INTRODUCTION
Obesity is an inflammatory disease1, characterized by the production of cytokines, concerning inflammatory responses2-4. These cytokines are interleukins (IL) produced in fatty tissue thanks to their endocrine
properties. Thus, the inflammatory response of obesity causes increased production
of inflammatory interleukins and reduces interleukins with anti-inflammatory properties5. The variation of these interleukins promotes a change in glycemic and insulinemic
profile, characterizing a concomitant metabolic syndrome6,7.
OBJECTIVE
This study analyzes the variations in the inflammatory response through changes in
interleukin levels and consequent modification of C-reactive protein (CRP) rates of
post-bariatric patients submitted to anchor abdominoplasty.
METHODS
The present prospective study was carried out with fourteen female patients who underwent
anchor abdominoplasty8 after weight loss obtained through bariatric surgery. The inclusion criteria were:
presenting weight loss at the expense of bariatric surgery and maintaining the new
weight for at least 18 months; being followed up in the body contouring surgery group
at the Hospital de Clínicas of FMUSP during the period of the work, the first semester
of 2018; in multidisciplinary follow-up, composed of an endocrinologist, digestive
tract surgeon, psychologist and plastic surgeon. Exclusion criteria were: patients
who were smokers, used contraceptive or replacement hormones, recreational drugs,
or that could affect behavior.
The average age at the time of plastic surgery was 45.92 years, with extremes ranging
from 29 to 60. The average interval between bariatric surgery and abdominoplasty was
5.8 years, ranging from 2 to 12 years. The mean BMI (body mass index) before bariatric
surgery was 45.63 kg/m2, and before abdominoplasty, it was 29.62 kg/m2, with extremes of 21.3 to 36.7 kg /m2. The average weight of the resected surgical pieces was 2,068kg, varying between
1,000 and 3,600kg (Tables 1 and 2).
Table 1 - Age of patients, in years, at the time of surgical procedures
| Patients' age (years): |
| Before bariatric surgery |
Before abdominoplasty |
| Average 42 - 35 |
Average 45-95 |
| Minimum 21 |
Minimum 29 |
| Maximum 58 |
Maximum 60 |
Table 1 - Age of patients, in years, at the time of surgical procedures
Table 2 - Variations in patients' BMI, in kg/m2,before surgical procedures.
| BMI (Kg/m2):
|
| Before bariatric surgery |
Before abdominoplasty |
| Average - 45, 63 |
Average, 29, 62 |
| Minimum - 35, 6 |
Low - 21.3 |
| Maximum - 56.7 |
High - 36.7 |
Table 2 - Variations in patients' BMI, in kg/m2,before surgical procedures.
Blood samples were collected five times: preoperative, intraoperative, 24 hours after
surgery,7 hours postoperatively and 14 th postoperative day.
Quantitative analyses of interleukins IL4, IL6 and IL10 were performed using the immunoassay
method with magnetic beads Milliplex and MagPix System (Merck Millipore, USA). The results were measured in pg/dL (picograms per deciliter).
The C-reactive protein (CRP) was analyzed by C- Reactive Protein Gen.3. Immunoturbidimetric test for quantitative in vitro determination of PCR in human
serum and plasma, using Roche/Hitachi cobas c systems and measured in mg/dL.
The patients signed a free and informed consent form authorizing the study before
the procedure.
The project was approved by the hospital’s research ethics committee(CAPPesq)under
number 48112015.8.0000.0068. It has no support from research funding agencies or private
entities, so there is no conflict of interest.
RESULTS
The results obtained were grouped into absolute values and are presented in Table3.
Table 3 - Illustration of the dosages(pg/dL)IL4, (pg/dL) IL6, (pg/dL) IL10 and (mg /dL) CRP
at thetimes measured: preoperative (A), transoperative (B), 24 hours after surgery
(C), 7th postoperative day (D) and 14th postoperative day (E).
| |
pre |
trans |
12:00 p.m. |
7PO |
14PO |
| IL4 |
0.22 ± 0.4 |
0.17 ± 0.2 |
0.37 ± 1.0 |
0.68 ± 1.2 |
0.79 ±2.2 |
| IL6 |
3.66 ± 13.0 |
23.5 ± 23.9 |
40.43 ±15.1 |
11.2 ± 8.4 |
4.53 ± 8.5 |
| IL10 |
6.02 ± 6.2 |
47.4 ± 50.6 |
11.48 ± 6.9 |
6.18 ± 6.3 |
4.59 ± 4.2 |
| CRP |
3.3 ± 7.7 |
1.15 ± + - 1.3 |
47.9 ±24.1 |
27.85 ± 19.8 |
17.2 ± 38.6 |
Table 3 - Illustration of the dosages(pg/dL)IL4, (pg/dL) IL6, (pg/dL) IL10 and (mg /dL) CRP
at thetimes measured: preoperative (A), transoperative (B), 24 hours after surgery
(C), 7th postoperative day (D) and 14th postoperative day (E).
These results have graphic representation in Figures 1, 2, 3 and 4, where the preoperative (A), transoperative (B), 24-hour after surgery (C), 7 postoperative
(D) and 14 postoperative (E) periods are presented.
Figure 1 - Graphic demonstration of il4 variations(pg/dL)at preoperative, transoperative, 24
hours after surgery, 7th postoperative day and 14th postoperative day.
