Abstract
Objective:
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.
Subjects and study design:
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-α).
Results:
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 μU/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-α) decreased. At the 1-month follow-up, all adipokines were similar to baseline.
Conclusion:
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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Flegal KM, Carroll MD, Ogden CL, Johnson CL . Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723–1727.
Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403.
Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343–1350.
Eckel RH, Krauss RM . American Heart Association call to action: obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation 1998; 97: 2099–2100.
Hsueh WA, Law R . The central role of fat and effect of peroxisome proliferator-activated receptor-gamma on progression of insulin resistance and cardiovascular disease. Am J Cardiol 2003; 92: 3J–9J.
Matarasso A, Hutchinson OHZ . Liposuction. JAMA 2001; 285: 266–268.
Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ . Abdominal fat and insulin resistance in normal and overweight women: direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes 1996; 45: 633–638.
Sheehan MT, Jensen MD . Metabolic complications of obesity. Pathophysiologic considerations. Med Clin North America 2000; 84: 363–385.
Kelley DE, Thaete FL, Troost F, Huwe T, Goodpaster BH . Subdivisions of subcutaneous abdominal adipose tissue and insulin resistance. Am J Physiol Endocrinol Metab 2000; 278: E941–E948.
Johnson D, Cormack GC, Abrahams PH, Dixon AK . Computed tomographic observations on subcutaneous fat: implications for liposuction. Plastic Reconstruct Surg 1996; 97: 387–396.
Wolf G . Adiponectin: a regulator of energy homeostasis. Nutr Rev 2003; 61: 290–292.
Ceddia RB, Koistinen HA, Zierath JR, Sweeney G . Analysis of paradoxical observations on the association between leptin and insulin resistance. FASEB J 2002; 16: 1163–1176.
Giese SY, Bulan EJ, Commons GW, Spear SL, Yanovski JA . Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study. Plastic Reconstruct Surg 2001; 108: 510–519.
Barouch LA, Berkowitz DE, Harrison RW, O’Donnell CP, Hare JM . Disruption of leptin signaling contributes to cardiac hypertrophy independently of body weight in mice. Circulation 2003; 108: 754–759.
Brasier AR, Recinos III A, Eledrisi MS . Vascular inflammation and the renin–angiotensin system. Arterioscler Thromb Vasc Biol 2002; 22: 1257–1266.
Magliano DJ, Liew D, Ashton EL, Sundararajan V, McNeil JJ . Novel biomedical risk markers for cardiovascular disease. J Cardiovascular Risk 2003; 10: 41–55.
Giugliano G, Nicoletti G, Grella E, Giugliano F, Esposito K, Scuderi N et al. Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women. Br J Plastic Surg 2004; 57: 190–194.
Klein S, Fontana L, Young VL, Coggan AR, Kilo C, Patterson BW et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004; 350: 2549–2557.
Danforth E . Failure of adipocyte differentiation causes type II diabetes mellitus? Nat Genet 2000; 26: 13.
Gonzalez-Ortiz M, Robles-Cervantes JA, Cardenas-Camarena L, Bustos-Saldana R, Martinez-Abundis E . The effects of surgically removing subcutaneous fat on the metabolic profile and insulin sensitivity in obese women after large-volume liposuction treatment. Hormone Metabol Res 2002; 34: 446–449.
Yost TJ, Rodgers CM, Eckel RH . Suction lipectomy: outcome relates to region-specific lipoprotein lipase activity and interval weight change. Plastic Reconstruct Surg 1993; 92: 1101–1108.
Saad MF, Anderson RL, Laws A, Watanabe RM, Kades WW, Chen YD et al. A comparison between the minimal model and the glucose clamp in the assessment of insulin sensitivity across the spectrum of glucose tolerance. Insulin Resistance Atherosclerosis Study. Diabetes 1994; 43: 1114–1121.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC . Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.
Perseghin G, Caumo A, Caloni M, Testolin G, Luzi L . Incorporation of the fasting plasma FFA concentration into QUICKI improves its association with insulin sensitivity in nonobese individuals. J Clin Endocrinol Metabol 2001; 86: 4776–4781.
Lillis PJ . The tumescent technique for liposuction surgery. Dermatol Clin 1990; 8: 439–450.
Burk III RW, Guzman-Stein G, Vasconez LO . Lidocaine and epinephrine levels in tumescent technique liposuction. Plastic Reconstruct Surg 1996; 97: 1379–1384.
Rizza RA, Haymond MW, Miles JM, Verdonk CA, Cryer PE, Gerich JE . Effect of alpha-adrenergic stimulation and its blockade on glucose turnover in man. Am J Physiol 1980; 238: E467–E472.
Pei D, Chen TW, Kuo YL, Hung YJ, Hsieh CH, Wu LY et al. The effect of surgical stress on insulin sensitivity, glucose effectiveness and acute insulin response to glucose load. J Endocrinol Invest 2003; 26: 397–402.
Adams M, Montague CT, Prins JB, Holder JC, Smith SA, Sanders L et al. Activators of peroxisome proliferator-activated receptor gamma have depot-specific effects on human preadipocyte differentiation. J Clin Invest 1997; 100: 3149–3153.
Hawkins M, Tonelli J, Kishore P, Stein D, Ragucci E, Gitig A et al. Contribution of elevated free fatty acid levels to the lack of glucose effectiveness in type 2 diabetes. Diabetes 2003; 52: 2748–2758.
Rohrich RJ, Morales DE, Krueger JE, Ansari M, Ochoa O, Robinson Jr J et al. Comparative lipoplasty analysis of in vivo-treated adipose tissue. Plastic Reconstruct Surg 2000; 105: 2152–2158.
Chen MD, Ou LF, Song YM . Postoperative plasma leptin levels in women undergoing suction lipectomy. Mayo Clinic Proc 2001; 76: 1177–1178.
Donahoo WT, Jensen DR, Yost TJ, Eckel RH . Isoproterenol and somatostatin decrease plasma leptin in humans: a novel mechanism regulating leptin secretion. J Clin Endocrinol Metabol 1997; 82: 4139–4143.
Acknowledgements
Supported M01-RR-59, National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Davis, D., Pellowski, D., Davis, D. et al. Acute and 1-month effect of small-volume suction lipectomy on insulin sensitivity and cardiovascular risk. Int J Obes 30, 1217–1222 (2006). https://doi.org/10.1038/sj.ijo.0803120
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ijo.0803120
Keywords
This article is cited by
-
The Short-Term Effect of VASER Assisted Liposuction on Lipid Profile
Aesthetic Plastic Surgery (2023)
-
Up-regulation of PCSK9 gene expression and diminished level of LDL-receptor in rat liver as a potential cause of post-lipectomy hypercholesterolemia
Molecular and Cellular Biochemistry (2019)
-
What Can We Learn from Interventions That Change Fat Distribution?
Current Obesity Reports (2016)
-
Short- and Long-Term Effects of Abdominal Lipectomy on Weight and Fat Mass in Females: a Systematic Review
Obesity Surgery (2015)
-
Metabolic Effects of Large-Volume Liposuction for Obese Healthy Women: A Meta-Analysis of Fasting Insulin Levels
Aesthetic Plastic Surgery (2014)