Early Effects of Sleeve Gastrectomy on Obesity-Related
Cytokines and Bile Acid Metabolism in Morbidly Obese Japanese
Published online: 31 May 2017
Springer Science+Business Media New York 2017
Background Laparoscopic sleeve gastrectomy (LSG) has
wide-ranging positive effects on adipocytokine metabolism,
bile acid profile, and chronic low-grade inflammation related
to obesity. However, the early temporal changes in these
markers following LSG have not been well investigated.
This study aimed to evaluate the early effects of LSG on
adipocytokines, bile acid profile, and inflammatory markers.
Methods This was a nonrandomized prospective study exam-
ining morbidly obese Japanese patients undergoing LSG.
Serial measurements of leptin, adiponectin, bile acids, fibro-
blast growth factor (FGF)-19, and inflammatory markers were
performed preoperatively and 1 and 6 months after LSG.
Results The study included ten patients (five females) with a
mean age of 48.8 years and BMI 40.9 kg/m
. At baseline, 90%
of the patients had T2DM, 70% had dyslipidemia, and 90%
had hypertension. Patients lost 5.1 kg/m
BMI at 1 month and
BMI at 6 months. The leptin levels sharply de-
creased, and FGF-19 increased significantly as early as
1 month postoperatively. Adiponectin levels showed an in-
creasing trend at 1 month and a significant increase at
6 months. A significant decrease in high-sensitivity CRP
and plasminogen activator inhibitor-1 was observed at
6 months. No significant changes were observed in interleukin
(IL)-6, IL-8, tumor necrosis factor-α, serum amyloid A pro-
tein, or monocyte chemotactic protein-1 throughout the study.
Conclusions LSG improved the secretion of adipocytokines,
increased FGF-19 secretion soon after surgery, and slowly
ameliorated inflammation related to obesity through signifi-
cant weight loss.
Keywords Sleeve gastrectomy
The pathophysiology of obesity is multi-factorial.
Adipocytokines released by macrophages and adipocytes play
an important role in the pathogenesis of obesity and metabolic
complications. Changes in weight and fat mass affect
adiponectin and leptin metabolism. While an increase in
adiponectin and a decrease in leptin accompanying weight
loss have been reported, the temporal pattern of these changes
after bariatric surgery has not been well investigated [1–5].
Many studies have also implicated chronic low-grade in-
flammation in the relationship between obesity and metabolic
complications [6, 7]. This inflammation is mediated by innate
immune system activation in adipose tissue, which promotes
an increase in the production and release of pro-inflammatory
cytokines . Bariatric surgery decreases CVD risk factors by
reducing adipose tissue mass and causing improvements in the
inflammatory milieu . There is limited information regard-
ing the early changes in chronic low-grade inflammation after
a sleeve gastrectomy. Recent work in both clinical studies and
animal models points to bile acids (BAs) as key mediators in
the effects of bariatric surgery for obesity treatment .
Increased serum levels of BAs after Roux-en-Y gastric bypass
(RYGB) have been reported by multiple research groups [10,
11]. Gerhard et al. provided insights into one potential mech-
anism behind the metabolic benefits following RYGB that are
* Hideharu Shimizu
Department of Surgery, Tokyo Metropolitan Tama Medical Center,
2-8-29, Musashidai, Fuchu, Tokyo, Japan
Department of Endocrinology, Tokyo Metropolitan Tama Medical
Center, Fuchu, Tokyo 183-8524, Japan
OBES SURG (2017) 27:3223–3229