title: Effect of Weight Reduction Following Bariatric Surgery on Serum Visfatin and Adiponectin Levels in Morbidly Obese Subjects The Effects on Obesity Related Peptides of Laparoscopic Gastric Band Applications in Morbidly Obese Patients Early effects of gastric bypass on endothelial function, inflammation, and cardiovascular risk in obese patients Plasma ghrelin in obesity before and after weight loss after laparoscopical adjustable gastric banding. Adiponectin is altered after maximal exercise in highly trained male rowers 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 Palaeolithic diet decreases fasting plasma leptin concentrations more than a diabetes diet in patients with type 2 diabetes: a randomised cross-over trial Modulation of circulating and adipose tissue adiponectin levels by antidiabetic therapy. Weight loss is a major contributor to improved sexual function after bariatric surgery Effect of marked weight loss on adiponectin gene expression and plasma concentrations. Energy economy hampers body weight loss after gastric bypass. The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. Visceral Adipose Tissue Loss and Insulin Resistance 6 Months after Laparoscopic Gastric Banding Surgery: A Preliminary Study Weight loss increases soluble leptin receptor levels and the soluble receptor bound fraction of leptin. Evaluation of the biochemical, inflammatory and oxidative profile of obese patients given clinical treatment and bariatric surgery. Relationship between energy expenditure and visceral fat accumulation in obese women submitted to adjustable silicone gastric banding (ASGB). The epidemic of obesity and diabetes: trends and treatments. Restoration of acute insulin response in T2DM subjects 1 month after biliopancreatic diversion. Increased plasma visfatin concentrations in morbidly obese subjects are reduced after gastric banding. Protein intake compliance of morbidly obese patients undergoing bariatric surgery and its effect on weight loss and biochemical parameters. Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea
abstract: Objective : Adipokines are signaling and mediator proteins secreted from adipose tissue . A novel adipokine , visfatin , was reported as a protein which was mainly expressed in visceral adipose tissue . Controversial results have been shown regarding the changes of adipokines following weight reduction . So we investigated the effects of weight reduction on serum concentrations of adiponectin and visfatin in morbidly obese subjects . Methods : 35 severely obese patients ( 26 females and 9 males ) , aged 15 - 58 years , were studied .  Anthropometric parameters and biochemical parameters  as well as  adiponectin and visfatin were analyzed before and 6 weeks after weight reduction . Results : Anthropometric indices decreased significantly . Blood levels of low-density lipoprotein cholesterol , high-density lipoprotein cholesterol , and triglyceride were reduced significantly . The reduction of visfatin and the elevation of adiponectin were significant as well . However , other parameters like fasting glucose and insulin did not change . Moreover , we could not find any significant correlation between the change of serum visfatin and that of adiponectin . Conclusions : 6-week weight reduction after bariatric surgery result ed in decreased serum visfatin and increased adiponectin levels . However , we can not find any significant correlation between changes of adiponectin , visfatin , BMI , waist circumference , and insulin resistance . Further studies with different design are suggested to clarify these associations ABSTRACT Background : The aim of this study was to examine the relationship between weight loss and resistin , apelin , chemerin , and visfatin after  laparoscopic adjustable gastric b and ing ( LAGB ) .  Methods : The study group consisted of 19 patients who were operated on for morbid obesity ( BMI : 48.7 ± 6.6 kg/m2 ) , and 22 healthy , normal-weight ( BMI : 22.9 ± 2.5 kg/m2 ) subjects formed the control group . We obtained blood sample s from the study subjects at three different times : before undergoing surgery and at one month and 6 months after surgery . Blood was obtained once from the control group . Results : Significant weight loss was achieved at one and 6 months after surgery . Plasma levels of apelin , resistin , chemerin , and visfatin were higher in morbidly obese patients compared with the control group . Obesity-related peptides decreased one month and 6 months after surgery . Conclusions : Elevated plasma resistin , apelin , chemerin , and visfatin levels in morbidly obese patients are gradually reduced after weight loss . According to these findings , LAGB surgery is found to be an important and efficient means for morbidly obese patients both to lose weight and to develop a better metabolic risk profile in a short time period 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 Weight reduction after gastric bypass surgery  has been attributed to a decrease of the orexigenic peptide ghrelin , which may be regulated by insulin and leptin . This study examined effects of long-term weight loss  after laparoscopical adjustable gastric b and ing  on plasma ghrelin and leptin concentrations and their relationship with insulin action . Severely obese patients ( 15 women , three men , 36 + /- 12 yr ) underwent clinical examinations every 3 months and modified oral glucose tolerance tests to assess parameters of insulin sensitivity and secretion every 6 months . After surgery , body mass index fell from 45.3 + /- 5.3 to 37.2 + /- 5.3 and 33.6 + /- 5.5 kg/m(2 ) at 6 and 12 months , respectively ( P < 0.0001 ) . This was associated with lower ( P < 0.0001 ) plasma glucose , insulin , insulin resistance , waist circumference , and blood pressure . Plasma leptin decreased from 27.6 + /- 9.5 to 17.7 + /- 9.8 ( P = 0.0005 ) and 12.7 + /- 5.1 ng/ml ( P < 0.0001 ) . Plasma ghrelin was comparable before and at 6 months ( 234 + /- 53 ; 232 + /- 53 pmol/liter ) but increased at 12 months ( 261 + /- 72 pmol/liter ; P = 0.05 vs. 6 months ) . At 6 and 12 months , ghrelin levels correlated negatively with fasting plasma insulin levels and hepatic insulin extraction but not with body mass or insulin action . In conclusion , prolonged weight loss results in a rise of fasting ghrelin concentrations that correlates with fasting insulin concentrations but not improvement of insulin sensitivity The purpose of present study was to investigate plasma adiponectin response to acute exercise in highly trained male rowers . Ten rowers performed a maximal 6,000-m rowing ergometer test [ mean performance time ≈20 min ; 1,200.8 ( 29.9 ) s ] , and venous blood sample s were obtained before , immediately after and after 30 min of recovery . In addition to adiponectin concentration , leptin , insulin , growth hormone and glucose values were measured . Adiponectin was not changed immediately after the exercise when uncorrected for plasma volume changes ( −8.1 % ; P>0.05 ) . However , adiponectin was decreased immediately after the exercise when adjusted for plasma volume changes ( −11.3 % ; P<0.05 ) . Adiponectin was significantly increased above the resting value after the first 30 min of recovery ( uncorrected for plasma volume , + 19.3 % ; corrected for plasma volume , + 20.0 % ) . No changes occurred in plasma leptin and insulin concentrations with exercise ( uncorrected for plasma volume changes ) . While growth hormone and glucose values were significantly increased and decreased to the pre-exercise level immediately after the exercise and after the first 30 min of recovery , respectively ( uncorrected for plasma volume changes ) , no differences in the responses to exercise were observed in these measured blood parameters when adjusting for plasma volume changes . There were no relationships between plasma adiponectin and other measured blood parameters before and after the exercise , nor were changes in adiponectin related to changes in other measured blood biochemical values after the exercise . These results suggest that plasma adiponectin is altered as a result of maximal acute exercise in highly trained athletes 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 Abstract Background We have previously shown that a Palaeolithic diet consisting of the typical food groups that our ancestors ate during the Palaeolithic era , improves cardiovascular disease risk factors and glucose control compared to the currently recommended diabetes diet in patients with type 2 diabetes . To eluci date the mechanisms behind these effects , we evaluated fasting plasma concentrations of glucagon , insulin , incretins , ghrelin , C-peptide and adipokines from the same study . Methods In a r and omised , open-label , cross-over study , 13 patients with type 2 diabetes were r and omly assigned to eat a Palaeolithic diet based on lean meat , fish , fruits , vegetables , root vegetables , eggs and nuts , or a diabetes diet design ed in accordance with current diabetes dietary guidelines during two consecutive 3-month periods . The patients were recruited from primary health-care