Evaluation of insulin resistance in individuals with severe obesity candidates for bariatric surgery
Abstract
Severe obesity is a disease that has reached worldwide proportions, and consequent increase in surgical treatment. This, besides reducing body fat, also helps to reduce associated comorbidities, such as insulin resistance (IR) and diabetes. The aim of this study was to evaluate IR in obese individuals in the preoperative period of bariatric surgery. A cross-sectional study was carried out with patients admitted for bariatric surgery at Hospital Universitário Oswaldo Cruz (HUOC-UPE) in Recife-PE. Insulin resistance was assessed by triglyceride-glucose index (TyG index) and Triglyceride/HDL-c ratio (TG/HDL). Body composition was obtained by dual X-ray emission densitometry (DEXA). Sociodemographic data, anthropometric and biochemical variables, physical activity level, and alcohol intake were also collected. Sixty patients participated, with a mean age of 38.88 ±9.67 years, the majority being female, with an education level of more than 10 years, classified as active and at low risk for alcohol dependence. Men presented significantly higher values for weight, neck circumference, waist circumference and lean body mass (Kg). The candidates had IR, by TyG index and TG/HDL ratio, with females showing higher TyG index (p=0.037). Therefore, evaluating insulin resistance by easily accessible parameters in the preoperative period allows the adoption of early intervention strategies and thus reduce the consequences from its non-treatment.
References
-Alexandrino, E.G.; Marçal, D.F.S.; Antunes, M.D.; de Oliveira, L.P.; Massuda, E.M.; Bertolini, S.M.M.G. Nível de atividade física e percepção do estilo de vida de pacientes pré-cirurgia bariátrica. Einstein. Vol. 17. Num. 3. 2019. p. 1-6.
-Altman, D. Practical Statistic for Medical Research. Chapman and Hall, p.404-409. 1991.
-ADA. American Diabetes Association. Summary of Revisions: Standards of Medical Care in Diabetes-2022. Diabetes Care. Vol. 45. 2022. p. S4-S7.
-Amorim, A.C.R.; Souza, A.F.O.; Nascimento, A.L.V.; Maio, R.; Burgos, M.G.P.A. Uso de bebida alcoólica em períodos pré e pós-operatório de cirurgia bariátrica. Revista do Colégio Brasileiro de Cirurgiões. Vol. 42. Num.1. 2015. p. 003-008.
-Babic, N.; Valjevac, A.; Zaciragic, A.; Avdagic, N.; Zukic, S.; Hasic, S. The Triglyceride/HDL Ratio and Triglyceride Glucose Index as Predictors of Glycemic Control in Patients with Diabetes Mellitus Type 2. Medical Archives. Vol.73. Num.3. 2019. p.163-168.
-Baez-Duarte, B.G.; Zamora-Gínez, I; González-Duarte, R.; Torres-Rasgado, E.; Ruiz-Vivanco, G.; Pérez-Fuentes, R. Triglyceride/High-Density Lipoprotein Cholesterol (Tg/Hdl-C) Index As A Reference Criterion Of Risk For Metabolic Syndrome (Mets) And Low Insulin Sensitivity In Apparently Healthy Subjects. Gaceta Medica de Mexico. Vol. 153. Num. 2. 2017. p. 152-158.
-Bandeali, S.; Farmer, J. High-density lipoprotein and atherosclerosis: the role of antioxidant activity. Current Atherosclerosis Reports. Vol.14. Num.2. 2012. p.101-107.
-Bickerton, A.S.; Roberts, R.; Fielding, B.A.; Hodson, L.; Blaak, E.E.; Wagenmakers, A.J.; Gilbert, M.; Karpe, F.; Frayn, K.N. Preferential uptake of dietary fatty acids in adipose tissue and muscle in the postprandial period. Diabetes. Vol. 56. Num. 1. 2007. p. 168-176.
-Burgos, M.G.P.A.; Cabral, P.C.; Maio, R.; Oliveira, B.M.; Dias, M.S.; Melim, D.B.; Correia, M.F. Prevalence of alcohol abuse before and after bariatric surgery associated with nutritional and lifestyle factors: a study involving a portuguese population.Obesity Surgery. Vol.25. Num.9. 2015. p.1716-1722.
-Cabral, E.B.; Haddad, J.R.; Pardo, I.M.C.G. Circunferência do Pescoço: Nova Medida Antropométrica para Rastreamento da Síndrome Metabólica em Adolescentes. Arquivos Catarinenses de Medicina. Vol. 48. Num. 2. 2019. p. 21-33.
-Carneiro, R.A.C.; Couto Filho, A.H.; Gasperini, A.M.; Cortes, J.A.; Carneiro, J.A.C.; Oliveira, R.M.; Queiroz, T.C.C.; Reis, A. Nível de atividade física em pacientes pré e pós cirurgia bariátrica. Brazilian Journal of Health Review. Vol. 4. Num. 3. 2021. p. 11101- 11107.
