4. Discussion
obesity, obese, cardiovascular disease, inflammation, cancer, abdominal obesity, MetS, gastroplasty, T2DM, metabolic dysfunction, adipose tissue dysfunction, atherosclerosis, weight loss
OBESITY, OBESE, CARDIOVASCULAR DISEASE, INFLAMMATION, SEVERE OBESITY, CANCER, METABOLIC SYNDROME, INSULIN RESISTANCE, CHRONIC INFLAMMATION, ATHEROSCLEROSIS, CORONARY ARTERY DISEASE
Our results showed that in female patients with severe obesity with or without MetS, weight loss induced by bariatric surgery with RYGB improved biochemical and systemic inflammatory parameters, particularly the adiponectin/leptin ratio. In line with the existing literature, our findings from pre- and post- surgical evaluations showed a relationship between MetS and severe initial obesity resulting from increases in leptin levels and reductions in adipose levels. In one randomized study, patients undergoing serial gastroplasty with unspecified forms of T2DM were selected for IL-6, IL-10, and IL-10. The authors observed significant improvements in leptin (It is known that leptin and adiponectin present opposite effects on insulin resistance and subclinical inflammation, whilst leptin can upregulate pro-inflammatory cytokines, such as IL-6 and TNF-α, both molecules being closely related to insulin resistance and T2DM, while adiponectin, through its capacity to downregulate the expression and release of several pro-inflammatory immune mediators, shows anti-inflammatory properties. Thus, interactions between angiotensin II and adiponectin/leptin imbalances may be important mediators of the T2DM and cardiovascular disease risks associated with abdominal obesity [Confirming the hypothesis of reduced inflammation for our study population, we observed an improvement in the adiponectin/leptin ratio, a biomarker for inflammation in adipose tissue [In addition to being good markers of adipose tissue-associated inflammation, both leptin and adiponectin are involved in the regulation of lipolysis, and thus reductions in adiponectin/leptin ratios may also reflect changes in this process, further metabolically contributing to obesity [Similarly, adiponectin/leptin ratio values also showed a high negative correlation with several low-grade chronic inflammation markers; they have emerged as an important predictive marker of cardiometabolic risk associated with obesity and MetS. Hence, elevations in this proportion have been related to a reduced risk of the development of atherosclerosis and some types of cancer [Notably, the results of a systematic review conducted by Lopez-Jaramillo et al. reinforce the role of the adiponectin/leptin ratio. In fact, the authors showed that in patients who presented with severe coronary artery disease, the lower circulating adiponectin levels and higher leptin levels were exclusively related to abdominal obesity. Moreover, an imbalance in the adiponectin/leptin ratio has also been related to a higher waist circumference, lower vascular response to acetylcholine, and elevation in vasoconstriction due to angiotensin II [In a study involving 292 individuals considered according to the BMI to be lean (83, 28%) and obese (209, 72%), the authors investigated the reliability of the adiponectin/leptin ratio as a marker of metabolic dysfunction. A significant negative correlation was observed between the adiponectin/leptin ratio and serum amyloid A (SAA), an important marker of adipose tissue dysfunction. Fruhbeck et al. with these results propose that the adiponectin/leptin ratio is an excellent marker of adipose tissue dysfunction inducing increased cardiometabolic risk [Therefore, in line with the results of these recent studies, it is believed that the adiponectin/leptin ratio may be an important inflammatory marker that can be used to investigate comorbidities in patients with severe obesity and MetS before and after bariatric surgery.In a recent literature review published by Iron et al., the current scientific knowledge regarding obesity, metabolic syndrome, and the effects of weight loss induced by the practice of physical activities, diets, pharmacological treatments, and/or surgical procedures was increased, since the authors concluded that a reduction in BMI, regardless of the method, improves glycemic control, reduces the concentration of pro-inflammatory proteins and increases that of anti-inflammatory markers, consequently significantly decreasing cardiovascular risk factors [According to the existing literature, bariatric and metabolic surgery have been effective at maintaining weight loss and metabolic improvement in patients with a BMI of > 40 kg/mOne of the limitations of this study was the fact that it involved only female patients. This fact is justified by the greater demand for bariatric surgery in our hospital from women with severe obesity. The postoperative follow-up period of just six months could be considered a limitation. However, a study showing the behavior of the adiponectin/leptin ratio in the medium and long term after surgical procedures would be very interesting. As a strong point of our study, we highlight the results that are in line with the literature, reinforcing the importance of considering the adiponectin/leptin ratio in obese patients with and without metabolic syndrome.