units and included three women and 10 men [ age ( mean ± SD ) 64 ± 6 years ; BMI 30 ± 7 kg/m2 ; diabetes duration 8 ± 5 years ; glycated haemoglobin 6.6 ± 0.6 % ( 57.3 ± 6 mmol/mol ) ] with unaltered diabetes treatment and stable body weight for 3 months prior to the start of the study . Outcome variables included fasting plasma concentrations of leptin , adiponectin , adipsin , visfatin , resistin , glucagon , insulin , C-peptide , glucose-dependent insulinotropic polypeptide , glucagon-like peptide-1 and ghrelin . Dietary intake was evaluated by use of 4-day weighed food records . Results Seven participants started with the Palaeolithic diet and six with the diabetes diet . The Palaeolithic diet result ed in a large effect size ( Cohen ’s d = −1.26 ) at lowering fasting plasma leptin levels compared to the diabetes diet [ mean difference ( 95 % CI ) , −2.3 ( −5.1 to 0.4 ) ng/ml , p = 0.023 ] . No statistically significant differences between the diets for the other variables , analysed in this study , were observed . Conclusions Over a 3-month study period , a Palaeolithic diet result ed in reduced fasting plasma leptin levels , but did not change fasting levels of insulin , C-peptide , glucagon , incretins , ghrelin and adipokines compared to the currently recommended diabetes diet . Trial registration : Clinical Trials.gov The relationship between insulin action and control of the adipocyte-derived factor adiponectin was studied in age- and weight-matched obese individuals with type 2 diabetes failing sulfonylurea therapy .  After initial metabolic characterization , subjects were r and omized to troglitazone or metformin treatment groups ; all subjects received glyburide ( 10 mg BID ) as well . Treatment was continued for 3 months . The extent of glycemic control after treatment was similar in both groups . However , the increase in maximal insulin-stimulated glucose disposal rate was greater following troglitazone therapy ( + 44 % ) compared with metformin treatment ( + 20 % ) . Troglitazone treatment increased serum adiponectin levels nearly threefold . There was no change in serum adiponectin with metformin treatment . A positive correlation was found between increases in whole-body glucose disposal rates and serum adiponectin levels after troglitazone ; no such relationship was seen with metformin . The adiponectin protein content of subcutaneous abdominal adipocytes was increased following troglitazone treatment and unchanged after metformin .  Adiponectin release from adipocytes was also augmented with troglitazone treatment . Adiponectin was present in adipocytes and plasma in several multimeric forms ; a trimer was the major form secreted from adipocytes . These results indicate that increases in adiponectin content and secretion are associated with improved insulin action but are not directly related to glycemic control . Modulation of adipocyte function , including upregulation of adiponectin synthesis and secretion , may be an important mechanism by which thiazolidinediones influence insulin action Background The relative contribution of anthropometric , hormonal , and metabolic changes after  bariatric surgery ( BS ) on sexual function ( SF ) in severely obese subjects is not well established . Methods Prospect i ve observational case series study of 39 men undergoing BS .  SF was assessed by means of the international index of erectile function ( IIEF ) before and at 1 year after surgery . At the same time points , anthropometric ( body mass index , waist circumference ) , hormonal ( testosterone , sex hormone binding globulin , estradiol , gonadotropins , inhibin B , prolactin , leptin ) , and metabolic parameters ( insulin sensitivity , C-reactive protein , lipid profile , hemoglobin A1c , presence of hypertension or sleep apnea ) were assessed . Results BS was associated with marked weight loss ( 77.18 % excess weight loss ) , improved IIEF score ( baseline : 54.85 ± 16.59 , 1 year : 61.21 ± 14.10 ; p < 0.01 ) , gonadal function ( testosterone : baseline 256.36 ± 120.98 , 1 year : 508.01 ± 161.90 ; p < 0.001 ) , and improved metabolic profile . However , on multivariate regression analysis whereas changes in body mass index ( beta : −0.677 , p = 0.001 ) , and baseline IIEF score ( beta : −0.397 , p = 0.023 ) , were independent predictors of the changes in the IIEF score at 1 year after surgery , changes in hormonal and metabolic factors were not . Variables in the model accounted for 66 % of the postsurgical variation in the IIEF score . Similar results were found when the different