-Carvalho, A.S.; Rosa, R.S. Cirurgias bariátricas realizadas pelo Sistema Único de Saúde em residentes da Região Metropolitana de Porto Alegre, Rio Grande do Sul. 2010-2016. Epidemiologia e Serviços de Saúde. Vol. 27. 2018. p. e2017010.
-Cazzo, E.; Jimenez, L.S.; Gestic, M.A.; Utrini, M.P.; Chaim, F.H.M.; Chaim, F.D.M.; Pareja, J.C.; Chaim, E.A. Type 2 diabetes mellitus and simple glucose metabolism parameters may reliably predict nonalcoholic fatty liver disease features. Obesity surgery. Vol. 28. Num. 1. 2018. p. 187-194.
-Cazzo, E.; Callejas-Neto, F.; Pareja, J.C.; Chaim, E.A. Correlation between post over preoperative surrogate insulin resistance indexes' ratios and reversal of metabolic syndrome after Roux-en-Y gastric bypass. Obesity Surgery. Vol.24. Num.6. 2014. p.971-973.
-Chen, Z.; Hu, H.; Chen, M.; Luo, X.; Yao, W.; Liang, Q.; Yang, F.; Wang, X. Association of Triglyceride to high-density lipoprotein cholesterol ratio and incident of diabetes mellitus: a secondary retrospective analysis based on a Chinese cohort study. Lipids Health Disease. Vol.4. Num.19. 2020. p.2-11.
-Craig, C.L.; Marshall, A.I.; Sjöström, M.; Bauman, A.E.; Booth, M.L.; Ainsworth, B.E.; Pratt, M.; Ekelund, U.; Yngve, A.; Sallis, J.F.; Oja, P. International physical activity questionnaire: 12-country reliability and validity. Medicine & Science in Sports & Exercise. Vol.35, Num.8. 2003. p. 1381-1395.
-Dumith, S.C.; Maciel, F.V.; Borchardt, J.L.; Alam, V.S.; Silveira., F.C.; Paulitsch, R.G. Preditores e condições de saúde associados à prática de atividade física moderada e vigorosa em adultos e idosos no sul do Brasil. Revista Brasileira de Epidemiologia. Vol. 22. 2019. p. 1-13.
-Du, T.; Yuan, G.; Zhang, M.; Zhou, X.; Sun, X.; Yu, X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovascular diabetology. Vol. 13.Num. 1. 2014. p. 1-10.
-Ellulu, M.S.; Khaza’ai, I.P.H.; Rahmat, A.; Abed, Y. Obesity and inflammation: the linking mechanism and the complications. Archives of medical science: AMS. Vol. 13, Num. 4, p. 851, 2017.
-Faludi, A.A.; Izar, M.C.O.; Saraiva, J.F.K.; Chacra, A.P.M.; Bianco, H.T.; Afiune Neto, A.; Bertolami, A.; Pereira, A.C.; Lottenberg, A.M.; Sposito, A.C.; Chagas, A.C.P.; Casella-Filho, A.; Simão, A.F.; Alencar Filho, A.C.; Caramelli, B.; Magalhães, C.C.; Magnoni, D.; Negrão, C.E.; Ferreira, C.E.S.; Scherr, C.; Feio, C.M.A.; Kovacs, C.; Araújo, D.B.; Calderaro, D.; Gualandro, D.M.; Mello Junior, E.P.; Alexandre, E.R.G.; Sato, I.E.; Moriguchi, E.H.; Rached, F.H.; Santos, F.C.; Cesena, F.H.Y.; Fonseca, F.A.H.; Fonseca, H.A.R.; Xavier, H.T.; Pimentel, I.C.; Giuliano, I.C.B.; Issa, J.S.; Diament, J.; Pesquero, J.B.; Santos, J.E.; Faria Neto, J.R.; Melo Filho, J.X.; Kato, J.T.; Torres, K.P.; Bertolami, M.C.; Assad, M.H.V.; Miname, M.H.; Scartezini, M.; Forti, N.A.; Coelho, O.R.; Maranhão, R.C.; Santos Filho, R.D.; Alves, R.J.; Cassani, R.L.; Betti, R.T.B.; Carvalho, T.; Martinez, T.L.R.; Giraldez, V.Z.R.; Salgado Filho, W. Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose-2017. Arquivos Brasileiros de Cardiologia. Vol.109. Num.2, 2017. p.1-76.
-Freitas, A.P.D.; Duarte, A.C.S.; Silva, A.M.J.C.C.G.; Silva, T.R.M.S. Perfil glicêmico e lipídico de pacientes submetidos a cirurgia bariátrica. Revista Brasileira de Obesidade, Nutrição e Emagrecimento. São Paulo. Vol. 14.Num. 87. 2020. p. 671-679.
