Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women

https://doi.org/10.1016/j.bjps.2003.12.010Get rights and content

Abstract

Liposuction is one of the more common elective surgical procedures in the US and is supposed to be on the increase. There are no reported studies specifically addressing the metabolic sequelae of liposuction in obesity. The aim of the present study was to investigate the role of large-volume liposuction on insulin resistance and circulating inflammatory markers in obese people. Thirty healthy premenopausal obese (body mass index (BMI) from 30 to 45) and 30 age-matched normal weight (BMI<25) women were studied. In obese women, insulin sensitivity, as measured by the Homeostasis Model Assessment (HOMA=fasting plasma glucose×fasting serum insulin divided by 25), as well as serum adiponectin, the novel adipocytokine with insulin sensitising properties, were significantly lower, as compared with nonobese women (p<0.01), indicating insulin resistance; on the contrary, serum concentrations of the proinflammatory cytokines IL-6, IL-18 and TNF-α, as well as the sensitive marker of inflammation C-reactive protein, were significantly higher (p<0.01). All obese women were submitted to a single large volume liposuction (superwet technique): the mean aspirate volume was 3540 ml (range 2550–4670), corresponding to a net lipid loss of 2.7±0.7 kg (mean±SD). After six months of stable body weight after liposuction, women were less insulin resistant (p<0.05), had reduced concentrations of IL-6, IL-18, TNF-α and CRP (p<0.05–0.02), and increased serum levels of adiponectin (p<0.02) and HDL-cholesterol (p<0.05). There was a significant correlation between the amount of fat aspirate and changes in HOMA (r=0.28, p<0.05), TNF-α (r=0.31, p<0.02), and adiponectin (r=−0.34, p<0.02), as well as between the decrease in TNF-α and the increase in adiponectin after the surgical procedure (r=−0.45, p<0.01). Our study demonstrates that liposuction is safe and free of metabolic sequelae in obese women, pending a careful screening of the patient. Moreover, it is associated with amelioration of insulin resistance and reduced circulating markers of vascular inflammation which may help obese subjects to reduce their cardiovascular risk.

Section snippets

Patients

Obese (BMI>30) premenopausal women aged 20–46 years were recruited from the outpatient Department for Weight Loss in the teaching hospital at the Second University of Naples, Italy. Exclusion criteria were type 2 diabetes mellitus, hypertension (blood pressure >140/90 mmHg), cardiovascular disease, history of alcohol abuse (intake of >500 g/week in the last year), and any medication use. Thus the obese women satisfied the criteria for successful liposuction surgery, that is healthy individuals

Results

The characteristics of the women who took part in the study are shown in Table 1. All women were premenopausal, with BMI values ranging from 30 to 45. Compared with nonobese women, obese women had higher values of WHR, fasting glucose and insulin concentrations, and HOMA. Serum IL-6, IL-18, TNF-α and CRP levels were higher, while adiponectin levels were lower in the obese group than in the nonobese group. Spearman rank correlation coefficients showed positive associations between circulating

Discussion

This is the first study to assess prospectively the effect of liposuction on metabolic parameters and markers of vascular inflammation in obese women. The data presented show that an amount of fat aspirate between 2 and 3 l is safe and associated with improvement of some metabolic (insulin resistance) and inflammatory (cytokines and CRP) markers.

The vascular inflammatory markers that improved after liposuction are linked to future thrombotic events through mechanisms of atherosclerotic plaque

Acknowledgements

This work was supported, in part, by an University Research Grant of the Second University of Naples, Italy.

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