Assuntos
Diabetes Mellitus/sangue , Dieta Redutora , Derivação Gástrica/métodos , Contagem de Leucócitos , Obesidade Mórbida/terapia , Adulto , Idoso , Glicemia/análise , Índice de Massa Corporal , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Feminino , Glucose/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Prognóstico , Medição de Risco , Sensibilidade e Especificidade , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: Endothelial dysfunction and inflammation are present in both type 2 diabetes mellitus (T2DM) and obesity. In this paper we compared the role of weight loss and of glycaemic control in determining circulating levels of ICAM-1, endothelin-1 (ET-1), and E-selectin in patients with morbid (grade 3) obesity. METHODS AND RESULTS: ICAM-1, E-selectin, and ET-1 were higher in obese patients (n=96) than in lean controls (n=30); among obese patients, the three molecules were higher in T2DM patients (n=26) than in patients with normal (NGT, n=43) or impaired (IGT, n=27) glucose tolerance. Sixty-eight obese patients had a significant weight loss induced by bariatric surgery, and showed a significant decrease in blood glucose, HbA1c and all molecules, so that ICAM-1, E-selectin, and ET-1 were not different in NGT, IGT and T2DM patients, and in lean controls; in 13 patients with a small weight loss induced by diet, changes were not significant, in spite of a significant reduction in blood glucose and HbA1c. At stepwise regression, changes in ICAM-1, ET-1, and E-selectin significantly correlated only with change in body mass index. CONCLUSIONS: These data indicate that weight loss is more important than glycaemic control in regulating circulating levels of ICAM-1, ET-1, E-selectin in morbidly obese subjects.
