Is Dermolipectomy Effective in Improving Insulin Action and Lowering Inflammatory Markers in Obese Women?

M. R. Rizzo; G. Paolisso; R. Grella; M. Barbieri; E. Grella; E. Ragno; R. Grella; G. Nicoletti F. D'Andrea

Disclosures

Clin Endocrinol. 2005;63(3):252-258. 

In This Article

Summary and Introduction

Objective: Obesity is a major risk factor for coronary heart disease, and surgical treatment of obese patients as part of a multidisciplinary approach seems to provide faster Results than diet therapy. The aim of this study was to evaluate the effect of dermolipectomy on insulin action and inflammatory markers in 20 obese women.
Patients: At baseline and 40 days after dermolipectomy, 20 obese women underwent indirect calorimetry and hyperinsulinaemic glucose clamp. Twenty obese nonsmoking females (age range 25–40 years) volunteered for the study. All subjects had a stable body weight for 2 months before the study. No patient was affected by cardiovascular and/or pulmonary disease, type 2 diabetes, thyroid dysfunction, acute or chronic hepatitis, renal insufficiency or cancer. No patients was receiving any drug therapy and all measurements were made during the follicular phase of the menstrual cycle.
Results: At baseline, fat mass (FM) correlated with plasma triglycerides (r = 0·58, P < 0·009), free fatty acids (FFA) (r = 0·73, P < 0·001), insulin (r = 0·70, P < 0·002), leptin (r = 0·55, P < 0·01), adiponectin (r = –0·32, P < 0·02) and resistin (r = 0·31, P < 0·01), insulin sensitivity (IS) (r = –0·59, P < 0·005) and respiratory quotient (Rq) (r = 0·62, P < 0·002). With regard to inflammatory markers, FM was significantly correlated with plasma interleukin (IL)-6 (r = 0·71, P < 0·001), IL-10 (r = –0·67, P < 0·002), tumour necrosis factor- (TNF-α) (r = 0·78, P < 0·001) and soluble IL-6 receptor (sIL-6r) (r = –0·65, P < 0·003). Dermolipectomy resulted in a significant decline in total FM of 2·3 ± 0·2 kg. A significant decline in BMI was also observed (30·0 ± 0·08 vs. 31·1 ± 0·7 kg/m2). After 40 days a significant decline in plasma resistin (P < 0·001) and inflammatory markers and an increase in plasma adiponectin (P < 0·03) were observed. Those metabolic changes were accompanied by a significant improvement in insulin-mediated glucose uptake (P < 0·001), substrate oxidation and degree of inflammation. Changes in FM following dermolipectomy correlated with the changes in IS (P < 0·01), substrate oxidation and FFA (P < 0·001).
Conclusions: In obese patients, dermolipectomy is associated with weight lost, improved glucose handling and lower inflammatory markers.

Several previous studies have shown obesity and visceral adiposity to be associated with insulin resistance,[1] elevated plasma free fatty acid (FFA) levels[2,3] and a significant rise in pro-inflammatory markers,[4,5,6] the latter also being a cause of atherosclerosis.[7,8,9,10] The molecular mechanisms underlying the metabolic abnormalities induced by excess adipose tissue have not been completely elucidated, although several cytokines [tumour necrosis factor- (TNF-α), interleukin-6 (IL-6), soluble IL-6 receptor (sIL-6r) and IL-10] and proteins (leptin, resistin and adiponectin) expressed by adipose tissue seem to be involved.[11,12,13,14,15,16,17] Correction of body weight excess is a useful method for preventing the metabolic damage associated with obesity.[18] Drug administration and diet therapy are recommended and used widely in treating obesity,[19,20,21] but both take some time and have a high failure rate. Alternatively, as part of a multidisciplinary treatment of obesity,[22] a surgical approach may be considered. Liposuction, however, has contrasting Results with regard to insulin sensitivity[23,24] and is also associated with severe complications.[25,26,27] In addition, liposuction can be applied only when the overlying skin can retract and adapt to the new situation. By contrast, when a considerable excess of skin and fat is present, dermolipectomy is a useful method for removing the excess fat by surgical resection, with larger incisions and a shorter operation time than liposuction.[28,29] Dermolipectomy may be especially useful for removing abdominal fat with a potential lowering effect on metabolic factors such as the release of FFA.

To the best of our knowledge, no investigation has documented the changes in insulin-mediated glucose metabolism and inflammatory markers following dermolipectomy. Our study therefore aimed to evaluate the changes in insulin action and inflammatory markers following dermolipectomy in obese women.

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