 to 1.7 mg/L ( P < 0.001 ) Asthma symptoms total score was significantly reduced ( P = 0.03 ) and asthma medication needs decreased , ten patients being able to stop all asthma drugs . No significant changes of these parameters from baseline were observed in asthmatic controls . Improvements in airway responsiveness and lung volumes happened in parallel and correlated with reductions of body mass index ( r = 0.58 , P = 0.049 ) , C-reactive protein levels ( r = -0.74 , P = 0.004 ) . CONCLUSION Airway responsiveness , lung volumes and asthma severity/control markedly improved with weight loss following bariatric surgery in severely obese patients High blood pressure ( HBP ) has been associated with elevated C-reactive protein ( CRP ) , a marker of chronic mild inflammation . However , the association between HBP and other inflammatory markers , particularly interleukin 6 ( IL-6 ) and tumour necrosis alpha ( TNF-α ) , has not been evaluated in well-controlled studies . We examined the cross-sectional relationship between IL-6 , TNF-α , and CRP and HBP in a r and om sample of 196 healthy subjects . All markers were measured in duplicate with high-sensitivity ELISA tests . Three blood pressure ( BP ) measurments were averaged for the analysis , and subjects with systolic BP ⩾140 and /or diastolic BP ⩾90 mmHg were considered hypertensive . Log binomial regression was used to estimate multivariate-adjusted prevalence ratios ( PR ) of HBP . Of the subjects , 40 % ( 79 ) were hypertensive ( mean age : 44 years ; range 30–64 ) . After adjustment for age , sex , body mass index , family history of HBP , and the level of the other inflammatory markers , subjects in the second ( PR : 3.10 , P=0.003 ) , third ( PR : 2.32 ; P=0.031 ) , and fourth quartiles ( PR : 2.30 ; P=0.036 ) of IL-6 were more than twice as likely to be hypertensive than those in the first quartile . Corresponding PR estimates for TNF-α levels were 1.41 ( P=0.014 ) for the second ; 1.59 ( P=0.001 ) for the third ; and 1.61 ( P=0.025 ) for the fourth quartile . The CRP – HBP association was not statistically significant . Our results suggest that TNF-α and IL-6 could be independent risk factors for HBP in apparently healthy subjects . Nevertheless , the temporal relationship between elevated inflammation markers and HBP should be ascertained in prospect i ve cohort studies The aim of this study was to describe the effect of surgically induced weight loss on vascular function measured by flow-mediated dilatation ( FMD ) in hypertensive obese patients . This prospect i ve study included 33 patients ( 78 % females , mean age 53 ( 9 ) years ) undergoing bariatric surgery ( BS ) .  Before and 12 months postoperatively , the BMI , 24-h ambulatory BP , high-sensitivity C-reactive protein ( hs-CRP ) , leptin , homeostasis model assessment ( HOMA IR ) , and abdominal fat  were measured . Endothelial function was assessed by FMD . After BS , the excess body weight loss was 71 % ; the 24-h [ systolic 18(11)//diastolic 7(7 ) mmHg ] BP values , hs-CRP , leptin , HOMA , and abdominal fat significantly decreased , with no changes in endothelial function . Weight loss achieved by BS was associated with a significant improvement in BP and metabolic and inflammation parameters , but FMD did not improve AIM The aim this study was to evaluate the influence of  gastric bypass surgery ( GBS )  on periodontal disease and quantify the periodontopathogenic bacteria in patients undergoing this surgery . MATERIAL AND METHODS This prospect i ve study was composed of 50 patients who underwent bariatric surgery  and the data collection was performed in three periods pre-operative , 6 ( 6 M ) and 12 months ( 12 M ) postoperative . The oral clinical examination to assess periodontal disease ; gingival fluid sample collection for quantification of the periodontopathogenic bacteria Porphyromonas gingivalis , Tannerella forsythia , Treponema denticola , and Prevotella intermedia using q-PCR ; body mass index ( BMI ) and for collection of the individual 's health-related data from medical files . RESULTS There was a significant reduction in serum C-reactive protein ( CRP ) and glucose levels after surgery . The mean probing pocket depth ( PPD ) and clinical attachment level ( CAL ) increased significantly in the postoperative period of 6 months ( p = 0.001 ) . In the same period , the amount of P. gingivalis increased ( p = 0.028 ) and the other bacteria decreased slightly ( p > 0.050 ) . In the presence of P. gingivalis , T. forsythia , T. denticola and P. intermedia , a poor periodontal condition was observed . CONCLUSION The periodontal disease increased in severity and P. gingivalis increased after GBS . A systemic inflammation resolution due to bariatric surgery in obese subjects does not seem to affect the course of periodontal disease BACKGROUND Excess visceral adipose tissue predicts for incipient diabetes mellitus and cardiovascular disease . Human data are mixed regarding the benefits of selective visceral adipose tissue reduction . We investigated the effects of omentectomy added to laparoscopic Roux-en-Y gastric bypass on glucose homeostasis and lipids , inflammatory markers , and adipokines 90 days postoperatively in nondiabetic patients at the Legacy Good Samaritan Hospital and Oregon Health and Science University ( Portl and , OR ) . METHODS A single-blind , r and omized study of laparoscopic Roux-en-Y gastric bypass plus omentectomy versus laparoscopic Roux-en-Y gastric bypass alone in 28 subjects ( 7 men and 21 women ) . The groups were matched at baseline for gender , age , and body mass index ( BMI ) . The eligibility criteria included age ≥18 years , BMI ≥40 and < 50 kg/m(2 ) without co-morbid conditions or BMI ≥35 and < 50 kg/m(2 ) with co-morbid conditions . The primary outcome measures were changes in the fasting plasma glucose , insulin , and homostatic model assessment of insulin resistance . The secondary measures were BMI and the high-sensitivity C-reactive protein , tumor necrosis factor-α , interleukin , total and high-molecular-weight adiponectin , fibrinogen , and plasminogen activator inhibitor-1 levels . RESULTS After surgery , the BMI decreased significantly in both groups and was not different at the follow-up point . Although many outcome parameters improved with weight loss in both groups postoperatively , only the omentectomy group experienced statistically significant decreases in fasting glucose ( P < .05 ) , total ( P = .004 ) and very-low-density lipoprotein ( P = .001 ) cholesterol , and an increase in the high-molecular-weight/total adiponectin ratio ( P = .013 ) . CONCLUSIONS Omentectomy added to laparoscopic Roux-en-Y gastric bypass results in favorable changes in glucose homeostasis , lipid levels , and adipokine profile at 90 days postoperatively . These data support the hypothesis that selective ablation of visceral adipose tissue conveys metabolic benefits in nondiabetic humans Background Increased  visceral adipose tissue ( VAT ) is thought to be a risk factor for cardiovascular and metabolic diseases . There are only limited data on whether VAT loss after laparoscopic gastric b and ing surgery ( LGBS ) is related to risk factor reduction . This study determined whether improvements in risk markers , in particular insulin resistance , were related to  VAT reduction at 6 months after LGBS ( T2 ) . Methods Thirty-four LGBS patients and 17 normal weight controls underwent initial and T2 testing . Fasting venous blood sample s were taken to evaluate glucose , insulin , hemoglobin A1c , lipids , C-reactive protein ( CRP ) , and hormone profiles . Insulin resistance was estimated using the homeostasis model assessment ( HOMA ) index .  VAT  was measured using CT techniques . Data were analyzed using repeated measures ANOVA and regression analysis . Results Results at T2 showed that patients had significant improvements in body composition , HOMA , and hemoglobin A1c . There were also reductions in plasma renin activity and leptin , and increases in ghrelin and GLP-1 . Reductions in VAT were significantly correlated with reductions in insulin , HOMA , and glucose . While high density lipoprotein cholesterol , triglycerides , CRP , and the apolipoprotein A1/B ratio were also improved , VAT reduction was significantly correlated only with an increased apolipoprotein A1/B ratio . Conclusion These data indicate that 6 months after LGBS there were significant improvements in many cardiovascular and metabolic risk markers . However , VAT reduction was most strongly associated with reductions in insulin resistance . Body weight loss was not associated with markers of improved insulin sensitivity Bariatric  surgery has been suggested to improve arterial hypertension and renal function . This prospect i ve controlled observational study aim ed to investigate changes in renal inflammation , renal function and arterial blood pressure before and after bariatric surgery Background C-Reactive protein ( CRP ) has been associated with the macro- and microvascular effects of hypertension and diabetes mellitus . Referring to serum cortisol , it has been proposed to contribute to the pathogenesis of metabolic syndrome , and it has been demonstrated that weight loss normalizes cortisol levels and improves insulin resistance . The aims of this study were to analyze CRP and cortisol levels pre- and postoperatively in morbidly obese patients undergoing a laparoscopic sleeve gastrectomy  and to correlate them with weight loss and parameters associated with cardiovascular risk . Methods A prospect i ve study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between October 2007 and May 2011 was performed . Results A total of 40 patients were included in the study .  CRP levels decreased significantly 12 months after surgery ( median reduction of 8.9 mg/l ; p = 0.001 ) . Serum cortisol levels decreased significantly 6 months after surgery ( median reduction of 34.9 μg/dl ; p = 0.001 ) . CRP values reached the normal range ( < 5 mg/l ) 1 year after surgery . Referring to cortisol , a significant association was observed with the cardiovascular risk predictor ( triglyceride/high-density lipoprotein cholesterol ratio ) from the 6th month after surgery onward ( Pearson correlation coefficient , 0.559 ; p = 0.008 ) . Conclusion CRP levels are increased preoperatively and in the postoperative course up to 1 year after surgery . Serum cortisol levels remain elevated until the 6th month after surgery . From this moment onward , serum cortisol is associated with the cardiovascular risk predictor reflecting the cardiovascular risk decreasement during the weight loss Background  Osteopontin ( OPN  ) is a multifunctional matrix glycoprotein associated with bone metabolism and has been linked to chronic inflammation , insulin resistance , and atherosclerosis . Diet-induced weight loss decreases elevated OPN concentrations in obese patients . The aim of the current study was to investigate the role of OPN after bariatric surgery , where not only improvements of chronic inflammation , insulin resistance and comorbidities , but also malabsorption and altered bone metabolism have been reported . Methods OPN plasma concentrations  were determined in 31 morbidly obese patients ( 5 men , 26 women , BMI 46.2 ± 7.1 kg/m2 , age 41 ± 11 years ; mean ± SD ) before and 18 months after bariatric surgery , together with parameters of bone metabolism and inflammation . Results OPN concentrations increased by + 20.3 ± 26.6 ng/ml ( mean ± SD , p < 0.01 ) , concomitant to a weight loss of −38 ± 22 kg , and a decrease in BMI by −13.1 ± 7.7 kg/m2 ( both p < 0.01 ) . HOMA-index improved from 5.2 ± 3.4 to 1.5 ± 1.0 ( p < 0.01 ) . Calcium concentrations slightly decreased , and phosphate increased ( −0.06 ± 0.13 mmol/l and + 0.08 ± 0.16 mmol/l , respectively ; both p < 0.05 ) , while 25-OH-VitaminD3 remained unchanged and PTH tended to increase ( + 5.1 ± 14.0 pg/ml , p = 0.054 ) . Monocyte chemoattractant protein 1 and interleukin 18 were significantly decreased and associated with HOMA both before and after bariatric surgery . ΔOPN was correlated with ΔPTH , but not with other parameters .  Conclusions OPN plasma concentrations increased concomitant to weight loss after bariatric surgery , which was independent from an improvement of insulin sensitivity and a decrease of inflammatory markers . Further studies are needed to differentiate whether these changes in bone metabolism after bariatric surgery are secondary to calcium deficiency or an adaptation to weight loss BACKGROUND Bariatric surgery is an effective treatment for morbid obesity . Obesity and type 2 diabetes are associated with chronic inflammation . There is lack of data examining the effects of sleeve gastrectomy ( SG ) on inflammatory biomarkers . Our aim was to study the effects of SG on specific cytokines associated with obesity including interleukin-6 ( IL-6 ) , interleukin-10 ( IL-10 ) , leptin , adiponectin , and C-reactive protein ( CRP ) preoperatively , 1 and 6 months after surgery . METHODS A nonr and omized prospect i ve study comprising of 22 participants with impaired glucose homeostasis and type 2 diabetes undergoing SG ( body mass index 50.1 kg/m(2 ) , glycated hemoglobin [ HbA1c ] 53 mmol/mol ) .  