Figure 1 - Graphic demonstration of il4 variations(pg/dL)at preoperative, transoperative, 24
hours after surgery, 7th postoperative day and 14th postoperative day.
Figure 2 - Graphic demonstration of il6 variations (pg/dL)at preoperative, transoperative, 24
hours after surgery, 7th postoperative day and 14th postoperative day.
Figure 2 - Graphic demonstration of il6 variations (pg/dL)at preoperative, transoperative, 24
hours after surgery, 7th postoperative day and 14th postoperative day.
Figure 3 - Graphic demonstration of il10 variations (pg/dL)at preoperative, transoperative, 24
hours after surgery, 7th postoperative day and 14th postoperative day.
Figure 3 - Graphic demonstration of il10 variations (pg/dL)at preoperative, transoperative, 24
hours after surgery, 7th postoperative day and 14th postoperative day.
Figure 4 - Graphical demonstration of CRP variations (mg/dL)at preoperative, transoperative,
24 hours after surgery, 7th postoperative day and 14th postoperative day.
Figure 4 - Graphical demonstration of CRP variations (mg/dL)at preoperative, transoperative,
24 hours after surgery, 7th postoperative day and 14th postoperative day.
IL4 began to rise in the first hours after surgery and remained on the rise until
the 14th postoperative day.
IL6 increased intraoperatively, being more expressive in the 24 hours after surgery,
with a progressive decrease until the 14thpostoperative day.
IL10 increased intraoperatively, followed by a fall lower than the initial levels.
CRP showed a large increase in the first hours after surgery, remaining elevated until
the 14th postoperative day.
DISCUSSION
Fatty tissue is responsible for the production of interleukin IL6, considered an inflammatory
marker, and IL4 and IL10, anti-inflammatory2-4. IL6, in addition to other properties, stimulates the production of inflammatory
proteins in the liver, with special emphasis, the object of this study, of C-reactive
protein (CRP). The patients in the study, being patients with severe obesity - mean
BMI of 45.63 kg/m2 (35.6 to 56.7 kg/m2) - before bariatric surgery, despite having presented large weight losses, still
maintained BMI elevated at the time of abdominoplasty, corresponding to 29.62 kg/m2 (21.3 to 36.7 kg/m2); therefore, with a basal pattern of inflammatory markers still high, as they are
moderately obese. However, it is notorious that the weight loss induced by bariatric
surgery, in addition to reducing diseases related to excess weight, minimizes the
inflammatory state in morbidly obese patients7-10.
According to the literature 2,11-13, IL4, with anti-inflammatory activity, is produced by interacting the monocyte/macrophage
complex with the adipose tissue. In response to the trauma, it begins an upward curve
in the first hours of the postoperative period and remains on the rise until the 14th
postoperative day.
Patients with compulsions can be considered to have a low degree of chronic inflammation,
associated with increased inflammatory markers such as IL6 and CRP14,15, which have a considerable increase in the immediate intra and postoperative period,
corresponding to the inflammatory response to surgical trauma16. CRP, in turn, presents an already high baseline value related to obesity itself,
even with surgically achieved weight loss10, remaining elevated until the 14th postoperative day in the present study or for
up to six months, according to other authors10,17.
IL10, an anti-inflammatory cytokine produced by adipocytes, increased intraoperatively,
followed by a fall to levels lower than the initial ones. This fact agrees with the
bibliography of 12,18 and reveals an anti-inflammatory reaction that accompanies the manifestations of
IL6, considered antagonistic and whose inflammatory activity changes in the estimated
period.
A abdominoplastia pós-cirurgia bariátrica não se limita a um melhor resultado estético
e qualidade de vida, como já avaliado por outros autores19,20; sobretudo promove modificação dos marcadores inflamatórios e anti-inflamatórios,
que, dada a ressecção do tecido gorduroso, acarretam uma amenização do quadro inflamatório
crônico.
CONCLUSION
Patients with severe obesity, despite large weight losses at the expense of bariatric
surgery, tend to persist with excess dermal fat tissue and, therefore, elevated baseline
inflammatory and anti-inflammatory markers that, in response to surgical trauma, change
for more time.
AGRADECIMENTOS
To Prof. Lineu Tadeu Velasco - Full Professor of the Discipline of Clinical Emergencies
of the Department of Clinical Clinic of the Faculty of Medicine of the University
of São Paulo - in whose laboratory - LIM-51, allowed the performance of the dosages
of the interleukins present in work.
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1. Hospital das Clínicas de São Paulo, Body Contour Group of the Plastic Surgery Discipline
of HC-USP, São Paulo, SP, Brazil.
2. Hospital das Clínicas of USP, Full Professor of the Plastic Surgery Service of
HC-USP, São Paulo, SP, Brazil.
Corresponding author: Nádia de Rosso Giuliani, Rua Capitão Rosendo, 100, Apt. 23b, Vila Mariana, São Paulo, SP, Brazil. Zip Code:
04120-060 E-mail: nagiuliani@yahoo.com.br
Article received: August 19, 2020.
Article accepted: April 23, 2021.
Conflicts of interest: none
SUPERVISION
NRG Analysis and/or data interpretation, Conception and design study, Formal Analysis,
Methodology, Realization of operations and/or trials, Writing - Review & Editing
MM Final manuscript approval, Supervision
WCJ Supervision, Writing - Review & Editing
RIR Supervision, Writing - Review & Editing
RG Supervision
