Impacto da cirurgia bariátrica em pacientes metabolicamente saudáveis e pacientes metabolicamente não saudáveis

Abstract

Obesity is a chronic, multifactorial and recurrent disease, characterized by excess adipose tissue, which become dysfunctional showing inflammation that contributes to the vicious cycle that aggravates obesity and its comorbidities. Notably, obesity manifest in a different way in each person, which lead to categorize obesity in phenotypes as metabolically healthy (MHO) and in metabolically unhealthy obesity. (MUO), since only in the latter, impairments in glucose homeostasis, dyslipidemias and hypertension are evident. Bariatric surgery is the most effective treatment for morbid obesity and its comorbidities, however whether such procedure displays the same mitigating effect on MHO and MUO subjects remain unknown. Thus, this study investigated the effects of surgical treatment of obesity on weight loss, body composition and in plasma biochemical parameters in MHO and MUO after 1 year of operation. Eighty-two women and men were included in the study. They were aged 18-65 years-old and BMI ≥ 30 kg/m², and 22% (n=18) and 78% (n=64) were characterized as MHO and MUO, respectively. Preoperative neck circumference and visceral adiposity index (VAI) were higher in the MUO group compared with the MHO group. NAFLD is the most common comorbidity in both groups studied. MUO subjects exhibited impaired glycemia control, insulin resistance, increased TG and VLDL, and reduced HDL plasma levels. After 1 year of operation, MUO and MHO groups showed a similar benefit of bariatric operation to reduce body weight, VAI and total body fat mass. However, despite bariatric surgery improved glucose homeostasis and dyslipidemia in MUO subjects, they already displayed increased ALT, AST and ferritin plasma levels, then MHO group. Therefore, MUO subjects were the main phenotype submitted to bariatric operation, and this procedure led to same benefits on body mass in MUO and MHO, but MUO after 1 year already displayed increased markers of inflammation and liver injury.