Abstract
Introduction
Bariatric surgery (BS) is the most effective therapy for morbid obesity. Cortisol and DHEA are steroid hormones with opposing effects, thus using Cortisol/DHEA ratio (C/D) rather than the use of either hormone alone has been found to predict health outcomes more reliably. It was interesting to study C/D as an indicator of favorable metabolic and cardiovascular outcomes after BS.
Objective
To assess C/D in morbidly obese patients before and after BS in relation to metabolic parameters and cardiovascular performance.
Patients and methods
Forty morbidly obese patients were followed prospectively for 1 year after BS. Fasting blood glucose (FBG), fasting insulin (FI), C/D, lipid profile, high-sensitive CRP (hs-CRP), and echocardiography were done before BS and at 3 months and 1 year post BS.
Results
A total of 40 morbidly obese patients undergone sleeve gastrectomy. Blood pressure, FBG, FI, hs-CRP, C/D were significantly decreased after BS (p < 0.001). At 1 year post BS; significant reduction in left ventricular posterior wall thickness (LVPW) (p < 0.001), left ventricular mass (LVM) (p = 0.003), relative wall thickness (RWT) (p < 0.001) with a significant improvement in early diastolic velocity (E) (p < 0.001), early diastolic velocity/late diastolic velocity (E/A) (p = 0.01). After BS; C/D significantly positively correlated with FBG (p = 0.019), hs-CRP (p = 0.008), interventricular septum thickness (IVS) (p = 0.028), LVPW (p = 0.028), relative wall thickness (RWT) (p = 0.022), early diastolic velocity /early diastolic velocity (E′) measured by pulsed tissue Doppler imaging (E/E′) (p = 0.001), and significantly negatively correlated with E′ (p = 0.032). C/D was the single significant independent variable affecting E′ and E/E′ post BS.
Conclusion
C/D can be used as a surrogate marker of the improved FBG and the resolution of inflammation post BS. C/D is an independent predictor of diastolic function improvement post BS.
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References
Endalifer ML, Diress G. Epidemiology, predisposing factors, biomarkers, and prevention mechanism of obesity: a systematic review. J Obes. 2020;2020:6134362.
Resende JH, da Veiga Jardim MD, de Andrade Irineu BT, Gontijo LR, Cruvinel LR, de Sousa Neto ZA, et al. Morbid obesity: a review on the reasons for impediments to physical exercises and social activities. Modern Plastic Surgery. 2020;10:93–100.
Xiao Y, Liu D, Cline MA, Gilbert ER. Chronic stress, epigenetics, and adipose tissue metabolism in the obese state. Nutr Metab. 2020;17:88.
Aoki K, Terauchi Y. Effect of dehydroepiandrosterone (DHEA) on diabetes mellitus and obesity. Vitam Horm. 2018;108:355–65.
Hu Y, Wan P, An X, Jiang G. Impact of dehydroepiandrosterone (DHEA) supplementation on testosterone concentrations and BMI in elderly women: a meta-analysis of randomized controlled trials. Complement Ther Med. 2021;56:102620.
Karbowska J, Kochan Z. Effects of DHEA on metabolic and endocrine functions of adipose tissue. Horm Mol Biol Clin Investig. 2013;14:65–74.
Yokokawa T, Sato K, Narusawa R, Kido K, Mori R, Iwanaka N, et al. Dehydroepiandrosterone activates 5’-adenosine monophosphate-activated protein kinase and suppresses lipid accumulation and adipocyte differentiation in 3T3-L1 cells. Biochem Biophys Res Commun. 2020;528:612–19.
Phillips AC, Carroll D, Gale CR, Lord JM, Arlt W, Batty GD. Cortisol, DHEAS, their ratio and the metabolic syndrome: evidence from the Vietnam Experience Study. Eur J Endocrinol. 2010;162:919–23.
Ji E, Weickert CS, Purves-Tyson T, White C, Handelsman DJ, Desai R, et al. Cortisol-dehydroepiandrosterone ratios are inversely associated with hippocampal and prefrontal brain volume in schizophrenia. Psychoneuroendocrinology. 2021;123:104916.
Leff-Gelman P, Flores-Ramos M, Carrasco AEÁ, Martínez ML, Takashima MFS, Coronel FMC, et al. Cortisol and DHEA-S levels in pregnant women with severe anxiety. BMC Psychiatry. 2020;20:393.
Boiko AS, Mednova IA, Kornetova EG, Bokhan NA, Semke AV, Loonen AJM, et al. Cortisol and DHEAS related to metabolic syndrome in patients with schizophrenia. Neuropsychiatr Dis Treat. 2020;16:1051–8.
