Biliopancreatic diversion (BPD) is a surgical procedure performed in patients with untreatable obesity and insulin resistance. The demonstrated metabolic and hormonal results of this procedure include: the reversal of insulin resistance, an increase in diet-induced thermogenesis and modifications of gut hormones, such as gastrin, enteroglucagone, neurotensin and cholecystokinin. On the other hand, obesity is a condition of increased oxidative stress; however few studies have investigated antioxidant systems in obese persons with BPD.
In order to evaluate the metabolic status and antioxidant systems in such patients, we studied a group of 11 morbidly obese patients, aged 28-62 years, with a mean BMI of 54.71± 2.52 kg/m2, before and after successful BPD (mean post-BPD BMI 44.68 ± 1.51 kg/m2). A control group composed of ten slightly overweight women, with a mean BMI of 28.5±0.72 kg/m2, was also studied. Coenzyme Q10 (CoQ10) levels (also normalized for cholesterol levels) and Total Antioxidant Capacity (TAC) in blood plasma were assessed in these populations.
The most striking datum was the extremely low level of CoQ10 in postoperative period (0.34±0.16 vs 0.66±0.09µg/ml, p=0.04); also the data corrected for cholesterol levels presented the same pattern, with a more marked significance (152.46±11.13 vs 186.4±17.98 nmol/mmol, p=0.001).This could be due to lipid malabsorption after surgery. In fact, the pre-BPD data present all the metabolic and hormonal characteristics of severe obesity and, after BPD, there was a net improvement in the metabolic parameters. The first pathophysiological phenomenon seems to be lipid malabsorption that has been argued to be cause of insulin resistance reversion. This metabolic interpretation is also confirmed by the absence of significant variations of TAC (57.5±5.3 vs 66±5.3).
The mechanisms of these phenomena remain to be established. These data suggest the importance of correcting post-surgical metabolic complications, in these clinical populations, with CoQ10 supplementation.
- Bariatric surgery
- Coenzyme Q10
- Oxidative stress