Insulin resistance, leptin and TNF-alpha system in morbidly obese women after gastric bypass.Obes Surg 2003; 13(4):615-21OS
Obesity is a complex disease associated with insulin resistance. Leptin and the TNF-alpha system could be involved in the pathogenesis of obesity and insulin resistance. Gastric bypass (GBP) is a surgical treatment for morbidly obese patients. We conducted a study after GBP to analyze the pattern of variation of anthropometric and body composition variables, leptin and sTNFR1 and 2.
29 morbidly obese women were studied, at baseline and throughout 6 months after gastric bypass.
At baseline, the BMI was 49 +/- 6 kg/m(2) and patients showed a higher fasting insulin resistance index (FIRI), leptin, leptin/fat mass and sTNFR1 and 2 than did controls. 6 months after GBP, BMI was 35+/-4, and FIRI, leptin and leptin/fat mass decreased significantly in the first months and throughout the follow-up. sTNFR1 and 2 showed an initial increase, but at 6 months their concentrations were similar to baseline (2.6+/-0.8 vs 3.1+/-0.95 ng/ml, P < 0.05; 4.6+/-1.4 vs 7+/-2.5 ng/ml, P < 0.05). At baseline, there was no correlation between leptin and BMI and body composition variables but there was a correlation with fat mass (r=0.42, P=0.004) and sTNFR1 (r=0.58, P=0.001). At 6 months, there was a correlation between leptin and BMI (r=0.53, P=0.004) and sTNFR1 (r=0.46, P=0.013).
Morbidly obese women after GBP became less insulin resistant with lower leptin concentrations, but showed an initial increase of sTNFR1 and 2. This pattern of variation of the leptin TNF-alpha axis suggests a disregulation of the system after dramatic weight loss and also that insulin and leptin up-regulate TNF-alpha production irrespective of insulin resistance status.