Plasma Lipopolysaccharide Is Closely Associated With Glycemic Control and Abdominal Obesity: Evidence from bariatric surgery

• Published in: Diabetes care Vol. 36; no. 11; pp. 3627 - 3632
• Main Authors: TRØSEID, Marius, NESTVOLD, Torunn K, RUDI, Knut, THORESEN, Hanne, NIELSEN, Erik W, LAPPEGARD, Knut T
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.11.2013
• Subjects: Adult; Bariatric Surgery; Biological and medical sciences; Blood Glucose; Care and treatment; Diabetes; Diabetes Mellitus, Type 2 - microbiology; Diabetes Mellitus, Type 2 - prevention & control; Diabetes. Impaired glucose tolerance; DNA, Bacterial - analysis; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Gastrointestinal surgery; Glycated Hemoglobin A - analysis; Glycemic index; Humans; Intra-Abdominal Fat - diagnostic imaging; Intra-Abdominal Fat - microbiology; Intra-Abdominal Fat - surgery; Lipopolysaccharide Receptors - blood; Lipopolysaccharides; Lipopolysaccharides - blood; Male; Measurement; Medical sciences; Metabolic diseases; Middle Aged; Obesity; Obesity, Abdominal - blood; Obesity, Abdominal - microbiology; Obesity, Abdominal - surgery; Omentum - microbiology; Omentum - surgery; Original Research; Physiological aspects; Plasma; Properties; Prospective Studies; Stomach, duodenum, intestine, rectum, anus; Subcutaneous Fat - diagnostic imaging; Subcutaneous Fat - microbiology; Subcutaneous Fat - surgery; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tomography, X-Ray Computed; Endocrinopathy; Human; Glycemic control; Nutrition; Bariatric surgery; Metabolic diseases; Visceral obesity; Blood plasma; Target tissue resistance; Association; Lipopolysaccharide; Insulin resistance; Endocrinology; Glycemia
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc13-0451

It is of vital importance to elucidate the triggering factors of obesity and type 2 diabetes to improve patient care. Bariatric surgery has been shown to prevent and even cure diabetes, but the mechanism is unknown. Elevated levels of lipopolysaccharide (LPS) predict incident diabetes, but the sources of LPS are not clarified. The objective of the current study was to evaluate the potential impact of plasma LPS on abdominal obesity and glycemic control in subjects undergoing bariatric surgery. This was a prospective observational study involving a consecutive sample of 49 obese subjects undergoing bariatric surgery and 17 controls. Main assessments were plasma LPS, HbA1c, adipose tissue volumes (computed tomography), and quantified bacterial DNA in adipose tissue compartments. Plasma levels of LPS were elevated in obese individuals compared with controls (P < 0.001) and were reduced after bariatric surgery (P = 0.010). LPS levels were closely correlated with HbA1c (r = 0.56; P = 0.001) and intra-abdominal fat volumes (r = 0.61; P < 0.001), but only moderately correlated with subcutaneous fat volumes (r = 0.33; P = 0.038). Moreover, there was a decreasing gradient (twofold) in bacterial DNA levels going from mesenteric via omental to subcutaneous adipose tissue compartments (P = 0.041). Finally, reduced LPS levels after bariatric surgery were directly correlated with a reduction in HbA1c (r = 0.85; P < 0.001). Our findings support a hypothesis of translocated gut bacteria as a potential trigger of obesity and diabetes, and suggest that the antidiabetic effects of bariatric surgery might be mechanistically linked to, and even the result of, a reduction in plasma levels of LPS.