IIEF-sexual domains were evaluated , except for intercourse satisfaction for which no independent predictor was identified . Conclusions Weight loss ’s beneficial effects on SF occurring after BS are beyond the parallel improvement in gonadal and metabolic profiles OBJECTIVE Adiponectin is the most abundant protein secreted by adipose tissue and is inversely associated with adiposity and insulin resistance . The aim of this study was to evaluate the hypothesis that marked weight loss , induced by gastric bypass surgery ( GBS ) , would increase adiponectin gene expression in both upper and lower subcutaneous body fat and increase plasma adiponectin concentration . RESEARCH METHODS AND PROCEDURES Adiponectin subcutaneous abdominal and femoral adipose tissue gene expression , determined by using quantitative reverse transcriptase-polymerase chain reaction , and adiponectin plasma concentrations , determined by using enzyme-linked immunosorbent assay , were evaluated in six extremely obese women ( BMI = 57.1 + /- 4.1 kg/m2 ) before and 1 year after GBS . RESULTS After GBS , subjects lost 36 + /- 5 % of their initial body weight and showed increased insulin sensitivity , manifested by a marked decrease in homeostasis model assessment of insulin resistance from 10.7 + /- 4.1 to 1.4 + /- 0.3 ( p < 0.05 ) . Adiponectin gene expression increased 8- to 15-fold in subcutaneous abdominal and femoral adipose tissues ( p < 0.05 ) . Plasma adiponectin concentrations increased from 5.2 + /- 0.9 to 8.4 + /- 1.2 mug/mL ( p < 0.05 ) . DISCUSSION These data show that marked weight loss induced by GBS increases adiponectin gene expression in both upper- and lower-body subcutaneous fat . The increase in adipose tissue adiponectin production result ed in an increase in plasma adiponectin concentrations , which likely contributed to the decrease in insulin resistance observed after weight loss The impact of energy economy on body weight loss was investigated in 20 obese women , su bmi tted to Roux-en-Y gastric bypass .  Resting energy expenditure ( REE ) , substrate oxidation rates , plasma glucose , free fatty acid , and insulin and leptin levels were measured before and 3 , 6 , and 12 months after surgery . Predicted REE was obtained from linear regression analysis of REE and fat free mass , in a group of 85 women , whose body mass index ranged between 20 and 60 kg/m(2 ) . The deviation from predicted REE , calculated as area under the curve ( AUC ) over the 12-month period for each patient , was considered as the expression of energy economy . Energy economy AUC was significantly ( P : < 0.005 ) negatively related to the weight lost during 12 months after surgery . Energy intake , calculated from self-reported food consumption , was also expressed as AUC . Energy intake AUC showed a significant ( P : < 0.002 ) positive correlation with weight loss . Lipid oxidation rate , also calculated as AUC , significantly correlated , negatively , with energy economy ( P : < 0 . 001 ) and , positively , with energy intake ( P : < 0.002 ) . Preoperative leptin values were significantly ( P : < 0.01 ) linked to individual energy economy capacity . In conclusion , after Roux-en-Y gastric bypass , energy economy hampers the weight loss process , probably through a low fat oxidation rate AIMS To evaluate the effect of weight loss after bariatric surgery ( BS )  on peripheral adipocytokines , renal parameters and other cardiovascular risk factors ( CVRFs ) . METHODS A total of 70 ( 41 women ) extremely obese adults were prospect ively studied before and 12 months after surgery . CONTROLS 24 ( 15 women ) normal-weight adults .  Anthropometric , biochemical and renal parameters were recorded . RESULTS Presurgery , adiponectin ( ADPN ) was lower , whereas leptin , insulin resistance , C-reactive protein , creatinine clearance and albuminuria were higher in patients than controls ( P<0.001 ) . All parameters improved postsurgery . Changes in ADPN correlated negatively with leptin , insulin resistance , albumin , C-reactive protein , and creatinine clearance . Multiple regression analysis : using changes in ADPN as the dependent variable , only changes in insulin resistance ( P=0.005 ) and albumin ( P=0.019 ) were significant independent determinants for changes in ADPN . No statistical differences were found in relation to the degree of obesity . CONCLUSION Patients changed to obesity type I after surgery . This implies a substantial improvement of CVRFs including ADPN , creatinine clearance and albuminuria . Changes in plasma ADPN correlated