Morbidly “Healthy” Obese Are Not Metabolically Healthy but Less Metabolically Imbalanced Than Those with Type 2 Diabetes or Dyslipidemia (original) (raw)

Abstract

Background

We have investigated the differences between metabolically “healthy” morbidly obese patients and those with comorbidities.

Materials and Methods

Thirty-two morbidly obese patients were divided by the absence (“healthy”: DM−DL−) or presence of comorbidities (dyslipidemic: DM−DL+, or dyslipidemic and with type 2 diabetes: DM+DL+). We have studied various plasma parameters and gene expression adipose tissue, before and after gastric bypass.

Results

The group DM+DL+ tends to have lower values than the other two groups for anthropometric parameters. Regarding the satiety parameters, only leptin (p = 0.0024) showed a significant increase with comorbidities. Lipid parameters showed significant differences among groups, except for phospholipids and NEFA. For insulin resistance parameters, only glucose (p < 0.0001) was higher in DM+DL+ patients, but not insulin or homeostasis model assessment of insulin resistance (HOMA-IR). The gene expression of adiponectin, insulin receptor (INSR) and glucose receptor-4 (GLUT4), in the subcutaneous fat, decreased in all groups vs. a non-obese control. Interleukin-6 (IL6) and the inhibitor of plasminogen activator type 1 (PAI-1) genes decreased only in DM−DL+ and DM+DL+, but not in “healthy” patients. Leptin increased in all groups vs. the non-obese control. The visceral fat from DM+DL+ patients showed a sharp decrease in adiponectin, GLUT4, IL6 and PAI-1. All parameters mentioned above improved very significantly by surgery, independent of the occurrence of comorbidities.

Conclusions

The morbidly obese “healthy” individual is not really metabolically healthy, but morbidly obese individuals with diabetes and dyslipidemia are more metabolically imbalanced.

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Abbreviations

RYGBP:

Roux-en-Y gastric bypass

HOMA-IR:

Homeostasis model assessment of insulin resistance

NEFA:

Non-esterified fatty acid

TG:

Triglyceride

TC:

Total cholesterol

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

DM:

Diabetes mellitus

DL:

Dyslipidemia

HTA:

Arterial hypertension

PAI-1:

Plasminogen activator inhibitor-1

CRP:

C-Reactive Protein

SAT:

Subcutaneous adipose tissue

VAT:

Visceral adipose tissue

CVD:

Cardiovascular disease

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Acknowledgments

Study concept and design (JAB-F, JP-O), surgery and endocrinology studies of patients (JAB-F, JMF, JMB, EC, OG, RV, AL) performed experiments (RF, EP, JR), tissue analyses (RF, EP, JR), analysis and interpretation of data (JAB-F, JP-O, AL, RF, EP, JR), obtained funding (JP-O), drafting of manuscript (JP-O), critical revision of the manuscript for important intellectual content (JAB-F, JP-O, AL, RF). We thank Dr. Miñarro of the Biostatistics Dept. of Biology Fac. (UB) for their invaluable help. All authors were involved in writing the paper and approved the final version of the manuscript. English grammar and language were corrected by American Journal Experts (www.journalexperts.com).

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that no conflicts of interest exist. The authors who have taken part in this study do not have a relationship, past or present, with the manufacturers of the drugs involved and did not receive funding from the manufacturers to conduct their research.

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Authors and Affiliations

  1. Biochemistry Department, Hospital Universitari Vall D’Hebron, Universitat Autònoma De Barcelona, Barcelona, Spain
    Roser Ferrer
  2. Biochemistry and Molecular Biology Department, Biology Faculty, Barcelona University, Barcelona, Spain
    Eva Pardina, Joana Rossell, Laura Oller, Anna Viñas & Julia Peinado-Onsurbe
  3. Surgery Unit, Arnau de Vilanova University Hospital (UdL), Lleida, Spain
    Juan Antonio Baena-Fustegueras
  4. Endocrinology and Nutrition Department from Arnau de Vilanova University Hospital (UdL) Lleida and Diabetes and Metabolism Research Unit (VHIR, UAB) Barcelona and CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM-ISCIII), Arnau de Vilanova University Hospital (UdL), Lleida, Spain
    Albert Lecube
  5. CIBER de Enfermedades Hepáticas y Digestivas (CIBEREHD) del Instituto de Salud Carlos III (ISCIII), Hospital Universitari Vall D’Hebron, Universitat Autònoma De Barcelona, Barcelona, Spain
    Víctor Vargas
  6. Endocrinology Surgery Unit, Hospital Universitari Vall D’Hebron, Universitat Autònoma De Barcelona, Barcelona, Spain
    José María Balibrea, Enric Caubet, Oscar González, Ramón Vilallonga & Jose Manuel Fort
  7. Dept. Bioquímica y Biología Molecular, Facultat de Biologia, Universitat de Barcelona, Diagonal 643, 08028, Barcelona, Spain
    Julia Peinado-Onsurbe

Authors

  1. Roser Ferrer
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  2. Eva Pardina
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  3. Joana Rossell
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  4. Laura Oller
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  5. Anna Viñas
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  6. Juan Antonio Baena-Fustegueras
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  7. Albert Lecube
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  8. Víctor Vargas
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  9. José María Balibrea
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  10. Enric Caubet
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  11. Oscar González
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  12. Ramón Vilallonga
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  13. Jose Manuel Fort
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  14. Julia Peinado-Onsurbe
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Corresponding author

Correspondence toJulia Peinado-Onsurbe.

Additional information

Roser Ferrer and Eva Pardina have contributed equally to this study.

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Ferrer, R., Pardina, E., Rossell, J. et al. Morbidly “Healthy” Obese Are Not Metabolically Healthy but Less Metabolically Imbalanced Than Those with Type 2 Diabetes or Dyslipidemia.OBES SURG 25, 1380–1391 (2015). https://doi.org/10.1007/s11695-014-1528-z

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