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Impact of Weight Loss on Inflammatory Proteins and Their Association With the Insulin Resistance Syndrome in Morbidly Obese Patients
Abstract
Objective— Obesity is closely linked to the insulin resistance syndrome (IRS), type 2 diabetes, and cardiovascular disease, the primary cause of morbidity and mortality in these patients. Elevated levels of C-reactive protein (CRP) and interleukin-6 (IL-6), indicating chronic subclinical inflammation, have been associated with features of the IRS and incident cardiovascular disease. Methods and Results— We studied the cross-sectional and longitudinal relation of CRP, IL-6, and tumor necrosis factor-α (TNF-α) with features of the IRS in 37 morbidly obese patients with different stages of glucose tolerance before and 14 months after gastric surgery. Weight loss after gastric surgery induced a significant shift from diabetes (37% vs 3%) to impaired glucose tolerance (40% vs 33%) and normal glucose tolerance (23% vs 64%). The baseline concentration of IL-6 was correlated with TNF-α ( r =0.59, P <0.01) and CRP ( r =0.44, P <0.05) levels. TNF-α, IL-6, and CRP were significantly correlated with insulin resistance estimated by the homeostatic model assessment ( r =0.48, P <0.05; r =0.56, P <0.01; and r =0.35, P <0.05, respectively). Concentrations of CRP and IL-6 decreased after weight loss (median, 8.6 and interquartile range, 2.7/14.5 vs 2.5 and 1.2/4.1 mg/L; P <0.006, and 5.13 and 2.72/12.15 vs 3.95 and 1.97/5.64 pg/mL, P <0.02, respectively), whereas serum levels of TNF-α remained unchanged (8.6 and 6.3/18.8 vs 11.7 and 5.8/17.2 pg/mL; NS.). Multiple regression analysis revealed that the decrease in insulin resistance remained independently and significantly correlated with the decrease in IL-6 concentrations ( P <0.01) and the decrease in body mass index with the decrease in CRP ( P <0.05), respectively. Conclusions— Weight loss in morbidly obese patients induces a significant decrease of CRP and IL-6 concentrations in association with an improvement of the IRS.
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BackgroundInfluentialBariatric Surgery in Patients With Morbid Obesity and Type 2 Diabetes
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Self-citationObesity and Inflammation: Lessons From Bariatric Surgery
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ResultThe Multiple Facets of the Fat Tissue
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“not correlate with HOMA-IR 14 months after gastroplasty, but instead independently correlated with BMI reduction [40].”
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BackgroundResultA therapeutic role for vitamin D on obesity-associated inflammation and weight-loss intervention
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“, gastric bypass surgery), decreases in inflammation, especially IL-6 and TNF-a, have been observed [133], while serum vitamin D levels have shown to increase in obese populations in a manner dependent upon weight loss [134, 135].”
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“Nonetheless, lifestyle changes have been reported to affect adiponectin (15, 19, 32), CRP (19, 24, 32, 33), IL-6 (15, 32, 33), and TNF (7, 15) favorably in type 2 diabetic volunteers; effects on resistin are variable (16, 19).”
BackgroundBasal high-sensitivity-C-reactive protein levels in patients with spontaneous venous thromboembolism
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“These data are underlined by the observation that basal CRP levels decrease as soon as a weight reduction is achieved (27, 28), for instance, in morbidly obese patients, who underwent vertical ring gastroplasty (29).”
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“It is also important to note that their results are further confounded by the populations studied, given that both CRP and adipocytokines are affected by obesity and weight loss [65, 66].”
ResultObesity and Periodontal Disease: A Narrative Review on Current Evidence and Putative Molecular Links
Spirito, F. D., Sbordone, L., Pilone, V., & D’Ambrosio, F. (2019) · The Open Dentistry Journal · doi:10.2174/1874210601913010526 · Cited by 45
Ethanol extract of propolis regulates type 2 diabetes in mice via metabolism and gut microbiota
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Dysregulation of maternal serum adiponectin in preterm labor
Mazaki‐Tovi, S., Romero, R. J., Vaisbuch, E., Erez, O., Mittal, P., Chaiworapongsa, T., Kim, S. K., Pacora, P., Yeo, L., Gotsch, F., et al. (2009) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767050902994655 · Cited by 45
“Intra-amniotic inflammation was diagnosed by an amniotic fluid IL-6 concentration 2.6 ng/ml [133].”