negatively with insulin resistance and with albuminemia but not with renal parameters . The lack of differences between different degrees of obesity suggests that the relationship between weight and CVRFs no longer exists when obesity becomes very extreme 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 OBJECTIVE Soluble leptin receptor ( sOB-R ) represents the main binding site for leptin in human blood . The aim of this study was to investigate the relationship between leptin and soluble leptin receptor and the bound/free ratio after pronounced weight reduction . RESEARCH METHODS AND PROCEDURES A total of 18 morbidly obese women participated in this prospect i ve study . Subjects were examined for fat mass , leptin , and sOB-R concentrations before and 1 year after Swedish adjustable gastric b and ing . RESULTS Anthropomorphic measures displayed a significant reduction of body mass index [ ( 42.9 + /- 5.6 to 32.9 + /- 6.0 kg/m(2 ) ( mean + /- SD ) ] . Fat mass decreased from 56.3 + /- 9.0 to 33.9 + /- 12.5 kg . Plasma leptin concentration decreased from 44.6 + /- 18.0 to 20.0 + /- 13.1 ng/mL ( p < 0.001 ) , whereas the sOB-R levels increased from 11.1 + /- 3.6 to 16.6 + /- 6.0 U/mL after weight-reducing surgery . Thus , the sOB-R bound fraction of leptin increased from 7 % to 33 % . DISCUSSION This work demonstrates a relationship between weight loss , leptin , and sOB-R concentrations in vivo . During weight loss , leptin levels decreased , whereas sOB-R levels and the receptor bound fraction of leptin increased . Thus , sOB-R may negatively regulate free leptin 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 OBJECTIVE To analyze the relationship between visceral fat accumulation and resting energy expenditure in obese women and to evaluate the effects of a severe weight loss both on energy expenditure and on fat distribution . DESIGN Twelve premenopausal women , aged 19 - 50 years , undergoing adjustable silicone gastric b and ing ( ASGB ) for morbid obesity participated at the study . The patients were evaluated twice . The baseline evaluation was performed immediately before surgery . After surgery , a diet specifically developed for patients su bmi tted to  gastric restriction  ( 2.5 MJ/day ) was given to the patients . The second evaluation was performed 6 months after surgery . MEASUREMENTS Resting metabolic rate ( RMR ) was determined by indirect calorimetry .  Total fat area ( TFA ) , visceral fat area ( VFA ) and subcutaneous fat area ( SFA ) were measured by abdominal computed tomography . Fat mass ( FM ) and fat free mass ( FFM ) were derived by bioelectrical impedance analysis . RESULTS At baseline , RMR was positively related to VFA ( r = 0.60 , P < 0.05 ) . ASGB induced a highly significant weight loss of 24.4 + /- 9.0 kg . This weight reduction was mainly due to a loss of FM ( 68.5 + /- 10.8 vs 48.5 + /- 9.2 kg , P < 0.001 ) , whereas FFM was only slightly reduced ( 52.6 + /- 4.0 vs 47.9 + /- 4.6 kg , P < 0.05 ) . The BMI reduction was positively related to the baseline BMI and FM values ( r = 0.61 , P < 0.05 and r = 0.55 , P < 0.05 , respectively ) . There was no significant correlation between the BMI reduction and the baseline variables of fat distribution , nor between the BMI reduction and the basal RMR . Weight loss was accompanied by modifications of fat distribution . In particular , the reduction of VFA after surgery was strictly related to the VFA values at baseline ( r = 0.91 , P < 0.001 ) . Weight loss induced a significant reduction of RMR ( 7.96 + /- 1.77 vs 6.57 + /- 6.90 MJ/day ; P < 0.01 ) . The reduction of the RMR observed with weight loss was significantly related to the FFM loss ( r = 0.63 , P < 0.05 ) , whereas no correlations were found between the changes of RMR and the FM loss . Regarding to fat distribution , the reduction of the RMR was significantly related to the visceral fat loss ( r = 0.57 , P < 0.05 ) , but not to the modifications of total or subcutaneous fat area . The independent contribution of the modifications of FFM , FM , and visceral fat to the changes of RMR was analyzed by multiple regression analysis . In this model , both FFM and visceral fat changes result ed independently related to the RMR . CONCLUSIONS ( 1 ) visceral fat accumulation was a significant predictor of RMR in the very obese woman ; ( 2 ) visceral obese women lost more visceral fat than subcutaneous ones ; ( 3 ) the reduction of the RMR observed during weight loss could partly be explained by a reduction of visceral fat mass Cardiovascular disease remains the leading cause