Serial measurements of IL-6 , IL-10 , leptin , adiponectin , and CRP  were performed during oral glucose tolerance testing preoperatively , 1 and 6 months postoperatively . RESULTS We observed significant improvements at 1 and 6 months in leptin ( P≤.001 ) and CRP ( P = .003 ) after SG . We also observed a significant reduction in IL-6 at 6 months ( P = .001 ) . No statistically significant differences were observed for adiponectin and IL-10 . CONCLUSION This study is the first to examine the detailed changes in the inflammatory cytokines after SG . Our study shows significant improvements in the inflammatory biomarkers after SG in patients with impaired glucose homeostasis and type 2 diabetes Background Laparoscopic sleeve gastrectomy ( LSG ) has been recently introduced as a st and -alone , restrictive bariatric surgery . Theoretically , LSG attenuates micronutrients deficiencies and associated complications that typically observed following malabsorptive procedures . The aim of this study was to assess iron indices and the 1-year incidence of iron deficiency in patients undergoing LSG .  Methods This was a prospect i ve , cohort study ; patients who underwent LSG from June 2007 to April 2008 at our institution were screened for inclusion . Preoperative hemoglobin and iron indices including serum iron , transferrin saturation , ferritin , and soluble transferrin receptor were compared to their levels at 6 and 12 months after surgery . Similarly , vitamin B12 and red blood cell ( RBC ) folate were analyzed as secondary end points . Weight parameters and C-reactive protein ( CRP ) levels were compared before surgery and 1 year postoperatively . Results A total of 61 patients were included in the study . One year after surgery , there was a significant decrease in the mean body mass index from 47.5 ± 9.6 to 30.5 ± 6.5 ( P < 0.001 ) . The incidence of iron deficiency was 4.9 % at both follow-up time points . Anemia was evident in 4.9 % of patients 1 year postoperatively . Significant decrease in the means of the natural logarithm of vitamin B12 and RBC folate were observed as early as 6 months after surgery ( P = 0.014 ; P < 0.005 , respectively ) . The decrease in mean CRP level 12 months postoperatively was statistically significant compared to its preoperative value ( P < 0.0001 ) . Conclusion LSG is an effective procedure for the treatment of morbid obesity and its associated inflammatory state . One year after surgery , development of iron deficiency was insignificant BACKGROUND We investigated the biochemical and inflammatory parameters as well as biomarkers of oxidative stress in morbidly obese patients before and after bariatric surgery and clinical treatment .  METHODS This study was conducted using 60 individuals ( 10 men and 50 women ) distributed into 3 groups :  the control group , 20 non-diabetic obese patients given clinical treatment , the bariatric group , 20 non-diabetic obese patients given a Roux-en-Y bypass gastroplasty , and the bariatric diabetic group , 20 diabetic obese patients given a Roux-en-Y bypass gastroplasty .  Measurements were made before and 1 , 3 , 6 , and 12months after surgery and clinical treatment . RESULTS We showed a significant decrease in body weight , body mass index ( BMI ) and waist circumference , accompanied by a decrease in the lipid profile and glucose and glycated hemoglobin concentrations in the groups that received bariatric surgery . The concentrations of lipid peroxidation , carbonyl protein and NPSH , as well as superoxide dismutase ( SOD ) and catalase ( CAT ) activity , significantly decreased in both groups after surgery . The concentrations of inteleukin-6 , inteleukin-1 , TNF-α and resistin were also significantly lower , while adiponectin concentrations significantly increased 12months after bariatric surgery . No significant alterations were observed in the biochemical , inflammatory or oxidative parameters of the control group . CONCLUSIONS Our findings demonstrate a decrease in body mass and a subsequent improvement in biochemical , metabolic and anthropometric parameters in patients given bariatric surgery .  