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Obesity-related insulin resistance: implications for the surgical patient

International Journal of Obesity volume 39, pages 1575–1588 (2015)Cite this article

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Abstract

In healthy surgical patients, preoperative fasting and major surgery induce development of insulin resistance (IR). IR can be present in up to 41% of obese patients without diabetes and this can rise in the postoperative period, leading to an increased risk of postoperative complications. Inflammation is implicated in the aetiology of IR. This review examines obesity-associated IR and its implications for the surgical patient. Searches of the Medline and Science Citation Index databases were performed using various key words in combinations with the Boolean operators AND, OR and NOT. Key journals, nutrition and metabolism textbooks and the reference lists of key articles were also hand searched. Adipose tissue has been identified as an active endocrine organ and the chemokines secreted as a result of macrophage infiltration have a role in the pathogenesis of IR. Visceral adipose tissue appears to be the most metabolically active, although results across studies are not consistent. Results from animal and human studies often provide conflicting results, which has rendered the pursuit of a common mechanistic pathway challenging. Obesity-associated IR appears, in part, to be related to inflammatory changes associated with increased adiposity. Postoperatively, the surgical patient is in a proinflammatory state, so this finding has important implications for the obese surgical patient.

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Acknowledgements

This work was supported by a CORE/ Nutritional Research Foundation Fellowship.

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Authors and Affiliations

  1. Gastrointestinal Surgery, National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK

    N Tewari & D N Lobo

  2. The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK

    S Awad

  3. School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, UK

    S Awad & D N Lobo

  4. School of Life Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, UK

    I A Macdonald

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  1. N Tewari
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  2. S Awad
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  3. I A Macdonald
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Correspondence to D N Lobo.

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Competing interests

NT declares no conflict of interest. SA and DNL have received research funding, educational and travel support from Fresenius Kabi (Bad Homburg). SA also received educational and travel support from Ethicon EndoSurgery, Fisher & Paykel and was previously awarded a Clinical Bariatric Fellowship that was supported by an unrestricted educational grant from Ethicon EndoSurgery. DNL has also received research funding and speakers’ honoraria from BBraun and Baxter Healthcare. IAM has received research funding from LighterLife, Mars Inc and Unilever.

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Tewari, N., Awad, S., Macdonald, I. et al. Obesity-related insulin resistance: implications for the surgical patient. Int J Obes 39, 1575–1588 (2015). https://doi.org/10.1038/ijo.2015.100

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