BackgroundInfluentialPreeclampsia and Obesity—The Preventive Role of Exercise
Poniedziałek‐Czajkowska, E., Mierzyński, R., & Leszczyńska‐Gorzelak, B. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20021267 · Cited by 73
Fain, J. N., Bahouth, S. W., & Madan, A. K. (2005) · Biochemical Pharmacology · doi:10.1016/j.bcp.2005.02.009 · Cited by 41
Solutions in weight control: lessons from gastric surgery
Blackburn, G. L. (2005) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/82.1.248s · Cited by 41
“Current metabolic studies of patients with diabetes undergoing weight loss surgery have shown the following: a recovery of acute insulin response (26); significant decreases of inflammatory indicators (C-reactive protein and interleukin) (27); improvement in insulin sensitivity correlated with increases in plasma adip…”
BackgroundMuramoto, A., Tsushita, K., Kato, A., Ozaki, N., Tabata, M., Endo, M., Oike, Y., & Oiso, Y. (2011) · Nutrition and Diabetes · doi:10.1038/nutd.2011.16 · Cited by 39
Adipose tissue, estradiol levels, and bone health in obese men with metabolic syndrome
Ørnstrup, M. J., Kjær, T. N., Harsløf, T., Stødkilde‐Jørgensen, H., HOUGAARD, D. M., Cohen, A. S., Pedersen, S. B., & Langdahl, B. L. (2014) · European Journal of Endocrinology · doi:10.1530/eje-14-0792 · Cited by 40
Obesity Surgery: Evidence for Diabetes Prevention/Management
Cummings, S., Apovian, C. M., & Khaodhiar, L. (2008) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2008.01.017 · Cited by 40
Mach, F. (2008) · Clinical Interventions in Aging · doi:10.2147/cia.s2706 · Cited by 40
“Weight loss and the reduction of adiposity were showed to induce favorable changes in hsCRP level (Tchernof et al 2002; Esposito et al 2003; Kopp et al 2003).”
Parameters of Inflammation in Morbid Obesity: Lack of Effect of Moderate Weight Loss
Solá, E., Jover, A., López‐Ruiz, A., Jarabo-Bueno, M. M., Vayá, A., Morillas, C., Gómez‐Balaguer, M., & Hernández‐Mijares, A. (2008) · Obesity Surgery · doi:10.1007/s11695-008-9772-8 · Cited by 38
“Like us, others have reported an absence of changes in inflammatory cytokines in patients that have lost weight through a very low calorie diet [38] or 4–12 months after bariatric surgery [22, 23, 29].”
BackgroundSoluble CD40L in patients with morbid obesity: significant reduction after bariatric surgery
Schernthaner, G.-H., Kopp, H., Krzyżanowska, K., Kriwanek, S., Koppensteiner, R., & Schernthaner, G. (2006) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2006.01649.x · Cited by 38
Self-citationOrtiz, S., Zapater, P., Estrada, J. L., Enriquez, P., Rey, M., Abad, Á. L., Such, J. M., Lluı́s, F., & Francés, R. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-4483 · Cited by 37
Impact of Bariatric Surgical Intervention on Peripheral Blood Neutrophil (PBN) Function in Obesity
Roberts, H. M., Grant, M. M., Hubber, N. A., Super, P., Singhal, R., & Chapple, I. (2017) · Obesity Surgery · doi:10.1007/s11695-017-3063-1 · Cited by 40
Cardiovascular Risk Reduction Associated with Pharmacological Weight Loss: A Meta-Analysis
Kane, J. A., Mehmood, T., Munir, I., Kamran, H., Kariyanna, P. T., Zhyvotovska, A., Yusupov, D., Suleman, U., Gustafson, D., & McFarlane, S. I. (2019) · International Journal of Clinical Research & Trials · doi:10.15344/2456-8007/2019/131 · Cited by 37
Guarnotta, V., Bianco, M. J., Vigneri, E., Panto’, F., Lo Sasso, B., Ciaccio, M., Pizzolanti, G., & Giordano, C. (2021) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2021.07.015 · Cited by 36
Appachi, S., Kelly, K. R., Schauer, P. R., Kirwan, J. P., Hazen, S. L., Gupta, M. K., & Kashyap, S. R. (2011) · Obesity Surgery · doi:10.1007/s11695-011-0447-5 · Cited by 36
“The change in TNF-α following bariatric surgery is a controversial topic in the literature, with some studies showing this cytokine decreases postsurgery [36, 37], and others indicating there is no change [38, 39].”
