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

Results

All subjects were obese, with a mainly central body fat distribution and had normal glucose tolerance ( Table 1 ). FM was significantly correlated with plasma triglycerides (r = 0·58, P < 0·009), 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), IS (r = –0·59, P < 0·005) and Rq (r = 0·62, P < 0·002). Furthermore, FM was significantly correlated with plasma IL-6 (r = 0·71, P < 0·001), IL-10 (r = –0·67, P < 0·002), TNF-α (r = 0·78, P < 0·001) and sIL-6r (r = –0·65, P < 0·003). The correlations between FM and inflammatory markers were still significant (above P < 0·03 for all) after adjustment for age, IS and WHR.

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). The mean weight loss observed following dermolipectomy was 2·6 ± 0·2 kg. Anthropometric changes were accompanied by a significant decline in fasting plasma insulin, arterial blood pressure, 2-h plasma glucose and plasma lipid levels at the end of the 40 days follow-up ( Table 1 ).

Glucose clamp data are reported in Table 2 . Despite similar metabolic conditions before and after dermolipectomy, glucose clamp showed dermolipectomy to be associated with a significant improvement in insulin-mediated glucose uptake, mainly due to an improvement in both oxidative and nonoxidative glucose metabolism with a parallel decline in lipid oxidation. Consequently, Rq (0·77 ± 0·02 vs. 0·80 ± 0·09; P < 0·001) and RMR (1342 ± 81 vs. 1486 ± 93 kcal/day; P < 0·001) were also considerably improved after dermolipectomy. The percentage decline in FM correlated with the percentage improvement in IS (r = 0·53, P < 0·01), Rq (r = 0·44, P < 0·04), insulin-stimulated glucose oxidation (GOX) (r = 0·43, P < 0·05) and nonoxidative glucose metabolism (NOGM) (r = 0·55, P < 0·01). Because dermolipectomy mainly lowers WHR, we also investigated the occurrence of a possible association between changes in WHR and glucose handling. In fact, the percentage decline in WHR was also correlated with a percentage decline in plasma FFA (r = 0·69, P < 0·001) and improvement in IS (r = 0·48, P < 0·03), Rq (r = 0·45, P < 0·04), GOX (r = 0·49, P < 0·01) and NOGM (r = 0·57, P < 0·006). In addition, dermolipectomy was also significantly associated with a decline in inflammatory markers ( Table 3 ) and in plasma leptin (28·5 ± 1·5 vs. 16·1 ± 1·8 mg/ml; P < 0·001) and resistin (4·4 ± 0·3 vs. 3·5 ± 0·4 mg/l; P < 0·001) levels and a rise in plasma adiponectin (12·1 ± 0·8 vs. 12·7 ± 0·9 µg/l; P < 0·03) levels. Differences in inflammatory markers were independent of the changes in FM or WHR (above P < 0·03 for all) but were lost after adjustment for the changes in IS values. By contrast, the difference in IS before and after dermolipectomy was lost (P < 0·23) after correction for the changes in FM.

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