الفهرس 
ObesityOnly 14 pages are availabe for public view
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Abstract
Introduction: Visfatin is a recent described adipokine that is highly expressed in visceral fat and localized to the blood stream and has various functions, including the activation of insulin receptor and has insulin mimetic effects, lowering blood glucose and improving insulin sensitivity.
Bariatric surgery is an effective treatment for obesity. patients tend to lose weight rapidly after surgery, with a negative energy balance in the first few weeks.
Laparoscopic Sleeve Gastrectomy is a technically less complex surgical procedure which is promising for the treatment of obesity and type 2 Diabetes Mellitus.
Objectives: To evaluate serum levels of visfatin before and after sleeve gastrectomy surgery and their relationship with insulin resistance in obese diabetic and obese non diabetic cases.
Patients and Methods: This study was conducted on eighty (80) patients with age ranged between (18-60 years old) who underwent laparoscopic sleeve gastrectomy in Bariatric Surgery Department Ain Shams university hospital and then reassessed three months after the operation.
They were divided into two groups: group 1: formed of 40 obese non diabetic patients with BMI ≥35 kg/m2with co-morbidity or≥ 40 kg/m2with or without other co-morbidities. group 2: formed of 40 obese patients who were diagnosed with type2 DM of more than one year duration with BMI ≥35 kg/m2with or without other co-morbidities.
Results: our results revealed that When comparing the obese non diabetic group (1) with the obese diabetic group (2) as regard baseline lipid profile: there is statistical difference (p≤ 0.05) with TGs being higher in group 2, While there are no statistical difference (p>0.05) as regard HDL, LDL and Tchol as shown in (table 2) (figure2).
When comparing the obese non diabetic group (1) with the obese diabetic group (2) as regard baseline blood sugar control parameters: There is a highly statistical difference (p≤0.001) as regard: FPG, HOMA-IR and HbA1C being higher in group 2, also there is statistical difference (p≤ 0.05) with fasting insulin being higher in group 2 as shown in (table 3) (figure3,4,5,6).
When comparing group (1) with group (2) as regard baseline visfatin there is statistical difference (p≤ 0.05) being higher in group 1 as shown in (table 4) (figure 7).
There is no significant correlation (p>0.05) between baseline Visfatin level and other baseline clinical and laboratory parameters in all patients, “Obesity without DM” group (1) and “Obesity with DM” group (2).
On comparison of clinical parameters before and after operation There is a highly statistical difference (p≤0.001) in both “Obesity without DM” group (1) and “Obesity with DM” group (2) as regard: weight, BMI, waist circumference, Waist/hip ratio and skin fold thickness being higher before operation, as shown in (table 6) (figure 8,9,10,11,12).
On comparison of laboratory parameters before and after operation: There is a highly statistical difference (p≤0.001) in both “Obesity without DM” group (1) and “Obesity with DM” group (2) as regard: FPG, fasting insulin, HOMA-IR, HbA1C and visfatin level being higher before operation as shown in (table 7) (figure13,14,15,16,17).
When comparing group (1) with group (2) as regard degree of change of clinical parameters: There is a highly statistical difference (p≤0.001) as regard: weight, BMI, waist circumference and Waist/hip ratio being higher in group 1, While there are no statistical difference (p>0.05) as regard skin fold thickness as shown in (table 8) (figure18,19,20,21).
When comparing group (1) with group (2) as regard degree of change of blood sugar control parameters: There is a highly statistical difference (p≤0.001) as regard: FPG, HOMA-IR, HbA1C and fasting insulin being higher in group 2 as shown in (table 9) (figure22,23,24,25).
When comparing group (1) with group (2) as regard degree of change of visfatin level there is statistical difference (p≤ 0.05) being higher in group 2 as shown in (table 10) (figure 26).
In our study there is a statistically significant direct correlation between percent reduction of Visfatin level and percent reduction of fasting blood sugar in all patients (p≤ 0.05) as regard the rest of parameters no statistically significant relations were found(p>0.05) as shown in (table 11) (figure 27).
Conclusions: Weight reduction after bariatric surgery is associated with a significant decrease in circulating concentrations of the adipokine visfatin in both morbidly obese subjects and subjects with obesity and type 2 diabetes mellitus.