Effects of Weight Reduction After Sleeve Gastrectomy on Metabolic Variables in Saudi Obese Subjects in Aseer Province of Kingdom of Saudi Arabia.

OBJECTIVES: The objectives of this study were to investigate the occurrence of oxidative stress, status of protective antioxidants enzymes, inflammatory biomarkers, and some metabolic health variables in the blood and to compare the results between those of the normal controls and obese patients submitted to sleeve gastrectomy-induced weight loss over a 1-year follow-up period. MATERIALS AND METHODS: A prospective study was conducted in Aseer Central Hospital and Abha Private Hospital in the Kingdom of Saudi Arabia from January 2012 to January 2013 on 50 normal (BMI = 22-25 kg/m2) control subjects and 50 obese (BMI = 45-50 kg/m2) patients. A subset of 20 men and 80 women patients, aged 20-45 years, was included. The systemic blood cell counts were determined by Beckman Coulter UniCel analyzer. The occurrence of oxidative stress, the status of antioxidant enzyme system in the blood, levels of serum hepatic enzymes, cardiovascular risk factors, and serum sodium, potassium, copper, and zinc levels were determined by spectrophotometric procedures. The concentration of TSH and T4 were analyzed by Siemens Immunoassay System. RESULTS: Group 1 (Obese: preoperative) This group compared with the normal controls exhibited significant (p < 0.05) increase in inflammatory biomarkers, a significant (p < 0.05) rise in hepatic enzymes, a significant (p < 0.05) decrease in serum total bilirubin. Concentration of serum total cholesterol (TC), triacylglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose(FBG) were significantly (p < 0.05) increased, but HDL cholesterol (HDL-C) was significantly depleted (p < 0.05). Serum urea and creatinine contents were significantly (p < 0.05) decreased. Serum copper and zinc levels were significantly (p < 0.05) increased. Group 2: Sleeve Gastrectomy Surgery (Obese: postoperative) This group compared with the obese group, preoperatively, demonstrated a profound reduction in body weight (-32%) as well as in BMI (-29%). Serum malondialdehyde, a stress index, was significantly (p < 0.001) inhibited and conversely, activities of antioxidant enzymes: superoxide dismutase(Cu-Zn SOD), glutathione peroxidase (GPx), glutathione-S-transferase (GST), glucose-6-phosphate dehydrogenase (G6PDH), and vitamin C, were remarkably (p < 0.001) increased. Furthermore, remarkable improvements in deranged metabolic variables approaching normality were discernible. Inflammatory biomarkers in the blood and hepatic enzymes in serum were significantly (p < 0.001) decreased. Levels of TC, TG, LDL-C, FBG, and HDL-C in serum exhibited significant (p < 0.05) reductions, a reversal toward normality. Serum albumin and total bilirubin concentrations were significantly increased (p < 0.001). Serum sodium, potassium, copper, zinc, and TSH levels were significantly (p < 0.001) decreased. CONCLUSIONS: Obesity is a chronic disease of multifactorial origin and resulted in perturbations of whole body metabolism in this study. It is thus likely that this imbalance was associated with an inhibition in protective antioxidants and occurrence of oxidative stress. The staging concept of sleeve gastrectomy is a safe and effective approach with remarkable efficacy in sustaining weight loss and bringing back normal metabolism of variables in tissues over a 1-year follow-up period.

Superoxide radical concentration and superoxide dismutase (SOD) enzyme activity in varicose veins.

The aim of this study is to measure the level of both the superoxide dismutase (SOD) enzyme and its substrate, superoxide radicals, in the wall of varicose veins. A total of 44 vein specimens were collected from 24 patients who underwent surgery for varicose veins at Asir Central Hospital (ACH), Abha, Saudi Arabia during the period from October 1999 to November 2000. The patients were 4 males and 20 females with a mean age of 35.3+/-SD 10.4 years (15-62 years). At operation, vein specimens were collected from both the stripped, mid-thigh long saphenous vein (LSV) and the avulsed distal calf varicosities, as appropriate. The samples were processed and both the SOD level and the superoxide radicals concentration were estimated using spectrophotometry. The mean SOD level in the distal calf varicosities (14.7+/-6.0 units/mg protein) was significantly higher than that in the mid-thigh LSV (8.2+/-2.9 units/mg protein, P<0.05). The mean superoxide radical concentration in the distal calf varicosities (69.5+/-11.9 nmol/ml) was also significantly higher than that in the mid-thigh LSV (33.8+/-10.5 nmol/ml, P<0.05). These results suggest that superoxide radicals play an important role in the pathogenesis of varicose veins.