期刊
AMERICAN JOURNAL OF MEDICINE
卷 121, 期 11, 页码 966-973出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2008.06.033
关键词
Bariatric surgery; Echocardiography; Leptin; Metabolism; Obesity; Pyruvate dehydrogenase kinase-4; Stearoyl Co-A desaturase
资金
- National Heart, Lung, and Blood Institute of the US Public Health Service [R01HL73162, M01 RR02558]
OBJECTIVE: The study objective was to define muscle metabolic and cardiovascular changes after surgical intervention in clinically severe obese patients. METHODS: Obesity is a state of metabolic dysregulation that can lead to maladaptive changes in heart and skeletal muscle, including insulin resistance and heart failure. In a prospective longitudinal study, 43 consecutive patients underwent metabolic profiling, skeletal muscle biopsies, and resting echocardiograms at baseline and 3 and 9 months after bariatric surgery. RESULTS: Body mass index decreased (mean changes, 95% confidence interval [CI]): 7.7 kg/m(2) (95% CI, 6.70-8.89) at 3 months and 5.6 kg/m(2) (95% CI, 4.45-6.80; P < .0001) at 9 months after surgery, with restoration of insulin sensitivity and decreases in plasma leptin at the same time points. Concurrent with these changes were dramatic decreases in skeletal muscle transcript levels of stearoyl coenzyme-A desaturase and pyruvate dehydrogenase kinase-4 at 3 and 9 months (P < .0001, for both) and a significant decrease in peroxisome proliferation activated receptor-alpha-regulated genes at 9 months. Left ventricular relaxation impairment, assessed by tissue Doppler imaging, normalized 9 months after surgery. CONCLUSION: Weight loss results in the reversal of systemic and muscle metabolic derangements and is accompanied by a normalization of left ventricular diastolic function. (C) 2008 Elsevier Inc. All rights reserved.
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