Endokrynne implikacje otyłości i zabiegów bariatrycznych

Abstract

Obesity is a highly prevalent disease in the world associated with the disorders of endocrine system. Recently, it may be concluded that the only effective treatment of obesity remains bariatric surgery. The aim of the review was to compare the concepts of appetite hormonal regulation, reasons of obesity development and bariatric procedures published over the last decade. The reviewed publications had been chosen on the base on: 1. reasons and endocrine consequences of obesity; 2. development of surgery methods from the first bariatric to present and future less aggressive procedures; 3. impact of surgery on the endocrine status of patient. The most serious endocrine disturbances during obesity are dysfunctions of hypothalamic circuits responsible for appetite regulation, insulin resistance, changes in hormones activity and abnormal activity of adipocytes hormones. The currently recommended bariatric surgeries are Roux-en-Y gastric bypass, sleeve gastrectomy and adjustable gastric banding. Bariatric surgical procedures, particularly combination of restrictive and malabsorptive, decrease the body weight and eliminate several but not all components of metabolic syndrome. Conclusions: 1. Hunger and satiety are mediated by an interplay of nervous and endocrine signals. 2. Healthy adipose tissue secretion of adipokines is coordinated in an anti-inflammatory, insulin-sensitizing and cardioprotective pattern. However, with increasing fat mass this secretion pattern is changed into a proinflammatory, insulin resistant, atherogenic and fatal systemic environment. 3. Bariatric surgery is not a solution of the obesity problem for everyone. 4. Long term postsurgical observations of the hormonal profile changes are necessary and should be obligatory.

Opioid-like peptides and ghrelin mitigation of bariatric results depends on obesity level

“…Bariatric surgeries have a strong impact on the metabolism, carbohydrates, and lipid turnover as well as on the hormonal system [3,21,22].…”

“…Increased release of corticoliberin from the hypothalamus stimulated synthesis and release of the adrenocorticotrophin from proopiomelanocortin. Paradoxically, proopiomelanocortin (POMC), the anorexigenic regulator of food uptake, is the precursor of enkephalins, which stimulate food intake [3].…”

“…Obesity is frequently subdivided into categories depending on a body mass index (BMI) value: class 1: BMI of 30 to < 35 kg/m 2 ; class 2: BMI of 35 to < 40 kg/m 2 ; and class 3: BMI of 40 kg/m 2 or higher. Class 3 obesity is sometimes categorised as "extreme" or "severe/morbid" obesity [2,3]. In spite of many scientific studies the borders between the three classes of obesity are inconsistent, and widely used parameters are not able to indicate the reason/reasons for progressive obesity.…”

“…Currently, it may be concluded that the only effective treatment of obesity remains surgery. However, it must be pointed out that bariatric surgery has strong effects on the metabolism, and on the nervous and hormonal systems [3], because hunger and satiety are mediated by an interplay of nervous and endocrine signals at the central and peripheral levels [4]. Also, it is not clear why many patients are losing weight very slowly or even regaining the weight in a short time.…”

Selected adipose tissue hormones in the blood of patients with ischaemic cerebral stroke

“…Resistin is one of the best-known adipocytokines. Over the years its blood concentrations have been tested, and its role in the pathogenesis of obesity, arterial hypertension, cardiovascular diseases, and stroke has been studied [16,17]. Qian et al [18] showed a higher concentration of this adipocytokine in the blood of obese mice.…”