Impact Of Sustained Weight Loss Achieved Through Gastric Gastric Sleeve Surgery With Circulating Level Of Obestatin Hormone In Iraqi Obese Subjects.

Background:The epidemic of obesity is a major health problem in the developed world with a great influence on morbidity and mortality. Diet therapy, with and without support organizations, is relatively ineffective in treating obesity in the long term. Laparoscopic sleeve gastrectomy (LSG) has been introduced as a surgical option. Obestatin has been reported to have actions opposite to ghrelin, such as decreasing food intake, body weight, and delaying gastric emptying, and to antagonize the actions of ghrelin when both peptides are co administered. Aim of study: To evaluate serum obestatin levels achieved through sleeve gastrectomy and on insulin resistance and the serial changes of insulin concentration in obese patients and to determine the effect of weight loss after sleeve gastrectomy on free testosterone and sex hormone binding globulin levels and sexual quality of life in obese men and women. Subjects and methods: Twenty four patients undergone gastric sleeve surgery with 25 controls were selected. Body mass index, waist circumference (WC), lipid profile , fasting blood sugar, glycated hemoglobin (HbA1c), fasting insulin, QUICKI , free testosterone, sex hormone binding globulin and ghrelin hormone concentration were measured for patients prior gastric sleeve and for controls, another measures done one month and then three months post-surgery. Results: a significant decline were noticed in BMI, WC, TC, TG, LDL-cholesterol, fasting insulin, and ghrelin, with significant increase in QUICKI and SHBG in patient undergone gastric sleeve surgery with a significant differences in all studied parameters between patients and controls except free testosterone and SHBG. A significant negative correlation was shown between obestatin and BMI and between obestatin and fasting insulin in patients before sleeve gastrectomy. Conclusion: Bariatric surgery represents a promising treatment option in morbidly obese patients and low level of obestatinsuggested that this hormone is a nutritional marker reflecting body adiposity and insulin resistance. Key word: obesity, bariatric surgery, obestatin. I. Introduction: The epidemic of obesity is a major health problem in the developed world with a great influence on morbidity and mortality. Dietary and behavioral approaches to obesity have met with limited success and bariatric surgery is currently the only effective therapy for morbid obesity. Benefits of surgery include durable weight loss, improved cardiovascular profile, remission of type II diabetes, and better quality of life. (1) Apart from the psychobiological factors, there is also a ‘brain phase’ in the food intake process. Experimental data have indicated the presence of several peptides with their receptors in the hypothalamus and other parts of the central nervous system that may affect the quantity and quality of food intake. These peptides act as sensors that transfer signals from the periphery and stimulate or inhibit appetite and food intake accordingly in order to maintain energy homeostasis; not only they regulate the amount of each meal but also long-term energy reserves (i.e. the amount of fat tissue). (2) Unfortunately, diet therapy, with and without support organizations, is relatively ineffective in treating obesity in the long term. There are currently no truly effective pharmaceutical agents to treat obesity, especially morbid obesity. In 1991, the National Institutes of Health established guidelines for the surgical therapy of morbid obesity (BMI ≥40 or BMI ≥35 in the presence of significant comorbidities), now referred to as bariatric surgery. (3)