This may contribute to the reduction of oxidative damage in these patients and consequently a reduction in the risk of the development and progression of multiple co-morbidities associated with obesity Background The effects of surgical weight loss ( WL ) on inflammatory biomarkers associated with sleep apnea  remain unknown . We sought to determine if any biomarkers can predict amelioration of sleep apnea achieved by bariatric surgery . We hypothesized that surgical WL would substantially reduce severity of sleep apnea and levels of proinflammatory cytokines . Methods Twenty-three morbidly obese adults underwent anthropometric measurements , polysomnography , and serum biomarker profiling  prior to and 1 year following bariatric surgery .  We examined the effect of WL and amelioration of sleep apnea on metabolic and inflammatory markers . Results Surgical WL result ed in significant decreases in BMI ( 16.7 ± 5.97 kg/m2/median 365 days ) , apnea – hypopnea index ( AHI ) , CRP , IL-6 , sTNFαR1 , sTNFαR2 , and leptin levels , while ghrelin , adiponectin , and soluble leptin receptor concentrations increased significantly . Utilizing an AHI cutoff of 15 events/h , we found significantly elevated levels of baseline sTNFαR2 and greater post-WL sTNFαR2 decreases in subjects with baseline AHI ≥15 events/h compared to those with AHI < 15 events/h despite no significant differences in baseline BMI , age , and Δ BMI . In a multivariable linear regression model adjusting for sex , age , impaired glucose metabolism , Δ BMI , and follow-up period , the post-WL decreases in AHI were an independent predictor of the decreases in sTNFαR2 and altogether accounted for 46 % of the variance of ΔsTNFαR2 ( P = 0.011 ) in the entire cohort . Conclusions Of all the biomarkers , the decrease in sTNFαR2 was independently determined by the amelioration of sleep apnea achieved by bariatric surgery . The results suggest that sTNFαR2 may be a specific sleep apnea biomarker across a wide range of body weight Background : Leptin is a hormone that regulates food intake ; its concentrations are elevated in the majority of obese individuals . During inflammation , plasma leptin is usually increased and may contribute to the anorexia and cachexia of infection . The purpose of this study was to characterize the dynamics of circulating leptin in the early postoperative period in relation to the acute phase response in extremely obese patients undergoing laparoscopic non-adjustable gastric b and ing ( LNAGB ) .  We compared plasma leptin changes with 4 proinflammatory cytokines and BMI . Methods : The prospect i ve study was performed on 18 patients with 3rd degree obesity .  Plasma concentration of leptin , tumor necrosis factor-α ( TNF-α ) , interleukin (IL)-1 , soluble IL-2 receptor ( sIL-2R ) , and IL-6 were estimated before operation and 24 , 48 , and 72 h after NALGB . Results : We demonstrate statistically significant elevation of plasma leptin concentration ( 32.2±10.2 µg/l ) 24 h after operation compared with preoperative status ( 18.4±5.2 µg/l , p<0.05 ) . There was diminished correlation of plasma leptin and BMI in this period . Leptin levels + 48 and + 72 h after b and ing quickly returned to preoperative levels . The regression coefficient was the highest for leptin and TNFalpha 24 h after surgery ( r = 0.40 , p < 0.05 ) , and for leptin and IL-6 24 h after surgery ( r = 0.29 , p < 0.05 ) . There was no significant correlation between leptin and IL-1 and between leptin and sIL-2R respectively . Conclusions : During the non-infectious stress response ( as with abdominal surgery ) , leptin shows itself as an acute phase reactant . Proinflammatory cytokines can be the main regulatory factors of leptin in this period . Significant correlation between leptin and TNF-alpha ( similarly demonstrated by other authors in models of bacterial