Published online before print April 24, 2003, doi: 10.1161/01.ATV.0000073313.16135.21
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© 2003 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Impact of Weight Loss on Inflammatory Proteins and Their Association With the Insulin Resistance Syndrome in Morbidly Obese Patients
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.
Correspondence to Hans-Peter Kopp, MD, Department of Medicine 1, Rudolfstiftung Hospital, Juchgasse 25, A-1030 Vienna, Austria. E-mail Hans-Peter.Kopp{at}kar.magwien.gv.at
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-
(TNF-) 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- (r=0.59, P<0.01) and CRP (r=0.44, P<0.05) levels. TNF-, 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- 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.
Key Words: obesity • weight loss • type 2 diabetes • C-reactive protein • interleukin-6
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