-Geloneze, B. Tratamento farmacológico da obesidade: passado, presente e futuro. HU Revista. Vol.44. Num.2. 2018. p.261-268.
-Gregorio, V.D.; Lucchese, R.; Vera, I.; Silva, G.C.; Silva, A.; Moraes, R.C.C. O padrão de consumo de álcool é alterado após a cirurgia bariátrica? Uma revisão integrativa. Arquivos Brasileiros de Cirurgia Digestiva. Vol. 29. Num.2. 2016. p. 111-115.
-Guerrero-Romero, F.; Villalobos-Molina, R.; Jiménez-Flores, J.R.; Simental-Mendia, L.E.; Méndez-Cruz, R.; Murguía-Romero, M.; Rodríguez-Morán, M. Fasting triglycerides and glucose index as a diagnostic test for insulin resistance in young adults. Archives of Medical Research. Vol. 47. Num. 5. 2016. p. 382-387.
-Guerrero-Romero, F.; Simental-Mendía, L.E.; González-Ortiz, M.; Martínez-Abundis, E.; Ramos-Zavala, M.G.; Hernández-González, S.O.; Jacques-Camarena, O.; Rodríguez-Morán, M. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic- hyperinsulinemic clamp. The Journal of Clinical Endocrinology & Metabolism. Vol. 95. Num. 7. 2010. p. 3347-3351.
-Ivezaj, V.; Benoit S.C.; Davis, J.; Engel S, Lloret-Linares, C.; Mitchell, J.E.; Pepino, M.Y.; Rogers, A.M.; Steffen, K.; Sogg S. Changes in alcohol use after metabolic and bariatric surgery: predictors and mechanisms. Current Psychiatry Reports. Vol. 21. Num. 9.2019. p. 1-9.
-Jellife, D.B. Evolución del estado de nutrición de la comunidade. Genebra, Suiça. Organización Mundial de la Salud. 1968.
-Kawai, T.; Autieri, M.V.; Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell Physiol. Vol.320. Num.3. 2021. p.1-19.
-Lalmohamed, A.; Vries, F.; Marloes T Bazelier, M.T.; Cooper, A.; van Staa, T.P; Cyrus Cooper, C.; Nicholas C Harvey, N.C. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. Vol. 345. 2012. p. e5085.
-Lee, J.; Kim, B.; Kim, W.; Ahn, C.; Choi, H.Y.; Kim, J.G.; Kim, J.; Shin, H.; Kang, J.G.; Moon, S.Lipid indices as simple and clinically useful surrogate markers for insulin resistance in the US population. Scientific Reports. Vol. 11. Num. 1. 2021. p. 1-9.
-Lima, C.T.; Freire, A.C.C.; Silva, A.P.B.; Teixeira, R.M.; Farrell, M.; Prince, M. Concurrent and construct validity of the AUDIT in an urban Brazilian sample. Alcohol and Alcoholism. Vol. 40. Num. 6. 2005. p. 584-589.
-Lohman, T.G.; Roche, A.F.; Martorell, R. Anthropometric standardization reference manual. Champaign (IL): Human Kinetics. 1988. p.3-8.
-Matsudo, S.; Araújo, T.; Matsudo, V.; Andrade, D.; Andrade, E.; Oliveira, L.C.; Braggion, G. Questionário internacional de atividade física (IPAQ): estudo de validade e reprodutibilidade no Brasil. Revista Brasileira de Atividade Física & Saúde. Vol. 6. Num. 2. 2001. p. 5-18.
-McLaughlin, T.; Abbasi, F.; Cheal, K.; Chu, J.; Lamendola, C.; Reaven, G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Annals of Internal Medicine. Vol. 139. Num. 10. 2003. p. 802-809.
-Mechanick, J.I.; Apovian, C.; Brethauer, S.; Garvey, W.T.; Joffe, A.M.; Kim, J.; Kushner, R.F.; Lindquist, R.; Pessah-Pollack, R.; Seger, J.; Urman, R.D.; Adams, S.; Cleek, J.B.; Correa, R.; Figaro, M.K.; Flanders, K.; Grams, J.; Hurley, D.L.; Kothari, S.; Seger, M.V.; Still, C.D. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 Update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists - Executive Summary. Endocr Pract. Vol. 25. Num.12. 2019. p.1346-1359.
-Neto, E.V.P.; Talarico, P.E.V.; Nunez, O.B.; Netto, J.A.P.; Vicentini, J.V.S.; Pilon, B. Abuso de álcool após cirurgia bariátrica. Brazilian Journal of Health Review. Vol. 5. Num. 2. 2022. p. 5594-5598.