of death in women . Both obesity and diabetes mellitus are important independent risk factors for the development of cardiovascular disease . Obesity is the leading risk factor for type 2 diabetes . The Centers for Disease Control and Prevention report that 32 % of white and 53 % of black women are obese . Women with a body mass index ( BMI ) of 30 kg/m2 have a 28 times greater risk of developing diabetes than do women of normal weight . The risk of diabetes is 93 times greater if the BMI is 35 kg/m2.1 The presence of diabetes can increase a woman 's risk of heart disease 2-fold . In addition , the presence of diabetes overshadows the protective effects of the premenopausal state . In 2007 , 11.5 million of all women over the age of 20 ( 10.2 % ) had diabetes , and rates were slightly higher in ethnic minority groups : 10.4 % in Hispanic women and 11.8 % in non-Hispanic black women.2 The national prevalence rates of diabetes have increased in parallel with the rates of obesity ( Fig. 1 ) . Fig. 1 Age-adjusted percentage of U.S. adults who were obese or who had a diagnosis of diabetes mellitus . Screening Screening for obesity and diabetes is the 1st step to treatment and often reveals individuals who are at risk for but do not yet have overt disease . The United States Preventive Services Task Force ( USPSTF ) recommends that all adults be screened for obesity . Obesity signifies excess adipose tissue . The most widely used method for screening is determination of the BMI . The BMI is weight in kilograms divided by height in meters squared ( BMI = kg/m2 ) ( Table I ) . Most electronic medical records automatically calculate BMI if height and weight are entered . There are also many smart-phone applications and online calculators that can calculate BMI ( for example , http://www.nhlbisupport.com/ bmi ) . Other screening tools include  waist circumference and the waist-to-hip ratio . In women , a waist circumference > 35 in ( 88 cm ) or a waist-to-hip ratio > 0.7 indicates excess visceral fat and increased risk for disease . TABLE I. Body Mass Index ( BMI ) Classification Recommendations for screening for diabetes vary by guideline author . The USPSTF recommends screening asymptomatic patients who have  blood pressures > 135/80 mmHg  . The American Diabetes Association ( ADA ) recommends that individuals who are ≥18 years of age and have a BMI ≥25 kg/m2 and 1 additional risk factor for diabetes should be screened annually ( Table II).3 Individuals over the age of 45 without risk factors should be screened every 3 years . In January 2010 , the ADA released new recommendations for the use of hemoglobin A1C as a screening tool . An A1C greater than 6.5 % indicates diabetes . In addition , the results of screening tests for diabetes can identify individuals with “ prediabetes ” who have a markedly increased risk of developing overt disease.3 TABLE II . American Diabetes Association Recommendations on Screening for Type 2 Diabetes3 Non-Pharmaceutical Treatment Lifestyle-treatment options for diabetes mellitus and excess weight are similar , and 2 recent studies 4,5 have demonstrated the critical components for treating pre-diabetes and diabetes through weight loss , using caloric restriction and physical activity . The 1st study was the Diabetes Prevention Program.4 The purpose of the study was to identify individuals who were at risk for developing diabetes because of elevated fasting plasma glucose or impaired glucose tolerance levels that were not yet in the diagnostic range , in order to determine if metformin or an intensive lifestyle intervention could delay or prevent the onset of diabetes . More than 3,000 individuals with prediabetes were r and omized to receive placebo , metformin , or a 16-session lifestyle-modification program . The intensive lifestyle program set a goal of 7 % weight loss and 150 min/wk of moderate physical activity . Fifty percent of the lifestyle-intervention group lost 7 % of their body weight . The 3-year incidence of diabetes in the metformin group was 31 % lower than that in the placebo group . The incidence was 58 % lower in the lifestyle group than in the placebo group.4 The clinical implication s of this study are that we should 1 ) identify individuals with pre-diabetes and 2 ) recommend lifestyle modifications that result in a 7 % weight loss and include 150 min/wk of moderate physical activity . The 2nd study that examined lifestyle treatment of diabetes and obesity is the Look AHEAD Trial . The purpose of the study was to determine the effect of intentional weight loss