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Bariatric Surgery

Bariatric surgery leads to an improvement in small nerve fibre damage in subjects with obesity

International Journal of Obesity volume 45, pages 631–638 (2021)Cite this article

Subjects

Abstract

Introduction

Subjects with obesity have metabolic risk factors for nerve fibre damage. Because bariatric surgery improves these risk factors we have assessed whether this can ameliorate nerve fibre damage.

Methods

Twenty-six obese subjects without diabetes (age: 46.23 ± 8.6, BMI: 48.7 ± 1.5, HbA1c: 38.0 ± 4.5) and 20 controls (age: 48.3 ± 6.2, BMI: 26.8 ± 4.2, HbA1c: 39.1 ± 2.6) underwent detailed assessment of neuropathy at baseline and 12 months after bariatric surgery.

Results

Obese subjects had normal peroneal (45.9 ± 5.5 vs. 48.1 ± 4.5, P = 0.1) and sural (46.9 ± 7.6 vs. 47.9 ± 10.6, P = 0.1) nerve conduction velocity, but a significantly higher neuropathy symptom profile (NSP) (4.3 ± 5.7 vs. 0.3 ± 0.6, P = 0.001), vibration perception threshold (VPT) (V) (10.2 ± 6.8 vs. 4.8 ± 2.7, P < 0.0001), warm threshold (C°) (40.4 ± 3.5 vs. 37.2 ± 1.8, P = 0.003) and lower peroneal (3.8 ± 2.2 vs. 4.9 ± 2.2, P = 0.02) and sural (8.9 ± 5.8 vs. 15.2 ± 8.5, P < 0.0001) nerve amplitude, deep breathing-heart rate variability (DB-HRV) (beats/min) (21.7 ± 4.1 vs. 30.1 ± 14, P = 0.001), corneal nerve fibre density (CNFD) (n/mm2) (25.6 ± 5.3 vs. 32.0 ± 3.1, P < 0.0001), corneal nerve branch density (CNBD) (n/mm2) (56.9 ± 27.5 vs. 111.4 ± 30.7, P < 0.0001) and corneal nerve fibre length (CNFL) (mm/mm2) (17.9 ± 4.1 vs. 29.8 ± 4.9, P < 0.0001) compared to controls at baseline. In control subjects there was no change in neuropathy measures over 12 months. However, 12 months after bariatric surgery there was a significant reduction in BMI (33.7 ± 1.7 vs. 48.7 ± 1.5, P = 0.001), HbA1c (34.3 ± 0.6 vs. 38.0 ± 4.5, P = 0.0002), triglycerides (mmol/l) (1.3 ± 0.6 vs. 1.6 ± 0.8, P = 0.005) and low-density lipoprotein cholesterol (mmol/l) (2.7 ± 0.7 vs. 3.1 ± 0.9, P = 0.02) and an increase in high-density lipoprotein cholesterol (mmol/l) (1.2 ± 0.3 vs. 1.04 ± 0.2, P = 0.002). There was a significant improvement in NSP (1.6 ± 2.7 vs. 4.3 ± 5.7, P = 0.004), neuropathy disability score (0.3 ± 0.9 vs. 1.3 ± 2.0, P = 0.03), CNFD (28.2 ± 4.4 vs. 25.6 ± 5.3, P = 0.03), CNBD (64.7 ± 26.1 vs. 56.9 ± 27.5, P = 0.04) and CNFL (20.4 ± 1.2 vs. 17.9 ± 4.1, P = 0.02), but no change in cold and warm threshold, VPT, DB-HRV or nerve conduction velocity and amplitude. Increase in CNFD correlated with a decrease in triglycerides (r = –0.45, P = 0.04).

Conclusion

Obese subjects have evidence of neuropathy, and bariatric surgery leads to an improvement in weight, HbA1c, lipids, neuropathic symptoms and deficits and small nerve fibre regeneration without a change in quantitative sensory testing, autonomic function or neurophysiology.

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Fig. 1: Study design.
Fig. 2: Representetive examples of CCM images.
Fig. 3: Corneal nerve morphological parameters at baseline and 12 months visits.

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Acknowledgements

This study was supported by a research donation from AMGEN and the Lipid Disease Fund. The authors acknowledge support from The Manchester Comprehensive Local Research Network and The National Institute for Health Research/Wellcome Trust Clinical Research Facility in Manchester.

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Authors and Affiliations

  1. Division of Cardiovascular Sciences, School of Medical Sciences, Core Technology Facility, University of Manchester, Manchester, UK

    Shazli Azmi, Maryam Ferdousi, Yifen Liu, Safwaan Adam, Zohaib Iqbal, Shaishav Dhage, Tarza Siahmansur, Alise Kalteniece, Jan Hoong Ho, Basil J. Ammori, Paul N. Durrington, Rayaz A. Malik & Handrean Soran

  2. Manchester Diabetes Centre, Manchester University Foundation Trust, Manchester, UK

    Shazli Azmi

  3. The Christie NHS Foundation Trust, Manchester, UK

    Safwaan Adam & Shaishav Dhage

  4. Cardiovascular Trials Unit, Manchester University Hospitals, Manchester, UK

    Zohaib Iqbal, Jan Hoong Ho & Handrean Soran

  5. Weill Cornell Medicine-Qatar, Doha, Qatar

    Georgios Ponirakis, Ioannis Petropoulos & Rayaz A. Malik

  6. Institute of Life course and Medical Sciences, University of Liverpool, Liverpool, UK

    Andrew Marshall

  7. Department of Diabetes and Endocrinology, Salford Royal Trust NHS Foundation Trust, Salford, UK

    Akheel Syed & John M. Gibson

  8. Department of Surgery, Salford Royal Trust NHS Foundation Trust, Salford, UK

    Basil J. Ammori

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Contributions

S Azmi and MF were involved in acquisition of data, analysis and interpretation of data and wrote the manuscript. S Azmi, HS, GP, S Adam, AS, SD, ZI and JHH recruited patients and controls. MF, YL, TS, S Azmi, GP, IP, AK, AM, AS, BJA, HS and JHH contributed to acquisition and analysis of the data. YL, TS, JHH and S Adam performed biochemical analysis. HS conceived the hypothesis and is the chief investigator of the study. HS, PND and RAM designed the study and contributed to interpretation of the data. HS is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors were involved in revising the manuscript critically for important intellectual content and for final approval of the version to be published.

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Correspondence to Handrean Soran.

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Azmi, S., Ferdousi, M., Liu, Y. et al. Bariatric surgery leads to an improvement in small nerve fibre damage in subjects with obesity. Int J Obes 45, 631–638 (2021). https://doi.org/10.1038/s41366-020-00727-9

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