Background. Obesity is a chronic metabolic disease that is manifested by excessive development of adipose tissue, which has a certain range of complications and a high risk of relapse after the end of treatment. The association of obesity with various metabolic disorders makes it one of the most important health problems for both developed and developing countries. The purpose was to analyze the dynamics of changes in lipid and carbohydrate metabolism in patients with morbid obesity (MO) before and after biliopancreatic diversion (BPD) in the modification of Hess-Marceau and sleeve gastrectomy. Materials and methods. A sample of the study consisted of 82 patients with MO and concomitant metabolic syndrome aged 21 to 62 years (mean age 40.60 ± 1.09 years) who underwent surgery and were under supervision in the postoperative period in Garvis clinic which is the base of surgery department 1 of the State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine” for 2 to 3 years or more after the operation. The distribution of patients by groups was carried out depending on the surgical method. Clinical group I consisted of 30 (36.6 %) patients with BPD in the Hess-Marceau modification; group II — 52 (63.4 %) patients with sleeve gastrectomy. In different number of patients in both groups during the observation period, the features of lipid and carbohydrate metabolism were determined using common practical and clinical methods. Evaluation of the results of weight loss, changes in the markers of lipid and carbohydrate metabolism was performed in the dynamics of observation — during the first visit at the stage of preoperative preparation, 3, 6, 12, 18, 24 and 36 months after surgery. Results. Analysis of the dynamics of morbid obesity after surgical treatment showed general trends to significant (from p < 0.01 to p < 0.001) decrease in body mass parameters and body mass index (BMI) in patients of all clinical groups within 3 months after the start of treatment. In group I, a significant decrease in indicators occurred within 18 months, in group II — in the period of 6–12 months. Dyslipidemic disorders in patients with MО reliably correlated with indicators of excessive body weight with varying degrees of significance (from p < 0.05 to p < 0.01). The results of the study of carbohydrate metabolism rates prior to surgical treatment showed the significant interdependence of C-peptide, insulin and glucose blood levels on the BMI of patients (from p < 0.01 to p < 0.001). The dynamics of the study showed trends towards normalization of lipid and carbohydrate metabolism in patients of both groups within 2 years after bariatric intervention, with the greatest changes in BPD group after 3 and 6 months. Conclusions. The direct correlation of the lipid and carbohydrate metabolism indices with the BMI and overweight indicated the need for surgical treatment in these patients. Tendencies toward lipid and carbohydrate metabolism normalization in patients of both groups within 2 years after bariatric intervention demonstrated its effectiveness.
morbid obesity; surgical treatment; biliopancreatic diversion; sleeve gastrectomy; lipid metabolism; carbohydrate metabolism
Fedorova EU, Kutyrina IM. Mechanisms of progression of kidney injury in obesity. Nephrology and Dialysis. 2006;8(2):102-111. (in Russian).
Butrova SA, Dzgoeva FKh. Visceral obesity is a key link in the metabolic syndrome. Obesity and metabolism. 2004;(1):10-16. (in Russian).
Buckland Y. The obesity epidemic. J Fam Health Care. 2002;12(4):111. PMID: 12416021.
Labib M. Acp Best Practice No 168. The investigation and management of obesity. J Clin Pathol. 2003 Jan;56(1):17-25. PMID: 12499427.
Lavrik AS, Tivonchuk AS, Manoylo NV, Dmitrienko EP, Lavrik OA. The possibilities of metabolic syndrome surgical correction with the patients struggling from obesity. Suchasni medychni tehnologii'. 2013;(3):98-101. (in Russian).
Wang Y, Lim H. The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry. 2012 Jun;24(3):176-88. doi: 10.3109/09540261.2012.688195.
Peterkova VA, Remizov OV. Obesity in childhood. Obesity and metabolism. 2004;(1):17-23. (in Russian).
Livingstoun B. Epidemiology of childhood obesity in Europe. Eur J Pediatr. 2000 Sep;159 Suppl 1:S14-34. PMID: 11011953.
Després JP. Optimal prevention of coronary risk in patients with visceral obesity and dyslipidemia. In: Proceeding of the 10th European Congress on Obesity (European Association for the Study of Obesity). 2000, May 24-27; Antwerp, Belgium. Int J Obes Relat Metab Disord. 2000 May;24 Suppl 1:S1-198. PMID: 10907057.
Ivashkin VT, Maevskaia MV. Lipotoxicity and metabolic disorders in obesity. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii. 2010;20(1):4-13. (in Russian).
Rebrova OIu. Statisticheskii analiz meditsinskikh dannykh. Primenenie paketa prikladnykh programm STATISTICA [Statistical analysis of medical data. Application of the STATISTICA software package]. Moscow: Media Sfera; 2002. 312 p. (in Russian).
Spalding KL, Arner E, Westermark PO, et al. Dynamics of fat cell turnover in humans. Nature. 2008 Jun 5;453(7196):783-7. doi: 10.1038/nature06902.
Rosell M, Jones MC, Parker MG. Role of nuclear receptor corepressor RIP140 in metabolic syndrome. Biochim Biophys Acta. 2011 Aug;1812(8):919-28. doi: 10.1016/j.bbadis.2010.12.016.
Al Sharif M1, Alov P, Vitcheva V, Pajeva I, Tsakovska I. Modes-of-Action Related to Repeated Dose Toxicity: Tissue-Specific Biological Roles of PPAR γ Ligand-Dependent Dysregulation in Nonalcoholic Fatty Liver Disease. PPAR Res. 2014;2014:432647. doi: 10.1155/2014/432647.
Hengstler JG, Marchan R, Leist M. Highlight report: towards the replacement of in vivo repeated dose systemic toxicity testing. Arch Toxicol. 2012 Jan;86(1):13-5. doi: 10.1007/s00204-011-0798-7.
Ametov AS, Pugovkina YV, Chernikova NA. Management of hyperglycemia in acute coronary syndrome. Issues and solutions. Meditsinskiy Sovet. 2016;(3):98-104. doi: 10.21518/2079-701X-2016-3-98-105. (in Russian).
Ametov AS. Risk factors for diabetes mellitus. The role of obesity. RMJ. 2003;11(27):1477-1480. (in Russian).
Dedov II, Suntsov IuI, Kudriakova SV. Epidemiology of diabetes mellitus. In: Dedov II, Suntsov IuI, Kudriakova SV. Sakharnyi diabet. Rukovodstvo dlia vrachei [Diabetes mellitus. A guide for doctors]. Moscow: Universum publishing; 2003. 75-93 pp. (in Russian).
Sattar N, Gaw A, Scherbakova O, et al. Metabolic syndrome with and without C-peptid protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation. 2003 Jul 29;108(4):414-9. doi: 10.1161/01.CIR.0000080897.52664.94.
Dedov II, Mel'nichenko GA, Romantsova TI. Pathogenetic aspects of obesity. Obesity and metabolism. 2004;(1):3-9. (in Russian).
Dedov II, editor. Morbidnoe ozhirenie [Morbid obesity]. Moscow: Meditsinskoe informatsionnoe agentstvo ; 2014. 608 p. (in Russian).
Makolkin VI. Metabolicheskii sindrom [Metabolic Syndrome]. Moscow: Meditsinskoe informatsionnoe agentstvo; 2010. 142 p. (in Russian).