on cardiovascular risk factors in individuals with diabetes . Approximately 5,100 individuals with type 2 diabetes and an elevated BMI were r and omized . Study conditions specified a 36-session intensive lifestyle intervention with the option of using partial meal replacements for caloric restriction or 4 sessions of st and ard diabetes support and education ( DSE ) . At 1 year , 55 % of the intensive-lifestyle-intervention group achieved 7 % weight loss . Hemoglobin A1C , systolic and diastolic blood pressure , and lipids improved significantly more in the intensive-lifestyle group than in the DSE group.5 The clinical implication of this study is that intentional weight loss of at least 7 % can improve the cardiovascular risk profile of patients with type 2 diabetes . Conclusions Excess weight affects two thirds of the U.S. adult population and increases risk for cardiovascular disease and diabetes . All patients should be screened for obesity and most should be screened for pre-diabetes and diabetes . The best treatment for diabetes is prevention . Prevention of diabetes can be accomplished through a 7 % weight loss through intensive lifestyle interventions that include caloric reduction and approximately 30 min of daily moderate physical activity . Practitioners will have access to these evidence -based programs soon . The Centers for Disease Control and Prevention are promoting community-based diabetes prevention programs throughout the country OBJECTIVE Biliopancreatic diversion ( BPD ) restores normal glucose tolerance in a few weeks in morbid obese subjects with type 2 diabetes , improving insulin sensitivity . However , there is less known about the effects of BPD on insulin secretion . We tested the early effects of BPD on insulin secretion in obese subjects with and without type 2 diabetes . METHODS AND PROCEDURES Twenty-one consecutive morbid obese subjects , 9 with type 2 diabetes ( T2DM ) and 12 with normal fasting glucose ( NFG ) were evaluated , just before and 1 month after BPD , by measuring body weight ( BW ) , glucose , adipocitokines , homeostasis model assessment of insulin resistance ( HOMA-IR ) , acute insulin response ( AIR ) to e.v . glucose and the insulinogenic index adjusted for insulin resistance ( [DeltaI5/DeltaG5]/HOMA-IR ) . RESULTS Preoperatively , those with T2DM differed from those with NFG in showing higher levels of fasting glucose , reduced AIR ( 57.9 + /- 29.5 vs. 644.9 + /- 143.1 pmol/l , P < 0.01 ) and reduced adjusted insulinogenic index ( 1.0 + /- 0.5 vs. 17.6 + /- 3.9 1/mmol(2 ) , P < 0.001 ) . One month following BPD , in both groups BW was reduced ( by approximately 11 % ) , but all subjects were still severely obese ; HOMA-IR and leptin decreased significanlty , while high-molecular weight ( HMW ) adiponectin and adjusted insulinogenic index increased . In the T2DM group , fasting glucose returned to non-diabetic values . AIR did not change in the NFG group , while in the T2DM group it showed a significant increase ( from 58.0 + /- 29.5 to 273.8 + /- 47.2 pmol/l , P < 0.01 ) . In the T2DM group , the AIR percentage variation from baseline was significantly related to changes in fasting glucose ( r = 0.70 , P = 0.02 ) , suggesting an important relationship exists between impaired AIR and hyperglycaemia . DISCUSSION BPD is able to restore AIR in T2DM even just 1 month after surgery . AIR restoration is associated with normalization of fasting glucose concentrations CONTEXT The insulin-mimetic adipocytokine visfatin has been linked to obesity . The influence of weight loss on plasma visfatin concentrations in obese subjects is unknown yet . OBJECTIVES In this study we investigated whether plasma visfatin concentrations are altered by weight loss in patients with obesity . DESIGN AND PATIENTS In a prospect i ve study , fasting plasma visfatin , leptin , and adiponectin concentrations were measured before and 6 months after gastric b and ing in 31 morbidly obese patients aged 40 + /- 11 yr with a body mass index ( BMI ) of 46 + /- 5 kg/m(2 ) . Fourteen healthy subjects aged 29 + /- 5 yr with a BMI less than 25 kg/m(2 ) served as controls . RESULTS Visfatin plasma concentrations were markedly elevated in obese subjects ( 0.037 + /- 0.008 microg/ml ) , compared with controls ( 0.001 + /- 0.000 microg/ml , P < 0.001 ) . Gastric b and ing  reduced BMI to 40 + /- 5 kg/m(2 ) , visfatin to 19.2 + /- 10.9 ng/ml , and leptin from 39.0 + /- 12.4 to 29.7 + /- 10.0 ng/ml and increased adiponectin from 0.015 + /- 0.007 to 0.017 + /- 0.007 microg/ml ( all P < 0.05 ) after 6 