-Mota, A.P.L.; Carvalho, M.G.; Lima, L.M.; Santos, M.E.R.C.; Sousa, M.O. Lipoproteína (a) em pacientes portadores de doença arterial obstrutiva periférica e/ou diabetes mellitus tipo 2. Jornal Brasileiro de Patologia e Medicina Laboratorial. Vol. 44. Num. 2. 2008. p. 89-95.
-Nóbrega, M.P.; Cabral, P.C.; Pinho, C.P.S.; Costa, J.; de Lima, D.S.C. Perfil alimentar e reganho de peso de pacientes submetidos à cirurgia bariátrica em um hospital universitário. Brazilian Journal of Development. Vol. 6. Num. 12. 2020. p. 94771-94785.
-Nordmo, M.; Danielsen, Y.S.; Nordmo, M. The challenge of keeping it off, a descriptive systematic review of high‐quality, follow‐up studies of obesity treatments. Obesity Reviews. Vol. 21. Num. 1. 2020. p. e12949.
-Pauli, J.R.; Cintra, D.E.; Souza, C.T.; Ropelle, E.R. Novos mecanismos pelos quais o exercício físico melhora a resistência à insulina no músculo esquelético. Arquivos Brasileiros de Endocrinologia e Metabologia. Vol.53. Num.4. 2009. p. 399-408.
-Penna, P.M.; Saron, M.L.G.; Hermsdorff, H.H.M. O papel de adipocinas na relação entre obesidade e resistência à insulina: uma revisão integrativa. Cadernos UniFOA. Vol. 15. Num. 42. 2020.
-Pinto, S.L.; Juvanhol, L.L.; Licursi de Oliveira, L.; Clemente, R.C.; Bressan, J. Changes in oxidative stress markers and cardiometabolic risk factors among Roux-en-Y gastric bypass patients after 3-and 12-months postsurgery follow-up. Surgery for Obesity and Related Diseases. Vol. 15. Num. 10. 2019. p. 1738-1745.
-Rogero, M.M.; Calder, P.C. Obesity, Inflammation, Toll-Like Receptor 4 and Fatty Acids. Nutrients. Vol.10. Num.4. 2018. p.1-19.
-Silva, G.G.; Oliveira, J.A.P. Cirurgia bariátrica: problemas advindos do uso abusivo do álcool e o papel do psicólogo no tratamento. Psicologia e Saúde em debate. Vol. 4. Num. 3. 2018.p. 84-95.
-Simental-Mendía, L.E.; Rodríguez-Morán, M.; Guerrero-Romero, F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metabolic Syndrome and Related Disorders. Vol. 6. Num. 4. 2008. p. 299-304.
-Smiderle, C.A.; Coral, G.P.; De Carli, L.A.; Matos, A.A.; Matos, A.Z.; Tovo, C.V. Performace of triglyceride-glucose index on diagnosis and staging of NAFLD in obese patients. Arquivos de Gastroenterologia. Vol. 58. 2021. p. 139-144.
-SBCBM. Sociedade Brasileira de Cirurgia Bariátrica e Metabólica. Consenso Bariátrico. 2006
-SBD. Sociedade Brasileira de Diabetes. Diretrizes da Sociedade Brasileira de Diabetes 2019-2020. 2020.
-Souza, A.A.M.; Weber, C.A.T. Alcoolismo em pacientes submetidos à cirurgia bariátrica: notas sobre a transferência da compulsão. Debates em Psiquiatria. Rio de Janeiro. Vol. 12, p. 1-17. 2022.
-Tedesco, A.K.; Biazotto, R.; Gebara, T.S.S.; Cambi, M.P.C.; Baretta, G.A.P. Pré e pós-operatório de cirurgia bariátrica: algumas alterações bioquímicas. Arquivos Brasileiros de Cirurgia Digestiva. Vol. 29. 2016. p. 67-71.
-Vasques, A.C.; Novaes, F.S.; de Oliveira, M.da S.; Souza, J.R.; Yamanaka, A.; Pareja, J.C.; Tambascia, M.A.; Saad, M.J.; Geloneze, B. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes research and clinical practice. Vol. 93. Num. 3. 2011. p. e98-e100.
-Viacava, F.; Oliveira, R.A.D; Carvalho, C.C.; Laguardia, J.; Bellido, J.G. SUS: oferta, acesso e utilização de serviços de saúde nos últimos 30 anos. Ciência & Saúde Coletiva. Vol. 23.Num. 6. 2018. p. 1751-1762.
-WHO. World Health Organization. World Health Statistics 2018: monitoring health for the SDGs, Sustainable Development Goals. Geneva. 2018.
-WHO. World Health Organization. Obesity and public health. Technical Report Series. Genebra. 2010.
-WOF. World Obesity Federation. Obesity: missing the 2025 global targets. London. 2020.
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