Gu L, Huang X, Li S, Mao D, Shen Z, Khadaroo PA, et al. A meta-analysis of the medium- and long-term effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. BMC Surg. 2020;20:30.
Martenstyn J, King M, Rutherford C. Impact of weight loss interventions on patient-reported outcomes in overweight and obese adults with type 2 diabetes: a systematic review. J Behav Med. 2020;43:873–91.
Allam MM, El-Zawawy HT. Type 2 diabetes mellitus non-surgical remission: a possible mission. J Clin Transl Endocrinol. 2019;18:100206.
Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100:342–62.
Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for medical care of patients with obesity. Endocrine Pract. 2016;22:1–203.
Ghiassi S, Morton JM. Safety and efficacy of bariatric and metabolic surgery. Curr Obes Rep. 2020;9:159–64.
Gutch M, Kumar S, Razi SM, Gupta KK, Gupta A. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015;19:160–4.
Ricci MA, De Vuono S, Scavizzi M, Gentili A, Lupattelli G. Facing morbid obesity: how to approach it. Angiology. 2016;67:391–7.
Ali H, El-Syed MK, Saad RM. Effects of laparoscopic sleeve gastrectomy on hypertensive morbidly obese patients. Egypt J Hosp Med. 2019;74:1804–8.
Khalaj A, Tasdighi E, Hosseinpanah F, Mahdavi M, Valizadeh M, Farahmand E, et al. Two-year outcomes of sleeve gastrectomy versus gastric bypass: first report based on Tehran obesity treatment study (TOTS). BMC Surg. 2020;20:160.
Graham C, Switzer N, Reso A, Armstrong C, Church N, Mitchell P, et al. Sleeve gastrectomy and hypertension: a systematic review of long-term outcomes. Surg Endosc. 2019;33:3001–7.
Outón S, Galceran I, Pascual J, Oliveras A. Central blood pressure in morbid obesity and after bariatric surgery. Nefrologia. 2020;40:217–22.
Jabbour G, Salman A. Bariatric surgery in adults with obesity: the impact on performance, metabolism, and health indices. Obes Surg. 2021;31:1767–89.
Akpinar EO, Liem RSL, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ, Dutch Audit for Treatment of Obesity Research Group. Metabolic effects of bariatric surgery on patients with type 2 diabetes: a population-based study. Surg Obes Relat Dis. 2021;S1550-7289:00096–4.
Benaiges D, Más-Lorenzo A, Goday A, Ramon JM, Chillarón JJ, Pedro-Botet J, et al. Laparoscopic sleeve gastrectomy: more than a restrictive bariatric surgery procedure? World J Gastroenterol. 2015;21:11804–14.
Heffron SP, Parikh A, Volodarskiy A, Ren-Fielding C, Schwartzbard A, Nicholson J, et al. Changes in lipid profile of obese patients following contemporary bariatric surgery: a meta-analysis. Am J Med. 2016;129:952–9.
van Berckel MMG, van Loon SLM, Boer AK, Scharnhorst V, Nienhuijs SW. Visual analysis of biomarkers reveals differences in lipid profiles and liver enzymes before and after gastric sleeve and bypass. Obes Facts. 2021;14:1–11.
Al Dahmani KM, Kayyal YM, Gariballa S. Transient severe hypercholesterolemia following bariatric surgery treated successfully with increased food intake. Nutrition. 2016;32:394–6.
Azran C, Hanhan-Shamshoum N, Irshied T, Ben-Shushan T, Dicker D, Dahan A, et al. Hypothyroidism and levothyroxine therapy following bariatric surgery: a systematic review, meta-analysis, network meta-analysis, and meta-regression. Surg Obes Relat Dis. 2021;S1550-7289:00115–5.
Sanyal D, Raychaudhuri M. Hypothyroidism and obesity: an intriguing link. Indian J Endocrinol Metab. 2016;20:554–7.
Lautenbach A, Stoll F, Mann O, Busch P, Huber TB, Kielstein H, et al. Long-term improvement of chronic low-grade inflammation after bariatric surgery. Obes Surg. 2021;5:1–8.
Oliveras A, Molina L, Goday A, Sans L, Riera M, Vazquez S, et al. Effect of bariatric surgery on cardiac structure and function in obese patients: Role of the renin-angiotensin system. J Clin Hypertens. 2021;23:181–92.