inflammation ) indicates that TNF-alpha can be a crucial regulator of leptin generation in the early postoperative period BACKGROUND Increased adipokine production and hyperfiltration may explain the links between obesity and chronic kidney disease . Indeed , hyperfiltration may precede a subsequent accelerated decline of kidney function in these patients . Glomerular filtration rate decreases after bariatric surgery in young obese patients with hyperfiltration . OBJECTIVE Our aim was to identify the factors associated with this decrease 1 year after bariatric surgery . SETTING We used data from a prospect i ve cohort of severely obese patients who underwent bariatric surgery in Nice University Hospital . METHODS We analyzed 175 patients before and 1 year after bariatric surgery .  Low- grade inflammation was evaluated by serum C-reactive protein levels . Lean body mass and fat body mass were estimated by bioelectric impedance analysis . Body surface area was assessed by the Du Bois formula . Serum creatinine levels were used to estimate glomerular filtration rate by the chronic kidney disease-epidemiology collaboration ( CKD-EPI ) equation . Glomerular filtration rate was de-adjusted from st and ard body surface area and then divided by lean body mass to calculate the decrease in hyperfiltration and to separate the patients into 2 groups : above or below the median decrease of hyperfiltration after bariatric surgery . RESULTS The factors associated with a large correction of hyperfiltration were baseline C-reactive protein levels ( 10.0 ± 5.8 mg/L versus 12.7 ± 7.4 mg/L , P = .01 ) and brachial circumference ( 41 ± 4 cm versus 44 ± 5 cm , P = .006 ) . A high fat mass reduction rate was significantly associated with a substantial hyperfiltration reduction after bariatric surgery ( P<.001 ) independently of sex and surgical procedure . CONCLUSIONS The correction of hyperfiltration is associated with a high reduction rate of fat mass after bariatric surgery but may be limited by low- grade inflammation Background This study examined the effect of weight loss on energy intake ,  vitamin C , E , β-carotene ( diet/blood ) , reduced glutathione ( GSH ) , C-reactive protein ( CRP ) , thiobarbituric acid reactive substances ( TBARS ) , catalase , and myeloperoxidase , in patients with Roux-en-Y bypass gastroplasty .  Methods Prospect i ve clinical study with control ( C ) and  bariatric ( B ) groups ( n = 20 each ) . Age was 38.8 ± 11.1 ( C ) and 37.8 ± 11.2 years ( B ) , and body mass indices ( BMI ) were 22.4 ± 2.4 and 48.1 ± 8.7 kg/m2 , respectively . Group C was assessed on a single occasion and B at three time points ( basal period and 3 and 6 months after gastroplasty ) . Results BMI was decreased at three ( 38.3 ± 1.7 , P = 0.018 ) and 6 months after surgery ( 34.9 ± 1.7 , P < 0.001 ) . Mean weight loss was 20.53 ± 1.1 after three and 27.96 ± 1.3 kg after 6 months . Serum vitamin C and β-carotene ( P < 0.01 and P < 0.001 , respectively ) were increased at 6 months compared to basal . Basal serum vitamin C ( P = 0.001 ) and β-carotene ( P < 0.001 ) were lower compared to controls . Serum vitamin E corrected for cholesterol and triglycerides was higher in group B at three ( P = 0.01 ) and 6 months ( P = 0.001 ) and lower at basal ( P < 0.001 ) compared to controls . GSH was higher in controls ( P < 0.001 ) compared to basal . Catalase ( P = 0.01 ) and TBARS ( P < 0.001 ) were higher in group B at 6 months . TBARS were higher ( P < 0.001 ) at basal compared to controls . Myeloperoxidase and CRP decreased in group B after three ( P = 0.028 , P = 0.010 ) and 6 months ( P < 0.001 , P = 0.001 ) , respectively . Conclusions Roux-en-Y bypass gastroplasty led to decreased proinflammatory parameters together with increased nutritional antioxidants , catalase , and TBARS , and decreased GSH 6 months after surgery BACKGROUND & AIMS Roux-en-Y gastric bypass  ( RYGB ) is associated with an increased risk for micronutrient deficiencies . This study aim ed to assess total ( dietary and supplement ) intake and association with iron ( including hepcidin ) , vitamin B12 , vitamin C and zinc status markers before and after Roux-en-Y gastric bypass ( RYGB ) . METHODS This prospect i ve study included patients with a planned