Acute and 1-month effect of small-volume suction lipectomy on insulin sensitivity and cardiovascular risk.

Abstract

The most common surgical procedure for obesity is liposuction, the majority of which are small-volume procedures. The effect of large-volume liposuction on cardiovascular risk and insulin sensitivity has been variable. This study was performed to evaluate the effect of the more common, smaller-volume liposuction on insulin sensitivity, inflammatory mediators, and cardiovascular risk factors. In all, 15 overweight or obese premenopausal women underwent metabolic evaluation prior to, 1 day following and 1 month following suction lipectomy of the abdomen. Metabolic evaluation included assessment of free fatty acids, glucose, insulin, insulin sensitivity by frequently sampled i.v. glucose tolerance test, and adipokines (IL-6, angiotensin II, leptin, PAI-1, adiponectin, and TNF-alpha). Free fatty acids did not change acutely although there was an almost 30% decrease in free fatty acids at 1 month. Fasting insulin levels decreased at one month from 8.3 +/- 1.1 to 5.6 +/- 1.3 microU/ml (P = 0.006). Insulin sensitivity by i.v. glucose tolerance test did not change at 1 month (4.0 +/- 0.8 to 5.0 +/- 0.7, P = 0.12) although with subgroup analysis insulin sensitivity improved in obese but not overweight participants. Several adipokines worsened acutely (IL-6 increased 15 fold and angiotensin II increased 67%), but there was no change in PAI-1, and other adipokines (adiponectin, leptin, and TNF-alpha) decreased. At the 1-month follow-up, all adipokines were similar to baseline. This study provides little evidence supporting increased or decreased cardiovascular risk although there is evidence supporting improved insulin sensitivity at one month, especially in obese women.