Inflammation, adipokines et obésité
Clément, K., & Vignes, S. (2009) · La Revue de Médecine Interne · doi:10.1016/j.revmed.2009.03.363 · Cited by 40
Schernthaner, G.-H., & Schernthaner, G. (2005) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.1080/00365510500236119 · Cited by 35
Self-citationGlucocorticoids Inhibit the Cerebral Microvascular Dysfunction Associated with Sepsis in Obese Mice
Vachharajani, V., Vital, S. A., Russell, J., Scott, L. K., & Granger, D. N. (2006) · Microcirculation · doi:10.1080/10739680600777599 · Cited by 35
“The chronic inflammatory hypothesis for the morbidity associated with obesity is largely based on reports describing elevated plasma concentrations of cytokines and other inflammatory mediators that correlate with markers of adipocyte mass, with weight loss resulting in a reduction of inflammatory mediators and a corr…”
BackgroundResultLiu, C.-W., Tsai, H., Huang, C., Tsai, C., Su, Y.-B., Lin, M., Lee, K., Hsieh, Y., Li, T., Huang, S., et al. (2017) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00094.2017 · Cited by 35
Mansoori, N., Tripathi, M., Alam, R., Luthra, K., Ramakrishnan, L., Parveen, S., & Mukhopadhyay, A. K. (2010) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000321666 · Cited by 32
Obesity-related cardiorenal disease: the benefits of bariatric surgery
Fenske, W., Athanasiou, T., Harling, L., Drechsler, C., Darzi, A. W., & Ashrafian, H. (2013) · Nature Reviews Nephrology · doi:10.1038/nrneph.2013.145 · Cited by 32
Cure of Type 2 Diabetes by Metabolic Surgery? A Critical Analysis of the Evidence in 2010
Schernthaner, G., Brix, J. M., Kopp, H.-P., & Schernthaner, G.-H. (2011) · Diabetes Care · doi:10.2337/dc11-s253 · Cited by 30
Self-citationGut Microbiome, Obesity-Related Comorbidities, and Low-Grade Chronic Inflammation
Tarantino, G. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-2074 · Cited by 32
Konukoğlu, D., Uzun, H., Fırtına, S., Arica, P. Ç., Kocael, A., & Taşkın, M. (2007) · Obesity Surgery · doi:10.1007/s11695-007-9113-3 · Cited by 31
Link Between Metabolic Syndrome, Inflammation, and Eye Diseases
Pieńczykowska, K., Bryl, A., & Mrugacz, M. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26052174 · Cited by 30
“…mechanisms driving the progression of metabolic syndrome converge to create a pro-inflammatory state, which accounts for the elevated levels of inflammatory markers like Interleukin 6 (IL-6), C-reactive protein (CRP), and Tumor Necrosis Factor Alpha (TNF α ) observed in individuals with MetS [17].”
Kopp, H.-P., Krzyżanowska, K., Schernthaner, G.-H., Kriwanek, S., & Schernthaner, G. (2006) · Obesity Surgery · doi:10.1381/096089206778392130 · Cited by 30
Self-citationFathy, S. M., & Morshed, G. (2014) · Archives of Medical Science · doi:10.5114/aoms.2014.46209 · Cited by 30
“Data on the effect of weight loss after bariatric surgery on inflammation and immune cells are emerging, suggesting the reduction in the circulating inflammatory markers [25]; another study also showed that immune cell activation can be regulated by acute energy restriction [26].”
BackgroundIndependent Evolution of Heart Autonomic Function and Insulin Sensitivity During Weight Loss
Bobbioni‐Harsch, E., Sztajzel, J. M., Barthassat, V., Makoundou, V., Gastaldi, G., Sievert, K., Chassot, G., Huber, O., Morel, P., Assimacopoulos‐Jeannet, F., et al. (2008) · Obesity · doi:10.1038/oby.2008.532 · Cited by 30
“On the other hand, the adipocyte secretor activity is deeply influenced by weight reduction, both during the active phase (35) and after weight loss (36,37).”
BackgroundThe key role of inflammation in the pathogenesis and management of obesity and CVD
Boutari, C., Hill, M. A., Procaccini, C., Matarese, G., & Mantzoros, C. S. (2023) · Metabolism · doi:10.1016/j.metabol.2023.155627 · Cited by 30
Metadata
- Authors
- Kopp, H. P., Kopp, C. W., Festa, A., Krzyzanowska, K., Kriwanek, S., Minar, E., Roka, R., & Schernthaner, G.
- Affiliations
- Vienna General Hospital (AT)
- From the Department of Medicine 1 (H.P.K., A.F., K.K., G.S.), Rudolfstiftung Hospital; the Department of Medicine 2 (C.W.K., E.M.), General Hospital of Vienna; and the Department of Surgery 1 and Ludwig Boltzmann Institute for Endocrine Surgery (S.K., R.K.), Rudolfstiftung Hospital, Vienna, Austria.
- Venue
- Arteriosclerosis, Thrombosis, and Vascular Biology
- Published
- 2003-06
- Volume
- 23
- Issue
- 6
- Pages
- 1042-1047
- ISSN
- 1079-5642 (ISSN-L)
- 1524-4636
- OpenAlex
- W2102170193
- Cited by
- 427
- References
- 45
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 10 · 2023: 14 · 2022: 9 · 2021: 10 · 2020: 10 · 2019: 13 · 2018: 17 · 2017: 10 · 2016: 6 · 2015: 24 · 2014: 24 · 2013: 25 · 2012: 15
- FWCI
- 20.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arteriosclerosis Thrombosis and Vascular Biology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Universität Wien
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- morbid obesity, weight loss, metabolic syndrome, C-reactive protein, interleukin-6, TNF-α, chronic inflammation, gastric bypass, bariatric surgery, impaired glucose tolerance, type 2 diabetes, HOMA, body mass index, glucose tolerance, cardiovascular risk factors, adipokines, adipose tissue inflammation, hepatic insulin resistance
- MeSH terms
- Adult, Blood Glucose, C-Reactive Protein, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Fibrinogen, Humans, Inflammation, Insulin, Insulin Resistance, Lipids, Longitudinal Studies, Male, Middle Aged, Obesity, Morbid, Tumor Necrosis Factor-alpha, Gastroplasty, Weight Loss, Interleukin-6, Body Mass Index
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