RYGB in University Hospitals Leuven , Belgium ; who were followed until 12 months post-RYGB . Patients completed an estimated dietary record of two non-consecutive days before and 1 , 3 , 6 and 12 months post-RYGB and supplement/drug use was registered . Associations between total micronutrient intake and status markers were analyzed . RESULTS Fifty-four patients ( 21 males ; mean age : 48.0 [ 95%CI 46.6 ; 49.3 ] years ; mean preoperative BMI : 40.4 [ 95%CI 39.4 ; 41.4 ] kg/m2 ) were included . One month post-RYGB , usual dietary intake of the studied micronutrients was significantly decreased compared to pre-RYGB , but gradually increased until 12 months post-RYGB , remaining below baseline values . By including micronutrient supplement intake , 12 months post-RYGB values were higher than baseline , except for zinc . Hemoglobin , ferritin , vitamin B12 and C-reactive protein serum concentrations were significantly decreased and transferrin saturation and mean corpuscular volume were significantly increased 12 months post-RYGB . Serum hepcidin concentration was significantly decreased 6 months post-RYGB . CONCLUSIONS Medical nutritional therapy is essential following RYGB as dietary intake of iron , vitamin B12 , vitamin C , copper and zinc was markedly decreased postoperatively and some patients still had an inadequate total intake one year post-RYGB INTRODUCTION Weight loss interventions such as Roux-en-Y gastric bypass ( RYGB ) and very low calorie diets ( VLCD ) lead to improvement of glucose metabolism in obese individuals with type-2 diabetes . Weight loss can also positively influence the unfavorable inflammatory profile associated with obesity . However , a direct comparison of the effect of VLCD and RYGB on systemic inflammation is lacking . METHODS Systemic inflammation was investigated in age- and BMI -matched morbidly obese T2DM women by determining the number and activation- or memory status of peripheral blood leukocytes by flow cytometry , in addition to measuring circulating levels of cytokines and CRP . Systemic inflammation was assessed one month before and three months after RYGB ( n=15 ) or VLCD ( n=12 ) . An age matched group of lean women ( n=12 ) was studied as control group . RESULTS Three months after the intervention , CRP and leptin levels were reduced whereas adiponectin levels were increased both by RYGB and VLCD .  TNF-α levels were increased by RYGB , but reduced by VLCD .  IL-2 and IL-6 levels were reduced and IL-4 levels were increased by VLCD but not affected by RYGB . The number of activated peripheral cytotoxic T ( CD8+CD25 + ) and B ( CD19+CD38 + ) cells was significantly higher after RYGB than after VLCD . CONCLUSION In conclusion , RYGB and VLCD have differential effects on the activation status of peripheral leukocytes and levels of cytokines in obese women with T2DM , despite comparable weight loss three months after the intervention . VLCD seems to have more favorable effects on the inflammatory profile as compared to RYGB OBJECTIVE Obesity and weight loss influence thyroid hormone physiology . The effects of weight loss by calorie restriction vs Roux-en-Y gastric bypass ( RYGB ) in obese subjects have not been studied in parallel . We hypothesized that differences in transient systemic inflammation and catabolic state between the intervention types could lead to differential effects on thyroid hormone physiology . DESIGN AND METHODS We recruited 12 lean and 27 obese females with normal fasting glucose ( normal glucose tolerant ( NGT ) ) and 27 obese females with type 2 diabetes mellitus ( T2DM ) for this study . Weight loss was achieved by restrictive treatment ( gastric b and ing or high-protein-low-calorie diet ) or by RYGB .  