Nguyen NT, Goldman CD, Ho HS, Gosselin RC, Singh A, Wolfe BM. Systemic stress response after laparoscopic and open gastric bypass. J Am Coll Surg. 2002;194:557–66. discussion 566-7
Manco M, Fernández-Real JM, Valera-Mora ME, Déchaud H, Nanni G, Tondolo V, et al. Massive weight loss decreases corticosteroid-binding globulin levels and increases free cortisol in healthy obese patients: an adaptive phenomenon? Diabetes Care. 2007;30:1494–500.
Ruiz-Tovar J, Oller I, Galindo I, Llavero C, Arroyo A, Calero A, et al. Change in levels of C-reactive protein (CRP) and serum cortisol in morbidly obese patients after laparoscopic sleeve gastrectomy. Obes Surg. 2013;23:764–9.
Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and endocrine consequences of bariatric surgery. Front Endocrinol. 2019;10:626.
Rosmond R, Holm G, Björntorp P. Food-induced cortisol secretion in relation to anthropometric, metabolic and haemodynamic variables in men. Int J Obes Relat Metab Disord. 2000;24:416–22.
Woods CP, Corrigan M, Gathercole L, Taylor A, Hughes B, Gaoatswe G, et al. Tissue specific regulation of glucocorticoids in severe obesity and the response to significant weight loss following bariatric surgery (BARICORT). J Clin Endocrinol Metab. 2015;100:1434–44.
Beiglböck H, Fellinger P, Ranzenberger-Haider T, Itariu B, Prager G, Kautzky-Willer A, et al. Pre-operative obesity-associated hyperandrogenemia in women and hypogonadism in men have no impact on weight loss following bariatric surgery. Obes Surg. 2020;30:3947–54.
Savastano S, Belfiore A, Guida B, Angrisani L, Orio F Jr, Cascella T, et al. Role of dehydroepiandrosterone sulfate levels on body composition after laparoscopic adjustable gastric banding in pre-menopausal morbidly obese women. J Endocrinol Investig. 2005;28:509–15.
Klinge CM, Clark BJ, Prough RA. Dehydroepiandrosterone research: past, current, and future. Vitam Horm. 2018;108:1–28.
Straub RH, Glück T, Cutolo M, Georgi J, Helmke K, Schölmerich J, et al. The adrenal steroid status in relation to inflammatory cytokines (interleukin-6 and tumour necrosis factor) in polymyalgia rheumatica. Rheumatology. 2000;39:624–31.
Vurgun E, Memet B, Kocaturk E, Guntas G. Evaluation of serum 25-hydroxyvitamin D levels and cortisol/dehydroepiandrosterone sulfate ratio in chronic spontaneous urticaria. Turk J Biochem. 2021;46:191–6.
Ruano-Campos A, Cruz-Utrilla A, López-Antoñanzas L, Luaces M, Pérez de Isla L, Rubio Herrera MÁ. et al. Evaluation of myocardial function following SADI-S. Obes Surg. 2021;31:3109–15.
Büber İ, Aykota MR, Sevgican CI, Adali MK. The effects of laparoscopic sleeve gastrectomy on cardiac diastolic function, aortic elasticity, and atrial electromechanics delay. Obes Surg.2021;31:3571–8.
Yang TWW, Johari Y, Burton PR, Earnest A, Shaw K, Hare JL, et al. Bariatric surgery in patients with severe heart failure. Obes Surg. 2020;30:2863–9.
Kaya BC, Elkan H. Impact of weight loss with laparoscopic sleeve gastrectomy on left ventricular diastolic function: a prospective study. Obes Surg. 2020;30:3280–6.
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Contributions
HTE: Conceived the presented research idea. Designed, planned, and directed the study. Supervised patient recruitment and management. Analyzed the data and wrote the manuscript. Critically reviewed the manuscript. AAE: Supervised patient recruitment and management. Critically reviewed the manuscript. KMK: Performed bariatric surgery for the patients. EME: Performed echocardiography for the patients. Participated in writing the draft. SMSG: Responsible for patient recruitment. Responsible for data collection.
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The study was approved by the regional ethics committee at Faculty of Medicine, Alexandria University, Egypt (reference number: 0201170) and followed the standards of the 1964 Declaration of Helsinki and its later amendments. Informed written consent was obtained from all the study participants.
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El-Zawawy, H.T., El-Aghoury, A.A., Katri, K.M. et al. Cortisol/DHEA ratio in morbidly obese patients before and after bariatric surgery: Relation to metabolic parameters and cardiovascular performance. Int J Obes 46, 381–392 (2022). https://doi.org/10.1038/s41366-021-00997-x
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DOI: https://doi.org/10.1038/s41366-021-00997-x
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