Bariatrik Cerrahi Geçiren Hastalarda Bağırsak Mikrobiyotası ve Metabolik Parametreler Arasındaki İlişkinin Değerlendirilmesi

Abstract

This study was planned as a case study to examine the effects of obesity and bariatric surgery on nutrition, metabolic parameters and gut microbiota. The data of the research was conducted from 15 patients who had bariatric surgery in Ankara Numune Education and Training Hospital as research group, 8 morbidly obese participants who did not have bariatric surgery as control group-1 and 11 participants who were lean (n=5) and pre-obese (n=6) as control group-2. General characteristics and health status of subjects were recorded, food frequencies with amounts and 24-hours dietary recalls were evaluated and anthropometric measurements were taken at the beginning, 3rd month and 6th month. Fasting glucose, triglyceride, total, LDL, HDL cholesterol, ALT, AST, CK18-M30, CK18-M65, IL-6. TNF-α and hs-CRP levels were analysed from blood samples of participants and microbiota compositions were analysed from faecal samples. Energy, macro and micro nutrient intakes of research group were decreased at 3rd and 6th months (p<0,05). There was no change determined in energy and nutrient intake in control group 1 and 2. All anthropometric measurements except waist/hip ratio were decreased both 3rd and 6th month after bariatric surgery (p<0,05). Median fasting blood glucose levels of research group were 94,0 mg/dL, 91,0 mg/dL, and 87,0 mg/dL at the beginning, 3rd month, and 6th month, respectively (p<0,05). Total cholesterol, LDL cholesterol, ALT and hs-CRP levels were also decreased after bariatric surgery (p<0,05). Triglyceride, HDL cholesterol, AST, CK18-M30, CK18-M65, IL-6 and TNF-a levels of subjects did not change significantly after surgery (p>0,05). A negative correlation determined between daily fiber intake and CK18-M30 (r=-0,437, p=0,010) and LDL cholesterol (r=-0,401, p=0,035) levels of subjects. A negative correlation determined between blood IL-6 levels and daily vitamin E (r=-0,440, p=0,009) and zinc (r=-0,449, p=0,019) intakes. Bacteroidetes, Firmicutes and Proteobacteria were 3 dominant bacterial phyla in gut microbiota of the subjects. Obese subjects had higher Firmicutes levels and lower Bacteroidetes levels than subjects who had normal body weight. Firmicutes levels were decreased and Bacteroidetes levels were increased after surgery in research group. In the beginning, Bifidobacterium bacteria levels were higher in research group than control group-2. This level decreased 3 and 6 months after surgery (p<0,01). Enterobacteriaceae genus levels decreased after surgery (p<0,05). Bacteroides levels were significantly low in morbidly obese patients before surgery and increased to similar levels with control group-2 after surgery (p<0,05). A negative correlation determined between changes in Proteobacteria levels and total cholesterol (r=-0,636, p=0,035), LDL cholesterol (r=-0,718, p=0,013) and IL-6 (r=-0,606, p=0,017) levels. A positive correlation determined between changes in Firmicutes levels and changes in total fat intakes (r=0,575, p=0,025) and MUFA intakes (r=0,592, p=0,020). This study shows the effects of bariatric surgery on metabolic parameters and gut microbiota, however randomized controlled clinical studies are needed.