Serial changes in inflammatory biomarkers after Roux-en-Y gastric bypass surgery

Background: A number of proteins secreted from adipose tissue, known as adipokines, are involved in the inflammatory process. The expression and secretion of adipokines are altered with obesity, leading to a pro-inflammatory state, with an enhanced vascular immune response. Although weight loss reduces inflammation, the time course for these changes during massive weight loss after bariatric surgery is not well described. We examined the changes in the biomarkers of inflammation after laparoscopic Roux-en-Y gastric bypass (RYGB) in morbidly obese individuals in a university hospital. Methods: The fasting levels of plasma inflammatory adipokines, including leptin, adiponectin, C-reactive protein (CRP), interleukin-6, tumor necrosis factor-alpha (TNF-alpha), and soluble receptor 1 for TNF-alpha were measured before surgery (baseline) and 3 weeks, 3 months, and 6 months after surgery in 15 morbidly obese patients who underwent Roux-en-Y gastric bypass without a major complication. Results: The mean weight loss at 6 months was 25.7% +/- 4.5% of the total body weight. The body mass index decreased from a mean of 55.1 +/- 6.6 kg/m(2) to 40.5 +/- 5.5 kg/m(2). The concentrations of leptin, CRP, and soluble receptor 1 for TNF-alpha decreased, and the adiponectin levels had increased from the baseline measures by 6 months postoperatively. The baseline and 6-month TNF-alpha and CRP levels correlated with each other. No other significant associations among the biomarkers were seen. Conclusion: RYGB reduced the pro-inflammatory biomarkers and increased the anti-inflammatory mediators of obesity, independent of the magnitude of weight loss. The lack of correlations between the changes in biomarkers and weight loss suggests that the driving force behind the changes in the inflammatory markers is multifactorial and needs further investigation to clarify the health changes that occur after RYGB. (Surg Obes Relat Dis 2011;7:618-627.) (C) 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.