months . Insulin sensitivity as estimated by the homeostasis model assessment insulin resistance index was unchanged from 5.8 + /- 3.1 to 4.6 + /- 1.9 ( P = 0.13 ) , but individual changes of insulin resistance and visfatin were significantly associated ( P < 0.05 , r = -0.43 ) . CONCLUSIONS Elevated plasma visfatin concentrations in morbidly obese subjects are reduced after weight loss . This may be related to changes in insulin resistance over time BACKGROUND Grade D evidence supports a daily protein intake ( DPI ) of > 60 g/d after Roux-en-Y gastric bypass . However , the physiologic effects of this recommendation have yet to be eluci date d. The primary aim of the present study was to assess the effects of DPI after laparoscopic Roux-en-Y gastric bypass on weight loss , leptin levels , and albumin levels . The setting was a 617-acute inpatient bed university-affiliated teaching hospital . METHODS The data from 427 consecutive bariatric surgery patients were prospect ively collected from December 2007 to April 2011 . The data were analyzed using Pearson 's correlation , the chi-square test , the paired t test , analysis of covariance , and hierarchical linear regression analysis . RESULTS Of the 427 patients , 167 ( 39.1 % ) had complete data at 3 , 6 , and 12 months of follow-up and were used for the present analysis . Of the 427 patients , 140 ( 83.8 % ) were women with a mean age and preoperative body mass index ( BMI ) of 42.7 ± 11 years and 47.3 ± 8.1 kg/m(2 ) , respectively . Of the 427 patients , 71.3 % were compliant with a DPI of ≥1 g/kg/d at 12 months postoperatively . The patients had a mean percentage of excess weight loss of 74.9 % ± 16.7 % and a mean BMI of 29.4 ± 5.4 kg/m2 at 12 months . When controlling for the preoperative BMI , carbohydrate violations , and exercise increase , DPI was associated with a greater percentage of excess weight loss ( P = .001 ) , BMI change ( P < .0001 ) , and percentage of lean mass ( P = .003 ) , and a lower percentage of body fat ( P < .0001 ) at 12 months . CONCLUSION Excellent compliance with a DPI of ≥1 g/kg/d at 12 months after laparoscopic Roux-en-Y gastric bypass is feasible and might result in the benefits of increased weight loss , a decreased percentage of body fat , and improved percentage of lean mass Introduction Morbid obesity and obstructive sleep apnea ( OSA ) interact at an inflammatory level . Bariatric surgery reduces inflammatory responses associated with obesity . Heme oxygenase-1 ( HO-1 ) is an enzyme with anti-inflammatory properties , which might be increased in morbid obesity or OSA . We studied morbidly obese patients with OSA to determine : ( a ) HO-1 plasma concentrations according to OSA severity and their relationship with insulin resistance and inflammation and ( b ) the impact of bariatric surgery on HO-1 and parameters of insulin resistance and inflammation . Material and Methods We analyzed the homeostasis model insulin resistance index ( HOMA ) and plasma concentrations of HO-1 , tumor necrosis factor alpha , interleukin-6 , interleukin-1-beta , C reactive protein ( CRP ) , and adiponectin according to polysomnography findings in 66 morbidly obese patients before bariatric surgery  and 12 months after surgery . Results Before surgery , HO-1 plasma concentrations were similar in three groups of patients with mild , moderate , and severe OSA , and correlated with HOMA ( r = 0.27 , p = 0.02 ) . Twelve months after surgery , low- grade inflammation and insulin resistance had decreased in all the groups , but HO-1 plasma concentration had decreased only in the severe OSA group ( p = 0.02 ) . In this group , the reduction in HO-1 correlated with a reduction in CRP concentrations ( r = 0.43 , p = 0.04 ) and with improved HOMA score ( r = 0.37 , p = 0.03 ) . Conclusions Bariatric surgery decreases HO-1 concentrations in morbid obesity with severe OSA , and this decrease is associated with decreases in insulin resistance and in inflammation
target: In conclusion , bariatric surgery is associated with a reduction in specific adipokines including leptin , chemerin , and PAI-1 , whereas adiponectin is raised , adaptations that could be indicative of improved fat mass and function
background: Different adipokines secreted from adipose tissue , exert a range of physiological effects .
  The aim of present systematic review and meta- analysis was to critically investigate the consequence of  bariatric surgery on circulating adipokines , that is , adiponectin , leptin , visfatin , resistin , plasminogen activator inhibitor , and chemerin .