Fasting serum leptin , TSH , triiodothyronine ( T₃ ) , reverse T₃ ( rT₃ ) , and free thyroxine ( fT₄ ) concentrations were measured at baseline and 3 weeks and 3 months after the start of the interventions . RESULTS Obesity was associated with higher TSH , T₃ , and rT₃ levels and normal fT₄ levels in all the subjects when compared with the controls . After 3 weeks , calorie restriction and RYGB induced a decline in TSH levels and a rise in rT₃ and fT₄ levels . The increase in rT₃ levels correlated with serum interleukin 8 ( IL8 ) and IL6 levels . After 3 months , fT₄ and rT₃ levels returned to baseline levels , whereas TSH and T₃ levels were persistently decreased when compared with baseline levels . No differences in the effects on thyroid hormone parameters between the interventions or between NGT and T2DM subjects were observed at any time point . CONCLUSIONS In summary , weight loss directly influences thyroid hormone regulation , independently of the weight loss strategy used . The effects may be explained by a combination of decreased leptin levels and transient changes in peripheral thyroid hormone metabolism OBJECTIVE To evaluate the behavior of acute phase proteins and lipid profile in patients undergoing Roux-en-Y gastric bypass .  METHODS We conducted a prospect i ve study , consisting of three moments : M1 - preoperative ( 24 hours before surgery ) ; M2 - 30 days after surgery ; and M3 - 180 days after surgery . We carried measured height and BMI , as well as determined the concentrations of acute phase proteins ( C-reactive protein ( CRP ) , albumin and Alpha-1-acid glycoprotein ) and total cholesterol , LDL-c , HDL-c and triacylglycerol . RESULTS participants comprised 25 individuals , with a mean age of 39.28 ± 8.07 , 72 % female . At all times of the study there was statistically significant difference as for weight loss and BMI . We found a significant decrease in CRP concentrations between the moments M1 and M3 ( p = 0.041 ) and between M2 and M3 ( p = 0.018 ) . There was decrease in Alpha-1-GA concentrations between M1 and M2 ( p = 0.023 ) and between M1 and M3 ( p = 0.028 ) . The albumin values increased , but did not differ between times . Total cholesterol and triacylglycerol decreased significantly ay all times . LDL-c concentrations decreased and differed between M1 and M2 ( p = 0.001 ) and between M1 and M3 ( p = 0.001 ) . HDL-c values increased , however only differing between M1 and M2 ( p = 0.050 ) . CONCLUSION Roux-en-Y gastric bypass promoted a decrease in plasma concentrations of CRP and Alpha-1-acid glycoprotein , improving lipid and inflammatory profiles Background Obesity causes renal problems including albuminuria . Bariatric surgery ( BS ) improves albuminuria . We investigated whether albuminuria is reduced by weight loss per se or by improved systemic inflammation induced by weight loss after BS . Methods Patients older than 18 years who received BS in Soonchunhyang University Hospital from 01 January 2011 to 31 December 2011 were included . Other inclusion criteria included body mass index ( BMI ) ≥ 30 kg/m2 , creatinine level ≤ 1.0 mg/dL , and no overt proteinuria ( trace amount or undetectable by dipstick ) . The patients were followed at 1 and 6 months after BS . Results Forty-three patients were analyzed . Three patients were men , 10 patients had diabetes , and 12 patients had hypertension . All patients had normal renal function ( creatinine ≤ 1.0 mg/dL ) , and estimated glomerular filtration rate was 115.7 ± 16.5 mL/min/1.73 m2 . There were significant reductions in body weight , BMI , high-sensitivity C-reactive protein ( hs-CRP ) , and urine albumin-to-creatinine ratio ( ACR ) . There were positive correlations between delta hs-CRP and delta body weight ( r = 0.349 , p = 0.043 ) or delta body mass index ( BMI , r = 0.362 , p = 0.035 ) ; between hs-CRP and body weight ( r = 0.374 , p = 0.001 ) , BMI ( r = 0.431 , p < 0.001 ) . Multivariate analysis using a linear mixed model demonstrated that hs-CRP ( β = 0.5364 , p = 0.026 ) was an independent risk factor affecting ACR . Conclusions Our study suggests that BS can reduce albuminuria in patients with severe obesity and normal kidney function by reducing systemic inflammation
target: Bariatric surgery  significantly lowered inflammatory factors ; however , baseline BMI , follow-up duration and type of surgery could impact the extent of observed effects
background: Obesity is one of the main causes of inflammation .
  Previous studies have reported inconclusive results regarding the effect of bariatric surgery on inflammatory markers .
  This systematic review and meta- analysis is aim ed at describing the effect of bariatric surgery on C-reactive protein ( CRP ) , interleukin-6 ( IL-6 ) , tumor necrosis factor-α ( TNF-α ) .